Modifiable Coronary Heart Disease Risk Research Articles

Effectiveness of telehealth cardiac rehabilitation programs on health outcomes of patients with coronary heart diseases: an umbrella review

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac rehabilitation using Telehealth has increased rapidly over the past two decades and has become the predominant mode of delivery during the Covid 19 pandemic. Numerous systematic reviews have been conducted summarizing the evidence on the advantages and disadvantages of cardiac rehabilitation using Telehealth on various cardiovascular risk factors and health-related behaviours. Purpose To conduct an umbrella review summarizing the evidence from existing systematic reviews of telehealth cardiac rehabilitation on health outcomes of patients with coronary heart disease (CHD). Methods An umbrella review of systematic reviews was undertaken in accordance with the PRISMA and JBI guidelines. A systematic search was conducted in Medline, APA PsycInfo, Embase, CINAHL, Web of Science, Cochrane database of systematic reviews, JBI evidence synthesis, Epistemonikos, and PROSPERO, searching for systematic reviews published from 1990 to current and was limited to the language source of English and Chinese. Outcomes of interest were modifiable CHD risk factors, psychosocial outcomes, and other secondary outcomes. Study quality was appraised using the JBI checklist for systematic reviews. A narrative analysis was conducted, and meta-analysis results were synthesized. Results From 1,301 identified reviews, 13 systematic reviews (10 meta-analyses) comprised 132 primary studies conducted in 28 countries. All the included reviews have high quality, with scores ranging from 73% to 100%. Findings to the modifiable risk factors remained inconclusive, except solid evidence was found in the significant improvement in physical activity level and behaviours from telehealth interventions, exercise capacity from m-health only and web-based only interventions, and medication adherence from m-health interventions. Conclusion Telehealth cardiac rehabilitation programs, work adjunct or in addition to traditional cardiac rehabilitation and standard care, are effective in improving modifiable CHD risk factors, particularly in physical activity. In addition, it does not increase the incidence in terms of mortality, adverse events, hospital readmission and revascularisation.

Effectiveness of Telehealth Cardiac Rehabilitation Programs on Health Outcomes of Patients With Coronary Heart Diseases: An Umbrella Review.

The aim of this study was to conduct an umbrella review summarizing the evidence from existing systematic reviews of telehealth cardiac rehabilitation (CR) on health outcomes of patients with coronary heart disease (CHD). An umbrella review of systematic reviews was undertaken in accordance with the PRISMA and JBI guidelines. A systematic search was conducted in Medline, APA PsycINFO, Embase, CINAHL, Web of Science, Cochrane database of systematic reviews, JBI evidence synthesis, Epistemonikos, and PROSPERO, searching for systematic reviews published from 1990 to current and was limited to the language source of English and Chinese. Outcomes of interest were health behaviors and modifiable CHD risk factors, psychosocial outcomes, and other secondary outcomes. Study quality was appraised using the JBI checklist for systematic reviews. A narrative analysis was conducted, and meta-analysis results were synthesized. From 1301 identified reviews, 13 systematic reviews (10 meta-analyses) comprised 132 primary studies conducted in 28 countries. All the included reviews have high quality, with scores ranging 73-100%. Findings to the health outcomes remained inconclusive, except solid evidence was found in the significant improvement in physical activity (PA) levels and behaviors from telehealth interventions, exercise capacity from mobile health (m-health) only and web-based only interventions, and medication adherence from m-health interventions. Telehealth CR programs, work adjunct or in addition to traditional CR and standard care, are effective in improving health behaviors and modifiable CHD risk factors, particularly in PA. In addition, it does not increase the incidence in terms of mortality, adverse events, hospital readmission, and revascularization.

Model of Potential Strengthening and The Role of Family in Control and Modification of Risk Factors in Adult Women with Coronary Heart Disease

Coronary heart disease is one of the non-communicable diseases with the highest prevalence in Indonesia. Coronary heart disease incidents can be prevented by controlling modifiable Coronary heart disease risk factors. Family is the strength for a person to survive pressure or keep life in balance. The purpose was to analyze the effect of strengthening family potency on the control of modifiable coronary heart disease risk factors in adult women. The research design used a quasi-experimental. The research variable was Coronary heart disease risk control models. The population in this study were families who had adult female family members with coronary heart disease in the work area of Arosbaya Public Health Center in 2019. In the sample in this study, as many as 30 people in each group were taken by simple random sampling. The research instrument used a simulation model for controlling Coronary heart disease risk factors that can be modified for women by the family using modules. Analysis used the Kolmogorov Smirnov and pair t-tes. The results showed that the mean modification of Coronary heart disease risk factors in adult women increased, except for avoidance of cigarette smoke (p <0.05). The pair t-test results show that there is a difference in controlling the risk factors for Coronary heart disease that can be modified after strengthening family potential, except for the avoidance of cigarette smoke. It can be concluded that the implementation of the family potential strengthening model is proven to significantly increase the family's ability to control the risk factors for Coronary heart disease can be modified in adult women. It is recommended that Coronary heart disease in adult women can be carried out by controlling risk factors that can be modified by involving all family components

Early Prevention of Atherosclerosis: Detection and Management of Hypercholesterolaemia in Children and Adolescents.

