Number Of Modifiable Risk Factors Research Articles

Narrowing socioeconomic inequalities in coronary heart disease: insight from Mendelian randomization

Abstract Background Socioeconomic inequalities in coronary heart disease (CHD) represent a pressing global public health concern. However, which dimensions of socioeconomic status (SES) affect CHD and the potential modifiable mediators remain elusive. Methods We performed two-sample Mendelian randomization (MR) analyses based on summary data from large-scale genome-wide association studies in populations of European ancestry. Specifically, by applying bidirectional univariable MR (UVMR) and multivariable MR (MVMR), we investigated the causal relationships of education, occupation, income, Townsend deprivation index (TDI) with CHD and the independent effects of these SES indicators. We further employed a two-step MR to comprehensively profile the mediating effects of 23 behavioral, 3 psychological and 5 biological factors in the relationships. Results An independent causal association was observed between genetically predicated education and CHD, with a 30% lower risk of CHD (OR: 0.70; 95% CI: 0.53-0.93) for each 4.2-year of schooling. Each one-s.d. higher household income was causally, but not independently, associated with a 39% lower risk of CHD (OR: 0.61; 95% CI: 0.49-0.77). No significant causal association was suggested for occupation and TDI with CHD, and no reverse causal effect was observed for CHD on the SES indicators. Of 31 candidate mediators, nine factors mediated the effect of education on CHD significantly, with an individual mediation proportion of 33.5% for smoking, 29.2% for sedentary behaviour, 14.4% for blood lipids, 13.4% for BMI, 11.7% for systolic blood pressure, 9.5% for diastolic blood pressure, 7.8% for well-being spectrum, 6.4% for depression and 2.8% for blood glucose. Conclusions This study highlights that education was the primary SES indicator affecting CHD with considerable mediation by a number of modifiable risk factors. These findings inform policies to mitigate disparities of CHD risk attributable to socioeconomic inequalities. Key messages • Education can be prioritized over other common SES indicators as an essential strategy to reduce the burden of CHD. • Interventions for narrowing socioeconomic inequalities in CHD could focus on more easily modifiable mediating factors.

Association between intraoperative tidal volume and postoperative acute kidney injury in non-cardiac surgical patients using a propensity score-weighted analysis

Acute kidney injury (AKI) is related to adverse clinical outcomes. Therefore, identifying patients at increased risk of postoperative AKI and proactively providing appropriate care is crucial. However, only a limited number of modifiable risk factors have been recognized to mitigate AKI risk. We retrospectively analyzed adult patients who underwent endotracheal intubation and mechanical ventilation of more than 2 h during non-cardiac surgery at Seoul National University Hospital from January 2011 to November 2022. Patients were grouped into low- or high-tidal volume groups based on their intraoperative tidal volume relative to their predicted body weight (PBW) of 8 ml/kg. The association between intraoperative tidal volume and postoperative AKI was evaluated using inverse probability of treatment weighting (IPTW), adjusting for various preoperative confounders. Among the 37,726 patients included, the incidence of postoperative AKI was 4.1%. The odds of postoperative AKI risk were significantly higher in the high-tidal volume group than in the low-tidal volume group before and after IPTW (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.08–1.32, P = 0.001 and OR: 1.10, 95% CI 1.02–1.19, P = 0.010, respectively). In the multivariable logistic regression analysis after IPTW, a high tidal volume was independently associated with an increased risk of postoperative AKI (OR: 1.21, 95% CI 1.12–1.30, P < 0.001). In this propensity score-weighted analysis, an intraoperative high tidal volume of more than 8 ml/kg PBW was significantly associated with an increased risk of postoperative AKI after IPTW in non-cardiac surgical patients. Intraoperative tidal volume showed potential as a modifiable risk factor for preventing postoperative AKI.

Associations between housing and psychological damage by earthquake and modifiable risk factors for dementia in general older adults: Tohoku Medical Megabank community-based cohort study.

