Primary Prevention Of CVD Research Articles

Fixed-dose combination therapy for the prevention of cardiovascular disease.

This is the protocol for a review and there is no abstract. The objectives are as follows: To determine the effectiveness of fixed-dose combination therapy on optimising CVD risk factors and reducing CVD fatal and non-fatal events for both primary and secondary prevention of CVD. Details of CVD events and risk factors included are listed in the methods. We will also determine any adverse events associated with taking fixed-dose combination therapy. This will include studies conducted in both developed and developing regions of the world.

Hypertension and hypertensive heart disease in African women

Hypertension and hypertensive heart disease is one of the main contributors to a growing burden of non-communicable forms of cardiovascular disease around the globe. The recently published global burden of disease series showed a 33 % increase of hypertensive disorders in pregnancy in the past two decades with long-term consequences. Africans, particularly younger African women, appear to be bearing the brunt of this increasing public health problem. Hypertensive heart disease is particularly problematic in pregnancy and is an important contributor to maternal case-fatality. European physicians increasingly need to attend to patients from African decent and need to know about unique aspects of disease presentation and pharmacological as well as non-pharmacological care. Reductions in salt consumption, as well as timely detection and treatment of hypertension and hypertensive heart disease remain a priority for effective primary and secondary prevention of CVD (particularly stroke and CHF) in African women. This article reviews the pattern, potential causes and consequences and treatment of hypertension and hypertensive heart disease in African women, identifying the key challenges for effective primary and secondary prevention in this regard.

CLINICAL AND ECONOMIC EFFICACY OF PRIMARY PREDICTION ORGANISATIONAL MODEL FOR CARDIOVASCULAR DISEASES IN RAILWAY SYSTEM WORKERS

Aim. To study clinical and economic efficacy of the organisational model for primary prevention of CVD in men working at railway system. Material and methods. Organisational model for primary prevention of CVD (the group preventive consulting at the workplace and individualized profound prophylactic consulting in outpatient environment of locomotory depot rehabilitation centre) has been performed for the first group of locomotory teams in 2010­2012 y.; second group was under annual medical observation (screening and medical comission workout). The monitoring of risk factors and analysis of morbidity causing temporary disability (TD) by CVD; direct and indirect expenses calculation; expense-efficacy estimation. Results. On the background of organisational model for primary CVD prevention in the first group there was a decrease of TD from CVD by 32,8% cases and 34,6% days, from DM by 55,6%; no cases of CHD; total expenses decreased by 44,1%. For three years of observation of 2nd group there was increase of TD from CVD by 19,2% and days — by 8,7%; TD from CHD and DM increased twice; total increase of expenses was by 24,3%. In the 1st group prevalence of smoking decreases 1,6 times and expenses for 1% — decrease of this addiction reached 10304,7 RUR; prevalence of abdominal obesity decreased 1,3 times, expenses for attaining the target waist circumference in 1% patients reached 20310,7 RUR; prevalence of hypercholestrolemia was 1,8 times rarer and expenses to reduce it in 1% patients were 8493,6 RUR by 100 workers. In the 2nd group prevalence of smoking decreased by 4,7% and expenses to reduce this addiction for 1% of men were 107607,4 RUR by 100 workers, that is 10,4 times more than in the 1st group; prevalence of abdominal obesity increased by 5,5%, of hypercholesterolemia — by 4,7%. Conclusion. Realisation of the organisational model for primary CVD prevention in railway system workers during first 3 years showed clinical and economic efficacy in terms of the main risk factor prevalence decrease, TD decrease and overall expenses for CVD.

Longitudinal study of the impact of lipid lowering therapy on carotid atherosclerosis

