Risk Factor For Poor Control Research Articles

Clinical Profile of Type 1 Diabetes Mellitus in Children less than 18 years age, in a Tertiary Care Centre, Bhilai, Chhatisgarh, India: A Cross-sectional Study

Introduction: Type 1 Diabetes Mellitus (T1DM) is a very common paediatric endocrine disorder and is increasing each year, particularly in younger children. The T1DM presents as Diabetic Ketoacidosis (DKA) in a significant number of patients. Race, ethnicity, age, and parent education plays an important role in the glycaemic control of the disease. Conflicting data are available about the age of onset, gender predominance, family history, and growth in various international and national studies. Aim: To study the clinical presentation of T1DM in children aged less than 18 years. Materials and Methods: The observational cross-sectional study was conducted from April 2011 to March 2013 at Jawaharlal Nehru Hospital and Research Centre, Bhilai, Chhattisgarh, India. Total 46 patients with T1DM, aged less than 18 years were included in the study. Socio-demographic data, clinical presentation, age, insulin dose, anthropometry, and laboratory investigations were collected using semi-structured performa. Statistical analysis was done by using Statistical Package for Social Sciences version 26.0. Result: Total 46 patients with T1DM attended the hospital with 24 (52.8%) boys and 22 (47.2%) girls. A 28 (60.8%) of patients presented with DKA. 16 (34.8%) of patients were less than 5 years of age. The youngest patient was of 2.5 years of age. In the present study, stunting was noted in 12 (26.08%) patients. Polyuria (85%) was the most common presenting complaint in newly diagnosed diabetes patients and pain in the abdomen (50%), breathlessness (46.8%) were the most common presenting complaint in established diabetics. Patients with poor control (HbA1c- >8.5%) had significantly higher mean age (12.3±4.01) than the group with good control (HbA1c< 8.5%) has mean age (8.5±3.54 years). Availability of medical facilities, higher socio-economic status, and parents’ education was found to be significantly associated with good glycaemic control. Conclusion: Polyuria was the most common symptom in newly diagnosed diabetics. Higher age was a significant risk factor for poor control of diabetes. DKA may present with respiratory distress in a significant number of patients.

Trombosis venosa de retina. Auditoría de un programa de atención especializada

Background and objectivesRetinal vein occlusion (RVO) is the second most frequent cause of retinal vascular disease and is related to classic cardiovascular risk factors. A specific program was designed to detect and treat risk factors in patients with RVO. The aim of this study is to audit the results of this program. Patients and methodsThe program consisted of a multidisciplinary clinical evaluation by the Ophthalmology and Internal Medicine departments. All patients with RVO were screened, at minimum, for hypertension, diabetes, dyslipidemia, smoking, overweight, and antiphospholipid syndrome. New risk factors or poor control of known risk factors were expected to be found in at least one-third of the patients. Among them, therapeutic measures were expected to be taken in at least two-thirds. A dissociated automated search of the data of all patients who entered the program between April 2021 and April 2022 was performed. ResultsFifty-six patients were included for analysis. Of these, 39 (69.6%) had at least one new or poorly controlled risk factor and 43 (76.8%) had their treatment modified in some way. Antiphospholipid syndrome was detected in five (8.9%). Only one patient had low-risk hereditary thrombophilia. After an exhaustive examination, no risk factors were found in 11 patients. ConclusionThis specific program has been effective in detecting new or poorly controlled risk factors and improving their treatment.

Clinical Profile of Peripheral Arterial Disease Inpatients at Dr. Soetomo General Hospital Surabaya from 2019-2021

