Prevalence Of Traditional Risk Factors Research Articles

Risk Factors, Clinical Profile, and Outcomes of Coronary Artery Disease in the Elderly

Objectives This study aimed to identify risk factors in patients diagnosed with angiographically significant coronary artery disease (CAD) after 65 years of age (elderly) with a subset analysis of more than 75 years, analyze their clinical, angiographic profile and assess their major acute cardiovascular and cerebrovascular events (MACCE). Methods This was an observational retrospective and prospective study conducted from January 2022 to June 2023 among consecutive elderly who underwent CAG for suspected or diagnosed CAD between 2010 and 2018 at a tertiary center in South India. Results A total of 1,511 patients satisfied eligibility criteria with mean age of 69.38 years and male preponderance (69%). Male gender, dyslipidemia and current tobacco use contributed to angiographically significant CAD by multiple logistic regression analysis but none of the risk factors contributed in the more than 75-year age group. Female patients had higher incidence of atypical presentation, less revascularizations and higher MACCE. Fourteen percent of patients with significant CAD developed MACCE over a median 3.5-year hospital follow-up. Survival analysis of 1,027 patients with significant CAD showed one, three, 5-year mortality rate of 4.3%, 6.9% and 10.8%, respectively, with left ventricular dysfunction and triple vessel disease being associated with worse survival. MACCE and 5-year survival was significantly better among those who underwent revascularization including those with significant left main or triple vessel disease. Conclusion This study showed a high prevalence of traditional risk factors in elderly patients among which male gender, dyslipidemia, current tobacco use were found to predict angiographically significant CAD. Triple vessel disease and left ventricular dysfunction were associated with worse survival. Mortality was significantly lower among elderly who underwent revascularization compared to medical management.

Agrochemical use in Farming Practices and Risk Factors for Kidney Disease among Dwellers of Rural Farming Communities in South-West Nigeria.

The outlook of chronic kidney disease (CKD) in low-and-medium-income-countries is poor. Modern farming practices in Nigeria are becoming increasingly associated with the use of herbicides and pesticides. The study aimed to evaluate agrochemical use in farming practices and risk factors for kidney disease among dwellers of rural farming communities in South-West Nigeria. This was a cross-sectional survey of adult dwellers of an agrarian rural farming community in South-West Nigeria. Participants provided information on demographics, lifestyles, knowledge, and awareness of risk factors for kidney disease, and the use of agrochemicals in farming practice. Anthropometric measurements and blood pressure values were obtained while blood and spot urine were collected for random blood glucose, serum creatinine, urinalysis, and albumin-creatinine ratio. A total of 572 rural dwellers were enrolled in the study, with a mean age of 49.9 ± 17.5 years while 39.3% were male and 88.9% engaged in active farming. The prevalence of traditional risk factors for kidney disease was hypertension (24.3%), Diabetes mellitus (2.8%), cigarette smoking (7.5%), alcohol intake (20.8%) and herbal consumption (57.1%). The use of pesticides/herbicides was reported in 69.9%, while 25.3% did not use protective gear during its use. Proteinuria, hematuria, and reduced eGFR were observed in 29.8%, 6.1%, and 33.9% of participants, respectively. This study showed a high prevalence of herbicides and pesticide use and traditional risk factors for kidney disease, in addition to the high prevalence of markers of kidney damage among the dwellers of rural farming settlements in South-West Nigeria.

The burden of premature coronary heart disease among adults with low socioeconomic status in Argentina: A modeling study.

