Management Of Major Risk Factors Research Articles

DAHNA-An integrated innovative mobile application for the screening and personalised management of the atherosclerotic cardiovascular disease risk

Abstract Background DAHNA (Diet According to the Healthy Heart Nutritional Approach) is an integrated and innovative mobile app that allows for: 1. Screening of atherosclerotic cardiovascular disease (ASCVD) risk; 2. A personalized healthy diet (macro- and micronutrients) based on cardiometabolic screening; 3. Long-term management of major risk factors; 4. Highly incentivizing rewards within the app. Objective To present the functionalities, mode of operation, and initial results of DAHNA through public implementation. Methods DAHNA can be downloaded on mobile phones (iOS and Android). Firstly, the app assesses the user's ASCVD risk score based on their country of residence using a "one-size-fits-all" risk calculator that combines the 2021 European Society of Cardiology (ESC) SCORE2/SCORE2-OP scores and the American Heart Association (AHA) Framingham score. For Europe, the calculation is based on the four SCORE2/SCORE2-OP tables for the four risk regions. DAHNA is not limited to healthy individuals and allows the user to indicate if they have diabetes, chronic kidney disease, or ASCVD. Secondly, based on the individual ASCVD risk score, DAHNA offers the following features: 1. Personalized healthy menus (Mediterranean diet) based on the only macro- and micronutrients proven to reduce individual ASCVD risk and in the recommended daily dose, with an automatically generated ingredient list and quantities; the user can choose to purchase the ingredients personally or order the list from suppliers; 2. Periodic follow-up of ASCVD risk outcomes; 3. Display of healthy life minutes gained by the user; 4. Notifications, reminders, rewards within the app, personalized weight loss plans, PDF reports to share with healthcare teams, and nutritional education; 5. A recommendation for a medical examination for those with high or very high risk; 6. Short movies to introduce physical activity and up-to-date medical information; 7. All data is collected in a central database. Results Between August 10th, 2022 and February 12th, 2023, 19,780 users downloaded DAHNA (mean age 48 +/- 10 years, 58% females, 11.13% with diabetes, 15.16% smokers, 16.4% with hypertension; 14% had low-to-moderate risk, 40% had high risk, and 46% had very high risk). A 100% correspondence was confirmed between the results of the DAHNA calculator and the ESC tables. Conclusion 1. DAHNA self-screening showed that 86% of users belong to the high or very high ASCVD risk group, which is consistent with statistical data showing Romania among the countries with a very high ASCVD risk. 2. This app is the first to assign a personalized healthy diet based on specific micronutrients to control ASCVD risk, provide medical recommendations for a healthy lifestyle, and allow for real-time management of major risk factors and ASCVD risk in large populations. These data should be important for adjusting health policies.

Identification and Management of Major Risk Factors in Construction of Healthcare Centers Projects

More attention is needed for healthcare centers projects and its development to change and improve the health situation in Iraq. The study of risk in this type of projects is essential to avoid the problems encountered during the project life cycle. This paper aimed to identify risk factors facing the construction of an advanced healthcare centers and to enhance the possible solutions based on the opinion of experts. For data collection, fifty-five risk factors were presented in a questionnaire form. The result showed that the major risk factor was government corruption, which has a direct influence on the economy and a negative impact on the infrastructure in the country and its development. The analysis showed that financial problems represent the highest risk during the years in all construction projects. Other considerable risk factors were time overrun, labor safety, as well as environmental risks, which are related to waste treatment. Other important risk factors were related to the ventilation system and air conditioning, also risk in providing continuous electrical power during the day. In term of risk groups, the five most effective ones were political, Economic, Safety, Operation & Maintenance and Construction risks.