Coronary heart disease (CHD) is the main cause of death and morbidity in the world. There is a strong evidence that the atherosclerotic process begins in childhood and that hypercholesterolaemia is a CHD major risk factor. Hypercholesterolaemia is a modifiable CHD risk factor and there is a tracking of hypercholesterolaemia from birth to adulthood. Familial hypercholesterolaemia (FH) is the most common primitive cause of hypercholesterolaemia, affecting 1:200–250 individuals. Early detection and treatment of hypercholesterolaemia in childhood can literally “save decades of life”, as stated in the European Atherosclerosis Society Consensus. Multiple screening strategies have been proposed. In 2008, the American Academy of Pediatrics published the criteria for targeted screening, while some expert panels recommend universal screening particularly in the young, although cost effectiveness has not been fully analysed. Blood lipid profile evaluation [total cholesterol, Low-Density Lipoprotein Cholesterol (LDL-C), High-Density Lipoprotein Cholesterol (HDL-C) and triglycerides] is the first step. It has to be ideally performed between two and ten years of age. Hypercholesterolaemia has to be confirmed with a second sample and followed by the detection of family history for premature (before 55 years in men and 60 years in women) or subsequent cardio-vascular events and/or hypercholesterolaemia in 1st and 2nd degree relatives. The management of hypercholesterolaemia in childhood primarily involves healthy lifestyle and a prudent low-fat diet, emphasising the benefits of the Mediterranean diet. Statins are the cornerstone of the drug therapy approved in USA and in Europe for use in children. Ezetimibe or bile acid sequestrants may be required to attain LDL-C goal in some patients. Early identification of children with severe hypercholesterolaemia or with FH is important to prevent atherosclerosis at the earliest stage of development, when maximum benefit can still be obtained via lifestyle adaptations and therapy. The purpose of our review is to highlight the importance of prevention and treatment of hypercholesterolaemia starting from the earliest stages of life.

The abnormal lipid profile in obesity and coronary heart disease (CHD) in Pakistani subjects

BackgroundObesity has become global epidemic in the last three decades, whereas Coronary Heart Disease (CHD) still remains the most important cause of mortality in the world. The study was aimed at determining the pattern of lipid profile for the obese and CHD population in Pakistan. As obesity is a strong predisposing risk factor for CHD, we aimed to analyze the lipid parameters in both conditions and compare them with the healthy controls of the same ethnicity.MethodsBlood samples were collected from one thousand individuals (500 with CHD, 250 with obesity, 250 healthy controls). The lipid profile (total Cholesterol, triglycerides, HDL-C, LDL-C and VLDL) was measured using commercially available kits. The pattern of dyslipidemia was then studied by comparing the results in both groups with controls as well as population cutoffs. The quantitative variables were checked for normality and log transformation was done for variables where appropriate. Analysis of variance and logistic regression were done to check the association of lipid parameters with obesity and CHD.ResultsThe obese and CHD groups showed a dyslipidemic profile than the healthy controls. CHD group had a higher proportion of CHD in any of the first degree blood relatives (36.0% vs. 1.8%), a similar trend was observed in the obese group, where 63.9% cases had positive family history. Among cases, 50.7% had combined lipid abnormalities, i.e., the values of TC, LDL-C, TG and HDL-C, all were deranged. Whereas 49.52% had TC more than normal cut off (> 200 mg/dl), 51.6% had LDL-C > 100 mg/dl. Similarly, 80.4% of patients had TG levels more than upper normal range (> 150 mg/dl) and 64% had HDL values in moderate CHD risk group (< 50 mg/dl). The results show that Pakistani cases are hyperlipidemic for lipid traits except for HDL which is lowered. Patients with comorbidities also had lipid profiles deviated from the normal range.ConclusionThe study provides information regarding the aberration of lipid profile in the metabolic disorders that can increase the predisposition to complications.