The well-established inverse relationship between socioeconomic status (SES) and risk of developing coronary heart disease (CHD) cannot be explained solely by differences in traditional risk factors. To model the role SES plays in the burden of premature CHD in Argentina. We used the Cardiovascular Disease Policy Model-Argentina to project incident CHD events and mortality in low and high-SES Argentinean adults 35 to 64 years of age from 2015 to 2024. Using data from the 2018 National Risk Factor Survey, we defined low SES as not finishing high-school and/or reporting a household income in quintiles 1 or 2. We designed simulations to apportion CHD outcomes in low SES adults to: (1) differences in the prevalence of traditional risk factors between low and high SES adults; (2) nontraditional risk associated with low SES status; (3) preventable events if risk factors were improved to ideal levels; and (4) underlying age- and sex-based risk. 56% of Argentina´s 35- to 64-year-old population has low SES. Both high and low SES groups have poor control of traditional risk factors. Compared with high SES population, low SES population had nearly 2-fold higher rates of incident CHD and CHD deaths per 10 000 person-years (incident CHD: men 80.8 [95%CI 76.6-84.9] vs 42.9 [95%CI 37.4-48.1], women 39.0 [95%CI 36.-41.2] vs 18.6 [95%CI 16.3-20.9]; CHD deaths: men 10.0 [95%CI 9.5-10.5] vs 6.0 [95%CI 5.6-6.4], women 3.2 [95%CI 3.0-3.4] vs 1.8 [95%CI 1.7-1.9]). Nontraditional low SES risk accounts for 73.5% and 70.4% of the event rate gap between SES levels for incident CHD and CHD mortality rates, respectively. CHD prevention policies in Argentina should address contextual aspects linked to SES, such as access to education or healthcare, and should also aim to implement known clinical strategies to achieve better control of CHD risk factors in all socioeconomic levels.

Analysis of predictors of recurrent acute cardiovascular events in patients with acute coronary syndrome

Aim. To assess the prevalence of traditional risk factors and analyze the predictors of recurrent cardiovascular events in patients with acute coronary syndrome (ACS).Material and methods. A total of 482 patients with ACS were included. The follow-up lasted three years. The composite endpoint (CE) included recurrent unstable angina, nonfatal myocardial infarction, repeated percutaneous coronary intervention (PCI), nonfatal ischemic stroke, hospitalization for decompensated heart failure, and cardiovascular death.Results. A high prevalence of traditional risk factors was revealed (dyslipidemia — 467 (96,9%), hypertension — 464 (96,3%), consumption of junk food — 450 (93,4%), sedentary lifestyle — 416 (86,3%)). During the three-year follow-up period, 90 patients had CE. Compared with patients without CE (n=392), patients with CE were significantly more likely to have a long-term CAD (69 (76,7%) vs 241 (61,5%), p=0,007), ACS accompanied by shortness of breath (50 (55,6%) vs 160 (40,9%), p=0,013); they had previously undergone myocardial revascularization (38 (42,2%) vs 116 (29,6%), p=0,024), often by PCI (36 (40,0%) vs 100 (25,5%), p=0,009), especially in the left main coronary artery (LMCA) (6 (6,7%) vs 3 (0,8%), p=0,002); they were more likely to develop in-hospital acute left ventricular failure (11 (12,2%) vs 18 (4,6%), p=0,012), had a lower hemoglobin level and hematocrit (p<0,05 for all); they more often required intensification of lipid-lowering therapy (86 (100%) vs 334 (85,2%), p=0,002), compliance with which was lower (6 (6,7%) vs 105 (26,8%), p<0,001) than in patients without CE. Previous intervention on the left coronary artery, non-compliance with lipidlowering therapy, hematocrit level 3 months and hemoglobin level 1 year after ACS were predictors of recurrent events. The combination of surgery on left coronary artery and non-compliance with lipid-lowering therapy demonstrated significantly less freedom from CE compared with other patients (77,4% vs 94,6%, p<0,001).Conclusion. A high prevalence of traditional risk factors in the population of patients with ACS was revealed, and potential predictors of recurrent cardiovascular events were identified.

Prevalence of major adverse cardiovascular events among Saudi patients with systemic lupus erythematosus compared with the general population: updates from the national SLE and PURE cohorts

ObjectiveThis study examined the prevalence of major adverse cardiovascular events (MACE) among Saudi patients with SLE and the general population and considered factors associated with such outcomes were taken into...

The Effects of Pharmacological Urate-Lowering Therapy on Cardiovascular Disease in Older Adults with Gout.