s / Atherosclerosis 231 (2013) e1–e10 e5 Reassuringly, 72% knew that FH should be considered in adults with a total cholesterol >7.5mmol/l, but just 56% were aware of or had used the Simon Broome criteria. Further, while 61% were aware of the NICE guidelines, just 12% had actually used them. Disappointingly, while 32% had detected FH in a first-degree relative of a patient already diagnosed with FH, 31% were not aware of the indications for cascade testing, Similar numbers believed the diagnosis requires genetic testing. This reflects the finding that only 50% knew the prevalence of FH in the United Kingdom and 54% the pattern of inheritance. 78% underestimated the relative risk of premature death associated with FH. Worryingly, just 8% thought their region managed FH well. 69% believed that better access to specialist lipid clinics would improve care and 74% felt more education would improve the identification and management of FH. These recommendations are in keeping with the results of this survey. We are investigating the effect of targeted education locally. LONGITUDINAL STUDY OF THE IMPACT OF LIPID LOWERING THERAPY ON CAROTID ATHEROSCLEROSIS M. Seed , D. Bond , M. Griffin , A. Nicolaides . 1 Imperial College NHS Trust, London, UK; Vascular U/S Diagnostic Centre, London, UK NICE guidelines for primary prevention of CVD include reduction of LDL-C to 2 mmol/l in high risk patients and by 50% in patients with FH. We wished to see whether such levels might be achieved in a lipid clinic setting, and if so what effect this had on carotid plaque thickness and type. Subjects: 31patients,10with definite FH (mean age 42), the remainder with mixed hyperlipidaemia (MHL), mean age 54, were treated, and followed up with serial carotid ultrasound examinations over a 2-9 year period. No FH patients were hypertensive or diabetic. 10 with MHL had hypertension and 3 type 2 diabetes; 6 were ex-smokers. Methods: B mode ultrasonic assessments of plaque thickness and type were performed in all patients initially and at follow-up (mean 4 years (all); mean 6 years, n1⁄417). Measurements were taken by a single “blinded” operator. Results FH (n1⁄410) MHL (n1⁄421)

Aspirin lacks efficacy in primary prevention of CVD, cancer

Aspirin lacks efficacy in primary prevention of CVD, cancer

ICT-supported CVD prevention through phone-based automated lifestyle coaching

The development and maintenance of a healthy lifestyle (smoking cessation, healthy nutrition, moderate physical exercises etc.) is a major objective concerning the primary and secondary prevention of CVD. CAPSYS is a computer-based lifestyle coaching system, which aims at supporting CVD patients in performing appropriate behavior changes in order to minimize their individual risk factors. Patients can access CAPSYS by dialing a local-rate telephone number and answer to a set of previously known questions concerning their current nutrition, physical activity, blood pressure, smoking etc.

OP25 Benefits and Risks from Aspirin use in the Primary Prevention of Cardiovascular Disease and Cancer: A Systematic Review and Overview of Reviews of Randomised Trial Evidence

BackgroundAlthough the overall benefits and risks are not yet clear, there is a policy push for use of aspirin to be used for primary prevention of CVD and cancer by...

OP75 Increased Consumption of Fruit and Vegetables for the Primary Prevention of Cardiovascular Diseases – A Cochrane Systematic Review

BackgroundCardiovascular disease (CVD) is a global burden and varies between regions. This regional variation has been linked in part to dietary factors and low fruit and vegetable intake has been...

Docosahexaenoic Acid Supplementation, Vascular Function and Risk Factors for Cardiovascular Disease: A Randomized Controlled Trial in Young Adults

BackgroundA high consumption of omega‐3 long‐chain polyunsaturated fatty acids, and particularly docosahexaenoic acid (DHA), has been suggested to reduce the risk of cardiovascular disease (CVD). However, while DHA supplementation may have benefits for secondary prevention, few studies have investigated the role of DHA in the primary prevention of CVD. Here, we tested the hypothesis that DHA supplementation improves endothelial function and risk factors for CVD.Methods and ResultsHealthy volunteers (n=328), aged 18 to 37 years, were randomly assigned to 1.6 g DHA/day (from a microalgae source) together with 2.4 g/day carrier oil (index group) or to 4.0 g/day olive oil (control) (both given in eight 500‐mg capsules/day for 16 weeks). Flow‐mediated endothelium‐dependent vasodilation (FMD) of the brachial artery (primary outcome) was measured before and after the intervention (n=268) using high‐resolution vascular ultrasound. FMD was the same in both groups at randomization (mean, SD; 0.27, 0.1 mm), but postintervention was higher in the control group (0.29, 0.1 mm) compared with the DHA‐supplemented group (0.26, 0.1 mm; mean difference −0.03 mm; 95% CI −0.005 to −0.06 mm; P=0.02). Of other outcomes, only triglyceride (mean difference −28%, 95% CI −40% to −15%; P<0.0001) and very low‐density lipoprotein concentrations were significant lower in DHA‐supplemented individuals compared with controls.ConclusionsDHA supplementation did not improve endothelial function in healthy, young adults. Nevertheless, lower triglyceride concentrations with DHA supplementation was consistent with previous reports and could have benefits for the prevention of CVD.Clinical Trial Registration InformationURL: http://www.controlled-trials.com/ Unique identifier: ISRCTN no: 19987575.

