Prevalence Of Modifiable Risk Factors Research Articles

Gender differences in risk factors and characteristics of young patients hospitalized for first acute coronary syndrome

Objective: To analyze the characteristics of modifiable risk factors, coronary artery lesions, reperfusion and drug treatment in young women hospitalized for first acute coronary syndrome (ACS). Methods: Clinical data of young adults of 18 to 44 years hospitalized for first ACS in Beijing Anzhen Hospital between January 2007 and December 2017 were analyzed. A total of 7 106 young adults with ACS were enrolled, 6 593(92.8%) were male and 513(7.2%) were female. There were 2 254(31.7%) patients with ST-segment elevation myocardial infarction (STEMI), 704(9.9%) patients with non-ST-segment elevation myocardial infarction (NSTEMI) and 4 148(58.4%) patients with unstable angina (UA). Clinical characteristics, laboratory examinations, coronary angiography and medical treatment were recorded. The gender differences in the characteristics of modifiable risk factors and coronary artery stenosis in young patients with ACS were also analyzed. Results: Dyslipidemia (87.5%) followed by overweight/obese(83.8%) and smoking (68.5%) were most prevalent modifiable risk factors in men. Dyslipidemia (63.4%), overweight/obese (63.4%) and hypertension (45.5%) were most prevalent modifiable risk factors in women. The prevalence rates of at least 1 risk factor in men and women patients were 99.1% and 87.9%, respectively. Between 2007 and 2017, the rates of hypertension and overweight/obese in men increased, and the rates of dyslipidemia and smoking decreased (trend P<0.01). The changes of incidence of modifiable risk factors through the years in women were not statistically significant. The rate of men receiving coronary angiography was higher than that in women (96.6% vs 93.4%, P<0.01). Women were more likely to suffer left main coronary artery disease than men (7.3% vs 4.1%, P<0.01). Multi-vessel coronary artery disease occurred more in men (43.4%), and single vessel coronary artery disease occurred more in women (47.0%). Women presented with STEMI had a lower probability of receiving clopidogrel/ticagrelor (76.8% vs 86.1%, P<0.01) and angiotensin Ⅰ-converting enzyme inhibitor/angiotonin receptor blocker (ACEI/ARB) (46.5% vs 60.2%, P<0.01) than that in men. Women presented with UA had a lower probability of receiving aspirin (86.3% vs 89.9%), clopidogrel/ticagrelor (69.7% vs 75.6%), statin (78.8% vs 85.0%) and ACEI/ARB (32.7% vs 38.6%) than men (all P<0.01). Women had a higher probability of presenting Killip II-IV than men (38.6% vs 25.6%, P<0.05). Conclusion: The majority of young patients with ACS were men. The prevalence rates of modifiable risk factors are very high in both man and woman. Compared with man, women with AMI are more likely to develop acute heart failure with lower probability of reperfusion and drug treatment.

Cardio-metabolic risk factors among healthcare staff: a cross-sectional study at the hospitals in six cities of Ukraine dedicated to World Heart Day 2020

Abstract Funding Acknowledgements Type of funding sources: None. Background. There is a little information on the prevalence of cardio-metabolic risk factors in the Ukrainian medical staff. The aim of investigation was to determine the abundance of certain risk factors for cardiovascular (CV) diseases among the medical personnel in the six cities of Ukraine, a study dedicated to World Heart Day 2020. Purpose. To establish the presence of cardio-metabolic risk factors among medical workers in Ukraine. Materials and methods. A hospital-based cross-sectional study including 471 participants (415 female and 56 male) between the age of 19 and 79 years surveyed. The cardio-metabolic risk markers assessed were non-modifiable risk factors (family history) and modifiable risk factors (obesity, hypertension, dyslipidemia, diabetes, prediabetes, smoking status). The prevalence of hypertension (HTN) estimated by ESC 2018 recommendations, diabetes and prediabetes by ADA 2019, ESC 2019 and body mass index WHO criteria for obesity classifications. Using standard methods were assessed: fasting glucose concentration, glycosylated hemoglobin (HbA1c) and blood lipids (total cholesterol, LDL-C, triglycerides, HDL-C). Results The median age of participants was 53,3 ± 11,77 years. Positive smoking status reported by 66 persons (14,0%). Analysis of family history showed that 51,4% of the participants had of HTN, 14,9% of myocardial infarction and 25,1% of stroke. The prevalence of modifiable risk factors: HTN registered in 51,4% cases. Around 34,8% of participants were overweight, and 34,6% were obese, 70,7% had waist circumference more than 94 cm (men) and &amp;gt; 80 cm (woman). Prediabetes glycemic levels and diabetes incidence were 42,8% and 12,6%, accordingly. Atherogenic dyslipidemia estimated by increased level of LDL-C more than 4,9 mmol/l, which determinate high risk of CV disorders, estimated in 13,6% participants. Also high triglycerides levels were defined as those of at least 2,3 mmol/l were in 14,9%. Low level of aerobic activity (less than 150 min in week) had 33,4% participants. 30,7% of participants older than 40 years presented high CV risk and 23,9% were in very high risk. Conclusion. Cardio-metabolic risk factors prevail among medical workers in Ukraine. The results point to the relevance of public health recommendations to contribute lifestyle changes and early identification of risk factors for prevention of CV outcomes.

