Major Non-communicable Chronic Diseases Research Articles

Economic burden of noncommunicable diseases attributable to risk factors in the Russian Federation

Abstract Aim to estimate the economic burden of major chronic noncommunicable diseases (NCDs) attributable to risk factors in the Russian Federation in 2016 Material and Methods The following risk factors were included in the analysis: smoking, high alcohol intake, high salt intake, low intake of fresh vegetables and fruits, consumption of processed red meat, low physical activity, obesity, hypertension, which reliably have a causal relationship with major NCDs: cardiovascular diseases(CVD),type 2 diabetes, chronic obstructive pulmonary disease(COPD), cancer of 10 localizations. The relative risks (RR)of morbidity and mortality from major NCDs associated with risk factors are identified through a literature search. Based on the data on the prevalence of risk factors in the Russian population and RR, the population attributable risk (PAR)was calculated for each analyzed disease. Statistical analysis calculations using descriptive statistics methods were performed in the MSExcel 10.0 program. Results The largest burden from the four main NCDs is associated with hypertension - 10.9 billion€, which is equivalent to 1.01% of GDP. The next largest contribution to the burden from NCDs was the burden from obesity 7.6 billion€ 0.7% of GDP, smoking over 5.2 billion €, 0.49% of GDP and the low physical activity 3.4 billion€, 0.32% of GDP. Of all the analyzed risk factors, the least contribution to total costs in connection with NCDs was determined by the burden from high alcohol intake 1.1 billion€, 0.1% of GDP, due to the low prevalence of high alcohol intake in the Russian population. Conclusions In this study, for the first time, the assessment of the economic burden of risk factors by the share (contribution) to the morbidity and mortality of main NCDs (CVD, T2DM, COPD and 10 cancer localizations) in the Russian Federation for 2016 was performed. Such the significant economic burden is a strong argument for increasing investments in the prevention and treatment of risk factors of NCDs. Key messages In Russia the largest burden from the four main NCDs is associated with hypertension. Such the significant economic burden is a strong argument for increasing investments in the prevention and treatment of risk factors of NCDs.

Assessment of medication adherence using medication adherence rating scale-5 in patients with major non-communicable diseases at tertiary care hospital

Background: To assess the medication adherence using medication adherence rating scale (MARS-5) for achieving good clinical outcomes in patients with major non-communicable chronic diseases who are undergoing long-term therapy and to compare the adherence between adult and geriatric patients based on patient counselling.Methods: A Prospective observational study was conducted in the Department of Medicine, Raja Muthiah Medical College Hospital (RMMCH), Chidambaram, India over a period of 6 months. Patient details were collected using self-designed patient proforma. Patients’ medication adherence was assessed using MARS-5 and patients were counselled regarding drug use with the help of pictograms and daily monitoring sheet.Results: A total of 150 patients were enrolled in the study out of which 77 were adults and 73 were from the geriatric population. 65.33% were affected with comorbid conditions. Non-compliance was mainly due to forgetfulness, lack of assistance in the elderly population, polypharmacy and also due to failing to refill prescriptions. Nearly half of the population about 40% showed poor adherence before patient counselling and was reduced to 13.33% after proper patient counselling. And the medication adherence was found to be more among the adults 90.90% when compared to the geriatric population 82.19%.Conclusions: A new approach through pharmaceutical care was implemented; it mainly aims in delivering information regarding the importance of therapy in non-communicable chronic illness and also on the non-therapeutic considerations. It also focuses in conveying the importance of their lives to their families and to the society, thereby improving the adherence to medicine.

Study design and baseline characteristics of Shenzhen ageing-related disorder cohort in China

PurposeThe Shenzhen ageing-related disorder cohort was designed to detect the associations of lifestyle, environmental and genetic factors with major ageing-related disorders, especially neurological and mental disorders.ParticipantsThe cohort was a community-dwelling...

Child psychiatry in China: Present situation and future prospects.

Child psychiatry in China: Present situation and future prospects.

