Primary Prevention Strategies Research Articles

An Updated Review Summarizing the Pharmaceutical Efficacy of Genistein and its Nanoformulations in Ovarian Carcinoma.

Implementing lifestyle interventions as a primary prevention strategy is a cost-effective approach to reducing the occurrence of cancer, which is a significant contributor to illness and death globally. Recent advanced studies have uncovered the crucial role of nutrients in safeguarding women's health and preventing disorders. Genistein is an abundant isoflavonoid found in soybeans. Genistein functions as a chemotherapeutic drug against various forms of cancer, primarily by modifying apoptosis, the cell cycle, and angiogenesis and suppressing metastasis. Furthermore, Genistein has demonstrated diverse outcomes in women, contingent upon their physiological characteristics, such as being in the early or postmenopausal stages. The primary categories of gynecologic cancers are cervical, ovarian, uterine, vaginal, and vulvar cancers. Understanding the precise mechanism by which Genistein acts on ovarian cancer could contribute to the advancement of anti-breast cancer treatments, particularly in situations where no specific targeted therapies are currently known or accessible. Additional investigation into the molecular action of Genistein has the potential to facilitate the development of a plant-derived cancer medication that has fewer harmful effects. This research could also help overcome drug resistance and prevent the occurrence of ovarian cancers.

Role of the screening with coronary computed tomography angiography on lipid management and risk factors control in an asymptomatic Chinese population: a community-based, parallel-group, open-label, randomized clinical trial (RESPECT2).

Lipid management based on cardiovascular risk level is the cornerstone of primary prevention of coronary artery disease (CAD), while the accuracy and adherence of traditional cardiovascular risk stratification have been questioned. Prevention strategies based on imaging screening for atherosclerotic plaques are found to be more objective and adherent in recent studies. This trial aims to investigate the role of coronary computed tomography angiography (CCTA) in guiding the primary prevention of CAD in a randomized controlled design. Approximately 3400 middle-aged asymptomatic community participants will be recruited and randomized in a 1:1 ratio to a traditional cardiovascular risk score-guided (usual care group) or CCTA-guided (CCTA group) strategy. Participants with cardiovascular disease, prior lipid-lowering therapy, CCTA contraindication, or serious diseases that affect life span will be excluded. The intervention strategy includes blood pressure, blood glucose, and lipid management and lifestyle modifications. Blood pressure and glucose targets and lifestyle modification recommendations keep the same in both strategies, while lipid management is personalized based on traditional risk level or CCTA results, respectively. The primary outcome is the proportion of participants taking lipid-lowering medication regularly at both 6 and 12months. The secondary outcomes include the proportion of participants achieving low-density lipoprotein cholesterol lowering targets at 12months, mean changes in lipid levels from baseline to 12months, barriers to adherence, adverse reactions related to CCTA examination, and cardiovascular events. The study is the first randomized clinical trial to examine the effectiveness of a CCTA-guided versus a traditional risk score-guided primary prevention strategy in an asymptomatic community-based population. ClinicalTrials.gov NCT05725096. Registered on 2 February 2023.

Association of veteran suicide risk with state-level firearm ownership rates and firearm laws in the USA

BackgroundVeterans have higher suicide rates than matched non-veterans, with firearm suicides being especially prevalent among veterans. We examined whether state firearm laws and state firearm ownership rates are important risk...

The Impact of Flavonoid Supplementation on Serum Oxidative Stress Levels Measured via D-ROMs Test in the General Population: The PREVES-FLAVON Retrospective Observational Study.