Prevalence and coprevalence of modifiable risk factors for upper digestive tract cancer among residents aged 40–69 years in Yangzhong city, China: a cross-sectional study

ObjectivesTo describe the prevalence of modifiable risk factors for upper digestive tract cancer (UDTC) and its coprevalence, and investigate relevant influencing factors of modifiable UDTC risk factors coprevalence among residents...

ARM BASED ON LEG BLOOD PRESSURES (ABLE-BP): CAN LEG BLOOD PRESSURE MEASUREMENTS PREDICT BRACHIAL BLOOD PRESSURE? INDIVIDUAL PARTICIPANT DATA META-ANALYSIS FROM THE INTERPRESS-IPD

Objective: Hypertension, a key modifiable risk factor for prevention of stroke, is diagnosed and managed using upper arm blood pressure (BP) measurement. Amputations, altered muscle tone or limb deformities can prevent accurate brachial BP measurement and cardiovascular risk estimation, thus placing a cohort with known vascular risks at a disadvantage. Leg BP measurement is often used as a practical alternative, but limited data exist to guide clinicians’ interpretation of leg BP values for the diagnosis and treatment of hypertension. Using data from the INTERPRESS-IPD Collaboration, which holds 34,543 individual records from 15 international studies, we will examine the relationship between arm and leg BP, develop and validate a multivariable model predicting arm BP from leg BP and investigate the prognostic role of leg BP in cardiovascular event and mortality risk prediction. Design and method: In an observational cohort design, individual participant data meta-analyses will be undertaken to explore cross-sectional relationships between arm and leg BP in multivariable models. Using hierarchical linear regression models, we will investigate the association between arm and leg BP and participant characteristics. Planned predictor variables will include age, sex, cardiovascular disease risk and past medical history. Prognostic models will be derived for all-cause and cardiovascular mortality and cardiovascular events. Heterogeneity will be assessed using I2 2 and tau2. Study quality will be assessed using a modified Quality In Prognostic Studies tool. Results: Arm and leg BP records exist for 34,543 individuals. The median follow-up period is 8.5 years, with 3,870 participants experiencing cardiovascular events and 3,096 dying within 10 years. Further analyses are underway and arm-leg BP models will be presented at the conference. Conclusions: We will provide the first evidence-based method for estimating individual brachial systolic BP, and cardiovascular risk, from leg BP measurements. Our findings will support clinicians and patients in detecting and managing hypertension more effectively where leg measurements are required.

Living with consequences of stroke and risk factors for unhealthy diet- experiences among stroke survivors and caregivers in Nairobi, Kenya

BackgroundStroke prevalence is increasing in sub-Saharan Africa and has been partly attributed to the rapid economic and population growth that have contributed to changes in lifestyle and increased the prevalence of modifiable risk factors for stroke. Healthy diet is important in stroke management and secondary stroke prevention. The aim was to explore the clinical characteristics and functioning after stroke and the experiences of nutritional aspects among stroke survivors and caregivers in Nairobi, Kenya.MethodsA cross-sectional study with qualitative and quantitative methods involving two rounds of data collection was utilised. In the first round, data on demographics and clinical characteristics were collected for 30 people poststroke during a seminar organized by the Kenya Stroke Association. In the second round, nine participants then agreed to be interviewed together with their caregivers and asked to describe their own experiences and their household eating patterns after suffering a stroke. The food frequency questionnaire and anthropometric measurements of weight, height and waist measurements were used. The self-reported data were analyzed using descriptive statistics and the transcribed interview texts used a constructivist-based theory.ResultsThe results give an insight in the life situation for people living with consequences after stroke and their caregivers in Nairobi. The participants were aware that they were overweight and that this indicated an increased risk for the development of cardiovascular diseases. A core category emerged: The caregiver as the main definer of health and enabler of healthy diet among persons who have had a stroke. Healthy diets and provided information on eating healthy were lacking from the healthcare professionals, whereupon the responsibility for managing a healthy diet had shifted to the caregivers.ConclusionsSupport needs to be given to people with stroke and their caregivers to achieve a healthy diet. The importance of healthy eating as a way of reducing the risk of suffering a stroke needs to be communicated by health care. The Kenyan food-based dietary guidelines need to be more implemented and accessible as well as an overall secondary stroke prevention program.