Cardiovascular disease is an important cause of mortality in older patients. In addition to the traditional risk factors for cardiovascular disease, hyperuricemia has been increasingly associated with an elevated risk of cardiovascular disease. Uric acid itself has several unfavorable effects on the cardiovascular system, and hyperuricemia can lead to the development of gout. Gout is the most prevalent inflammatory rheumatic disease. Older patients with gout have an increased risk of cardiovascular morbidity and mortality due toan increased prevalence of traditional risk factors, as well as the inflammatory burden of gout activity. As the prevalence of traditional risk factors and the prevalence of both hyperuricemia and gout are increasing in older adults, cardiovascular risk management in these patients is very important. This risk management consists of, on the one hand, treatment of individual traditional risk factors and, on the other hand, of urate lowering, thereby decreasing inflammatory burden of gout. However, there is insufficient evidence to conclude that urate-lowering therapy reduces the risk of cardiovascular events. Moreover, from a cardiovascular point of view, there is no preference for one urate lowering drug over another in patients with gout, nor is there enough evidence to support a preference in patients with gout with increased cardiovascular risk. Personalized treatment in older patients with gout should be aimed at optimizing serum uric acid levels, as well as targeting traditional cardiovascular risk factors. Further prospective randomized trials are needed to support the hypothesis that urate lowering reduces cardiovascular risk in older patients with gout.

ХАРАКТЕРИСТИКА КАРДИОВАСКУЛЯРНОГО РИСКА У БОЛЬНЫХ С ПСОРИАТИЧЕСКИМ АРТРИТОМ

Abstract. Introduction. Patients with psoriatic arthritis are exposed to a higher risk of developing cardiovascular complications. Development and progression of these disorders are based on a complex of closely interrelated factors, such as traditional cardiovascular risk factors, cardiovascular toxicity of some antirheumatic drugs, primarily non- steroidal anti-inflammatory drugs and glucocorticoids, and chronic autoimmune inflammation, which, according to many researchers, is the leading pathogenetic mechanism of atherosclerotic vascular lesions. The aim of the study was to assess the prevalence of traditional risk factors, the state of the blood lipid spectrum, and atherosclerotic remodeling of peripheral arteries in patients with psoriatic arthritis. Materials and Methods. We examined 84 patients (41 women and 43 men) aged 20 to 65 years. Arthritis was diagnosed based on the CASPAR criteria. Patients were assessed regarding traditional risk factors, such as hypertension, obesity, smoking, aggravated family history of CVD, diabetes, physical inactivity, and dyslipidemia; ten-year total coronary risk was calculated using the SCORE scale. To diagnose subclinical atherosclerosis, the patients underwent Doppler ultrasound of the carotid arteries with an assessment of the intima-media complex thickness. Results and Discussion. Assessment of disease development risk factors showed that all patients with psoriatic arthritis had from one to five risk factors. More common risk factors were smoking in 50 (59.5 %) patients, AO in 44 (52.4 %), dyslipidemia in 48 (57.1 %), and arterial hypertension. Patients with a long history of the disease have a higher prevalence of risk factors. According to the results of calculating the ten-year total coronary risk (SCORE scale), most patients were in the group of low (46.4 %) and moderate (38 %) risk. An association was found between the level of total coronary risk and arthritis activity in groups of patients with low and moderate risk. The average intima-media complex thickness of the common carotid artery in the group of patients with psoriatic arthritis was statistically significantly higher than in those in the control group (p=0.0361).Conclusions. An increased risk of cardiovascular complications was found in patients with psoriatic arthritis, while most patients have several risk factors in various proportions. According to the risk assessment on the SCORE scale, it was found to be statistically significant in the group of patients with psoriatic arthritis, which correlates with disease activity. The presence of subclinical atherosclerosis was detected in form of a statistically significant increase in the intima-media complex thickness of the carotid arteries. All the above indicates the current problem of psoriasis comorbidity, which dictates a personalized comprehensive approach to therapy for the selection of safe and adequate therapy for all diseases diagnosed in an individual patient.