To evaluate the association between housing and psychological damage caused by the Great East Japan Earthquake (GEJE) and modifiable risk factors (MRFs) of dementia for general population of older adults. This cross-sectional study enrolled 29 039 community-dwelling older adults (mean age 69.1 ± 2.9 years, 55.5% women). We evaluated disaster-related damage (by complete or not complete housing damage) and psychological damage (by post-traumatic stress reaction [PTSR]) after the GEJE using a self-report questionnaire. MRFs encompassed the presence of depression, social isolation, physical inactivity, smoking, and diabetes. We examined the association between disaster-related damage and MRFs using ordinary least squares and modified Poisson regression models adjusted for sociodemographic and health status variables. Complete housing damage and PTSR were identified in 2704 (10.0%) and 855 (3.2%) individuals, respectively. The number of MRFs was significantly larger for the individuals with complete housing damage (β = 0.23; 95% confidence interval [CI]: 0.19-0.27) and PTSR (β = 0.60; 95% CI: 0.53-0.67). Prevalence ratios (PRs) for depression and physical inactivity were higher in individuals with complete housing damage. The PRs for all domains of the MRFs were significantly higher in individuals with PTSR. Housing and psychological damage caused by the GEJE were associated with an increased risk factor of dementia. To attenuate the risk of dementia, especially among older victims who have experienced housing and psychological damage after a disaster, multidimensional support across various aspects of MRFs is required. Geriatr Gerontol Int 2024; 24: 509-516.

Impact of the number of modifiable risk factors on clinical outcomes after percutaneous coronary intervention: An analysis from the e-Ultimaster registry

AimsA substantial proportion of the patients undergoing percutaneous coronary intervention (PCI) have none of the of standard modifiable cardiovascular risk factors (SMuRFs): hypertension, diabetes, hypercholesterolaemia and smoking. The aim of this analysis was to compare clinical outcomes after PCI according to the number of SMuRFs. MethodsPatients with an indication for a PCI were stratified based upon the number of SMuRFs: 0, 1, 2 or 3–4. The primary outcome was target lesion failure (TLF), a composite of cardiac death, target vessel-related myocardial infarction or clinically driven target lesion revascularization at 1-year. Inverse weighted propensity score (IWPS) adjustment was performed to adjust for differences in baseline characteristics. ResultsThe prevalence of SMuRFs was: 0 SMuRF 16.4 %; 1 SMuRF 27.8 %; 2 SMuRFs 34.7 % and 3–4 SMuRFs 21.1 %. Patients without SMuRFs were younger, more likely to be male and had less complex coronary artery disease. The incidence of TLF increased with the number of SMuRFs: 2.65 %, 2.75 %, 3.23 %, and 4.24 %, Ptrend < 0.001. The relative risk (RR) for a TLF was 60 % higher (95 % confidence interval 1.32–1.93, p < 0.01) for patients with 3–4 SMuRFs compared to patients without SMuRFs. The trend remained (Ptrend < 0.01) after IWPS with TLF rates of 2.88 %, 2.64 %, 2.88 % and 3.65 %. The RR for a TLF was 27 % higher (95 % CI 1.05–1.53, p < 0.01). ConclusionThe incidence of clinical events at 1-year increased with the number of SMuRFs. While patients without SMuRFs have a relatively favourable risk profile, more research is needed to optimize therapeutic management in the majority of patients.

Severe nutritional anemia among hospitalized children in Central India – Descriptive study

Despite numerous efforts, pediatric nutritional anemia remains one of the most serious health issues in developing countries. Severe nutritional anemia is associated with a number of modifiable risk factors, which can be overcome if the risk factors are accurately identified and addressed for different population groups. The purpose of this descriptive study is to focus on severe nutritional anemia in hospitalized children aged 1–5 years in a tertiary care center in Central India. Hospitalized children were enrolled in the study, and demographic, socioeconomic, clinical, and laboratory data, as well as clinical and laboratory images, were reviewed. For defining severe anemia, the World Health Organization cutoff value was used. Out of total 9850 children of 1–5 years of age group admitted in hospital for 2 years, 197 children had severe nutritional anemia, indicated the incidence of 2%. Lower socioeconomic status and malnutrition were significantly correlated to severe nutritional anemia.