Oxidative stress has emerged as a key contributor to numerous NCDs (non-communicable diseases), including cardiovascular diseases, cancer, and diabetes. This study aims to explore the potential of targeted interventions to mitigate oxidative stress as part of a primary prevention strategy. The study included 32 healthy participants (11 men, 21 women) aged 45-65 who completed both the initial and follow-up assessments of the Healthy Days Initiative, a community-based wellness program organized by the non-profit Associazione O.R.A. ETS. Through blood analysis, vital sign assessment, lifestyle questionnaires, and individualized recommendations, participants received guidance on improving their health and reducing disease risk. The initiative also offered the opportunity for participants to consume a flavonoid supplement containing quercitrin, rutin, and hesperidin, with the goal of reducing oxidative stress. Participants who opted for supplementation were instructed to take 1-2 tablets daily for two weeks. Data collected included demographic information, anthropometric measurements, vital signs, dietary and lifestyle habits, medical history, WHO-5 Well-Being Index scores, and blood parameters. Significant reductions were observed in glucose levels (from 82 to 74.5 mg/dL), reactive oxygen metabolites (d-ROMs) (from 394.5 to 365.5 U.CARR), and systolic blood pressure (from 133 to 122 mmHg) after the two-week flavonoid intervention. Most participants (26/31) reported no side effects, and the majority (30/31) expressed a willingness to continue using a product combination of quercitrin, rutin, and hesperidin or a similar product long-term. While limited in scope and duration, the PREVES-FLAVON study contributes valuable insights to the growing body of evidence suggesting that flavonoid supplementation may play a significant role in reducing risk factors associated with NCDs in primary prevention settings. By targeting novel risk factors such as oxidative stress, this intervention holds promise for mitigating the global burden of NCDs and promoting healthy aging.

Literacy Promotion: An Essential Component of Primary Care Pediatric Practice: Policy Statement.

Reading together often with infants and young children strengthens their relationships with parents/caregivers at a critical time in child development, stimulating brain circuitry and early attachment. A positive parenting practice, shared reading helps build the foundation for healthy social-emotional, cognitive, language, and literacy development, setting the stage for school readiness and providing enduring benefits across the life course. Pediatric physicians and advanced care providers have a unique opportunity to encourage parents/caregivers to establish routines and enjoy conversations around books and stories with their children beginning in infancy. Research has demonstrated that parents read and children learn when pediatricians offer literacy promotion as a practical and evidence-based primary prevention strategy in primary care practice to support early brain and child development. This supports families with a strengths-based approach, shaping a child's life trajectory and helping mitigate stress and adverse experiences. The American Academy of Pediatrics (AAP) recommends that pediatricians encourage shared reading beginning at birth and continuing at least through kindergarten as a strategy for supporting parents/caregivers, enhancing foundational relationships, promoting positive language-rich interactions, and helping families create a nurturing and stimulating home environment. The integration of literacy promotion into pediatric resident education is crucial to achieve that goal and thus is also essential. The AAP supports advocacy toward establishing public and private funding for diverse high-quality, developmentally appropriate children's books in the languages preferred by the family to be provided at pediatric health supervision visits to all children, but especially to children living in underresourced communities. This statement is supported by multiple AAP policies and implementation resources, including the accompanying "Literacy Promotion: An Essential Component of Primary Care Pediatric Practice: Technical Report."

Literacy Promotion: An Essential Component of Primary Care Pediatric Practice: Technical Report.

Early literacy promotion in pediatric primary care supports parents and caregivers reading with their children from birth, offering counseling in interactive, developmentally appropriate strategies and providing developmentally and culturally appropriate and appealing children's books. This technical report reviews the evidence that reading with young children supports language, cognitive, and social-emotional development. Promoting early literacy in pediatric primary care offers a strengths-based strategy to support families in creating positive childhood experiences, which strengthen early relational health. An increasing body of evidence, reviewed in this report, shows that clinic-based literacy promotion, provided with fidelity to an evidence-based model, has benefits for children, for parents and caregivers, and for pediatric physicians and advanced care providers as well. Reading with young children supports early brain development and the neural "reading network," and improves school readiness. High-quality literacy promotion is especially essential for children who face disparities and inequities because of social factors, systemic racism, and socioeconomic risk. All families benefit from high-quality and diverse books and from developmentally appropriate guidance supporting interactions around books and stories. Thus, literacy promotion can be a universal primary prevention strategy to strengthen families and support healthy development. Partnerships at community, local, and state levels offer opportunities for integration with other programs, services, and platforms. Literacy promotion in primary care pediatric practice, recognized by the AAP as an essential component since 2014, has become increasingly common. There are successful models for public funding at federal, state, county, and municipal levels, but sustainable funding, including payment to pediatric physicians and advanced care providers, remains a need so that the benefits of pediatric early literacy promotion and the joys of books and shared reading can truly be offered on a population level.