Epidemiology of Left Ventricular Systolic Dysfunction and Heart Failure in the Framingham Study: An Echocardiographic Study Over 3 Decades

ObjectivesThe purpose of this study was to describe the temporal trends in prevalence of left ventricular systolic dysfunction (LVSD) in individuals without and with heart failure (HF) in the community over a 3-decade period of observation. BackgroundTemporal trends in the prevalence and management of major risk factors may affect the epidemiology of HF. MethodsWe compared the frequency, correlates, and prognosis of LVSD (left ventricular ejection fraction [LVEF] <50%) among Framingham Study participants without and with clinical HF in 3 decades (1985 to 1994, 1995 to 2004, and 2005 to 2014). ResultsAmong participants without HF (12,857 person-observations, mean age 53 years, 56% women), the prevalence of LVSD on echocardiography decreased (3.38% in 1985 to 1994 vs. 2.2% in 2005 to 2014; p < 0.0001), whereas mean LVEF increased (65% vs. 68%; p < 0.001). The elevated risk associated with LVSD (∼2- to 4-fold risk of HF or death) remained unchanged over time. Among participants with new-onset HF (n = 894, mean age 75 years, 52% women), the frequency of heart failure with preserved ejection fraction (HFpEF) increased (preserved LVEF ≥50%: 41.0% in 1985 to 1994 vs. 56.17% in 2005 to 2014; p < 0.001) and heart failure with reduced ejection fraction (HFrEF) decreased (reduced LVEF <40%: 44.10% vs. 31.06%; p = 0.002), whereas heart failure with midrange LVEF remained unchanged (LVEF 40% to <50%: 14.90% vs. 12.77%; p = 0.66). Cardiovascular mortality associated with HFrEF declined across decades (hazard ratio: 0.61; 95% confidence interval: 0.39 to 0.97), but remained unchanged for heart failure with midrange LVEF and HFpEF. Approximately 47% of the observed increase in LVEF among those without HF and 75% of the rising proportion of HFpEF across decades was attributable to trends in risk factors, especially a decline in the prevalence of coronary heart disease among those with HF. ConclusionsThe profile of HF in the community has changed in recent decades, with a lower prevalence of LVSD and an increased frequency of HFpEF, presumably due to concomitant risk factor trends.

Lipidomic approach provides new clues toward solving the mystery of accelerated atherosclerosis in diabetes

Despite considerable progress in the management of major risk factors over recent decades, cardiovascular diseases (CVD) attributable to atherosclerosis are still a predominant cause of death worldwide. This is due, in large part, to the expansion of risk factors related to obesity such as insulin resistance and diabetes [1]. In fact, the risk of developing CVD in adults with diabetes is two to four times higher than in those without diabetes. Moreover, it is well established that insulin resistance and hyperglycemia promote atherosclerosis, leading to coronary artery disease. Yet the underlying mechanisms linking diabetes and atherosclerosis are still not completely understood. To overcome this lack of understanding, numerous studies have been conducted, using mouse models with targeted deletion in intimal cells, to evaluate the impact of impaired insulin signaling at the level of the arterial wall on atherosclerosis development and progression [2]. Taken together, this work highlights the critical consequences of altered insulin signaling, in both macrophages and endothelial cells, in atherogenesis and the formation of advanced plaques. In humans, comparative analyses of atherosclerotic plaques from diabetic and non-diabetic individuals have revealed some important differences in the quality and composition of plaques between these groups. Lesions from diabetic patients are characterized by a larger necrotic core, increased inflammation, neovascularization, intra-plaque hemorrhage, and calcification [3], [4], [5], [6] and [7]. Higher macrophage and T-cell content, along with increased proportions of apoptotic macrophages and smooth muscle cells, may contribute to this larger necrotic area [4] and [8]. When combined with the increased prevalence of thin-cap fibroatheroma and fibrocalcific atheroma, observed using Virtual Histology intravascular ultrasound in vessels of diabetic patients [5], these alterations of plaque morphology may explain the higher risk of acute coronary syndrome in diabetic patients. Indeed, coronary lesions of patients with diabetes mellitus are more vulnerable to rupture and subsequent thrombosis [3] and [6].

Impact of Pharmacist Care in the Management of Cardiovascular Disease Risk Factors