Prevalence and risk factors of disabilities among Egyptian preschool children: a community-based population study

BackgroundChild disability has significant implications on their well-being and healthcare systems. Aim: This survey aimed to assess the magnitude of seven types of disability among Egyptian children aged 1 < 6 years and their socio-demographic, epidemiological, and perinatal predictors.MethodsA national population-based cross-sectional household survey targeting 21,316 children from eight governorates was conducted. The screening questionnaire was derived from the WHO ten-question survey tool validated for identifying seven disability categories.ResultsThe percentage of children with at least one disability was 8.1% as follows: speech/communication (4.4%), Mobility/physical (2.5%), Seizures (2.2%), Comprehension (1.7%), Intellectual impairment (1.4%), Visual (0.3%) and Hearing (0.2%). Age was not found to affect the odds of disability except for visual disability (significantly increased with age (AOR = 1.4, 95% CI:1.1–1.7). Male sex also increased the odds of all disabilities except visual, hearing, and seizures. Convulsions after birth significantly increased the odds of disability as follows: hearing (AOR = 8.1, 95% CI: 2.2–30.5), intellectual impairment (AOR = 4.2, 95% CI: 2.5–6.9), and mobility/physical (AOR = 3.4, 95% CI: 2.3–5.0). Preterm delivery and being kept in an incubator for more than two days after birth increased the odds for visual disability (AOR = 3.7, 95% CI: 1.1–12.1 & AOR = 3.7, 95% CI: 1.7–7.9 respectively). Cyanosis increased the odds of seizures (AOR = 4.7, 95% CI: 2.2–10.3). Low birth weight also increased the odds for all disability domains except for visual and hearing. Maternal health problems during pregnancy increased the odds for all types of disability except hearing and seizures. Higher paternal education decreased the odds for all disabilities by at least 30% except for vision and hearing.ConclusionThe study found a high prevalence of disability among Egyptian children aged 1–6 years. It identified a number of modifiable risk factors for disability. The practice of early screening for disability is encouraged to provide early interventions when needed.

The suicidal activity and comorbid mental pathology in persons with gender dystrophia

According to foreign publications, 58% of patients with gender disorders had additional psychiatric diagnosis, 39.3% had at least one suicide attempt. The data of suicidal activity and mental comorbidity in Russian population of transgenders are absent.Purpose of the study is to assess suicidal activity and mental comorbidity in persons with gender disorders.The retrospective analysis of records of patients applied with complains on gender disorders from January 2014 to April 2021 was applied. The demographic characteristics, life anamnesis, comorbid mental pathology at time of appliance, frequency of suicidal attempts, suicidal thoughts and auto-aggressive behavior were examined. The data of 926 patients with gender disorders were included: FtM 515 (55.7%), MtF 411 (44.3%). The median age of patients applied for care appliance was 24 years (13-65 years). In group of transgender patients 75.2% had no mental illness, except gender disorders. At that, there was high prevalence of comorbid mental pathology (24.8% on average). Usually, it was background mental illnesses and reversible mental disorders, which were not causes of gender disorders. The suicide rate in transgender group was 12.5%. For 1 patient with suicidal experience, there were 1.3 suicidal attempts (from 1 to 5). The significant dependence of increased suicidal activity, depression, auto-aggressive behavior and rate of comorbid mental pathology on age of debut of gender disorders was established. The transgender patients with debut of gender dysphoria in puberty age are most vulnerable to development of any mental pathology. The suicidal activity of patients with gender disorders depends on both social causes and presence of comorbid mental pathology. A number of modifiable risk factors for suicidal behavior were identified: support of relatives, external correspondence to associated gender, early steps to "change gender", earlier apply for medical care, background compensated mental illnesses.

Machine Learning-based Model for Early Prediction of Coronary Artery Disease

The global healthcare industry manages millions of individuals and generates enormous amounts of data. Machine learning-based algorithms are analysing complex medical information and produce superior insights. “Coronary artery disease (CAD)”, the most prevalent form of cardiac disease is getting the greatest interest in the development of predictive models due to its large number of modifiable risk factors. This research study aims at comparing five algorithms of supervised machine learning for the CAD prediction. The research utilizes the Cleveland dataset from the UCI repository for training and testing the algorithms. The results of the comparison revealed that KNN is the best algorithm with significant performance measures which can be effective in predicting CAD accurately. Therefore, it can be suggested that these predictive models, which were developed using machine learning (ML) algorithms, can help doctors identify CAD early and may lead to better results that would help to avoid adverse clinical outcomes.