Study protocol: process and outcome evaluation of the Walk with Ease program for fall prevention

BackgroundFalls are the leading cause of injury related morbidity and mortality in older adults. Primary and secondary prevention strategies that address modifiable risk factors are critically important to reduce the number of falls and fall related injuries. A number of evidence-based fall prevention programs are available, but few offer potential for broad dissemination and public health impact due to implementation barriers, such as a need for trained program leaders and clinicians.MethodsThe study will use a randomized controlled trial design to evaluate incorporating physical therapy exercises (primary prevention strategy) within an existing intervention called Walk with Ease. While Walk with Ease has an established evidence-base related to the management of arthritis pain and symptoms, the present study will determine the potential to also reduce falls and fall risk in community-dwelling older adults. The integrated process and outcome evaluation will determine the relative effectiveness of individually-prescribed exercises (compared to standardized exercises) as well as the potential of ‘habit training’ resources (relative to generic behavior prompts) to improve compliance with exercises in this population.DiscussionThe study, conducted through a local clinical-community partnership will advance both the science and practice of community-based fall prevention programming, while also informing implementation strategies needed to promote broader dissemination.Trial registrationClinicalTrials.gov, NCT05693025, Registered January 20, 2023, Updated March 1, 2023.

Parental Socioeconomic Status and an Infant’s Risk of Hospital Admission for RSV

Abstract Background While clinical risk factors for RSV bronchiolitis are well established, data on socioeconomic risk factors is lacking. We explored the association of parental education, income, and employment status on an infant’s risk of hospitalization for RSV bronchiolitis. Methods This population-based retrospective case-control study covered all RSV-related hospital admissions of under 1-year old children in Finland between 2004 and 2018. Controls were matched by month and year of birth, sex, province of residence, and family size. Registry data were linked using unique personal identity codes. Cases and controls were compared using adjusted odds-ratios (aOR) calculated for socioeconomic outcomes including maternal and paternal education, household income, and parental employment. Results A total of 10 767 infants and 50 054 controls were included in the study. Lower parental education significantly raised the risk for RSV hospital admission in infants, the risk growing with decreasing education levels; aOR 1.03 (0.96-1.09) with post-secondary education, 1.12 (1.05-1.2) with secondary education, and 1.33 (1.2-1.47) with primary education. Combined parental income was not significant: aOR 0.97 (CI 0.91-1.05), 1.02 (CI 0.95-1.1), 1(CI 0.92-1.08) and 0.94 (CI 0.85-1.04), respectively with decreasing income level. Unemployment of both parents seemed to be a risk factor for the child’s RSV hospital admission, aOR 1.24 (1.12-1.38). Conclusions Lower parental socioeconomic status may increase the risk of an infant’s RSV hospitalization. Socioeconomic risk factors should be considered when designing RSV infection primary prevention strategies.

Incident reporting and data monitoring of sexual violence and harassment on public transport

IntroductionSexual violence and harassment occur in different settings, including public transport, and cause significant harm to victim-survivors' mental and physical health. While sexual violence and harassment on public transport is a documented problem, the public transport sector uptake has been slow and the true prevalence of sexual violence and harassment on public transport is yet to be determined. We aimed to investigate existing public transport and key stakeholder data systems, and explore the views of service providers, to ultimately improve sexual violence and harassment incident reporting and data monitoring. MethodsUsing a mixed methods design, researchers worked with public transport providers and other interested stakeholders in one Australian state. Twelve organizations were involved in the project and six provided current data on public transport safety for analysis. An audit of public transport and stakeholder websites was also undertaken to assess sexual violence and harassment incident reporting pathways. In addition, seven managers from five public transport organizations were interviewed to capture views on gender sensitive data collection and monitoring, and the challenges and enabling factors facing the sector. ResultsThe results uncovered varied sexual violence and harassment reporting formats and subsequent limited reporting of sexual violence and harassment incidents on public transport. In addition, poor-quality data sets lacked gender sensitivity, comprehensiveness, comparability, reliability and accessibility. Three key themes from public transport providers, on sexual violence and harassment data collection included increasing incident reporting, barriers and enablers of collecting and analysing quality data and governance frameworks. A minimum data set collection tool has been developed and could be tested in future. ConclusionTo improve women's safety on public transport, enhanced gender-sensitive data collection and monitoring is required. Long term government investment in sexual violence and harassment primary prevention strategies on public transport are urgently needed.

First manifestation of cardiovascular disease according to age and sex in a Mediterranean country.