Abstract PS7-26: Acute myocardial infarction prevalence and trends in females with active breast cancer

Abstract Introduction:Breast cancer is among the three most common malignancies worldwide, and a better understanding of the epidemiology of the cardiovascular disease in females with breast cancer is needed Methods:Females with active breast cancer diagnosis hospitalized from January 2010 to December2017 were identified in the Nationwide Readmissions Database. Outcomes of interest were the prevalence of acute myocardial infarction (AMI), non-ST-segment myocardial infarction (NSTEMI), cardiac complications, and in-hospital mortality.Results:1,424,102 females with breast cancer were identified. Of whom, 17,578 (1.23%) were hospitalized for AMI. AMI patients were older with a mean age of 72.51 (11.73) vs. 62.22 (14.29), p&amp;lt;0.001. AMI patients had a higher prevalence of hypertension; 65.3% vs. 47.3%, p&amp;lt;0.001, known coronary artery disease; 51.1% vs. 8.2%, p&amp;lt;0.001, hyperlipidemia; 46.6% vs. 24.2%, p&amp;lt;0.001, known heart failure; 42.6% vs. 8.8%, p&amp;lt;0.001, smoking; 26.7% vs. 21.6%, p&amp;lt;0.001, history of stroke; 6.2% vs. 3.2%, p&amp;lt;0.001, history of prior AMI; 9.5% vs. 2.3%, p&amp;lt;0.001, and diabetes with chronic complications; 11.0% vs. 4.2%, p&amp;lt;0.001, and diabetes without complications; 25.2% vs. 15.8%, p&amp;lt;0.001. Over the 8 years, the prevalence of cardiovascular risk factors increased in breast cancer patients including; diabetes with chronic complications; from 2.3% in 2010 to 10.4% in 2017, p-trend&amp;lt;0.001, obesity; 7.8% in 2010 to 13.3% in 2017, p-trend&amp;lt;0.001, coronary artery disease; 8.1% in 2010 to 10.2% in 2017, p-trend&amp;lt;0.001, hyperlipidemia; 20.7% in 2010 to 29.7% in 2017, p-trend&amp;lt;0.001, and smoking; 16.8% in 2010 to 28.2% in 2017, p-trend&amp;lt;0.001. AMI increased over the study duration from 1.0% in 2010 to 1.8% in 2017, p-trend&amp;lt;0.001, and NSTEMI increased from 0.8% in 2010 to 1.5% in 2017, p-trend&amp;lt;0.001. The observed increase was persistent when patients with localized malignancies were examined with AMI inclining from 2.1% in 2010 to 2.4% in 2017, p-trend&amp;lt;0.001, and NSTEMI from 1.6% in 2010 to 2.0% in 2017, p-trend&amp;lt;0.001. Breast cancer patients with AMI had a higher hospital mortality rate; 14.7% vs. 4.2%, OR: 3.96, 95% CI (3.80-4.13), p&amp;lt;0.001, cardiac arrest; 3.9% vs. 0.5%, OR: 8.53, 95% CI (7.87-9.24), p&amp;lt;0.001, and cardiogenic shock, 5.1% vs. 0.1%, OR: 42.03, 95% CI (38.73-45.60), p&amp;lt;0.001.Conclusion:Females with breast cancer have a concerning prevalence of cardiovascular disease with stern worse outcomes, and the prevalence is shown to be increasing over the study duration. Known cardiovascular risk factors are also increasing in breast cancer patients. Further efforts should be directed to aggressively reduce the prevalence of modifiable risk factors in order to improve the outcomes of breast cancer patients. 20102011201220132014201520162017P-trendCoronary Artery Disease8.1%8.3%8.0%8.5%8.9%8.1%9.7%10.2%&amp;lt;0.001Diabetes with chronic complications2.3%2.5%2.5%2.9%3.3%3.9%7.2%10.4%&amp;lt;0.001Heart Failure7.8%7.8%7.9%8.5%9.5%9.0%11.3%12.5%&amp;lt;0.001Hyperlipidemia20.7%21.9%22.8%24.6%25.8%23.1%28.0%29.7%&amp;lt;0.001Obesity7.8%8.7%9.8%11.2%12.2%12.2%12.2%13.3%&amp;lt;0.001Smoking16.8%17.2%19.0%20.7%23.2%22.2%27.6%28.2%&amp;lt;0.001OutcomesAMIOverall1.0%1.0%1.1%1.1%1.3%1.2%1.5%1.8%&amp;lt;0.001Localized Malignancies2.1%1.9%2.0%2.0%2.1%1.8%2.0%2.4%&amp;lt;0.001Patients with History of Radiation Therapy1.2%0.7%1.1%0.7%1.2%1.2%1.6%1.6%&amp;lt;0.001History of prior AMI3.5%3.6%4.2%4.7%5.5%4.3%6.6%6.5%&amp;lt;0.001NSTEMIOverall0.8%0.8%0.9%0.9%1.0%1.0%1.3%1.5%&amp;lt;0.001Localized Malignancies1.6%1.5%1.6%1.6%1.7%1.5%1.7%2.0%&amp;lt;0.001Patients with History of Radiation Therapy0.9%0.6%0.9%0.6%0.9%1.0%1.5%1.3%&amp;lt;0.001History of prior AMI3.0%2.5%3.8%3.7%4.5%3.9%5.7%5.6%&amp;lt;0.001 Citation Format: Mohamed M Gad, Anas M Saad. Acute myocardial infarction prevalence and trends in females with active breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-26.