Insulin delivery with a needle-free insulin injector versus a conventional insulin pen in Chinese patients with type 2 diabetes mellitus: A 16-week, multicenter, randomized clinical trial (the FREE study)

BackgroundInsulin therapy is poorly accepted by patients with type 2 diabetes mellitus (T2DM). A needle-free insulin injector has been developed for patients who fear injections or are reluctant to initiate insulin therapy when it is clearly indicated. The objective of this trial was to evaluate the glucose-lowering effect, tolerability, patient satisfaction and compliance with insulin treatment via a needle-free insulin injector (NFII) compared with insulin treatment via a conventional insulin pen (CIP) in patients with T2DM. MethodsA total of 427 patients with T2DM were enrolled in a prospective, multicenter, randomized, open-label study, and were randomly assigned 1:1 to receive 16 weeks’ treatment with basal insulin or premixed insulin administered either by a NFII or CIP. Trial registrationClinicalTrials.gov (NCT03243903). FindingsIn the 412 patients who completed the study, the adjusted mean reduction of HbA1c from baseline at week 16 in the NFII group was 0.55% (95% CI −0.71, −0.39), which was non-inferior and statistically superior to the HbA1c reduction in the CIP group (0.26%, 95% CI −0.42, −0.11). Patients in the NFII group showed significantly higher treatment satisfaction scores than those in the CIP group (mean scores, 8.17 ± 1.78 vs. 7.21 ± 2.22, respectively; p<0.0001). The occurrence of hypoglycemia was similar in the two groups, and the NFII group showed reduced incidences of skin scratches, indurations and lower VAS pain scores. InterpretationInsulin therapy through needle-free injector showed a non-inferior glycemic-lowering effect and a significantly enhanced level of patient satisfaction with insulin treatment compared with conventional insulin therapy through needle injections. In addition, the needle-free injector also had a better safety profile. FundingThis study were funded by Beijing QS Medical Technology Co., Ltd, as well as The Major Chronic Non-communicable Disease Prevention and Control Research.

Cardiovascular health metrics and all-cause mortality and mortality from major non-communicable chronic diseases among Chinese adult population

BackgroundIncreasing evidence indicates that an ideal cardiovascular health (CVH) profile is beneficial not only for cardiovascular disease (CVD), but also for other non-communicable diseases (NCDs). By using a national representative sample of Chinese adults, we aimed to evaluate the association of CVH metrics with long-term all-cause mortality and major NCDs mortality. MethodsWe used data from 45,984 Chinese adults without previous history of CVD who participated in a national representative survey between January 2007 and September 2010 and whose mortality until December 2017 was determined via linkage to the Mortality Registration and Reporting System. Altogether, five CVH metrics (body mass index, smoking status, blood pressure, total cholesterol, and fasting blood glycemia) were adopted according to the American Heart Association definition. Outcomes included all-cause, and major NCDs mortality. ResultsDuring a mean follow-up of 9.7 years, altogether 1451 deaths occurred. Among them, 541 deaths were of cardiovascular origin and 555 deaths were due to cancer. Participants with four to five ideal CVH metrics were associated with 42% (hazard ratio [HR] 0.58; 95% CI 0.39–0.85), 59% (HR 0.41; 95% CI 0.23–0.73), and 62% (HR 0.38; 95% CI 0.20–0.72) decreased risk of all-cause mortality, CVD-related mortality, and cancer-related mortality, respectively, relative to those with a poor CVH score (0–1 ideal CVH metrics). ConclusionsOur findings highlight the benefit of better CVH with respect to all-cause and major NCDs-related mortality in a Chinese adult population. The assessment of CVH profile at the population level should be advocated in China.

Economic damage of risk factors associated with morbidity and mortality from major chronic non-communicable diseases in Russia in 2016

Aim.To assess the socioeconomic damage of risk factors associated with morbidity and mortality from major chronic non-communicable diseases (CNCDs) in the Russian population in 2016.Material and methods.The following RF were included in the analysis: smoking, alcohol abuse, high salt intake, insufficient consumption of vegetables and fruits, consumption of processed red meat, low physical activity, obesity, hypertension (HTN), which have a significant causal relationship with the major CNCDs: cardiovascular diseases (CVDs), type 2 diabetes, chronic obstructive pulmonary disease (COPD), cancer of 10 locations (lung, breast, cervix, ovary, prostate, kidney, stomach, liver, pancreas, colon). Based on the data on the RF prevalence in the Russian population by ESSE-RF study and relative risks by large studies, the population attributable risk for each CNCD was estimated. We used the data of the Federal State Statistics Service, annual forms of Federal Statistical Observation, as well as the results of the Government Guarantee Program for free medical care and the corresponding diagnosis-related groups for 2016. The direct costs of the healthcare system and economic losses due to morbidity and mortality from the major CNCDs associated with the considered RF are determined. The calculations were performed in Microsoft Excel 10.0.Results.Indirect losses due to premature mortality prevail over direct costs of medical care and disability benefits in the economic damage structure of each RF. The largest damage of four major CNCDs was associated with HTN — 869,9 billion rubles, which is equivalent to 1,01% of gross domestic product (GDP). The next places were taken by obesity — 605,8 billion rubles (0,7% of GDP), smoking — 421,4 billion rubles (0,49% of GDP) and low physical activity — 273,0 billion rubles. (0,32% of GDP). The contribution of improper feeding (high salt intake, insufficient consumption of vegetables and fruits, consumption of processed red meat) amounted to 0,17% of GDP (145,3 billion rubles), 0,19% of GDP (160,9 billion rubles) and 0,10% of GDP (83,4 billion rubles), respectively. Alcohol abuse made the smallest contribution to CNCD-related damage — 82,5 billion rubles (0.1% of GDP). This is due to the low prevalence of alcohol abuse in the Russian population according to ESSE-RF study.Conclusion.Assessment of the economic damage of CNCD RF allows determining the priority areas in healthcare and substantiating the effectiveness of CNCD preventive measures aimed at reducing the RF impact, and, consequently, the burden on the healthcare system and the national economy.