Quantifying Importance of Major Risk Factors for Coronary Heart Disease

To optimize preventive strategies for coronary heart disease (CHD), it is essential to understand and appropriately quantify the contribution of its key risk factors. Our objective was to compare the associations of key modifiable CHD risk factors-specifically lipids, systolic blood pressure (SBP), diabetes mellitus, and smoking-with incident CHD events based on their prognostic performance, attributable risk fractions, and treatment benefits, overall and by age. Pooled participant-level data from 4 observational cohort studies sponsored by the National Heart, Lung, and Blood Institute were used to create a cohort of 22 626 individuals aged 45 to 84 years who were initially free of cardiovascular disease. Individuals were followed for 10 years from baseline evaluation for incident CHD. Proportional hazards regression was used to estimate metrics of prognostic model performance (likelihood ratio, C index, net reclassification, discrimination slope), hazard ratios, and population attributable fractions for SBP, non-high-density lipoprotein cholesterol (non-HDL-C), diabetes mellitus, and smoking. Expected absolute risk reductions for antihypertensive and lipid-lowering treatment were assessed. Age, sex, and race capture 63% to 80% of the prognostic performance of cardiovascular risk models. In contrast, adding either SBP, non-HDL-C, diabetes mellitus, or smoking to a model with other risk factors increases the C index by only 0.004 to 0.013. However, primordial prevention could have a substantial effect as demonstrated by population attributable fractions of 28% for SBP≥130 mm Hg and 17% for non-HDL-C≥130 mg/dL. Similarly, lowering the SBP of all individuals to <130 mm Hg or lowering low-density lipoprotein cholesterol by 30% would be expected to lower a baseline 10-year CHD risk of 10.7% to 7.0 and 8.0, respectively (absolute risk reductions: 3.7% and 2.7%, respectively). Prognostic performance decreases with age (C indices for age groups 45-54, 55-64, 65-74, 75-84 are 0.75, 0.72, 0.66, and 0.62, respectively), whereas absolute risk reductions increase (SBP: 1.1%, 2.3%, 5.4%, 10.3%, respectively; non-HDL-C: 1.1%, 2.0%, 3.7%, 5.9%, respectively). Although individual modifiable CHD risk factors contribute only modestly to prognostic performance, our models indicate that eliminating or controlling these individual factors would lead to substantial reductions in total population CHD events. Metrics used to judge importance of risk factors should be tailored to the research objectives.

Modifiable Coronary Heart Disease Risk Factors Trends in Urban Black South African Females and the Implications for Health Promotion Interventions

BACKGROUND: Multiple risk factors can contribute to the development of coronary heart disease (CHD) in an individual, yet any change in the modifiable CHD risk status of Black South African females in recent times is unknown.AIM: The researcher aimed to establish the current CHD risk status of urban Black African females and to report on any trends over a 10-year period with the purpose to direct health promotion programs.METHODS: Data from 62 urban Black females (Mean age 32.4 ± 8.5 years) in 2006 was paired for age with that of 67 women (Mean age 32.0 ± 9.0 years) in 2016. The modifiable CHD risk factors assessed were cigarette smoking, sedentary lifestyle, obesity, hypertension, and hypercholesterolemia.RESULTS: Physical inactivity (72.6% of the sample in 2006 vs. 75.8% in 2016) and obesity (42% in 2006 vs. 38.8% in 2016) were the top-ranked risk factors for CHD with the pattern unchanged in 2016. Significantly fewer participants (4.5% vs. 16.6%; p &lt; 0.05) were hypertensive and significantly more women had hypercholesterolemia (5.6% vs. 23.9%; p &lt; 0.05) in 2016. The multiple CHD risk profile showed that 42.4% had at least one CHD risk factor (an increase of 25%) and significantly fewer (27.3% vs. 45.2%; p &lt; 0.05) had two CHD risk factors in 2016.CONCLUSION: A sedentary lifestyle and obesity were the highest CHD risk factors. Also, the multiple CHD risk profile of Black African women changed over a period of 10 years from higher to lower and normal risk. Health promotion strategies must be directed towards weight reduction, increasing physical activity levels and be tailored for the population for which the health promotion programs have been designed.