Impact of urgent coronary artery bypass grafting on acute kidney injury : Amatched cohort study.

There is limited knowledge regarding the specific interrelationships between urgent coronary artery bypass graft (U-CABG) surgery and postoperative acute kidney injury (AKI). We aimed to (1)analyze the impact of urgent CABG (U-CABG) on the incidence and severity of postoperative AKI, (2)estimate the influence of AKI after U‑CABG or elective CABG (E-CABG) on mortality and (3)identify risk factors for AKI depending on the urgency of operation. U‑CABG patients showed ahigher incidence of AKI (49.8% vs. E‑CABG: 39.7%; p = 0.026), especially for higher AKI stages 2 + 3. In-hospital mortality was higher in U‑CABG patients (12.6%) compared to E‑CABG patients (2.3%; p < 0.001). The impact of AKI on mortality did not differ, but showed astrong coherency between higher AKI stages (2 + 3) and mortality (stage1: OR 2.409, 95%CI 1.017-5.706; p = 0.046 vs. stage 2 + 3: OR 5.577; 95%CI 2.033-15.3; p = 0.001). Univariate logistic regression analysis revealed that preoperative renal impairment, peripheral vascular disease and transfusion of more than two red blood cell concentrates were predictors for postoperative AKI in both groups. U‑CABG is arisk factor for postoperative AKI and even "mild" AKI leads to asignificantly higher mortality. Hence, the prevention of modifiable risk factors might reduce the incidence of postoperative AKI and thus improve outcome.

Epidemiology of atypical parkinsonian syndromes.

Atypical parkinsonism or atypical parkinsonian syndromes (APS) refer to a group of neurodegenerative disorders which mimic typical Parkinson's disease but poorly respond to levodopa treatment and deteriorate faster. APS are very rare and among them, progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal degeneration (CBD) are the three relatively better characterized entities. The prevalence estimates of PSP, MSA, or CBD are mostly <10/105, and the incidence estimates are around 1/105 person-year; both estimates remain stable over the past few decades. The age at onset is relatively young for MSA at late 50s, followed by CBD at early 60s, and then PSP at late 60s. The gender difference is not significant in APS, although slight female predominance in CBD has been reported in literature. Little is known about genetic and environmental risk factors for PSP, MSA, and CBD; although the COQ2 mutation has been identified as a genetic risk for MSA, familial cases are extremely rare. Survival after symptom onset is generally within 10 years, but cases with longer disease duration do exist. Respiratory infection remains the major cause of death for APS, but cardiac arrest should be particularly considered in MSA. In addition to disease rarity, the phenotype–pathology discrepancy in APS makes the epidemiological studies even more challenging. Including biomarkers in future diagnostic criteria and establishing disease registry for collecting sufficient number of APS cases may increase the likelihood of finding modifiable risk factors for prevention and intervention.

SAVE LIFE SAVE PAKISTAN THROUGH PRIMARY PREVENTION BY RISK STRATIFICATION OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE

About one fourth of the world population, living in the South Asia region are at an increased risk of atherosclerotic cardiovascular diseases (ASCVD).1,2 Pakistan’s population comprises of over 200 million inhabitants of the South Asian origin. According to a recent study, more than 30% of the Pakistani individuals were at high risk (&gt;7.5%) of 10 years of ASCVD event. Smoking, diabetes (type II), systemic hypertension, and high cholesterol were the most prevalent modifiable risk factors.3 Ten years risk assessment of ASCVD was done in Karachi (a city representing the whole of Pakistan because of multi ethnic composition) by offering pooled cohort equation and Astronaut Cardiovascular Health and Risk Modification (Astro-CHARM) risk calculators.3 Risk stratification in South Asian populations comparable with studies done in the US.1 The study done by Ashraf et al.4 showed an overall hypertension to be 45.6%, diabetes mellitus 15.8%, current smoker 14.25%, family history of myocardial infarction 30.57%. Regarding ethnic distribution to ethnicities of this population Urdu speaking were shown to have an increase trend for diabetes, smoking and family history of heart attack while hypertension in Pushtoons (Table 1). Regarding distribution of coronary artery calcium (CAC) score for various ethnicities, rate of moderate (100 to 399 Agatstan Units) and high (≥ 400 Agatston Units) risk among Punjabis was 4% and 8% respectively, while, for Urdu speaking it was 7% and 2.3% respectively.5 The pairwise comparison of ten years risk of atherosclerotic cardiovascular disease (ASCVD) event by various ethnicities of Pakistan with Pooled Cohort Equation (PCE) and Astro-CHARM showed Urdu speaking at high risk and Sindhi at least risk.5 What needs be done? Implementation of pooled cohort equation and Astro-CHARM in Pakistani population needs to be done through general practitioners. This can be done through pharmaceutical friends by involving all private and public institutions of the countries. This purpose can be achieved through delivering lecturers and demonstrations either by direct lecturers or usual social media i.e. Zoom meetings, webinars, etc. An app can be created for pooled and Astro-CHARM which can be installed in GPs mobile phone. After risk stratification, life style modification, use of statins will be delivered to the general public. All data assimilated will be analyzed and share with medical community for further preventive strategies. A major setback in the risk calculator is that the risk score for subjects under 40 years of age cannot be calculated. Pakistan population having cardiac events are mostly of young age group.6 To overcome this plan is to have a baseline estimation of risk using this calculator in young patients of mentioned age group. This young cohort will be followed through the same mechanism of risk stratification and follow up for 5 years. Although ASCVD scoring system including PCE and Astro-CHARM may help in primary prevention of Pakistan population in identifying individuals at high risk. Through risk calculators need validation with similar cohorts in this population with appropriate changes as needed.