Pattern of Coronary Artery Disease in Young Patients with Acute Coronary Syndrome

Background: Coronary artery disease (CAD), historically considered a malady of the elderly, has increasingly emerged as a significant health concern among young adults, including individuals in their third or fourth decade of life. Objective: The primary aim of the study is to identify the pattern of coronary artery disease in young patients with acute coronary syndrome (ACS). Methods: This retrospective observational study was conducted at a tertiary cardiac care center in Rawalpindi from July 2023 to November 2023. The study included a cohort of 180 young patients aged less than 45 years who were diagnosed with ACS. These patients were identified from medical records and databases over a defined time period. Detailed demographic data, including age, gender, and pertinent medical history, were extracted from the medical records of each patient. This information facilitated a comprehensive understanding of the patient population under investigation. Results: Data were collected from 180 patients. The analysis of clinical profiles and demographics revealed a diverse patient population. The study cohort comprised individuals with a mean age of 39 years. Male patients predominated, constituting approximately 65% of the cohort. Among the study participants, 40% had a documented history of smoking, while 20% reported a family history of CAD. Hypertension was the most prevalent risk factor, affecting nearly 50% of the patients, followed by hyperlipidemia (30%) and diabetes (20%). Conclusion: It is concluded that coronary artery disease (CAD) is not confined to older age groups but can significantly impact young individuals aged less than 45 years presenting with acute coronary syndrome (ACS). The prevalence of traditional risk factors and genetic predisposition among these patients underscores the multifactorial nature of CAD in this demographic.

Stroke in Young Adults.

Stroke in young adults is associated with significant morbidity, and its prevalence is rising in the United States. This is partly attributed to a rise in the prevalence of traditional risk factors including hypertension, hypercholesterolemia, obesity, diabetes mellitus, smoking and heart disease. In addition, there are non-modifiable risk factors comprising migraine, pregnancy and postpartum state, illicit drug use, oral contraceptives and hypercoagulable state. The mechanisms causing stroke in young adults are unique and include cervical dissection, cardioembolic phenomenon, vasculitis and vasculopathy, connective tissue disease, patent foramen ovale and cerebral venous thrombosis. The diagnosis of stroke in the young population can be challenging given its myriad clinical presentations. In this document, we provide an overview of the epidemiology of stroke in young adults, explore mechanisms that may explain increasing rates of stroke in this population, and provide a critical updated overview of the existing literature on the management and prevention of stroke in young adults.

Cardiovascular risk in myositis patients compared with the general population.

We aimed to evaluate cardiovascular (CV) risk in patients with idiopathic inflammatory myopathies (IIM) compared with healthy controls (HC) and to assess its association with disease-specific features. Ninety IIM patients and 180 age-/sex-matched HC were included. Subjects with a history of CV disease (angina pectoris, myocardial infarction and cerebrovascular/peripheral arterial vascular events) were excluded. All participants were prospectively recruited and underwent examinations of carotid intima-media thickness (CIMT), pulse wave velocity (PWV), ankle-brachial index (ABI), and body composition. The risk of fatal CV events was evaluated by the Systematic COronary Risk Evaluation (SCORE) and its modifications. Compared with HC, IIM patients had a significantly higher prevalence of traditional CV risk factors, carotid artery disease (CARD), abnormal ABI and PWV. After propensity score matching (using traditional CV risk factors), the prevalence of CARD and pathological PWV remained significantly higher in IIM than HC. No significant difference in SCORE was observed. The most unfavourable CV risk profile was observed in patients with necrotizing myopathy, especially in statin-induced anti-HMGCR+ patients. The calculated CV risk scores by SCORE, SCORE2 and SCORE multiplied by the coefficient 1.5 (mSCORE) were reclassified according to CIMT and the presence of carotid plaques. SCORE was demonstrated to be most inaccurate in predicting CV risk in IIM. Age, disease activity, lipid profile, body composition parameters and blood pressure were the most significant predictors of CV risk in IIM patients. Significantly higher prevalence of traditional risk factors and subclinical atherosclerosis was observed in IIM patients compared with HC.

Prevalence of Traditional Risk Factors in First-Degree Relatives of Patients With Established Cardiovascular Disease.