Lifestile And Socio-Demographic Factors Determining The Coronary-Arterial Disease Risks In Brazilian Free-Living Adults

PURPOSE: Coronary heart disease(CHD) continues to be a leading cause of morbidity and mortality among adults worldwide. The risk factors include complications of Metabolic Syndrome(MetS) and environmental factors. The Framingham score(FS) is a predictive algorithm developed using categorical variables, allowing the 10-yr prediction of multivariate CHD risk in patients without overt CHD. The purpose is to determine the intrinsic and the involved environmental factors of CHD in free-living adults. METHODS: A lifestyle modification program(LSM) involving dietary counseling and regularly supervised physical activity(“Move for Health”) has been used here, since 1991 for NCDs primary care. In a cross-sectional study we used the baseline data from 709 subjects(2005-2016), older than 35 yrs.The FS distribution was used as main variable and, as co-variablessocio-demographic, behavioral(dietetic and physical fitness)anthropometric and clinical-biochemistry.For these accomplishments, were used IPAQ(long-version), Healthy Eating Index(through 24h food intake recall), body weight, height and electrical bio-impedance, clinical signs and fasting plasma markers of insulin resistance(HOMA-IR), inflammatory(hs-CRP) and oxidative(MDA and uric acid) states. Statistical comparisons were defined by p=0.05. RESULTS: The top quartile of FS was found as ≥10% for females(F) and ≥15% for males(M) and, they differed from the lower quartile (≤3% and ≤5%, respectively), by presenting 1.81x higher either HOMA-IR, 1.61x hs-CRP and 1.6x MDA values. Prevalence of MetS was 2.6x higher in p75(71.9% F and 73.1%M) than p25(28.1%F and 26.9%M) with p75 being fatter(higher BMI, total body and abdominal fatness) with lower physical activity, lower aerobic capacity, lower either muscle mass and hand grip force.The p75 FS subjects presented also lower schooling and lower income.Their poor diet quality(HEI) was characterized by being more processed foods(higher CHO/fibers and sodium/potassium ratio), higher daily consumption of oils(and PUFAs) and cholesterol and, less amounts of MUFA, fruits and vegetables(and fibers). CONCLUSIONS: The higher FS(moderate CHD risk) of this community followed markers of the MetS aggravation, having inadequate- dietary quality and physical unfitness as environmental factors.

The role of registries and genetic databases in familial hypercholesterolemia.

To review how leveraging familial hypercholesterolemia registries can impact molecular genetic research and precision medicine. Familial hypercholesterolemia is both much more common and more phenotypically heterogeneous than previously thought with some evidence for significant genotype to phenotype correlations. Genetic testing for familial hypercholesterolemia is becoming both more widely available and cheaper, spurring conversations about its clinical utility. In most countries, familial hypercholesterolemia is underdiagnosed and diagnosed later in life, often after the onset of coronary heart disease (CHD). Familial hypercholesterolemia is undertreated; low goal attainment and additional modifiable risk factors further increase CHD risk. Familial hypercholesterolemia epitomizes the goal of precision medicine to define a subset of individuals with a high risk of morbidity and mortality through genetic diagnosis to manage and treat the risk accordingly. Genetic cascade screening can be used to identify familial hypercholesterolemia patients at a younger age and start timely treatment to prevent CHD. Familial hypercholesterolemia registries are tools for clinical research and improving healthcare planning and patient care. As genotype and phenotype correlations in familial hypercholesterolemia become increasingly understood, this information will likely play a more important role in diagnosis and treatment especially as the cost of genetic testing continues to decline.

Abstract P046: Cardiometabolic Risk Liver Transplant Survivors

Background: Coronary heart disease (CHD) is an important cause of long-term mortality in liver transplant recipients (LTR). LTR are at increased risk for CHD-related mortality due to exposure to chronic immunosuppression contributing to cardiometabolic risk. Physical activity (PA) and nutrition are important lifestyle management tools used in clinical practice to reduce CHD risk, however, little is known about the long-term effects of these strategies in LTR. Objective: The aim of this study was to evaluate PA and diet and correlate findings with the atherogenic lipoprofile, obesity and 10-year risk of CHD. Methods: LTR (≥ 2 years post LT; stable immunosuppression) without documented CHD, diabetes, graft cirrhosis, physical limitations, and malignancy were included. PA was quantitated via International Physical Activity Questionnaire (IPAQ). Anthropometric assessment was used to obtain body mass index (BMI) and waist hip ratio (WHR). NMR Lipoprofile was used to obtain athrogenic lipoprotein concentration and size followed by generic lipid profile. Food preferences were evaluated via Olbrisch Eating Style Questionnaire and Diet History Questionnaire. CHD risk was assessed by Framingham Risk Score (FRS). Results: Of 122 subjects screened, 27 met entry criteria. Most were overweight (N=11) or obese (N=8) with mean BMI 28.5 kg/m 2 ( SD =4.05; range=20.2-37.8) and mean WHR= 0.94 (SD=0.22; range=0.65-1.85). According to IPAQ, 20 patients (75%) were sedentary. Eating style and food preference choices suggested that 23 (85.2%) were unable to control portion sizes and 14 (51.9%) preferred sugar, fat, or starches in their diet. Fasting glucose was 98.8mg/dL ( SD =14.2, range=78-133) suggesting 7 participants were “pre-diabetes” and 2 undiagnosed type 2 diabetes. Four reported smoking; of these, one was highly nicotine dependent. FRS was 7.15% (SD=6.15, ranged 7-23). While the calculated total cholesterol 166.44 (SD=34.15), HDL 55.19 (SD=15.31), LDL 84.56 (SD=26.58), and TG 143.44 (SD=76.29)(all in mg/dL) were within normal range, numbers and sizes of lipoprotein particles indicate that LTRs were at moderate risk of CHD: LDL-C 1221.48 (SD+447.31)&gt;1000 nmol/L as reference), small LDL-P 799.81 (SD=489.95) &gt;527nmol/L), LDL-size 20.89 (SD=1.12)&gt;20.5nm, Large VLDL-P 2.93 (SD=4.35) &gt;2.7 nmol/L, and VLDL size 51.07(SD=9.74) &gt;46.6 nm. PA (more time sitting) was associated with higher BMI (r=.394, P&lt;0.05) and WHR (r=.535, P&lt;0.01) but not with particle number or density. PA (MET minutes/week) was associated with WHR (r=.535, p&lt;0.01). Neither PA nor nutrition (Kcal/day) was associated with FRS. Conclusion: LTR are generally inactive and make poor dietary choices which are reflected by the obesity indices and characterized by the atherogenic lipoprofile.