Prevalence of modifiable risk factors for chronic noncommunicable diseases in the elderly and senile population

This article discusses the prevalence of modifiable risk factors for chronic non-communicable diseases among older age groups, namely in elderly and senile patients living in the city of Bukhara. The true frequency of MRF in elderly and senile people, most likely, in the conditions of the regions of Uzbekistan, is much higher.

Anticholinergic burden in older adult inpatients: patterns from admission to discharge and associations with hospital outcomes.

Background:Anticholinergic medications are associated with adverse outcomes in older adults and should be prescribed cautiously. We describe the Anticholinergic Risk Scale (ARS) scores of older inpatients and associations with outcomes.Methods:We included all emergency, first admissions of adults ⩾65 years old admitted to one hospital over 4 years. Demographics, discharge specialty, dementia/history of cognitive concern, illness acuity and medications were retrieved from electronic records. ARS scores were calculated as the sum of anticholinergic potential for each medication (0 = limited/none; 1 = moderate; 2 = strong and 3 = very strong). We categorised patients based on admission ARS score [ARS = 0 (reference); ARS = 1; ARS = 2; ARS ⩾ 3] and change in ARS score from admission to discharge [admission and discharge ARS = 0 (reference); same; decreased; increased]. We described anticholinergic prescribing patterns by discharge specialty and explored multivariable associations between ARS score categories and mortality using logistic regression [odds ratios (ORs), 95% confidence intervals (CIs)].Results:From 33,360 patients, 10,183 (31%) were prescribed an anticholinergic medication on admission. Mean admission ARS scores were: Cardiology and Stroke = 0.56; General Medicine = 0.78; Geriatric Medicine = 0.83; Other medicine = 0.81; Trauma and Orthopaedics = 0.66; Other Surgery = 0.65. Mean ARS did not increase from admission to discharge in any specialty but reductions varied significantly, from 4.6% (Other Surgery) to 27.7% (Geriatric Medicine) (p < 0.001). The odds of both 30-day inpatient and 30-day post-discharge mortality increased with admission ARS = 1 (OR = 1.21, 95% CI 1.01–1.44 and OR = 1.44, 1.18–1.74) but not with ARS = 2 or ARS ⩾ 3. The odds of 30-day post-discharge mortality were higher in all ARS change categories, relative to no anticholinergic exposure (same: OR = 1.45, 1.21–1.74, decreased: OR = 1.27, 1.01–1.57, increased: OR = 2.48, 1.98–3.08).Conclusion:The inconsistent dose–response associations with mortality may be due to confounding and measurement error which may be addressed by a prospective trial. Definitive evidence for this prevalent modifiable risk factor is required to support clinician behaviour-change, thus reducing variation in anticholinergic deprescribing by inpatient speciality.Plain language summary We describe how commonly medicines which block the chemical acetylcholine are prescribed to older adults admitted to hospital as an emergency and explore links between these medicines and death during or soon after hospital admission Backgroud: Medicines which block the chemical acetylcholine are commonly prescribed to treat symptoms such as itch and difficulty sleeping or to treat medical conditions such as depression. However, some studies in older adults have found potential links between these medicines and confusion and falls. Therefore, doctors are recommended to prescribe these drugs cautiously in adults aged 65 years and over.Methods: In our paper we use data collected as part of routine medical care at one university hospital to describe how often these medicines are prescribed in a large sample of older adults admitted to hospital as an emergency. We look at the medicines patients are prescribed on admission to the hospital and also when they are later discharged.Results: We find that these medicines are frequently prescribed. We also find that, in general, patients are prescribed fewer of these potentially harmful medicines on hospital discharge compared with hospital admission. This suggests that clinicians are aware of advice to prescribe acetylcholine blocking medicines cautiously and they are more often stopped in hospital than started. However, we find a lot of variation in practice depending on which hospital specialty was caring for the patient during their inpatient stay. We also find potential links with these medicines and death during the admission or soon after hospital discharge, but these potential links are not always consistent.Conclusion: Further study is needed to fully understand links between medicines that block acetylcholine and late life health. This will be important to reduce variation in prescribing practices.