An Alzheimer's dementia cumulative risk model in a sample of general population over 65: Public health implications

Background and objectivesWith the population ageing, the identification of modifiable risk factors for dementia represents a public health priority. Co-occurrence of risk factors in the same individual is more frequent than an isolated appearance and may create synergistic effects, with an increased risk of negative outcomes such as dementia and mortality. We aim to study the cumulative risk of incident Alzheimer's Dementia (AD) in a community sample aged >65 (n= 3044). MethodsTo this end, we will examine the impact on the risk of AD of the co-occurrence of variables that have previously been shown to increase risk: age, gender, education, marital status, depression, anxiety, body mass index (BMI) and hearing loss. ResultsThe most frequent number of co-occurring risk factors was 3. We found a cumulative increased risk of both death and AD by the confluence of 2 or more risk factors. Using a competing risk regression model, each increase in a co-occurring risk factor was associated with a significant increase in the risk of incident AD of more than two-fold. By the analysis of the Population Attributable Fractions (PAF) of AD due to several risk factors, we found that if 4 or more co-occurring risk factors could be eliminated from the population, the prevalence of AD would be reduced by approximately 38%. ConclusionOur study offers an estimate of the impact that preventive interventions could have if the number of modifiable risk factors of AD at a population level.

Preventable causes of cancer in Texas by race/ethnicity: Major modifiable risk factors in the population.

BackgroundA number of modifiable risk factors have been designated as being causally related to cancer development. We aimed to estimate the percentage of incident cancer cases diagnosed in persons aged ≥25 years in Texas in 2015, overall and by race/ethnicity, that were attributable to these modifiable risk factors.MethodsWe calculated population attributable fractions (PAFs) for cancers attributable to thirteen modifiable risk factors using prevalence data from the Texas Behavioral Risk Factor Surveillance System and the National Health and Nutrition Examination Survey, as well as relative risks estimates from prior studies and cancer incidence data from the Texas Cancer Registry.ResultsOverall, 32.3% of all incident cancers (N = 33,416) in 2015 were attributable to modifiable risk factors. Men (35.1%) had a numerically higher overall PAF than women (29.5%). Tobacco smoking caused the highest proportion of cancers (18.4%), followed by overweight and obesity (6.6%) and excess alcohol consumption (2.9%). Non-Hispanic Blacks had a numerically higher overall PAF (36.8%) than non-Hispanic Whites (31.9%) and Hispanics (31.7%). Further, non-Hispanic Blacks had the highest combined PAFs for 85% of cancer sites analyzed, including lung/bronchus and mouth/pharynx/larynx.ConclusionModifiable risk factors cause about one third of cancers in Texas. Non-Hispanic Blacks are especially affected by an excessive preventable cancer burden.

We all know A and B, but what about C? Exploring the management of modifiable risk factors in patients with atrial fibrillation

Abstract Background The European Society of Cardiology (ESC) guidelines for the management of atrial fibrillation (AF) advise to treat AF according to the ABC pathway: A, anticoagulation, B, better symptom control, and C, comorbidities and cardiovascular risk factor management. Optimal treatment of comorbidities and risk factors slows AF progression and improves success rates of rhythm interventions for AF. However, several studies report underdiagnosis and therefore possible undertreatment for common cardiovascular comorbidities. Purpose This study aims to evaluate how common modifiable cardiovascular risk factors are managed in AF patients referred for catheter ablation. Methods This is a substudy of the ISOLATION study, a prospective cohort study including consecutive patients with paroxysmal or persistent AF referred for AF ablation. Screening for common modifiable risk factors for AF is structurally embedded in the work-up for AF ablation in the two participating centres. In the present study the prevalence of the following risk factors at this screening moment was assessed: (1) body mass index (BMI) above the target BMI for ablation (≥27 kg/m2), (2) hypertension, defined as on-site systolic blood pressure &amp;gt;130 mmHg and/or diastolic blood pressure &amp;gt;80 mmHg, (3) decreased glucose tolerance or diabetes mellitus, defined as HbA1c ≥6.5%, (4) dyslipidaemia, defined as low-density lipoprotein (LDL) ≥2.5 mmol/l, (5) regular alcohol consumption, defined as self-reported consumption of &amp;gt;15 standardized units/week, and (6) sleep disordered breathing (SDB), defined as apnoea-hypopnoea index (AHI) ≥15 assessed with home sleep tests (subset of patients). Results Among the 981 patients studied (median age 65 [59–71] years old, 64% male, 69% paroxysmal AF), previously diagnosed comorbidities were common (46% hypertension, 7% diabetes, 22% dyslipidaemia, 10% SDB), and a large proportion of patients received targeted treatment (Table 1). However, non-optimally managed risk factors remained significant (Figure 1). BMI ≥27 kg/m2 was present in 56% of patients. High systolic and diastolic blood pressure were present in 62% and 51% of patients, respectively, and any form of high blood pressure (either systolic or diastolic) was seen in 72% of patients. HbA1c was found to be above target ranges in 9% patients and LDL in 56%. A weekly alcohol consumption of ≥15 units was reported by 4% of patients. Screening for SDB was performed in a subset of patients (n=287), for whom AHI was ≥15 in 52%. Overall, 9% of patients had 4 or more non-optimally controlled modifiable risk factors, whereas the median number of modifiable risk factors was 2 [1–3]. Conclusions Structural screening revealed a high prevalence of non-optimally controlled modifiable cardiovascular risk factors in patients referred for AF catheter ablation. According to recent ESC guidelines, improving treatment of comorbidities may improve AF ablation success rates and even reduce mortality. Funding Acknowledgement Type of funding sources: None.