Cardiovascular (CV) diseases are the most common cause of death worldwide. This study aimed to investigate the incidence and type of first CV event in a broad cohort of Spaniards, focusing on age and sex differences. This was a retrospective study using the SIDIAP database. Subjects aged 30-89 years in 2010 were included. Individuals with prevalent CV disease or atrial fibrillation were excluded. Subjects were followed until the occurrence of a CV event, death, or the study end (December 2016). CV outcomes (coronary heart disease [CHD], cerebrovascular or peripheral artery disease and heart failure [HF]) during follow-up were analyzed. Clinical, anthropometrical, and laboratory data were retrieved from clinical records. Overall, 3,769,563 at-risk individuals (51.2 ± 15.2 years) were followed for a median of 7 years. The cumulative incidence of a first CV event was 6.66% (men vs. women, 7.48% vs. 5.90%), with the highest incidence (25.97%) among individuals >75 years. HF (29%) and CHD (28.8%) were the most common first events overall; in men it was CHD (33.6%), while in women it was HF and cerebrovascular disease (37.4% and 27.4%). In younger age groups, CHD was more prevalent, with HF in older age groups. Baseline CV risks factors conferred more risk in younger ages and differed between men and women. The incidence and type of the first CV event in this Mediterranean region were significantly influenced by age and sex. This information is relevant for tailoring primary prevention strategies including the treatment of risk factors.

Pathophysiology and clinical implications of coronary artery calcifications.

To provide a summary of current understanding of coronary artery calcifications (CACs), outlining the role of calcium in atherosclerosis to comprehend the clinical implications of CAC. CAC serves as a reliable indicator of coronary artery disease (CAD) and it is associated with cardiovascular events. In recognition of its significance, recent global guidelines have integrated CAC assessment into risk evaluation protocols, highlighting its role as a noninvasive tool for evaluating and stratifying patients' risk for cardiovascular events. Beyond the amount of CAC values, also, calcium morphology had been linked to cardiovascular events.By leveraging CAC assessment, healthcare providers can effectively up or down reclassify patients' risk and tailor preventive strategies accordingly. This comprehensive approach may involve lifestyle modifications, meticulous management of risk factors, and judicious use of preventive medications to mitigate the likelihood of future cardiovascular events, or withhold treatments in those without signs of CAC, to optimize resource use. The identification of CAC burden and morphology through noninvasive imaging modalities can reclassify the prediction of future cardiovascular risk and serve as a risk modifier for atherosclerosis. These data underscore the utility of selectively using CAC assessment in both primary and secondary prevention strategies for atherosclerotic cardiovascular disease.

B-cell Depletion Therapy in Pediatric Neuroinflammatory Disease.

B-cell depletion therapy, including anti-CD20 and anti-CD19 therapies, is increasingly used for a variety of autoimmune and conditions, including those affecting the central nervous system. However, B-cell depletion therapy use can be complicated by adverse effects associated with administration and immunosuppression. This review aims to summarize the application of anti-CD20 and anti-CD19 therapies for the pediatric neurologist and neuroimmunologist. Most existing literature come from clinical trials with adult patients, although more recent studies are now capturing the effects of these therapies in children. The most common side effects include infusion related reactions and increased infection risk from immunosuppression. Several strategies can mitigate infusion related reactions. Increased infections due to persistent hypogammaglobulinemia can benefit from replacement immunoglobulin. B-cell depletion therapies can be safe and effective in pediatric patients. Anticipation and mitigation of common adverse effects through primary prevention strategies, close monitoring, and appropriate symptomatic management can improve safety and tolerability.

The Effect Of Weight Loss With Lifestyle Changes On LDL Cholesterol: Retrospective Cohort Study

Aim: This study aimed to investigate the rate of decrease in lipid levels with effective lifestyle changes (LC) and the minimum body weight loss necessary for effective lipid reduction in obese patients. Method: The study is a retrospective cohort study. The study included 71 patients who were followed up in the obesity clinic, who were diagnosed with hyperlipidemia but did not use any hyperlipidemia treatment. The patients' high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol, triglyceride, body fat ratio and mass, body mass index (BMI), height and weight information were recorded at the first visit and the 6th month. In our study, patients were divided into two groups (based on the weight loss rates in the 6-month follow-up) those who lost less than 10% of their previous weight and those who lost 10% or more weight and their lipid parameters were compared. Results: LDL-C reduction rates of patients classified according to their weight loss rates were found to be statistically significantly (p=0.011) higher in those with 10% or more weight loss than (group 1=18.48%) in those with less than 10% weight loss (group 2=13.04%). Total cholesterol reduction rates were also significantly (p=0.015) higher in the 1st group than in the 2nd group. According to the findings of our study, at least 10% weight loss is required to decrease total cholesterol and LDL-C significantly. Conclusion: Implementation of primary and secondary prevention strategies to reduce the risk of cardiovascular disease is important in the context of primary care. To reach the targeted LDL-C values, the weight monitoring of obese patients should be considered, and the importance of losing at least 10% of weight as one of the first steps should be emphasized.