Economic damage of risk factors associated with morbidity and mortality from major chronic non-communicable diseases in Russia in 2016

Aim. To assess the socioeconomic damage of risk factors associated with morbidity and mortality from major chronic non-communicable diseases (CNCDs) in the Russian population in 2016. Material and methods. The following RF were included in the analysis: smoking, alcohol abuse, high salt intake, insufficient consumption of vegetables and fruits, consumption of processed red meat, low physical activity, obesity, hypertension (HTN), which have a significant causal relationship with the major CNCDs: cardiovascular diseases (CVDs), type 2 diabetes, chronic obstructive pulmonary disease (COPD), cancer of 10 locations (lung, breast, cervix, ovary, prostate, kidney, stomach, liver, pancreas, colon). Based on the data on the RF prevalence in the Russian population by ESSE-RF study and relative risks by large studies, the population attributable risk for each CNCD was estimated. We used the data of the Federal State Statistics Service, annual forms of Federal Statistical Observation, as well as the results of the Government Guarantee Program for free medical care and the corresponding diagnosis-related groups for 2016. The direct costs of the healthcare system and economic losses due to morbidity and mortality from the major CNCDs associated with the considered RF are determined. The calculations were performed in Microsoft Excel 10.0. Results. Indirect losses due to premature mortality prevail over direct costs of medical care and disability benefits in the economic damage structure of each RF. The largest damage of four major CNCDs was associated with HTN — 869,9 billion rubles, which is equivalent to 1,01% of gross domestic product (GDP). The next places were taken by obesity — 605,8 billion rubles (0,7% of GDP), smoking — 421,4 billion rubles (0,49% of GDP) and low physical activity — 273,0 billion rubles. (0,32% of GDP). The contribution of improper feeding (high salt intake, insufficient consumption of vegetables and fruits, consumption of processed red meat) amounted to 0,17% of GDP (145,3 billion rubles), 0,19% of GDP (160,9 billion rubles) and 0,10% of GDP (83,4 billion rubles), respectively. Alcohol abuse made the smallest contribution to CNCD-related damage — 82,5 billion rubles (0.1% of GDP). This is due to the low prevalence of alcohol abuse in the Russian population according to ESSE-RF study. Conclusion. Assessment of the economic damage of CNCD RF allows determining the priority areas in healthcare and substantiating the effectiveness of CNCD preventive measures aimed at reducing the RF impact, and, consequently, the burden on the healthcare system and the national economy.

Insulin Delivery with a Needle-Free Insulin Injector Versus a Conventional Insulin Pen in Chinese Patients with Type 2 Diabetes Mellitus: A 16-Week, Multicenter, Randomized Clinical Trial (the FREE Study)