Molecular heterogeneity and commonalities in pancreatic cancer precursors with gastric and intestinal phenotype

ObjectiveDue to the limited number of modifiable risk factors, secondary prevention strategies based on early diagnosis represent the preferred route to improve the prognosis of pancreatic ductal adenocarcinoma (PDAC). Here,...

Lower number of modifiable risk factors was associated with reduced atrial fibrillation incidence in an 18-year prospective cohort study

Prevention strategies for atrial fibrillation (AF) are lacking. This study aimed to identify modifiable risk factors (MRFs) and estimate their impact on AF in the midlife general population. We assessed 9049 participants who were free of prevalent AF at baseline from the Korean Genome and Epidemiology Study. Cox models with time-varying assessment of risk factors were used to identify significant MRFs for incident AF. The MRF burden was defined as the proportion of visits with MRFs during follow-up. Over a median follow-up of 13.1 years, 182 (2.01%) participants developed AF. Three MRFs, including systolic blood pressure (SBP) ≥ 140 mmHg, obesity with central obesity, and an inactive lifestyle were significantly associated with incident AF. Among participants with 3, 2, 1, and 0 MRFs at baseline, 16 (3.9%), 51 (2.5%), 90 (1.8%) and 25 (1.5%) had incident AF, respectively. Compared to participants with three MRFs, those with one or no MRFs had a decreased risk of AF (hazard ratio [95% CI] for one MRF, 0.483 [0.256–0.914]; and for no MRF, 0.291 [0.145–0.583]). A decreasing MRF burden was associated with reduced AF risk (hazard ratio [95% CI] per 10% decrease in burden for SBP ≥ 140 mmHg, 0.937 [0.880–0.997]; for obesity with central obesity, 0.942 [0.907–0.978]; for inactivity, 0.926 [0.882–0.973]). Maintaining or achieving MRF ≤ 1 was associated with decreased AF risk, suggesting that minimizing the burden of MRF might help prevent AF.

Mediators of the association between educational attainment and type 2 diabetes mellitus: a two-step multivariable Mendelian randomisation study

Aims/hypothesisType 2 diabetes mellitus is a major health burden disproportionately affecting those with lower educational attainment (EA). We aimed to obtain causal estimates of the association between EA and type 2 diabetes and to quantify mediating effects of known modifiable risk factors.MethodsWe applied two-step, two-sample multivariable Mendelian randomisation (MR) techniques using SNPs as genetic instruments for exposure and mediators, thereby minimising bias due to confounding and reverse causation. We leveraged summary data on genome-wide association studies for EA, proposed mediators (i.e. BMI, blood pressure, smoking, television watching) and type 2 diabetes. The total effect of EA on type 2 diabetes was decomposed into a direct effect and indirect effects through multiple mediators. Additionally, traditional mediation analysis was performed in a subset of the National Health and Nutrition Examination Survey 2013–2014.ResultsEA was inversely associated with type 2 diabetes (OR 0.53 for each 4.2 years of schooling; 95% CI 0.49, 0.56). Individually, the largest contributors were BMI (51.18% mediation; 95% CI 46.39%, 55.98%) and television watching (50.79% mediation; 95% CI 19.42%, 82.15%). Combined, the mediators explained 83.93% (95% CI 70.51%, 96.78%) of the EA–type 2 diabetes association. Traditional analysis yielded smaller effects but showed consistent direction and priority ranking of mediators.Conclusions/interpretationThese results support a potentially causal protective effect of EA against type 2 diabetes, with considerable mediation by a number of modifiable risk factors. Interventions on these factors thus have the potential of substantially reducing the burden of type 2 diabetes attributable to low EA.Graphical abstract

Pressure Injury Development, Mitigation, and Outcomes of Patients Proned for Acute Respiratory Distress Syndrome.