Research progress in stroke risk perception assessment tool.

One of the main illnesses in the globe that causes impairment and death in people is stroke. In the globe today, it ranks as the second leading cause of death and the leading cause of death in China. This paper analyses into the critical role of risk perception in developing individual awareness of stroke risk and encouraging proactive preventive health behaviors, essential for effective primary stroke prevention strategies and reduced stroke incidence. It discusses the concept of risk perception, the content and dimensions of global stroke assessment tools, and their application status, aiming to provide insights for their development and intervention research. Risk perception encompasses subjective assessments of stroke likelihood and severity, influenced by personal experiences, knowledge of risk factors, beliefs about prevention effectiveness, and emotional responses. Global stroke assessment tools, like the Framingham Stroke Risk Score and CHA2DS2-VASc Score, evaluate stroke risk based on factors such as age, gender, blood pressure, and cholesterol levels. In order to improve risk perception and proactive health management and lower the burden of strokes, the paper assesses the advantages and disadvantages of these tools and makes recommendations for improving accessibility, customizing interventions, running educational campaigns, promoting multidisciplinary collaboration, and integrating technology. By combining the research tools of stroke risk perception, it is found that the evaluation tools are mostly single-dimensional evaluation tools centered on the two dimensions of onset possibility and susceptibility. Some scholars have developed multi-dimensional evaluation tools, but the evaluation population is relatively limited, and the evaluation system lacks comprehensiveness and systematization.

O33 ARE METABOLICALLY HEALTHY OBESE INDIVIDUALS REALLY A BENIGN CARDIOVASCULAR GROUP? AN ANALYSIS OF 162,590 PARTICIPANTS WITH MEASURES OF ARTERIAL STIFFNESS IN UK BIOBANK

Background and Objective: There is conflicting evidence as to whether so called metabolically healthy but overweight and obese individuals are at increased cardiovascular risk or mortality. We assessed whether metabolic health correlates with vascular health among these individuals using arterial stiffness as a proxy for vascular health and cardiovascular risk. Methods: Participants in UK Biobank with body-mass index (BMI) and arterial stiffness index (ASI) recorded between 2006 and 2010, and free from cardiovascular diseases and not underweight (BMI<18.5 kg/m2) were included. Participants were stratified by BMI and metabolic abnormalities (hypertension, diabetes, dyslipidaemia). The primary outcome was the severity of ASI analysed using multivariate-adjusted linear regression. Results: Of 162,590 participants, 55.0% were female, their mean age was 57 years (SD 8), 42.5% were overweight and 24.4% were obese. Within the normal BMI strata, 50.7% had ≥1 metabolic abnormality. Compared to individuals with normal BMI and no metabolic abnormalities (reference group), increased BMI or metabolic abnormalities were similarly associated with higher ASI: normal BMI with metabolic abnormalities (adjusted β-coefficient 0.35;95%CI 0.30 to 0.40), overweight without metabolic abnormalities (β 0.32; 95%CI 0.26 to 0.37). Obese individuals with no metabolic abnormalities had higher ASI (β 0.65; 95%CI 0.57 to 0.74) but was lower than overweight participants with metabolic abnormalities (β 0.80; 95%CI 0.75 to 0.84). Obese participants with metabolic abnormalities had the highest ASI (β 1.07; 95%CI 1.02 to 1.12) among all six metabolic combinations, p<0.001 for each vs ref group. Sensitivity analysis suggested higher ASI with increasing number of metabolic abnormalities within BMI categories. Conclusions: Excess weight and metabolic abnormalities, are independently associated with adverse measures of vascular health to a similar degree, suggesting that the so called metabolically health overweight and obese are not benign groups. Primary prevention strategies should be considered in overweight, or obese individuals even if metabolic abnormalities are absent.