'Mediterranean' dietary pattern for the primary prevention of cardiovascular disease

The Seven Countries study in the 1960s showed that populations in the Mediterranean region experienced lower cardiovascular disease (CVD) mortality probably as a result of different dietary patterns. Later observational studies have confirmed the benefits of adherence to a Mediterranean dietary pattern on CVD risk factors. Clinical trial evidence is limited, and is mostly in secondary prevention. To determine the effectiveness of a Mediterranean dietary pattern for the primary prevention of CVD. We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 9 of 12, September 2012); MEDLINE (Ovid, 1946 to October week 1 2012); EMBASE (Ovid, 1980 to 2012 week 41); ISI Web of Science (1970 to 16 October 2012); Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database and Health Economics Evaluations Database (Issue 3 of 12, September 2012). We searched trial registers and reference lists of reviews and applied no language restrictions. We selected randomised controlled trials in healthy adults and adults at high risk of CVD. A Mediterranean dietary pattern was defined as comprising at least two of the following components: (1) high monounsaturated/saturated fat ratio, (2) low to moderate red wine consumption, (3) high consumption of legumes, (4) high consumption of grains and cereals, (5) high consumption of fruits and vegetables, (6) low consumption of meat and meat products and increased consumption of fish, and (7) moderate consumption of milk and dairy products. The comparison group received either no intervention or minimal intervention. Outcomes included clinical events and CVD risk factors. Two review authors independently extracted data and contacted chief investigators to request additional relevant information. We included 11 trials (15 papers) (52,044 participants randomised). Trials were heterogeneous in the participants recruited, in the number of dietary components and follow-up periods. Seven trials described the intervention as a Mediterranean diet. Clinical events were reported in only one trial (Women's Health Initiative 48,835 postmenopausal women, intervention not described as a Mediterranean diet but increased fruit and vegetable and cereal intake) where no statistically significant effects of the intervention were seen on fatal and non-fatal endpoints at eight years. Small reductions in total cholesterol (-0.16 mmol/L, 95% confidence interval (CI) -0.26 to -0.06; random-effects model) and low-density lipoprotein (LDL) cholesterol (-0.07 mmol/L, 95% CI -0.13 to -0.01) were seen with the intervention. Subgroup analyses revealed statistically significant greater reductions in total cholesterol in those trials describing the intervention as a Mediterranean diet (-0.23 mmol/L, 95% CI -0.27 to -0.2) compared with control (-0.06 mmol/L, 95% CI -0.13 to 0.01). Heterogeneity precluded meta-analyses for other outcomes. Reductions in blood pressure were seen in three of five trials reporting this outcome. None of the trials reported adverse events. The limited evidence to date suggests some favourable effects on cardiovascular risk factors. More comprehensive interventions describing themselves as the Mediterranean diet may produce more beneficial effects on lipid levels than those interventions with fewer dietary components. More trials are needed to examine the impact of heterogeneity of both participants and the intervention on outcomes.

Abstract P168: Primary Prevention of Cardiovascular Disease with Aspirin: Self-Reported and Validated Aspirin use in a Minnesota Community

Introduction: Aspirin (ASA) is recommended for the primary prevention (PP) of cardiovascular disease (CVD, defined as a first myocardial infarction or stroke) by the American Heart Association, Centers for Disease Control, and the U.S. Preventive Services Task Force. Rates of current ASA use for primary prevention of CVD are not well established. Furthermore, self-reported ASA use may be higher than actual use. We thus investigated self-reported and validated ASA use in a Minnesota population. Hypotheses: Current ASA use for primary prevention is low and self-report overestimates actual use. Methods: A population-based telephone survey was conducted of males 45-79 and females 55-79 years of age in a Minnesota community in 2012. Subjects were classified as PP or secondary prevention (SP) based on a history of CVD or previous cardiovascular procedures. Self-reported aspirin use was validated by measurement of serum thromboxane B 2 (sTXB 2 ), a stable metabolite of thromboxane A 2 , measured in a subset (n=54) using the Thromboxane B 2 EIA Kit (Cayman Chemical, Ann Arbor, MI) and reported as median (IQR). Results: A sample of 103 subjects (response rate 56%, age 64±9, 67% male) included both PP (n=74) and SP (n=29) cohorts. Risk factors were prevalent in both PP and SP groups: hypertension (41 vs 62%); diabetes (12 vs. 38%); hyperlipidemia (46 vs 76%); and current smoking (20 vs 23%). Daily aspirin use was reported by 37% of the PP vs. 76% of the SP groups. Within the PP group, most (96%) took aspirin to reduce the risk of CVD events. sTXB 2 levels were 165.6 (18.5, 250.1) ng/mL in aspirin non-users and were 2.8 (0.5, 12.0) ng/mL in self-reported aspirin users. A sTXB 2 cutpoint of 25 ng/mL to validate ASA exposure was associated with a sensitivity of 94% and specificity of 73%. Conclusions: Self-report of ASA use is a valid measure. Use is relatively low in a contemporary primary prevention population.