To describe trends and risk factors for pressure injuries (PIs) in adult critical care patients proned to alleviate acute respiratory distress syndrome secondary to COVID-19 and examine the effectiveness of products and strategies used to mitigate PIs. The authors conducted a retrospective chart review between April 9 and June 8, 2020. Demographic data were analyzed using descriptive statistics. Differences between groups with and without PIs were analyzed. Among 147 patients, significant PI risk factors included male sex (P = .019), high body mass index (>40 kg/m2; P = .020), low Braden Scale score (<12; P = .018), and low-dose vasopressor therapy (P = .020). Taping endotracheal tubes (ETTs) caused significantly fewer facial PIs than commercial ETT holders (P < .0001). Maximum prone duration/session was a significant risk factor for anterior PIs (P = .016), which dropped 71% with newer pressure redistribution products. d-Dimer greater than 3,200 μg/mL (P = .042) was a significant risk factor for sacrococcygeal PIs while supine. Mortality was 30%; significant risk factors included age older than 60 years (P = .005), Sequential Organ Failure Assessment score greater than 11 (P = .003), and comorbid congestive heart failure (P = .016). Taping the ETT, limiting the maximum duration of prone positioning to less than 32 hours, and frequent repositioning while supine may reduce the number of modifiable risk factors for PIs. Standardized methods for testing products for PI prevention will inform individualized patient care.

Фактори ризику фібриляції передсердь і невирішені проблеми її профілактики

Подано основні патогенетичні механізми виникнення та прогресування фібриляції передсердь (ФП). Проаналізовано найбільш поширені та значимі фактори ризику її розвитку. На сьогодні проблема профілактики ФП залишається невирішеною. Насамперед йдеться про первинну профілактику ФП. Саме первинна профілактика ФП є найбільш ефективним методом боротьби з цією патологією, що дозволить значно знизити захворюваність на ФП, а завдяки цьому — ризик розвитку ускладнень і смертність. Невирішеність проблеми первинної профілактики ФП пов’язана зі значною складністю її реалізації. Це обумовлено дуже великою поширеністю та численністю модифікованих факторів ризику, а також наявністю таких немодифікованих факторів ризику, як вік і генетична схильність.

The adverse effect of modifiable dementia risk factors on cognition amplifies across the adult lifespan.

BackgroundReversible lifestyle behaviors (modifiable risk factors) can reduce dementia risk by 40%, but their prevalence and association with cognition throughout the adult lifespan is less well understood.MethodsThe associations between the number of modifiable risk factors for dementia (low education, hypertension, hearing loss, traumatic brain injury, alcohol or substance abuse, diabetes, smoking, and depression) and cognition were examined in an online sample (N = 22,117, ages 18–89).FindingsOlder adults (ages 66–89) had more risk factors than middle‐aged (ages 45–65) and younger adults (ages 18–44). Polynomial regression revealed that each additional risk factor was associated with lower cognitive performance (equivalent to 3 years of aging), with a larger association as age increased. People with no risk factors in their forties to seventies showed similar cognitive performance to people 10 or 20 years younger with many risk factors.InterpretationModifiable dementia risk factors amplify lifespan age differences in cognitive performance.

The risk factor profile in Egyptian patients with acute coronary syndrome: an observational study

ObjectiveTo evaluate the pattern of risk factor profile among Egyptian patients with acute coronary syndrome (ACS).BackgroundLittle is known about risk factors and treatment modalities in Egyptian patients with ACS.Patients and methodsThis cross-sectional study was conducted on 200 adult participants presented to the National Heart Institute, Cairo, Egypt, during May 2017 throughout April 2018. Patients with ACS including ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, or unstable angina were included. All patients were subjected to history taking, clinical examination, 12-lead ECG, and plasma troponin I to confirm myocardial necrosis and to identify ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, and unstable angina.ResultsThe percent of current smokers was significantly higher than nonsmokers (63.5 vs. 36.5%, P = 0.001). History of hypertension was significantly more frequent among the studied patients (57.5 vs. 42.5%, P = 0.034), and the same was observed for diabetes mellitus (60.5 vs. 39.5%, P = 0.003). Dyslipidemia (57%) was also significantly higher. Regarding the BMI, a high percentage of the studied patients were overweight and obese (40.5%). The mean low-density lipoprotein and BMI were significantly higher in females than males (P = 0.043 and 0.018, respectively).ConclusionThe findings of the present study revealed a number of modifiable risk factors for ACS among Egyptian patients. These comprised smoking, obesity, hypertension, diabetes mellitus, and dyslipidemia. Considering lifestyle interventions and awareness of the public especially among women would contribute toward minimizing ACS.