World Health Organization (WHO)/International Society of Hypertension (ISH) risk prediction charts are useful for predicting 10-year combined myocardial infarction and stroke risk (fatal and non-fatal). Hence the current study was conducted to assess the 10-year risk of cardiovascular disease among adults in Ahmedabad, India. The primary aim of the study was to assess the cardiovascular risk among first-degree relatives of patients attending the outpatient clinic. Also, to create awareness regarding assessment of cardiovascular risk among the studied group. A cross-sectional study was carried out among 372 first-degree relatives of patients at an out-patient cardiology clinic present in Vadaj, Ahmedabad. The WHO/ISH risk prediction chart for South-East Asia Region D (SEAR D) was used for calculating the 10-year cardiovascular risk. A maximum (80.10%) of the study participants were in the low-risk (<10%) category followed by 8.33% for moderate-risk (10-20%), 7.25% for moderately high-risk (20-30%), 2.42% for high-risk (30-40%) and 1.88% for very high-risk (>40%). WHO/ISH risk prediction charts provide a quick and effective way to assess and categorize the population in a low-resource setting which in turn helps in delivering focused intervention to the high-risk groups.

The characteristics of head and neck squamous cell cancer in young adults: A retrospective single-center study.

We aimed to characterize clinical and prognostical factors of primary head and neck squamous cell carcinoma (HNSCC) in 85 young patients (≤39years, median age: 37years; between 2000-2018) in comparison with 140 institutional general HNSCC patients (median age: 61.5years). The patient's medical records were collected from the institutional database. The prevalence of smoking and alcohol consumption (65.8% and 48.1%) in the young group exceeded the regional population average but was below the institutional (86.4% and 55%) general HNSCC patient population. Primary tumor sites in the group of young patients were as follows: oral cavity (56.4%), oropharynx (17.6%), hypopharynx (11.7%), and larynx (14.1%). Cumulative five-year overall survival was 44.2% in the young group, but significantly better with early T (T1-2 vs. T3-4: 52.6% vs. 26.7%; p = 0.0058) and N0 status (N0 vs. N+: 65.2% vs. 32.3%; p = 0.0013). Young age, abstinence, earlier stage and laryngeal tumor site might predict a better prognosis. The age distribution and the high prevalence of traditional risk factors among the young patients as well as the predominance of oral cavity tumor localization suggest that the early onset of tumor development could be originated from the premature failure of the intrinsic protective mechanisms.

Premature stroke and cardiovascular risk in primary Sjögren's syndrome.

Primary Sjögren's syndrome (pSS) is associated with an increased prevalence of traditional risk factors and cardiovascular diseases (CVDs). The study aimed to identify specific risk factors for CVD in pSS patients. PSS patients with and without CVD were compared. All patients fulfilled the EULAR/ACR classification criteria. Patients with CVD presented at least one of the following manifestations: myocardial infarction, transient ischemic attacks, ischemic or hemorrhagic stroke, peripheral artery disease, coronary artery disease, and carotid plaques. Data were collected by a standardized protocol and review of medical records. 61/312 (19.6%) pSS patients presented with CVD. Traditional risk factors such as hypertension, hypercholesterinemia and diabetes (p < 0.05), pSS manifestations, in particular vasculitis (p = 0.033) and Raynaud's phenomenon (p = 0.018) were associated with CVD. Among patients with ischemic events (28/312, 9%), particularly cerebrovascular disease (n = 12/28, 42.9%), correlations with increased EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) (p = 0.039) and EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) (p = 0.048) were observed. Age at first cerebrovascular event was 55.2 [48.9-69.6] years. Multivariate analysis confirmed hypertension [odds ratio (OR) 3.7, 95% confidence interval (CI) 1.87-7.18, p < 0.001], hypercholesterinemia (OR 3.1, 95% CI 1.63-5.72, p < 0.001), male gender (OR 0.4, 95% CI 0.17-0.78, p = 0.009), Raynaud's phenomenon (OR 2.5, 95% CI 1.28-4.82, p = 0.007), and CNS involvement (OR 2.7, 95% CI 1.00-7.15, p = 0.048) as independent CVD predictors. Raynaud's phenomen as well as vasculitis and high ESSDAI have shown a significant association to CVD. PSS patients with cerebrovascular events were younger than expected. Knowledge about risk factors may help clinicians to identify pSS patients at risk for CVD. After diagnosis of pSS, patients should be screened for risk factors such as hypertension and receive appropriate therapy to prevent or at least reduce sequelae such as infarction. However, further investigations are necessary in order to achieve a reliable risk stratification for these patients.