A telephone-supported cardiovascular lifestyle programme (CLIP) for lipid reduction and weight loss in general practice patients: a randomised controlled pilot trial.

To evaluate a primary prevention care model using telephone support delivered through an existing health call centre to general practitioner-referred patients at risk of developing CVD, using objective measures of CVD risk reduction and weight loss. Participants were randomised into two groups: (i) those receiving a telephone-supported comprehensive lifestyle intervention programme (CLIP: written structured diet and exercise advice, plus seven telephone sessions with the Heart Foundation Health Information Service); and (ii) those receiving usual care from their general practitioner (control: written general lifestyle advice). Fasting plasma lipids, blood pressure, weight, waist circumference and height were assessed on general practice premises by a practice nurse at Weeks 0 and 12. Two general practices in Adelaide, South Australia. Forty-nine men and women aged 48·0 (sd 5·88) years identified by their general practitioner as being at future risk of CVD (BMI = 33·13 (sd 5·39) kg/m2; LDL cholesterol (LDL-C) = 2·66 (sd 0·92) mmol/l). CLIP participants demonstrated significantly greater reductions in LDL-C (estimated mean (EM) = 1·98 (se 0·17) mmol/l) and total cholesterol (EM = 3·61 (se 0·21) mmol/l) at Week 12 when compared with the control group (EM = 3·23 (se 0·18) mmol/l and EM = 4·77 (se 0·22) mmol/l, respectively). There were no significant treatment effects for systolic blood pressure (F(1,45) = 0·28, P = 0·60), diastolic blood pressure (F(1,43) = 0·52, P = 0·47), weight (F(1,42) = 3·63, P = 0·063) or waist circumference (F(1,43) = 0·32, P = 0·577). In general practice patients, delivering CLIP through an existing telephone health service is effective in achieving reductions in LDL-C and total cholesterol. While CLIP may have potential for wider implementation to support primary prevention of CVD, longer-term cost-effectiveness data are warranted.

Urinary magnesium excretion and risk of cardiovascular disease in the general population

Magnesium has been favorable associated with many cardiovascular (CVD) risk factors. Previous studies on dietary magnesium and risk of CVD have yielded inconsistent results, possibly due to the use of dietary questionnaires or blood levels to assess magnesium exposure. Whether urinary excretion of magnesium, as reflection of actual dietary uptake, is associated with CVD risk remains unclear. We prospectively followed 7747 adults free of diagnosed cardiovascular diseases or cancer at baseline (1997-1998) from the community-based, observational PREVEND (Prevention of Renal and Vascular End-Stage Disease) Study. Urinary magnesium excretion was estimated from two 24-h urine collections and was measured by a xylidyl blue method on a Modular analyzer (Roche). During a median follow-up of 10.5 year, 638 CVD events occurred. After adjustment for age, BMI, sex, smoking status, alcohol consumption and educational attainment, urinary magnesium excretion showed a nonlinear relationship with CVD risk. The hazard ratios (HR) for CVD were significantly lower (P >In conclusion, low urinary magnesium excretion was associated with a higher risk of CVD, even after controlling for possible intermediates in the causal pathway such as blood pressure, diabetes and markers of inflammation and atherosclerosis. These results highlight the need to evaluate whether increasing the uptake of dietary magnesium could be effective for primary prevention of CVD.

Fixed-dose combination therapy for the prevention of cardiovascular disease.

This is the protocol for a review and there is no abstract. The objectives are as follows: To determine the effectiveness of fixed-dose combination therapy on optimising CVD risk factors and reducing CVD fatal and non-fatal events for both primary and secondary prevention of CVD. Details of CVD events and risk factors included are listed in the methods. We will also determine any adverse events associated with taking fixed-dose combination therapy. This will include studies conducted in both developed and developing regions of the world.

Increased consumption of fruit and vegetables for the primary prevention of cardiovascular diseases.

This is the protocol for a review and there is no abstract. The objectives are as follows: The primary objective is to determine the effectiveness of i) advice to increase fruit and vegetable consumption ii) the provision of fruit and vegetables to increase consumption, for the primary prevention of CVD.

'Mediterranean' dietary pattern for the primary prevention of cardiovascular disease.

This is the protocol for a review and there is no abstract. The objectives are as follows: The primary objective is to determine the effectiveness of dietary advice to follow a Mediterranean style diet or the provision of foods relevant to the Mediterranean diet for the primary prevention of CVD.