Распределение концентраций липидов и липопротеидов в плазме крови у студентов РУДН из разных климато-географических регионов

The concentration of total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) were determined among students of PFUR aged 17-25, from different climatic and geographical regions. In all the concentrations (> 6.2 mmol/L) of total plasma cholesterol were detected at 6 (2.4%) students, indicating a high or very high risk of coronary heart disease (CHD). Elevated levels of plasma LDL-C (> 3.31 mmol/l) were found at 4 (1.6%) students, indicating a high or very high risk of coronary heart disease. Lower concentrations of HDL-C plasma ( 1.1 mmol/L) were detected at 30 (12.4%) indicating a moderate risk of CHD and at 11 (4.6%) students concentration of HDL-C were lower (1,1 mmol/L), indicating a high risk of coronary heart disease. The results can be used as a justification for the screening survey to identify dyslipidemia among adolescents and young adults, with the subsequent conducting of the individual preventive and therapeutic measures.

Antipsychotic Induced Weight Gain: Therapeutic Management in Daily Practice.

Introduction The excess cardiovascular mortality associated with bipolar disorder is attributed in part to an increased risk of the modifiable coronary heart disease risk factors such as obesity. Antipsychotic medication can induce weight gain or worsen other metabolic cardiovascular risk factors. Methods We presented two case exemples illustrating weight gain induced by atypical antipsychotics, and discuss therapeutic managements according to litterature data. Results Case report 1 Mr H.D is a 23 year-old university student, with medical history of seizures treated by Valproic Acid, stopped three years ago. He was diagnosed with schizoaffective disorder since 2008, treated by Olanzapine 15 mg/day. Treatment by mood stabilizers was hampered by liver cytolisis. Within three months after introducing Olanzapine, the patient experienced considerable weight gain amounting to 10 kilograms. Therefore, treatment doses were decreased. Case report 2 : Mrs I.T is a 31-year old female patient with medical history of asthma, anemia and herniated disc worsened by obesity. She was diagnosed with bipolar disorder and received Carbamazepine and Fluoxetine. But increased gamma-GT level induced by Carbamazepine led us to achieve a swith to Quetiapine, to which the patient showed weight gain amounting four Kilograms within three months (body mass index=34.5). A switch to Aripiprazole was achieved. Conclusion Psychiatrics must pay attention to concomitant medications and individual factors underlying overweight and obesity. Although several management options of weight gain are available, the best approach seems to attempt to prevent this weight gain.

Is inflammatory chronic obstructive pulmonary disease a coronary heart disease risk equivalent? A longitudinal analysis of the third National Health and Nutrition Examination Survey (NHANES III), 1988-1994.