Background: Insulin therapy is poorly accepted by patients with type 2 diabetes mellitus (T2DM). A needle-free insulin injector has been developed for patients who fear injections or are reluctant to initiate insulin therapy when it is clearly indicated. Objective To evaluate the glucose-lowering effect, tolerability, patient satisfaction and compliance with insulin treatment via a needle-free insulin injector (NFII) compared with insulin treatment via a conventional insulin pen (CIP) in patients with T2DM. Methods: A total of 427 patients with T2DM were enrolled in a prospective, multicenter, randomized, open-label study, and were randomly assigned 1:1 to receive 16 weeks’ treatment with basal insulin or premixed insulin administered either by a NFII or CIP. Findings: In the 412 patients who completed the study, the adjusted mean reduction of HbA1c from baseline at week 16 in the NFII group was 0.55% (95% CI -0.71, -0.39), which was non-inferior and statistically superior to the HbA1c reduction in the CIP group (0.26%, 95% CI -0.42, -0.11). Patients in the NFII group showed significantly higher treatment satisfaction scores than those in the CIP group (mean scores, 8.17 ± 1.78 vs 7.21 ± 2.22, respectively; p<0.0001). The occurrence of hypoglycemia was similar in the two groups, and the NFII group showed reduced incidences of skin scratches, indurations and lower VAS pain scores. Interpretation: Insulin therapy through needle-free injector showed a greater glycemic-lowering effect and a significantly enhanced level of patient satisfaction with insulin treatment compared with conventional insulin therapy through needle injections. In addition, the needle-free injector also had a better safety profile. Trial registration: ClinicalTrials.gov (NCT03243903) Funding Statement: Beijing QS Medical Technology Co., Ltd, China. This work was also supported by Grants 2016YFC1305600, 2016YFC1305603 from the Major Chronic Non-communicable Disease Prevention and Control Research. Declaration of Interests: Linong Ji receives consulting fees from Beijing QS Medical Technology Co. He also reports grants and personal fees from Novo Nordisk, Merck, Bristol-Myers Squibb, Novartis, Sanofi, MSD, AstraZeneca, and Roche, and personal fees from Eli Lilly, Takeda, Bayer, and Boehinger Ingelheim, outside the submitted work. The other authors have nothing to disclose. Ethics Approval Statement: Before the study was commenced, approval was received from the Ethics Committee of Peking University People’s Hospital, and the study was conducted in accordance with the moral, ethical, and scientific principles of the declaration of Helsinki and the provisions of good clinical practice (GCP) in China. Written informed consent was obtained from all participants.

Incidence Rates of Four Major Non-Communicable Chronic Diseases in the Chinese Adult Population from 2007 to 2016: A Study Based on a National Commercial Claims Database.

BackgroundThe spread of non-communicable chronic diseases (NCDs) is a global crisis. Understanding the dynamics of NCDs at the population level is crucial to develop prevention strategies as well as to evaluate the effectiveness of intervention. However, studies investigating the incidence rate of NCDs among the general population are limited, especially for developing countries like China. We aim to evaluate the incidence rates of four major NCDs from 2007 to 2016, based on a national commercial claims database in China.MethodsCancer, stroke, coronary heart disease (CHD) and end-stage kidney disease (ESKD) accounted for over 90% of claims data were included as major NCDs. The definition of the above diseases followed the guideline of disease definitions of critical illness insurance released by the Insurance Association of China. Age-standardized incidence rates (ASRs) of those major NCDs among subgroups of sex, demographic regions, and China city tiers were reported. The trends of incidence rates were described as annual percent change (APC) as well as average annual percent change (AAPC) and were then examined by joinpoint models.ResultsFor the population insured in 2007, the average 10-year ASRs of cancer, CHD, stroke, and ESKD were 221.0, 55.5, 43.5, 11.0 per 100,000 person-years, respectively. For males, the ASRs of cancer, CHD, ESKD continuously increase in the past decade with AAPC of 1.4%, 5.2%, and 3.3%; while the ASRs of stroke were decreased with APC of 3.7% after 2009. For females, the increased ASRs of cancer with AAPC of 4.2% and CHD with AAPC of 2.0%; while decreased trends of ASRs were observed for stroke and ESKD. Patterns of ASRs changing varied between different demographic regions and city tiers.ConclusionCommercial claims data could be a valuable data source to evaluate the disease burden for major NCDs in China. The disease burden of severe stroke was decreasing while cancer, CHD and ESKD were still increasing in China. More efforts should be put into control of CHD, especially in the northern part of China.

Factors Associated With Hypertension among Age Groups of 18 Years and Above In, Southwestern, Ethiopia, 2020: A Community Based Cross-Sectional Study

Background: Hypertension is one of the major noncommunicable chronic diseases in the globe which is now changed from a relative rarity to a major public health problem. Because now a day's, globally cardiovascular disease accounts for approximately 17 million deaths a year, nearly one-third of the total death. Of these, complications of hypertension account for 9.4 million deaths worldwide every year. Hypertension is responsible for at least 45% of deaths due to heart disease, and 51% of deaths due to stroke. The study aimed to assess the magnitude and associated factors of hypertension among the age group of 18 years and above in Southwest, Ethiopia, 2020. Method: A community based cross-sectional study was conducted. A total of 356 adults were recruited for the study. A pre-tested and structured questionnaire was used to collect the data. Both bivariate and multivariate logistic regressions were carried out to assess the association of independent variables with hypertension and P-value <0.05 was considered as significant. Result: A total of 351 participants were included in the analysis. About 17.7% of the respondents had elevated their Blood pressure. Sex (AOR = 6.7, 95% CI 2.10-21.53), age (AOR= 2.6, 95% CI.1.07-7.40), and body mass index (BMI), (AOR=2.8, 95% CI. 1.14-6.93 and AOR=8.5, 95%CI.1.68-42.45), and vigorous physical exercise (AOR=3.9, 95% CI. 1.40-11.13) were significantly associated with hypertension. Conclusions and recommendation: The study showed that the overall prevalence of hypertension was higher in the study area which was comparatively higher in men than females. The study also showed that BMI, sex, age, and engaging in vigorous physical exercise were found to be significant factors that influence hypertension in the study area. Community-based screening programs should be established for hypertension in this community.