Efficacy of albumin use in decompensated cirrhosis and real‐world adoption in Australia

AbstractThe current treatment approach to patients with liver cirrhosis relies on the individual management of complications. Consequently, there is an unmet need for an overall therapeutic strategy for primary and secondary prevention of complications. The clinical potential of long‐term albumin infusions supported by recent clinical trials has expanded its indications and holds promise to transform the management and secondary prevention of cirrhosis‐related complications. This renewed interest in albumin comes with inherent controversies, compounding challenges and pressing need for rigorous evaluation of its clinical potential to capitalize on its therapeutic breakthroughs. Australia is among a few countries worldwide to adopt outpatient human albumin infusion. Here, we summarize currently available evidence of the potential benefits of human albumin for the management of multiple liver cirrhosis‐related complications and discuss key challenges for wide application of long‐term albumin administration strategy in Australian clinical practice. Australian Gastroenterological week (AGW), organised by the Gastroenterological Society of Australia (GESA), was held between 9‐11 September 2022. A panel of hepatologists, advanced liver nurses and one haematologist, were invited to a roundtable meeting to discuss the use of long‐term albumin infusions for liver cirrhosis. management in Australia. In this review, we summarise the proceedings of this meeting in context of the current literature.

O28 EVALUATE THE IMPACT OF STRUCTURED TRAINING COURSE ON HEALTHCARE PROVIDERS KNOWLEDGE AND AWARENESS OF LIFESTYLE MODIFICATIONS FOR HYPERTENSION MANAGEMENT

Background: This study explores how structured training program enhances healthcare professionals’ awareness of lifestyle modifications for hypertension. Assessing its impact on both knowledge and patient guidance, with an aim to improve healthcare delivery by equipping professionals with informed strategies for lifestyle modification. Design and Methods: A quasi-experimental design was employed with sample size of 750 HCPs. The Hypertension Knowledge-Level Scale (HK-LS), a modified questionnaire based on guidelines from the World Health Organization (WHO), was utilized to assess participants’ understanding of hypertension, knowledge of lifestyle modification, and clinical practice. A 12-week online course comprising seven modules was delivered to the HCPs, followed by pre- and post-tests to measure changes in knowledge regarding lifestyle modifications. Results: The analysis revealed a substantial increase in HCPs knowledge levels post-intervention compared to pre-intervention regarding hypertension (t = 4.90, p = 0.001), lifestyle modification (t = 3.62, p = 0.001), and their proficiency in offering lifestyle advice to patients (t = 3.56, p = 0.001). In addition to these positive outcomes among HCPs, the intervention also highlighted significant gender disparities in attendance and outcomes among participants. Females exhibited a higher attendance rate of 75% compared to males, with consequent improvements in practice, while males showed a more substantial enhancement in knowledge levels post-intervention. These findings underscore the importance of addressing gender-specific barriers to improvement, such as socio-cultural factors for females and preconceived notions for males, to optimize the effectiveness of future interventions in promoting healthier behaviors and outcomes. Conclusions: Structured training programs are imperative for enhancing HCPs’ knowledge of lifestyle modification, particularly in the context of hypertension, as a crucial component of primary prevention strategies. This signifies the effectiveness of the structured training program in enhancing HCPs’ comprehension of hypertension management and their ability to guide patients toward adopting healthier lifestyles.

Integration of Primary Preventive Care of Cardiovascular Disease in a Retroviral Clinic in an adult retroviral clinic in Ibadan: A retrospective study.

A consequence of improved survival of people living with human immunodeficiency virus (HIV) (PLHIV) is an aging population with an increased risk of developing atherosclerotic cardiovascular diseases (ASCVDs). International guidelines recommend primary preventive strategies which should be integrated into routine care of PLHIV. This study audited the ASCVD preventive practices offered to PLHIV at the adult antiretroviral clinic in Ibadan. This was a retrospective review of clinical records of all persons who were recruited into the antiretroviral therapy clinic between January 1 and December 31, 2018. Cardiovascular disease (CVD) preventive practices were audited against recommendations of the American Heart Association for PLHIV. The records of 568 persons with a mean (standard deviation) age of 39.95 (11.77) years were reviewed. There were 365 (64.26%) females and 203 (35.74%) males. Only 364 (64.08%) patients had the required parameters for the calculation of the low-density lipoprotein cholesterol (LDL-C) by the Friedewald formula. Ten-year ASCVD risk was not calculated for any of the patients during their clinic visits. Thirty-seven (6.51%) patients had either an LDL-C ≥4.91 mmol/L or an age between 40 and 75 years with diabetes mellitus or ASCVD risk score (when calculated) ≥ 7.5%. Only one of these persons was referred for specialist care of lifestyle modification. Fifty (8.80%) persons had an eGFR <60 mLs/min, but only 11 (1.94%) were referred for nephrology care. The integration of primary preventive cardiovascular practices into routine care for PLHIV is suboptimal. A revision of the recommendations of the Nigerian National Guidelines for HIV may be a useful first step addressing this.