BackgroundEvidence suggests that there is an association between chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD). An important etiological link between COPD and CHD may be an underlying systemic inflammatory process. Given that COPD patients are at greater risk of cardiovascular mortality, understanding the burden of CHD on COPD patients could permit future risk attenuation.MethodsLongitudinal cohort analyses of the Third National Health and Nutrition Examination Survey from 1988–1994 were performed. 3,681 individuals ≥40 years of age with good quality spirometry data were included. Participants were divided into 5 groups: 1) no COPD, no CHD; 2) COPD without inflammation, no CHD; 3) COPD with inflammation, no CHD; 4) CHD only, and 5) CHD + COPD. A novel “inflammatory” COPD designation included those with COPD and clinical evidence of inflammation (i.e., CRP ≥95.24 nmol/L).ResultsThe risk for CHD mortality was significant only for the CHD group (HR 5.56, 95% CI 3.24-9.55) and the COPD + CHD group (HR 5.02, 95% CI 2.83-8.90). Similarly, the risk for cardiovascular disease (CVD) mortality was significant only for the CHD group (HR 4.25, 95% CI 2.70-6.69) and the CHD + COPD group (HR 4.12, 95% CI 2.60-6.54) after adjusting for nonmodifiable CHD risk factors (age, gender, race/ethnicity, family history of CHD). After adjusting for modifiable CHD risk factors (diabetes, BMI, physical activity, systolic blood pressure, cholesterol, and smoking), hazard ratios of the two groups remained similar but attenuated. For total mortality, the risk was significant for the four groups: the non-inflammatory COPD group; the COPD with inflammation group, the CHD group, and the COPD + CHD group.ConclusionsOur study did not confirm that inflammatory COPD may be a CHD risk equivalent. However, due to the small size of the “inflammatory” COPD group, further prospective replication and validation is needed. Moreover, given that COPD results from inflammation, the systemic inflammation associated with COPD may have worsened comorbid conditions and may have lead to the increased total mortality found in the COPD with inflammation and COPD + CHD groups which requires further investigation.

Lack of causal relationship between leukocyte telomere length and coronary heart disease

ObjectiveTo investigate the association between genetic variation in telomerase RNA component (TERC) and leukocyte telomere length (LTL) with risk of coronary heart disease (CHD). Methods and resultsAn analysis of LTL was conducted, focusing on two SNPs in 2 community-based cohort populations comprising 3500 Chinese Han individuals. In addition, LTL ratio was determined in a case–control setting involving 4351 participants: 2211 healthy individuals and 2140 CHD patients. The association between LTL and the presence and extent of cardiovascular and cerebrovascular lesions were tested. Results confirmed the association of rs12696304 and rs16847897 with LTL in the Chinese Han population (P = 1.63 × 10−6 and P = 1.44 × 10−7, respectively). However, these SNPs confer a moderate risk for CHD but did not achieve significant threshold after multiple corrections. Decreased LTL ratio was associated with CHD (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.02–1.34; P < 0.01). In addition, the LTL ratio in CHD patients was related to numbers of vascular disease lesions. ConclusionsOur results do not support a causal role of LTL for the development of CHD. However, LTL may be related to complex conditions associated with cardiovascular and cerebrovascular disease manifestations.

Assessing 10-year coronary heart disease risk in people with Type 2 diabetes mellitus: Framingham versus United Kingdom Prospective Diabetes Study

Aims: Previous studies have suggested that the Framingham coronary heart disease risk prediction equation underestimates risk among people with Type 2 diabetes. We compared the 10-year absolute risks of coronary heart disease (CHD) using a Framingham equation and a United Kingdom Prospective Diabetes Study (UKPDS) equation in adults with Type 2 diabetes. Methods: Participants were from a cross-sectional survey of a randomly selected population. There were 461 people with newly (n = 132) or previously diagnosed (n = 329) diabetes aged 35 to 74 years with no past history of cardiovascular disease or nephropathy. We examined predicted 10-year CHD risk by age, gender, and newly or previously diagnosed diabetes. Results: Overall the mean 10-year CHD risks predicted by the two equations were similar. Among men, the UKPDS and Framingham scores were almost identical below 60 years of age but at older ages, the UKPDS score was 4% - 11% higher than Framingham. For women, the Framingham score was higher than the UKPDS score between ages 40 and 65 years, but the UKPDS score was about 4% - 5% higher for women aged 70 years and over. The UKPDS equation tended to give higher risk estimates in people with a predicted 10-year Framingham CHD risk above 15%. Conclusion: Framingham CHD risk scores tended to be lower than UKPDS scores primarily in people above standard thresholds for drug treatment, so the clinical impact of underestimating risk is likely to be limited. Moreover, the UKPDS equation predicted lower risks than Framingham for women and newly diagnosed diabetes at otherwise low to moderate CHD risk, which could result in later initiation of therapy in these groups if the UKPDS score was used instead of the Framingham score.