Determinants of health seeking behavior for chronic non-communicable diseases and related out-of-pocket expenditure: results from a cross-sectional survey in northern Bangladesh

BackgroundIn spite of high prevalence rates, little is known about health seeking and related expenditure for chronic non-communicable diseases in low-income countries. We assessed relevant patterns of health seeking and related out-of-pocket expenditure in Bangladesh.MethodsWe used data from a household survey of 2500 households conducted in 2013 in Rangpur district. We employed multinomial logistic regression to assess factors associated with health seeking choices (no care or self-care, semi-qualified professional care, and qualified professional care). We used descriptive statistics (5% trimmed mean and range, median) to assess related patterns of out-of-pocket expenditure (including only direct costs).ResultsEight hundred sixty-six (12.5%) out of 6958 individuals reported at least one chronic non-communicable disease. Of these 866 individuals, 139 (16%) sought no care or self-care, 364 (42%) sought semi-qualified care, and 363 (42%) sought qualified care. Multivariate analysis confirmed that the following factors increased the likelihood of seeking qualified care: a higher education, a major chronic non-communicable disease, a higher socio-economic status, a lower proportion of chronic household patients, and a shorter distance between a household and a sub-district public referral health facility. Seven hundred fifty-four (87 %) individuals reported out-of-pocket expenditure, with drugs absorbing the largest portion (85%) of total expenditure. On average, qualified care seekers encountered the highest out-of-pocket expenditure, followed by those who sought semi-qualified care and no care, or self-care.ConclusionOur study reveals insufficiencies in health provision for chronic conditions, with more than half of all affected people still not seeking qualified care, and the majority still encountering considerable out-of-pocket expenditure. This calls for urgent measures to secure better access to care and financial protection.

Progress in non-coding RNA research

Non-coding RNAs (ncRNAs), including transfer RNAs, ribosomal RNAs, small nucleolar RNAs (snoRNAs), and long noncoding RNAs (lncRNAs), are referred to as RNAs without a coding potent.It is widely acknowledged that they play important regulation roles in different biological processes of human life, such as individual development, growth and reproduction; apoptosis, differentiation and reprogramming of cells. Of great importance, ncRNAs are shown to closely associated with human diseases. In recent years, with the development of Chinese economy and the tendency of population aging; cardiovascular diseases, tumors, metabolic diseases and other diseases rise to major chronic non-communicable diseases that threaten the health of Chinese residents. In addition, due to the huge population of China, some rare diseases such as Prader-Willi syndrome (PWS) also affect the health of its residents. Chinese scientists have found that non-coding RNAs are highly associated with these diseases in exploring the development of these diseases, and they notice that ncRNAs are involved in the regulation of a series of cardiovascular diseases, tumors, metabolic diseases, infectious immunological diseases and PWS. This review focuses on advances in ncRNAs contributed by Chinese scholars. We summarize the formation, processing as well as the functions of non-coding RNAs and review the important regulatory roles of these non-coding RNAs in PWS, cardiovascular diseases, tumors, metabolic diseases as well as infectious immune diseases.

Individual and joint association of bioavailable testosterone and aging with neutrophil-to-lymphocyte ratio in Chinese middle-aged and elderly men

Background and objectivesAccumulating evidences suggest that chronic systemic inflammation (CSI) is independently associated with large number of major non-communicable chronic diseases (NCDs) ranging from metabolic disorders to cancers, and neutrophil-to-lymphocyte ratio (NLR) has been accepted as a novel, convenient marker for CSI response. Testosterone deficiency in men is linked to high risk of NCDs. This cross-sectional study aimed to investigate the individual and joint association of bioavailable testosterone (BIOT) and aging with NLR.MethodsA total of 132 male adults were enrolled during Jan. 2011 and Oct. 2017 in the first affiliated hospital of University of Science and Technology of China. Local weighted regression (LOESS) and multivariable generalized linear regression models were utilized to comprehensively examine the individual and joint association between BIOT and age with NLR.ResultsObvious linear relationships between NLR and BIOT or age were observed with the LOESS models. NLR was negatively correlated to BIOT after adjusting for some potential confounding factors (P = 0.034). As compared to the lowest quartile of BIOT, the adjusted decrease of NLR for the 2nd, 3rd and 4th quartiles were 0.40, 0.64 and 0.72, respectively. Meanwhile, NLR was observed to be independently correlated to elevated age (P = 0.043). Furthermore, as compared to the counterparts, men over 70 years combined with plasma BIOT less than 4.7 nmol/L had the highest NLR level, which suggested that low BIOT and aging jointly correlated to the level of NLR (P = 0.005).ConclusionBIOT deficiency and aging were individually and jointly correlated to CSI. Men over 70 years combined with BIOT < 4.7 nmol/L were more like to have higher grade of CSI than others.