Pharmacists may improve the clinical management of major risk factors for cardiovascular disease (CVD) prevention. A systematic review was conducted to determine the impact of pharmacist care on the management of CVD risk factors among outpatients. The MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials that involved pharmacist care interventions among outpatients with CVD risk factors. Two reviewers independently abstracted data and classified pharmacists' interventions. Mean changes in blood pressure, total cholesterol, low-density lipoprotein cholesterol, and proportion of smokers were estimated using random effects models. Thirty randomized controlled trials (11,765 patients) were identified. Pharmacist interventions exclusively conducted by a pharmacist or implemented in collaboration with physicians or nurses included patient educational interventions, patient-reminder systems, measurement of CVD risk factors, medication management and feedback to physician, or educational intervention to health care professionals. Pharmacist care was associated with significant reductions in systolic/diastolic blood pressure (19 studies [10,479 patients]; -8.1 mm Hg [95% confidence interval {CI}, -10.2 to -5.9]/-3.8 mm Hg [95% CI,-5.3 to -2.3]); total cholesterol (9 studies [1121 patients]; -17.4 mg/L [95% CI,-25.5 to -9.2]), low-density lipoprotein cholesterol (7 studies [924 patients]; -13.4 mg/L [95% CI,-23.0 to -3.8]), and a reduction in the risk of smoking (2 studies [196 patients]; relative risk, 0.77 [95% CI, 0.67 to 0.89]). While most studies tended to favor pharmacist care compared with usual care, a substantial heterogeneity was observed. Pharmacist-directed care or in collaboration with physicians or nurses improve the management of major CVD risk factors in outpatients.

Rapid health-risk assessment of effluent irrigation on an Australian university campus

Rapid health-risk assessment of chlorinated sewage-effluent irrigation of lawns, fields and crops adjacent to populated areas at the University of Western Sydney was carried out in response to warnings from the supplying authority of deteriorating bacteriological quality of the water. Irrigation with low-quality effluent offered potential for the contamination of a range of foodstuffs and the exposure of staff, students and visitors. The need for early investigation was emphasised by eutrophication presenting as sudden algal bloom in one of the campus dams and an odour suggestive of anaerobic proteolysis on irrigation. No baseline data existed regarding improvement or deterioration in water quality with passage through the dams, or relating to potential for direct or indirect exposure. The assessment design incorporated three methodologies to generate biophysical, environmental and social data. Environmental and social data were used to augment short-term data for biophysical indicators in the estimation of risk. Where required qualitative information was converted to quantitative data using categorical ranking tables, and risk evaluation was carried out using ranked risk and uncertainty values. Results for biophysical indicators showed a steady improvement in water quality with passage through campus dams, emphasising a need to regard the impoundments as part of a treatment chain, rather than as passive storage units. Effluent quality at most irrigation sites marginally exceeded regional action thresholds for relevant crop types, suggesting a need for risk management through revised irrigation practice, system design, distribution management and risk communication. Problems requiring urgent intervention included the concentration of contaminants of bovine faecal origin in one dam as the result of a closed loop within the reticulation. Also of concern was the exposure of certain most susceptible individuals including crèche children who visited pastureland and orchards where irrigated oranges were collected, and potentially immunocompromised or mentally challenged adults in a work-opportunity gardening scheme. Despite its limitations, rapid risk assessment enabled identification and proactive management of major risk factors, promoted risk communication and awareness, and laid the foundation for ongoing risk surveillance.

Are National Cardiac Guidelines being Applied by Vascular Surgeons?

Introduction. National cardiac guidelines recommend that patients with intermittent claudication should be managed in the same way as those with established coronary heart disease. This survey aimed to determine the attitudes of vascular consultants to risk factor management in new patients attending their out-patient clinic. Methods. An anonymous postal questionnaire was sent to all 394 members of the Vascular Surgical Society in June 2002. Questions were asked about the following measures: serum cholesterol levels, the presence of diabetes, antiplatelet therapy, exercise regimens, blood pressure, thrombophilia, smoking and the availability of local guidelines and expertise. Results. A response rate of 65% was obtained. Most (85%) consultants would measure a random cholesterol, but 34% would only treat claudicants if the cholesterol was greater than 5.5 mmol/l. Furthermore, 23% would inappropriately use diet alone as initial cholesterol lowering therapy. Over a quarter of consultants would not screen for diabetes or measure blood pressure. Nearly all (99%) would recommend aspirin and 66% would recommend nicotine replacement therapy. Only 55% had access to a smoking cessation clinic, and 34% to a formal exercise program. The majority (56%) did not have local risk factor management guidelines, only 16% had access to a vascular physician, and 65% would prefer to have this expertise available for difficult cases. Discussion. Management of major risk factors was found to be sub-optimal. Thus guidelines for the prevention of coronary disease in clinical practice are not being applied to claudicants.