Economic Evaluation of Cardio inCode®, a Clinical-Genetic Function for Coronary Heart Disease Risk Assessment

BackgroundA clinical–genetic function (Cardio inCode®) was generated using genetic variants associated with coronary heart disease (CHD), but not with classical CHD risk factors, to achieve a more precise estimation of the CHD risk of individuals by incorporating genetics into risk equations [Framingham and REGICOR (Registre Gironí del Cor)].ObjectiveThe objective of this study was to conduct an economic analysis of the CHD risk assessment with Cardio inCode®, which incorporates the patient’s genetic risk into the functions of REGICOR and Framingham, compared with the standard method (using only the functions).MethodsA Markov model was developed with seven states of health (low CHD risk, moderate CHD risk, high CHD risk, CHD event, recurrent CHD, chronic CHD, and death). The reclassification of CHD risk derived from genetic information and transition probabilities between states was obtained from a validation study conducted in cohorts of REGICOR (Spain) and Framingham (USA). It was assumed that patients classified as at moderate risk by the standard method were the best candidates to test the risk reclassification with Cardio inCode®. The utilities and costs (€; year 2011 values) of Markov states were obtained from the literature and Spanish sources. The analysis was performed from the perspective of the Spanish National Health System, for a life expectancy of 82 years in Spain. An annual discount rate of 3.5 % for costs and benefits was applied.ResultsFor a Cardio inCode® price of €400, the cost per QALY gained compared with the standard method [incremental cost-effectiveness ratio (ICER)] would be €12,969 and €21,385 in REGICOR and Framingham cohorts, respectively. The threshold price of Cardio inCode® to reach the ICER threshold generally accepted in Spain (€30,000/QALY) would range between €668 and €836. The greatest benefit occurred in the subgroup of patients with moderate–high risk, with a high-risk reclassification of 22.8 % and 12 % of patients and an ICER of €1,652/QALY and €5,884/QALY in the REGICOR and Framingham cohorts, respectively. Sensitivity analyses confirmed the stability of the study results.ConclusionsCardio inCode® is a cost-effective risk score option in CHD risk assessment compared with the standard method.

Risk factors for coronary heart disease and survival after myocardial infarction

Several risk factors for coronary heart disease (CHD) have been associated with improved in-hospital survival after myocardial infarction (MI). We aimed to confirm this paradox and assess whether it extends to long-term outcome. In addition, we investigated temporal mortality trends. We examined the relation between the presence of four modifiable risk factors for CHD (hypertension, dyslipidaemia, diabetes mellitus and smoking) and mortality in 14,434 consecutive patients admitted with MI to a coronary care unit from 1985 to 2008. Two-thirds of MI patients (n = 10,003) had at least one risk factor for CHD on hospital admission. The presence of at least one compared to no CHD risk factors was associated with a favourable 30-day mortality rate (5% vs. 7%, adjusted odds ratio 0.72, 95% confidence interval (CI): 0.62-0.83). There was significant interaction between the presence of CHD risk factors and decade of hospitalization (p = 0.001). The adjusted 10-year mortality hazard ratio (HR) of at least one CHD risk factor compared to none, was 1.2 (95% CI: 1.0--1.4), 0.89 (0.65--1.2) and 0.89 (0.79--0.99) in 1985--1990, 1990--2000 and 2000--2008, respectively. Survival improved over time. Adjusted 10-year mortality fell (adjusted HR [2000--2008 vs. 1985--1990] 0.59 [95% CI: 0.52--0.66] in patients with, and 0.76 [95% CI: 0.65-0.89] in those without CHD risk factors). The presence of at least one modifiable CHD risk factor was associated with improved outcome after MI. Patients with CHD risk factors benefited from more substantial mortality reductions during the past few decades.

Time trends in absolute and modifiable coronary heart disease risk in patients with Type 2 diabetes in the Swedish National Diabetes Register (NDR) 2003–2008

The aim was to evaluate treatment goal achievements early in the course of Type 2 diabetes, and their effect on 10-year risk of coronary heart disease in patients receiving usual care. Assessment of risk factor control 3 years after diagnosis in patients with Type 2 diabetes with no previous coronary heart disease included from the Swedish National Diabetes Register; a total of 19,382 patients (mean age 58 years) in cross-sectional surveys from 2003 to 2008, and a subgroup of 4293 patients followed individually from year of diagnosis to follow-up after a mean 2.6 years. Estimation of absolute 10-year risk of coronary heart disease using the U.K. Prospective Diabetes Study risk engine, and modifiable 10-year risk defined as percentage excess risk above patients with 'normal' risk factor values. Treatment goals for HbA1c , blood pressure, total and LDL cholesterol were achieved in 78.4, 65.5, 55.6% and 61.0%, respectively, in the cross-sectional survey in 2008, following a trend of generally improved control. In the individually followed patients in the subgroup, mean absolute 10-year coronary heart disease risk increased from 13.7% (men/women 16.9/9.5%) to 14.2 (men/women 17.6/9.6%) (P < 0.001) from year of diagnosis to follow-up after 2.6 years, while mean modifiable risk decreased from 37.7% (men/women 28.6/49.9%) to 19.1% (13.2/26.9%) (P < 0.001 in all). A high achievement of treatment goals and a low mean modifiable 10-year coronary heart disease risk was found at the 3-year follow-up, both in the cross-sectional survey in 2008 and in patients individually followed since diagnosis. This indicates the feasibility and significance of early multifactorial risk factor treatment.