Co-occurrence and clustering of the four major non-communicable disease risk factors in Brazilian adolescents: Analysis of a national school-based survey.

BackgroundThe major non-communicable chronic diseases (NCD) are associated with a small group of modifiable lifestyle-related risk factors, including smoking, insufficient physical activity, unhealthy eating, and alcohol abuse. In this study, we evaluated the co-occurrence and clustering of the major NCD risk factors among Brazilian adolescents.MethodsThis cross-sectional study analyzed data of 101,607 adolescents from the Brazilian National Survey of School Health (PeNSE) 2015. The risk factors included were: regular consumption of ultra-processed foods, irregular consumption of fruits and vegetables, insufficient physical activity, smoking, and alcohol consumption. Clustering was defined through the ratio between observed and expected prevalences of combination of risk factors greater than 1. Expected prevalence of the co-occurrence of risk factors was calculated from the joint probability of the behaviors. Additionally, we examined the presence of at least four risk factors according to socioeconomic characteristics.ResultsOf the 32 combinations of risk factors, 13 corresponded to clustering. We observed a strong correlation between alcohol consumption and smoking, which were found together in 8 of the 13 clusters identified. The most frequent combinations of risk factors involved unhealthy eating and insufficient physical activity. Only 2.9% of the adolescents did not present any risk behaviors, while 38.0%, 32.9%, 9.4% and 1.8% accumulated two, three, four and five risk factors, respectively. The accumulation of risk factors was higher in girls, older adolescents, those who did not live with both parents, children of less-educated mothers, students attending public school, and residents of cities in more developed urban areas of the country.ConclusionsThe main risk factors for NCD are frequent and not randomly distributed among Brazilian adolescents. Our results provide information for policymakers to target specific groups and joint behavioral risk factors for health improvement in adolescents.

THE EFFECT OF ARTERIAL HYPERTENSION ON MORTALITY AND CARDIOVASCULAR ENDPOINTS AMONG RURAL RESIDENTS OF RUSSIA AND THE KYRGYZ REPUBLIC (ACCORDING TO THE INTEREPID STUDY)

Objective: In post-Soviet countries, mortality rates from CVD are one of the highest in the world. High hypertension prevalence and low control is the common problem for most CIS countries. Aim is to study the association of hypertension with cardiovascular morbidity and mortality among rural residents of the two countries: Russia, the Kyrgyz Republic, with an analysis of ethnic characteristics (according to the Interepid study) Design and method: This study was carried out as part of the international project Interepid, which included a one-stage epidemiological study of the prevalence of major chronic noncommunicable diseases and their risk factors, and a prospective stage among residents of small towns and rural areas of the two countries. The analysis includes the results of a survey of representative samples of the rural population of the Samara Region of Russian Federation (n = 1050), the Chui region of the Kyrgyz Republic (n = 1341) aged 20–64. The study in Russia and the Kyrgyz Republic was conducted according to a same protocol. The following endpoints are included in the analysis: 1. Cases of death from all causes 2. Deaths from CVD 3. Cases of non-fatal cardiovascular events (non-fatal myocardial infarction(MI), nonfatal stroke), unstable angina pectoris, revascularization (surgery-aortocoronary bypass, percutaneous angioplasty, carotid endarterectomy, revascularization of the arteries of the lower extremities) Results: Prospective follow-up was 3.9 years. Hypertension impact was insignificant on the outcomes in the Samara region, but not in Kyrgyz Republic. In Kyrgyz Republic among Russian population hypertension was significantly associated with all-cause mortality (RR 2.27(95% CI 1.09; 3.61), p < 0.01), cardiovascular mortality (RR 2.98 (95% CI 1.14; 5.37), p < 0.01), non-fatal endpoints (RR 3.30 (95% CI 1.30; 6.06), p < 0.01). Among native population hypertension was associated only with non-fatal endpoints (RR 1.47 (95% CI 1.12; 1.88), p < 0.05) Conclusions: Despite a short observation period, the results indicate significant unfavourable effect of hypertension on the risk of cardiovascular morbidity, with ethnic and country differences. All this underlines the need to develop differentiated preventive and treatment and preventive programs adjusted to country specific and ethnic specific differences in hypertension prevalence and its impact on the prognosis