Practical recommendations for prevention of development and progression of hypertension among the flight personnel of the Russian Aerospace forces

The article substantiates the relevance of studying the problem of early development and progression of hypertension among the flight personnel of the Russian Aerospace forces. The article analyzes the incidence of hypertension among aircrew in comparison with the incidence in the Armed forces and the population of the country. The article considers the most significant signs of early development and course of hypertension, which lead to early disqualification from flight work for medical reasons. The total risk of developing cardiovascular complications is assessed on the scale for assessing the risk of fatal cardiovascular disease over 10 years in the examined individuals with previously established and newly detected arterial hypertension and high levels of stress. Attention is drawn to the high prevalence of modifiable risk factors for cardiovascular pathology among the examined individuals against the background of occupational stress. It was found that people with diagnosed hypertension under the influence of a high level of professional stress are characterized by irrational changes in eating behavior, high prevalence of Smoking, increased alcohol consumption and low physical activity. In addition, stress-induced hypertension indicates a high risk of developing cardiovascular complications in the next 10 years and necessitates additional expansion of the range of measures for its prevention and correction. Practical recommendations for preventing the development and progression of hypertension among the flight personnel of the Russian Aerospace forces are presented. These recommendations are based on the analysis of the incidence of hypertension in flight personnel at the present stage, as well as the identified risk factors for developing hypertension, taking into account the specifics of flight work and conditions of military service of these specialists.

Sudden Unexpected Death in Epilepsy (SUDEP) and seizure safety: Modifiable and non-modifiable risk factors differences between primary and secondary care

IntroductionThe SUDEP and Seizure Safety Checklist (“Checklist”) is a risk factors Checklist based around a person with epilepsy (PWE) demographics, seizure, physical, psychological, and lifestyle issues. The Checklist provides a cumulative picture of current risk when applied to a PWE. This study compares and contrasts risk factors of PWE in primary versus secondary care. MethodsThe Checklist was applied to all PWE registered in four primary care practices in central Cornwall UK (pop: 120,000). Individual, modifiable, non-modifiable, and total risk factors and scores were compared between PWE open to secondary care and those not. Statistical tests were used to calculate significance of individual risk factors in primary or secondary care, to compare the total risk scores between care settings and to find the frequency differences of each risk factor between primary practices. ResultsPeople with total and non-modifiable risk scores were higher in secondary care (both p < 0.001). However, modifiable risk scores were higher in primary care (p < 0.001). Psychiatric concerns were the most prevalent modifiable risk factor in primary care. There were significant differences in the risk profiles between all four primary care practices. ConclusionThis study highlights that there is a lack of clarity on who is referred to secondary care and when. There needs to be an evidence-based system to allow for a bidirectional flow of PWE considering their fluctuating risk. The Checklist can be a decision support tool to enable this.

Role of apolipoprotein ε4 allele as a predictor in the course and outcome in patients with subcortical vascular dementia

AbstractBackgroundVascular dementia (VaD) is the second most common dementia in elderly and the major contributor being Cerebral Small Vessel Disease (SVD) which has radiological manifestations of White Matter Hyperintensities(WMH), Cerebral Microbleeds and Lacunar infarcts. This study looks into the role of clinico‐demographic profile, genetic factors in terms of Apo E4 status and neuropsychological characteristics in predicting the course and outcome in patients with Subcortical VaD.MethodA prospective cohort study involving 202 patients who were followed up at baseline and subsequently after 1 and 2 years’ time intervals following informed consent and IEC approval with attempt to understand the role of APOE4 positive status as a predictor for cognitive decline. Comparison of Neuropsychological test performance with ANOVA, regression analysis and survival analysis by plotting Kaplan Meier’s curve was done using SPSS v.21.ResultThe major risk factor identified was Hypertension in 92% followed by smoking in 76% and low socioeconomic status in 56% patients. 35.7% of the population had an APO E4 allele positivity. Regression analysis done showed APO E4 positive status as a significant independent predictor of poorer performance in neuropsychological test scores across time periods. However, survival analysis utilizing Kaplan Meir’s plot showed that unlike smoking and WMH (Odds ratio : 2.62) which increased mortality rates more than twofold, APO E4 did not contribute to increased mortality.ConclusionThis study comprehensively looks into the role of APO E4 in VaD and identifies need for prevention of modifiable risk factors like smoking, hypertension, low SES, poor cognitive reserves and WMH which predicts cognitive decline in subcortical VaD and lead to early mortality in patients with VaD. Positive APO E4 allele status significantly affects performance in cognitive assessments but does not appear to predict mortality and hence risk modification needs to be tailored in patients with VaD.