Motivational interviewing: a useful approach to improving cardiovascular health?

To review and synthesise, systematically, the research findings regarding motivational interviewing and to inform education, research and practice in relation to cardiovascular health. Motivational interviewing is designed to engage ambivalent or resistant clients in the process of health behaviour change, and it has been widely used in different clinical conditions such as substance abuse, dietary adherence and smoking cessation. Motivational interviewing has also been proposed as a method for improving modifiable coronary heart disease risk factors of patients. Systematic review. Eligible studies published in 1999-2009 were identified from the following databases: CINAHL, Medline, PsycINFO, Cochrane Library, EBSCO, Web of Science, Embase and British Nursing Index. A manual search was conducted of bibliographies of the identified studies and relevant journals. Two researchers independently reviewed the studies. Four meta-analyses, one systematic review and three literature reviews of motivational interviewing and five primary studies of motivational interviewing pertaining to cardiovascular health were identified. Despite a dearth of primary studies in cardiovascular health settings, there appears to be strong evidence that motivational interviewing is an effective approach focusing on eliciting the person's intrinsic motivation for change of behaviour. Motivational interviewing is an effective approach to changing behaviour. It offers promise in improving cardiovascular health status. This review indicates that motivational interviewing is a useful method to help nurses improve health behaviour in people with coronary risk factors.

Predictors of Anterior and Posterior Wall Carotid Intima Media Thickness Progression in Men and Women at Moderate Risk of Coronary Heart Disease

Synopsis: Early detection of arterial wall thickening, the subclinical phase of atherosclerosis, may be useful for identifying individuals at risk for future cardiovascular events. Carotid intima media thickness (CIMT)-assessed rate of atherosclerosis progression is a risk factor for clinical cardiovascular events, but the relationships between various coronary heart disease (CHD) risk factors and CIMT progression are unclear. Purpose: The aim of this study was to investigate associations between CHD risk markers and CIMT progression in individuals at moderate CHD risk. Methods: Participants included men (45–75 years) and women (55–74 years) in the control arm of a clinical trial. All had at least one major CHD risk factor and baseline posterior CIMT 0.7–2.0 mm, without significant stenosis. Posterior wall (n = 134) and anterior wall with contrast (n = 72) CIMT were assessed by the use of high-resolution B-mode ultrasound at baseline, 12 months and ∼18 months. Fasting lipoprotein lipid, apolipoprotein (apo), inflammatory, and oxidative stress markers were evaluated. Results: Anterior wall CIMT was significantly greater at baseline than posterior wall CIMT (0.86 vs 0.77 mm, P < .001). On average, posterior wall CIMT progressed and anterior wall CIMT regressed (0.0091 vs −0.0164 mm/yr, respectively, P = .014). Baseline CIMT was inversely associated (P < .001) with CIMT progression in both walls. After adjustment for baseline CIMT, significant predictors of anterior wall CIMT progression in linear regression analyses included triglycerides (TG, P = .006), high-density lipoprotein cholesterol (HDL-C, inverse, P = .006), and ratios, including total cholesterol (TC)/HDL-C (p=0.013), TG/HDL-C (P = .005), and Apo B/HDL-C (P = .021). Significant baseline CIMT-adjusted predictors of posterior CIMT progression included TC (P = .028), low-density lipoprotein cholesterol (LDL-C, P =.035), non-HDL-C (P =.004), TG (P =.016), apoB (P =.005), and ratios of TC/HDL-C (P < .001), TG/HDL-C (P =.015), apoB/apoA1 (P =.012), and apoB/HDL-C (P =.004). Oxidative stress and inflammatory markers were generally unrelated to CIMT progression. Conclusions: The strongest predictors for CIMT progression in anterior and posterior walls were lower baseline CIMT, increased TG, and elevated lipid ratios, including TC/HDL-C, TG/HDL-C, and apoB/HDL-C. Non-HDL-C was a stronger predictor than LDL-C. These results support the hypothesis that TG-rich lipoproteins are associated with CIMT progression, either directly, or as an indicator of a greater number of circulating atherogenic particles.