Modelling eating practices in non-fatal acute coronary syndrome or stroke development: A case/case-control study

Background and aimsAlthough significant evidence exists regarding the role of specific foods and dietary patterns on the development of cardiovascular disease, the influence of eating practices has not been thoroughly examined and understood. The aim of the present work was to evaluate the independent role of eating practices on the likelihood of developing an acute coronary syndrome (ACS) or ischemic stroke. Methods and resultsDuring 2009–2010, 1000 participants were enrolled; 250 were consecutive patients with a first ACS, 250 were consecutive patients with a first ischemic stroke and 500 were population-based control subjects (250 age–sex matched one-for-one with ACS patients, and 250 age–sex matched one-for-one with stroke patients). Eating practices were evaluated using a special questionnaire. Socio-demographic, clinical, psychological, dietary and other lifestyle characteristics were also measured. After controlling for potential confounding factors, each 20 min prolongation of dinner-to-sleep time was associated with 10% lower likelihood of ischemic stroke (95%CI: 0.83–0.98). Furthermore, eating practices related to stress (i.e., eating while being stressed, eating while working at the same time, skipping a meal due to work obligations) were associated with higher likelihood of having an ACS. Finally, eating while watching television was associated with lower likelihood of having an ACS (OR: 0.46, 95%CI: 0.27–0.78) or stroke event (OR: 0.42, 95%CI: 0.23–0.77). ConclusionResults of this work, present novel information, indicating the significance of eating practices, in addition to dietary patterns, regarding the development of coronary heart disease and stroke, and could be used in the primary prevention of CVD.

Selenium supplementation for the primary prevention of cardiovascular disease.

This is the protocol for a review and there is no abstract. The objectives are as follows: The primary objective is to determine the effectiveness of selenium only supplementation for the primary prevention of CVD. We will also determine potential adverse effects of selenium only supplementation on major CVD risk factors, such as blood pressure, blood lipids and type 2 diabetes. Results will be stratified by baseline selenium status and country where possible, as well as by selenium dosage.

Aspirin not worth risks for primary CVD prevention

Aspirin not worth risks for primary CVD prevention

Abstract 9164: Who Receives ASA for Primary Prevention in Canada?: Insight From the PRIMARY CARE AUDIT OF GLOBAL RISK MANAGEMENT (PARADIGM) Study

BACKGROUND: The role of ASA for primary CVD prevention is controversial. We assessed the use of ASA in healthy, middle-aged subjects in the PARADIGM study. METHODS: PARADIGM enrolled 3015 men &gt;40 or women &gt;50 to assess trends in CV risk assessment. Subjects with diabetes, vascular disease, or those receiving lipid lowering drugs were excluded. We report on the 406 subjects (13.5%) who were receiving ASA for primary CVD prevention. RESULTS: Subjects prescribed ASA, compared to those not, were more likely to be older (61.6 vs. 55.5y, p&lt;0.0001), male (p&lt;0.001), white Caucasian (88.9 vs. 66.6%, p&lt;0.0001), past/current smokers (43.8 vs. 33.3%, p=0.0004), hypertensive (60.8 vs. 25.7%, p&lt;0.00001), and to have a CV family history (30.9 vs. 23.3%, p=0.002). SBP, DBP, creatinine, hsCRP, waist circumference (WC) and BMI were discriminators of ASA use (all p&lt;0.0005). LDL-c fasting glucose, IFG, and HbA1c did not differ between those prescribed ASA or not. Mean modified FRS for those prescribed ASA vs. not were 22.3 vs. 13.5% respectively (p&lt;0.00001). Of those prescribed ASA, FRS categories were 18% low, 47.8% intermediate, and 34.2% high. In ASA-treated subjects, rates of smoking, HT, family history and mean BP, BMI and hsCRP were similar between genders. Mean HDL and LDL (both p&lt;0.0001), glucose (p=0.05), and HbA1c (p=0.0001), were higher in women than men. Mean FRS was lower in ASA-treated women (14.4 vs. 27.0%, p&lt;0.00001). FRS categories for ASA-treated women vs men were: low (34.4 vs 8.2%), intermediate (43 vs. 34.5%), and high (22.5 vs. 57.3%, all p&lt;0.00001). CONCLUSIONS: In PARADIGM, 13.5% of men &gt;40 and women &gt;50 received ASA for primary CVD prevention. Smoking, HT, family history, hsCRP and abdominal obesity were discriminators of ASA use, yet lipid and glycemic levels were not. Two thirds of ASA-treated subjects had low/intermediate FRS. The majority of ASA use in women was in those with low or intermediate risk scores.