White coat hypertension is another clinical characteristic of patients with inflammatory bowel disease: A cross-sectional study.

In this cross-sectional study, our aim was to analyze association of ambulatory blood pressure monitoring (ABPM) values with pulse wave velocity (PWV) in inflammatory bowel disease (IBD) patients as well as the prevalence and characteristics of white coat hypertension (WCH) in this group of patients with chronic inflammation and high prevalence of anxiety. We enrolled 120 consecutive IBD patients (77 Crohn´s disease; 43 ulcerative colitis) who were not treated with antihypertensive drugs without cardiovascular, cerebrovascular and renal morbidity. Office blood pressure, ABPM, and PWV were measured with Omrom M6, SpaceLab 90207, and Arteriograph, respectively. The prevalence of true normotension, sustained hypertension and WCH was analyzed in IBD patients. WCH was found in 27.5% patients. IBD-WCH patients had significantly lower prevalence of traditional risk factors than general WCH subjects. PWV and augmentation index (AIx) values were higher in WCH than in true normotensive patients. When adjusted for age and duration of IBD, only PWV was a positive predictor of WCH, and patients with higher PWV and longer disease duration had OR´s for WCH of 0.69 and 2.50, respectively. IBD patients had significantly higher prevalence of WCH and higher PWV values than healthy control patients. WCH is highly prevalent in IBD patients but IBD-WCH patients have lower frequency of traditional cardiovascular risk factors than general WCH population. Our results suggest that WCH could be considered as another clinical characteristic of IBD which is associated with increased arterial stiffness and those patients should be monitored more closely.

Changes in cardiovascular risk factors in patients undergoing first time coronary revascularization from 2003–2020, A nationwide population study

Abstract Introduction Current knowledge of cardiovascular risk factors is primarily based on older studies that may not reflect current populations. Monitoring risk factors may influence decisions about prevention and treatment of ischemic heart disease. We hypothesize that the prevalence of traditional risk factors in patients undergoing first-time coronary revascularization has changed over time. Purpose We examined the proportion of patients with traditional cardiovascular risk factors from year 2003–2020 in patients undergoing first-time coronary revascularization. Methods We identified all adults undergoing first-time coronary revascularization (percutaneous intervention and bypass grafting) from 2003–2020 using Danish nationwide registries. Risk factors were defined as either medical prescriptions or diagnosis prior to first-time revascularization. We calculated the proportion of individual risk factors per year with associated 95% CI, and calculated the trend using chi-squared test for trend in proportion. Results We identified 152,692 patients who underwent first-time coronary revascularization. 78.5% of the patients underwent percutaneous coronary intervention and 21.5% underwent coronary artery bypass grafting, 73.8% were male, mean age 65 (SD 11.5), and 67.9% had at least 1 risk factor at first-time revascularization. Figure 1 shows the trends in risk factors from 2003 to 2020. From 2003–2005 to 2018–2020, the proportion of patients with at least 1 risk factors changed from 70.9 to 64.0%, hypertension changed from 41.4 to 36.0%, hypercholesterolemia decreased from 47.6 to 43.6%, aspirin use decreased from 52.4 to 32.06%, diabetes increased from 11.7 to 15.8%, chronic kidney disease increased from 2.4 to 4.4%, and chronic obstructive pulmonary disease increased from 4.95 to 4.96% (p-value for trend &amp;lt;0.001 for all risk factors, except chronic obstructive pulmonary disease (p-value 0.96)). Conclusion We assessed the temporal trends in coronary risk factors over a 17-year period in patients undergoing first-time coronary revascularization. We found a large decrease in the proportion of patients with any risk factor, hypertension, hypercholesterolemia, and aspirin use, and an increase in diabetes and chronic kidney disease. The proportion of patients with chronic obstructive pulmonary disease was unchanged. Funding Acknowledgement Type of funding sources: None.