1644-P: Novel Subgroups of Prediabetes and Their Clinical Outcomes: A Data-Driven Analysis

The progression of prediabetes to diabetes and the reversion of them to NGT are highly heterogeneous. To develop a refined classification of prediabetes, we used data-driven K-means clustering in patients diagnosed with IGT and IFG according to WHO 1999 criteria in Pinggu Study (a prospective population-based survey for diabetes in suburban Beijing, n=628), NHANES III study (a cross-sectional population-based survey in the U.S., n=1532) and Beijing Prediabetes Reversion Program (BPRP, a RCT to evaluate the efficacy of lifestyle and/or pioglitazone on prediabetes reversion, n=1905). Based on five variables including HbA1c, BMI, age, HOMAIR and HOMAB, we identified four replicable clusters across all three datasets including high glucose group (HGG), lean group (LG), early-onset group (EOG) and insulin resistant group (IRG) (Figure). HRG had significant higher 1-year diabetes progression rate (15.4% in BPRP and 25.6% in Pinggu study) and the LG had the lowest diabetes progression rate (7.1% in BPRP and 11.1% in Pinggu Study). In BPRP, HGG treated with Intensive lifestyle plus pioglitazone had significant higher reversion rate to NGT and EOG treated with intensive life style plus placebo had least reversion rate compared to other treatment. Our study provides risk stratification for prediabetes and can potentially facilitate clinical decision, representing a first step towards precision management. Disclosure X. Zou: None. Z. Zhu: None. Y. Luo: None. Y. Li: None. X. Zhou: None. L. Ji: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Bristol-Myers Squibb Company, Eli Lilly and Company, Merck KGaA, Merck Sharp &amp; Dohme Corp., Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi, Takeda Pharmaceutical Company Limited. Research Support; Self; AstraZeneca, Bristol-Myers Squibb Company, Eli Lilly and Company, Merck Sharp &amp; Dohme Corp., Novartis AG, Roche Pharma, Sanofi. Funding The Major Chronic Non-Communicable Disease Prevention and Control Research of China; Beijing Science and Technology Committee; National Natural Science Foundation of China

1521-P: An Efficacy Evaluation on Prediabetes Management Using a Machine Learning-Based Risk Stratification Approach

The progression of prediabetes towards diabetes was heterogeneous, suggesting a demand for individualized management. We aim to investigate whether stratifying participants with prediabetes according to their progression risk could affect the response to interventions. We developed a 1-year diabetes progression risk evaluating model with a panel of diabetes risk factors using a machine learning method (i.e., Bagging algorithm with 300 decision trees) in prediabetes participants in Pinggu Study (a prospective population-based survey in suburban Beijing, n=622). The model training phase was conducted on 2/3 randomly selected participants and the validation phase was conducted on other 1/3. This model successfully predicted the 1-year progression of prediabetes participants in Pinggu study (internal ROC AUC 1.000, external ROC AUC 0.883). In Beijing Prediabetes Reversion Program (BPRP, a multi-central RCT to evaluate the efficacy of lifestyle and/or pioglitazone on prediabetes reversion, n=1897), subjects were divided into tertiles as high, medium and low risk groups according to their progression probability predicted by the model. Pioglitazone plus intensive lifestyle significantly increased reversion and reduced diabetes progression only in high risk group. This study suggests personalized treatment on prediabetes according to their progression risk is necessary. Disclosure X. Zou: None. Z. Zhu: None. Y. Luo: None. Y. Li: None. X. Zhou: None. L. Ji: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Bristol-Myers Squibb Company, Eli Lilly and Company, Merck KGaA, Merck Sharp &amp; Dohme Corp., Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi, Takeda Pharmaceutical Company Limited. Research Support; Self; AstraZeneca, Bristol-Myers Squibb Company, Eli Lilly and Company, Merck Sharp &amp; Dohme Corp., Novartis AG, Roche Pharma, Sanofi. Funding The Major Chronic Non-Communicable Disease Prevention and Control Research of China; Beijing Science and Technology Committee; National Natural Science Foundation of China