Comparison of Prevalence, Presentation, and Prognosis of Acute Coronary Syndromes in ≤35 years, 36 – 54 years, and ≥ 55 years Patients

Whether very young patients (≤35-year-old) differ in the prevalence, presentation and prognosis of ACS is not well known. Of 43,446 patients who were referred to a tertiary care cardiac catheterization laboratory between January 1, 2006 and June 30, 2017, 26,545 patients were ACS (defined as ST Elevation MI, Non-ST Elevation MI or unstable angina pectoris). Detailed chart review was performed and characteristics at baseline were compared for ages ≤35 years, ages 36 to 54 years and ages ≥55 years. A total of 291 (1.1%) were ≤35-year-old, 7,649 (28.8) were 36 to 54-year-old and 18,605 (70.1%) were ≥55-year-old. ACS patients aged ≤35-year-old, were more likely to be men, Caucasian white, smoker, obese, and have family history of coronary artery disease and less likely to have comorbidities such as hypertension, diabetes mellitus, and hyperlipidemia compared with older patients. They were also more likely to present with elevated troponin levels than other groups. They also tended to present with late ST elevation myocardial infarction and were more likely to receive bare metal stents than older patients. The prevalence of 2- and 3-vessel disease was lower compared with older patients. They also had higher prevalence of cardiogenic shock. Compared with 36 to 54-year-old patients, ≤35-year-old were at significant higher risk of 30-day mortality in a multivariable adjusted regression model (Odds ratio 5.65, 95% confidence interval 2.49 to 12.82, p <0.001). Very young patients comprised ∼1% of all ACS cases but had much more prevalence of modifiable risk factors and significantly worse mortality. Modifying these risk factors may mitigate the risk in these patients and should be studied in the future.

USING GAIL MODEL FOR BREAST CANCER RISK ASSESSMENT OF SAUDI FEMALES LIVING AT NATIONAL GUARD RESIDENTIAL CITY, JEDDAH, SAUDI ARABIA

Background: The primary reason for cancer death in women worldwide is breast cancer. It is also the most prevalent cancer in Saudi Arabia. The risk factors for breast cancer development have been divided into modifiable, which can be prevented, and non modifiable risks. Factors such as menarche at early age and family history of breast cancer are nonmodifiable risks, while lifestyle-related behaviors such as dietary habits, physical activity, smoking, or secondhand smoke are modifiable. Risk assessment tools for breast cancer are used to give patients a degree of their level of risk to better-recommended screening tests. It is also informative for the women about the behaviors they should modify to lower the risk. The Gail Model is the best online available tool to estimate the breast cancer risk for early prevention. Methodology: A cross-sectional survey of 144 Saudi females is conducted. Females aged 35 – 70-year-old, who lives at the National Guard residential city in Jeddah were included. Through home visits, females were interviewed, and an individualized risk assessment was made. Body Breast cancer determinants were collected, and the Mass Index was calculated for each participant. According to the result, specific health education regarding breast cancer prevention and screening was provided for all females who participated in the study. Results: This study revealed that Saudi females have many protective factors against breast cancer, such as multiparity (60%), late age menarche (71%), and breastfeeding (47%). Age and family history (11%) are significant nonmodifiable determinants of breast cancer in our population. On the other hand, other factors related to a sedentary lifestyle such as Obesity (21%) and secondhand smoke (43%) can be modified. Conclusion: Primary prevention of modifiable risk factors is essential for reducing the breast cancer burden. Raising awareness regarding early detection and screening is necessary.

Cáncer en Chile y en el mundo: una mirada actual y su futuro escenario epidemiológico

Cancer is a chronic non-communicable disease associated with a high mortality burden. The prevalence of cancer is increasing rapidly worldwide. However, this scenario will be worse in low and middle-income countries such as Chile, where 70% of cancer deaths occur. The aim of this review was to assess the epidemiological scenario of cancer and its projection for the Chilean population. In Chile, 53,365 new cases of cancer were diagnosed in 2018, led by prostate, colorectal, breast, stomach, lung and gallbladder cancer. From 1986 to 2016, cancer increased by 109%. When we reviewed mortality by sex, stomach and prostate cancer were responsible for more than 30% of cancer deaths among men. However, for women the first three places were occupied by breast, colorectal and lung cancer, as in the rest of the world. Considering that 40% of cancers are related to unhealthy lifestyles, working on the prevention of modifiable risk factors represents an opportunity for the creation of public health policies that allow changes at the environmental and individual level.

Abstract P048: Hospital Readmission Of Heart Failure Patients And Its Precipitated Factors And Hypertension

Introduction: Hypertension is one of the most prevalent modifiable risk factor for the development of heart failure (HF). Chronic heart failure (CHF) is the most common cause of readmission for patients in worldwide. Despite this recent attention to HF readmission, we know relatively little about its actual causes despite the fact that patients are in many ways best positioned to identify the underlying factors that contribute to their readmission. Objective: To systematically investigate the patients' perspectives about the reasons for their hospital readmission related to hypertension after discharged of stabalized HF patients and to study how to improve our heart failure care system to reduce the number of readmission in cost effective way. Method and Materials: Patients were recruited for this study was admitted to national institute of cardiovascular diseases, through emergency department. Patients discharged with a primary discharge diagnosis for HF who were then readmitted for any cause in the subsequent 6 month were eligible for the study. We recruited patients over the period of 3 month form June 2019 till August 2019. Eligible patients were approached, consented, and interviewed within the next 24 hours while they were still in hospital. Result: For the readmission, median length of stay was 6 days. Total 500 patient included, out of which 375 (75%) were male and most important cause of heart failure is ischaemic cardiomyopathy 400 (80%). No death recorded. Common reasons for readmission are lack of counselling 200(40%), under dose 75(15%), non-compliance 60(12%), volume over load 50(10%), hypertension 50(10%), secondary infection 35(7%). Conclusion: We concluded that hypertension is not largely associated with heart failure hospitalization in our study. But patient compliance of medication, appropriate fluid intake, self-care and life style modification are the important elements in hospital readmission of heart failure.