Cardiovascular Risk Management in the South Asian Patient: A Review.

South Asians represent a growing percentage of the diverse population in the U.S. and are disproportionately impacted by a greater burden of aggressive and premature cardiovascular disease. There are multiple potential explanations for these findings including a high prevalence of traditional risk factors (particularly diabetes, dyslipidemia, and obesity), a genetic predisposition, and unique lifestyle factors. In this review, we discuss the cardiovascular risk stratification and disease management goals for South Asian adults. We review the pharmacologic and non-pharmacologic interventions studied in this population and discuss the role of specialized clinics and digital outreach to improve care for this vulnerable group of patients.

Cardiovascular risk management in gout patients: do patients benefit from screening in secondary care?

To estimate the 10-year cardiovascular disease (CVD) risk in gout patients in secondary care and to evaluate the effect of CVD risk screening on the 10-year CVD risk after 1 year. A prospective cohort study was performed in patients with gout from Reade Amsterdam. Data on gout and CVD history, traditional risk factors, medication, and lifestyle were collected at baseline and 1 year. The 10-year CVD risk was calculated with the use of the NL-SCORE. A paired sample t-test and McNemar test was performed to test for differences between baseline and the 1-year visit. A very high prevalence of traditional CV risk factors was seen in our secondary care gout patients. Nineteen percent without previous CVD were categorised in the high-risk group according the NL-SCORE. The prevalence of CVD increased from 16% to 21% after 1-year follow-up. A decrease was seen in total- and LDL-cholesterol after 1 year. No decrease in mean BMI, waist-hip ratio, blood pressure or NL-SCORE was observed. The current need for CVD risk screening of gout patients in secondary care was illustrated by the high prevalence of traditional risk factors in this cohort. Recommendations to patients and the general practitioner (GP) alone did not result in overall improvement of traditional CVD risk factors nor the 10-year CVD risk. Our results indicate that a more prominent role of the rheumatologist is necessary to optimise the process of initiation and management of CVD risk in gout patients.

Effect of age and sex on the associations between potential modifiable risk factors and both type 2 diabetes and impaired fasting glycaemia among West African adults

BackgroundType 2 diabetes mellitus (T2DM) is becoming one of the leading causes of morbidity and mortality worldwide, including among Africans. Knowledge of the association between traditional risk factors and both diabetes and pre-diabetes, and whether these differ by age and sex, is important for designing targeted interventions. However, little is known about these associations for African populations.MethodsThe study used data from WHO STEPS surveys, comprising 15,520 participants (6,774 men and 8,746 women) aged 25–64 years, from 5 different West African countries, namely Burkina Faso (4,711), Benin (3,816), Mali (1,772), Liberia (2,594), and Ghana (2,662). T-test and chi-square tests were used to compare differences in the prevalence of traditional risk factors for both sexes. Multinomial logistic regression was conducted to ascertain the relative risks (RR) and 95% confidence intervals (CI) for both T2DM and impaired fasting glucose (IFG) relating to each risk factor, including obesity [defined by BMI, waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR)], high blood pressure (HBP), fruit and vegetable consumption, physical inactivity, alcohol consumption, and smoking. Models for each of these traditional risk factors and interactions with age and sex were fitted.ResultsFactors associated with T2DM and IFG were age, obesity [defined by BMI, WC, WHtR, and WHR], HBP, smoking, physical inactivity, and fruit and vegetable consumption (p < 0.05). Analysis of interaction effects showed few significant differences in associations between risk factors and T2DM according to age or sex. Significant interaction with age was observed for HBP*age and T2DM [RR; 1.20, 95% CI: (1.01, 1.42)) (p = 0.04)], WHtR*age and T2DM [RR; 1.23, 95% CI: (1.06, 1.44) (p = 0.007)] and WHR*age and IFG [RR: 0.79, 95% CI: (0.67, 0.94) (p = 0.006)]. Some interactions with age and sex were observed for the association of alcohol consumption and both IFG and T2DM, but no clear patterns were observed.ConclusionThe study found that with very few exceptions, associations between traditional risk factors examined and both IFG and T2DM did not vary by age or sex among the West African population. Policies and public health intervention strategies for the prevention of T2DM and IFG should target adults of any age or sex in West Africa.