Cognitive impairment in patients with chronic noncommunicable diseases: a review

The aim of this review was to summarize the information about the specific weight and the clinical significance of cognitive impairment in the course and prognosis of major chronic noncommunicable diseases.&#x0D; Materials and methods. Scientific literature from 2013 to 2018 on the cognitive impairment in patients with noncommunicable diseases was analyzed. Publications from previous years were taken into account in the absence of new research in this area or if conclusions have not lost relevance. Under the cognitive impairment dementia or mild cognitive impairment were understood.&#x0D; Results Cognitive impairment is common for chronic cardiovascular diseases, both central nervous system and non-central nervous system cancer, chronic lung diseases, diabetes, and presented mostly from mild to moderate form. It can be caused by pathophysiological changes related to the underlying disease (in all diseases reviewed) or its treatment (in the case of cancer and diabetes), such as hypoxia, cerebral hypoperfusion, inflammation, acidosis etc. Cognitive impairment can reduce adherence to medication, self-management, recovery from disability; impact different social and daylife activities, such as academic performance, employing, driving, reading and other life aspects. For central nervous system cancer cognitive decline is also serve as an indicator of the tumor possible localization, a prognostic factor of survival and an indicator of the cancer recurrence.&#x0D; Conclusions. Cognitive impairment is highly prevalent in patients with all major types of chronic noncommunicable diseases, with the executive function, memory and attention impaired most often. It reflects the severity of the underlying disease and its effect on the brain. Cognitive impairment can negatively affect the course, prognosis and treatment of major chronic noncommunicable diseases by reducing the management and self-management of therapy, adherence to therapy, quality of life, functional and social outcome and patient`s autonomy. Identification of cognitive impairment, development the ways to treat or compensate it, minimization of the poor cognitive function negative impact on course and prognosis is important for successful chronic noncommunicable diseases management.

Prevalence, awareness and control of diabetes in Russia: The Ural Eye and Medical Study on adults aged 40+ years.

PurposeNon-communicable chronic diseases have become the leading causes of mortality and disease burden worldwide. With information about the frequency of diabetes as a major non-communicable chronic disease in Russia being scarce, we assessed the prevalence of diabetes and its associated factors in a rural and urban population in Russia.MethodsThe Ural Eye and Medical Study is a population-based study in the city of Ufa/Russia and in villages in a distance of 65 km from Ufa. Inclusion criterion was an age of 40+ years. All study participants underwent a standardized interview and a detailed general examination. Diabetes mellitus was defined by a plasma glucose concentration ≥7.0 mmol/L or self-reported history of physician diagnosis of diabetes.ResultsOut of a population of 7328 eligible individuals, 5899 individuals (2580 (43.7%) men) (participation rate:80.5%) participated (mean age:59.0±10.7 years (range:40–94 years)). Diabetes mellitus was present in 687 individuals (11.7%;95% confidence interval (CI):11.9,12.5). Awareness rate of having diabetes was 500/687 (72.8%;95%CI:69.0,76.0), with mean known duration of diabetes of 10.0±9.4 years. Known type 1 diabetes was present in 44 subjects and known type 2 diabetes in 358 subjects. Prevalence of undiagnosed diabetes was 3.2% (95%CI:2.7,3.6) in the study population. Among patients with diabetes, 59.1% (95%CI:55.4,62.8) received treatment for diabetes, among whom 237 (58.5%;95%CI:53.7,63.3) individuals had adequate glycemic control. In multivariable analysis, higher prevalence of diabetes mellitus was associated with older age (P<0.001; odds ratio (OR):1.03;95%CI:1.01,1.04), higher body mass index (P<0.001;OR:1.07;95%CI:1.04,1.10), lower prevalence of vigorous daily work (P = 0.002;OR0.68;95%CI:0.53,0.87), positive history of arterial hypertension (P = 0.03;OR:1.40;95%CI:1.03,1.89) and cardiovascular diseases (P = 0.001;OR:1.60;95%CI:1.21,2.13) including heart attacks (P = 0.01;OR:1.80;95%CI:1.15,2.81), higher serum concentration of triglycerides (P<0.001;OR:1.51;95%CI:1.30,1.75), higher systolic blood pressure (P = 0.01;OR:1.01;95%CI:1.01,1.02), higher number of meals taken daily (P<0.001;OR:1.46;95%CI:1.25,1.69), and non-Muslim religion (P = 0.02;OR:0.73;95%CI:0.56,0.94).ConclusionsIn this ethnically mixed, urban and rural Russian population aged 40+ years, the awareness rate of diabetes (72.8%) was relatively high, while the diabetes prevalence (11.7%) was comparable with that of other countries such as China and the USA. Factors associated with higher diabetes prevalence were similar in Russia and these other countries and included older age, higher body mass index and higher serum concentration of triglycerides, lower prevalence of vigorous daily work, arterial hypertension and cardiovascular diseases.