Stroke and dementia, leading causes of neurological disability and death, potential for prevention

AbstractBackgroundStroke and dementia share a number of modifiable risk factors and are the leading cause of disability and the second leading cause of death worldwide, after cardiovascular diseases. We aim to realize the potentially preventable disability and deaths related to ischemic heart disease, stroke and dementia, and their changes from 2010 to 2019.MethodWe report the Global Burden of Disease study (GBD) 2019 estimations for disability‐adjusted life years (DALYs) and death numbers and rates per 100,000 population related to ischemic heart diseases, stroke, and Alzheimer’s disease and other dementias in the world, as well as their risk attributed DALYs and deaths and their changes between 2010 and 2019.ResultIn 2019, neurological disorders have remained globally the leading cause of DALYs (273.1 million) and second leading cause of deaths (9.4 million) after cardiovascular diseases (excluding stroke). Stroke and dementia combined contributed to 87.2% (8.2 million) of neurological deaths and 61.7% (168.5 million) of neurological DALYs in 2019. From 2010 to 2019, the absolute number of deaths and DALYs from ischemic heart disease, stroke, and dementias increased, while their age‐standardized rates decreased (ischemic heart disease: ‐9.7% and ‐9.8%, stroke: ‐14.7% and ‐13.7%, and dementia: ‐1.2% and ‐0.3%, respectively). For stroke, 86.4% of DALYs and for dementias 32.8% of DALYs are attributable to risk factors. Globally, hypertension (54.8%) and unhealthy diet (30.0%) pose the greatest risk for stroke DALYs, and smoking (15.1%) and obesity (12.5%) for dementia DALYs.ConclusionStroke and dementia are increasing in numbers, but show decreasing age‐standardized mortality and disability rates. They account for 62% DALYs and 87% deaths due to neurological diseases, pose risks for each other, offering the possibility of their joint delay, mitigation or prevention. It will require global, population, and individual management to flatten the curve of stroke and dementia.

Knowledge, health beliefs and attitudes towards dementia and dementia risk reduction among descendants of people with dementia: a qualitative study using focus group discussions

BackgroundIndividuals with a parental family history of dementia have an increased risk of developing dementia because they share their genes as well as their psychosocial behaviour. Due to this increased risk and their experience with dementia, they may be particularly eager to receive information regarding dementia risk reduction (DRR). This study evaluated the knowledge, beliefs and attitudes towards dementia and DRR among descendants of people with dementia.MethodUsing a semi-structured topic guide, three focus group discussions were conducted consisting of 12 female (80%) and 3 male (20%) descendants of people with dementia with a mean (± SD) age of 48.8 (± 12) years. Focus group discussions were audio recorded and transcribed. Each transcript was analysed thoroughly, and where appropriate, a code was generated and assigned by two researchers independently. Then, similar codes were grouped together and categorized into themes.ResultsThe items in the topic guide could only be addressed after participants had been given the opportunity to share their experiences of having a parent with dementia. Participants were unaware or uncertain about the possibility of reducing the risk of developing dementia and therefore hesitant to assess their dementia risk without treatment options in sight. Moreover, participants indicated that their general practitioner only gave some information on heritability, not on DRR. Although participants identified a large number of modifiable risk factors as a group during the group discussions, they were eager to receive more information on dementia and DRR. In the end, participants adopted a more positive attitude towards a DRR programme and provided suggestions for the development of future DRR programmes.ConclusionsAlthough the research aim was to evaluate the knowledge, beliefs and attitudes towards dementia and DRR, sharing experiences of having a parent with dementia seemed a prerequisite for considering participants’ own risk of developing dementia and participating in a DRR programme. Knowledge of dementia and DRR was limited. Due to unawareness of the possibility of reducing dementia risk, participants were hesitant about assessing their dementia risk. Group discussions positively changed the perception of dementia risk assessment and participants’ willingness to participate in a DRR programme.