Racial disparity in the occurrence of suicides among patients with background intimate partner violence.

The prevalence of Intimate Partner Violence (IPV) continues to increase in the USA. IPV is a major risk factor for suicide and inflicts a substantial economic burden on the United States in terms of health care costs and reduced productivity. The increased racial disparity has been explained in terms of higher prevalence of traditional risk factors of suicide in the white population. To determine if race/ethnicity is an independent predictor of suicide risk among women with background of intimate partner violence. We queried the National Inpatient Database NIS 2005-2015 using the ICD-9 diagnosis codes to extract data on IPV associated in the study period. We conducted a trend analysis to determine trends of IPV from 2005-2015. A multivariate regression was done to determine the predictors of suicides in the study cohort. Patients with background IPV who attempted suicide was compared with a propensity score generated control group controlling for age, gender, alcohol addiction, schizophrenia, obesity, insurance and median income. The primary outcome was racial disparity among the two groups. There were a total of 18,769 IPV associated hospitalization in the NIS from 2005-2015. The prevalence of self-inflicted injury or suicide in the study population was 2.6%. This is higher than the average prevalence in the general population attesting to the increased prevalence of suicide among people with background IPV. The prevalence of IPV increased between 2000-2015, however, this remained stable at 20%: 80% among men and women with background IPV. Whites experienced suicides more than any other race/ethnicity, even after controlling for age, gender, alcohol addiction, schizophrenia, obesity, insurance and median income (OR=3.87; 95% CI 2.68-5.56, p < 0.05). The prevalence of IPV has continue to increase in the USA. The higher prevalence of suicides among whites with background IPV is independent of traditional risk factors.

Overweight/obesity in adolescents with type 1 diabetes belonging to an admixed population. A Brazilian multicenter study

BackgroundTo determine the prevalence of overweight/obesity and associated risk factors in Brazilian adolescents with type 1 diabetes (T1D) and its association with diabetic retinopathy (DR) and chronic kidney disease (CKD).MethodsThis study was performed in 14 Brazilian public clinics in ten cities, with 1,760 patients. 367 were adolescents (20.9%):184 females (50.1%), 176 (48.0%) Caucasians, aged 16.4 ± 1.9 years, age at diagnosis 8.9 ± 4.3 years, diabetes duration 8.1 ± 4.3 years, school attendance 10.9 ± 2.5 years and HbA1c 9.6 ± 2.4%.Results95 (25.9%) patients presented overweight/obesity, mostly females. These patients were older, had longer diabetes duration, higher levels of total and LDL-cholesterol, higher prevalence of family history of hypertension, hypertension, undesirable levels of LDL-cholesterol, and metabolic syndrome compared to eutrophic patients. No difference was found regarding ethnicity, HbA1c, uric acid, laboratorial markers of non-alcoholic fatty liver disease (alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase).ConclusionsAlmost one quarter of our patients presented overweight/obesity. These patients had higher prevalence of traditional risk factors for micro and macrovascular diabetes-related chronic complications such as diabetes duration, hypertension, high levels of LDL-cholesterol and metabolic syndrome. The majority of the patients with or without overweight/obesity presented inadequate glycemic control which is also an important risk factor for micro and macrovascular diabetes-related chronic complications. No association was found between overweight/obesity with diabetic CKD, DR and laboratorial markers of non-alcoholic fatty liver disease. The above-mentioned data point out that further prospective studies are urgently needed to establish the clinical prognosis of these young patients.