Demographic Differences in Insomnia and Anxiety and the Association with Cardiovascular Risk Factors among Jordanian Healthy Adult.

Prior studies showed that anxiety and insomnia are both associated with Cardiovascular Disease (CVD). There is a lack of literature related to the prevalence of insomnia and anxiety among healthy adult populations in developing countries as in Jordan, Therefore, this study aimed to examine the association between the CVD risk factors and both insomnia and anxiety among healthy adults had one or more modifiable CVD risk factors. A cross-sectional method was used to examine the prevalence of anxiety, insomnia, and demographical and clinical association with anxiety and insomnia among 1000 Jordanian adult participants using the Hamilton Anxiety Rating Scale and the insomnia severity index. Pearson's correlation was used to examine the correlation between anxiety and insomnia scores. Linear regression was used to examine predictors to anxiety and insomnia based on demographical and clinical details. The result of the current study showed that (30.20%) of participants had higher anxiety scores, (29.70%) had moderate to severe insomnia. Moreover, there was a significant positive correlation between anxiety and insomnia scores, p = 0.01. Based on the current study findings only marital status and anxiety were unique predictors of insomnia F(14,45) = 989, p = 0.001. Moreover, Predictors of anxiety were gender, hypertension, Diabetes mellitus, dyslipidemia, and insomnia F(19,89) = 989, p = 0.001. Sleep and psychological well-being are important components of an adult's health and well-being. The study showed that marital status and anxiety are predictors of insomnia. Whereas, gender, hypertension, diabetes mellitus, dyslipidemia, and insomnia were predictors of anxiety. This study highlights the importance of the implementation of a primary prevention strategy for individuals with modifiable CVD risk factors to reduce anxiety and insomnia levels among adults.

Association of elevated lipoprotein(a) levels with ischemic stroke in young patients - a systematic review and meta-analysis

IntroductionLipoprotein(a) [Lp(a)] is an established independent causal risk factor for cardiovascular disease and atherosclerosis. However, its association with young-onset ischemic stroke is not well-established. A systematic review and meta-analysis was performed to investigate the association of elevated Lp(a) with young ischemic stroke. MethodsFour electronic databases: PubMed (MEDLINE), EMBASE, Scopus and Cochrane Library were systematically searched, profiling studies from inception till 6 Mar 2024. We included studies investigating the relationship between stratified Lp(a) levels and young ischemic stroke. We compared the odds of young stroke patients (age <65 years) having elevated Lp(a) compared to age-matched controls without stroke or transient ischemic attack. ResultsFive case-control studies comprising a total of 1345 patients were included; 57.7 % (776/1345) were females, with a mean age of 41.5 years. Among them, 22.5 % (264/1171) were smokers. Additionally, 16.8 % (197/1171) had hypertension, 5.9 % (69/1171) had diabetes, and 29.2 % (284/971) had hyperlipidemia. Young stroke patients were more likely to have high Lp(a) level than age-matched controls (OR 1.61, 95 %CI 1.24–2.10). Four studies defined a high Lp(a) level as ≥30mg/dL, whilst one study used a Lp(a) level of >23.2mg/dL as the cut-off. A sensitivity analysis excluding this study showed that young stroke patients were still more likely to have Lp(a) ≥30mg/dL than controls (OR 1.43, 95 %CI 1.08–1.88). ConclusionYoung stroke patients are more likely to have elevated Lp(a) compared to age-matched controls, suggesting an association between elevated Lp(a) and young stroke. Further research is warranted to evaluate the causal relationships between Lp(a) and young-onset ischemic stroke, as well as to conduct a cost-benefit analysis of Lp(a) screening in young adults as part of a primary prevention strategy.