The Impact of Smoking on Early Postoperative Complications in Hand Surgery

Smoking is a prevalent modifiable risk factor that has been associated with adverse postoperative outcomes across numerous surgical specialties. We examined the impact of smoking on 30-day complications in patients undergoing hand surgery procedures. The American College of Surgeons National Surgical Quality Improvement Program data sets were queried for patients who underwent common hand surgery procedures from 2011 to 2016. Cohorts were divided into smoking and nonsmoking and compared in terms of demographic characteristics, comorbidities, and postoperative complications. Multivariable logistic regression models were used to control for demographic characteristics and comorbidities in assessing the association between smoking and postoperative infections as well as other major and minor complications. We identified a cohort of 48,370 patients in the National Surgical Quality Improvement Program who underwent certain outpatient and inpatient hospital facility-based hand surgery procedures from 2011 to 2016. Up to 22% of these patients reported active smoking. Compared with nonsmokers, smokers were more likely to be younger and male and to have a lower body mass index. In addition, they were more likely to have a higher American Society of Anesthesiologists classification and to report dyspnea and chronic obstructive pulmonary disease. Multivariable logistic regression identified an independent association between smoking and major complications. Smoking was not significantly associated with minor complications. When regrouped by complication type, smoking was associated with infectious and wound healing complications. In subgroup analysis, smokers undergoing elective hand surgery had increased odds of wound healing complications but not major, minor, or infectious complications. Smokers may be at a significantly higher odds of certain complications compared with nonsmokers. For patients undergoing the elective procedures evaluated in this study, perioperative smoking may increase the risk of wound-healing complications. Prognostic II.

Abstract C025: Lifestyle risk factors for oral and oropharyngeal cancers in patients attending sexually transmitted infection clinics in Puerto Rico

Abstract Introduction: Incidence of oral and oropharyngeal cancers in the United States have increased an average of 0.7% per year over the last decade. Various lifestyles increase the risk of these malignancies, including tobacco, marihuana, and alcohol use, poor oral hygiene, and a diet low in fruits and vegetables. Oral and oropharyngeal cancers are the fourth most common cancer in Puerto Rican men, a group that has shown an excess risk of death from this malignancy compared to other racial and ethnic groups in the United States. This study assessed lifestyle risk factors for oral and oropharyngeal cancers in Hispanic patients attending sexually transmitted infection (STI) clinics in Puerto Rico. Methods: Data from an ongoing cross-sectional study (November 2018-present) among men and women receiving services at STI clinics in the San Juan metropolitan area of Puerto Rico was analyzed. Individuals aged 21-49 years, who are sexually active, and are HIV-negative are eligible for the study. Up to date, 72 patients have been recruited and completed all study procedures. An interviewer-administered questionnaire collects information on sociodemographic and lifestyle characteristics. An oral care index was created using tooth brushing and flossing following the American Dental Association (ADA) recommendations. Results: Over half of participants (52.8%) were men, and the mean age was 32 ± 7.9 years. The majority (70.8%) of participants were single, and more than half reported having public insurance (59.7%), an annual income below $20,000 (55.6%), and having had less than 10 lifetime sexual partners (55.7%). Oral and oropharyngeal cancers’ risk factors reported by participants included current tobacco use (20.8%), recent (30 days) binge drinking (55.1%), concurrent use of tobacco and alcohol use (16.7%), current marijuana use (43.1%), and vegetable consumption at least once a day (36.1%). Regarding oral health, the majority (81.9%) of the sample did not followed recommendations about oral care by ADA and only 38.0% reported visiting their dentists every six months. Persons with lowest annual household income (&amp;lt;$20,000) had higher prevalence of smoking (80.0% vs 49.1%), and non-adherence to ADA recommendations (61.0% vs 30.8%) as compared to their counterparts (p&amp;lt;0.05). Conclusion: Given the high prevalence of modifiable risk factors for oral and oropharyngeal cancers in this population, it is crucial to improve risk factor awareness and encourage behavior change. STI clinics represent an important venue for identifying at-risk populations that might benefit from cancer prevention efforts (NIDCR Grant 1R21DE027226-01A1). Citation Format: Paola M Rosado, Filipa Godoy-Vitorino, Jose A Vivaldi, Ana P Ortiz, Jeslie M Ramos-Cartagena, Cynthia M Pérez. Lifestyle risk factors for oral and oropharyngeal cancers in patients attending sexually transmitted infection clinics in Puerto Rico [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C025.