Background:</strong> As one of the leading causes of vascular morbidity and mortality, peripheral arterial disease (PAD) remains one of the most underdiagnosed and undertreated atherosclerotic diseases. The relatively high prevalence of PAD combined with an aging population, increasing burden of chronic diseases, and poor control of risk factors will contribute to poorer clinical outcomes in the coming decades. <strong>Objective:</strong> This study aims to identify the clinical profile of PAD inpatients at Dr. Soetomo General Hospital Surabaya in 2019 – 2021. <strong>Material and methods:</strong> This study is a retrospective observational descriptive study using the total sampling technique to acquire data from patients medical records and arteriography reports diagnosed as PAD, which confirmed by arteriography examination at Dr. Soetomo General Hospital Surabaya during January 2019 - July 2021. <strong>Results:</strong> Among 74 PAD inpatients included, PAD was more prevalent in men (52.7%) than in women. The most commonly affected age group above the age of 45. Duplex ultrasonography examination reported triphasic waveform was the most commonly found waveform on the left (33.8%) and right (39.2%) lower extremities with the left common femoral artery (55.4%) and right common femoral artery (52.7%) lower as the disease location. Arteriography examination reported complete total occlusion on the left (44.6%) and right (41.9%) lower extremities with femoral artery (51.4%) as the disease location. Critical limb ischemia (70.3%) was the most found clinical presentation among the patients. Antiplatelet agents (93.2%) were the most prescribed pharmacological agent among the patients with PAD. Patients with PAD on average were hospitalized for 6.76 days. <strong>Conclusion:</strong> This study discovered that the vast majority PAD inpatients were men over the age of 45, with the femoral artery being the most common location for PAD lesion.

Abstract 13575: Utilizing Electronic Health Record Alerts to Increase Prescription of Lipid Lowering Therapies in Patients Admitted With Acute Coronary Syndromes

Introduction:Patients who present to the hospital with acute coronary syndromes (ACS) often have poor control of cardiac risk factors. Multiple studies have demonstrated that lipid lowering therapy is not appropriately initiated or intensified in these patients.Hypothesis:We hypothesized that an interruptive alert delivered via the electronic medical record would increase the initiation and intensification of lipid lowering therapies.MethodsUsing Epic EHR (Epic Systems, Verona, WI), an interruptive alert was designed to trigger upon opening the patient’s chart when the patients were admitted with an ICD code that indicated an ACS (i.e., STEMI, NSTEMI, or Unstable Angina). The alert included an order set to obtain a cholesterol panel or if a cholesterol panel had already been collected it would be displayed and suggest modifications to the patient’s current medication regimen. These alterations included statin intensification or the addition of ezetimibe.ResultsBetween September 1, 2021 and May 30, 2022 172 unique patients were identified. The mean age was 64.8 ±13.8 years, 64.5% were male, 74% were white, and 12% were black. The identified patients had multiple comorbidities including cerebrovascular disease (23%), heart failure (47%), peripheral vascular disease (30%), and being a current or former smoker (53%). The triggered order set had a direct effect on 42 (24%) patients, with 10 initiating ezetimibe and 32 having their statins intensified. The most common indicated reason for overriding the alert (n=99) was not meeting criteria. Of these 99 patients, 4 were ultimately started on ezetimibe, 57 had their statin intensified, and 23 were appropriately excluded (including patients with type II myocardial infarctions who were not the target of this intervention). Of note, 15 patients should have received intensified therapy but had their alert over ridden.ConclusionsThis targeted alert led to direct intensification of lipid lowering therapy in 24% of ACS patients with an additional 35% of patients identified by the alert also having therapeutic intensification. This alert will remain in place to allow for further assessment of its effects and can be easily translated to other clinical systems.

Prevalence of Cardiovascular Risk Factors Among Patients With Diabetes Mellitus Type 2 at King Fahad University Hospital, Saudi Arabia.

BackgroundDiabetes mellitus is considered a major risk factor for cardiovascular diseases. Patients with diabetes mellitus type 2 (DM-II) are at twice as high risk for the development of cardiovascular diseases than the general population. Thus, we aimed to assess the most prevalent cardiovascular risk (CVR) factors among DM-II patients in the Eastern province of Saudi Arabia.MethodThis is a cross-sectional, retrospective, and observational study conducted on DM-II patients at King Fahad University Hospital (KFUH) Al Khobar, Saudi Arabia, from January 2016 to December 2021. The total number of participants was 373 who were patients with DM-II. The patients' demographic information (age, sex, marital status, height, weight, body mass index (BMI), waist, hip circumference, and waist-hip ratio were calculated or obtained from hospital electronic records as were the CVR factors, age, gender, smoking habits, physical activity, BMI, haemodynamic measurements, glycosylated haemoglobin (HbA1C) levels and lipid profile.The collected data were analyzed by using SPSS Statistics v.28 (IBM Corp., Armonk, NY). The descriptive statistics were reported using mean±SD for numerical data and relative frequencies (%) for categorical data. P < 0.05 were counted significant. Quantitative data were analyzed using the ANOVA test to compare the means of the three groups. Qualitative data were analyzed and compared using the chi-square test. Fisher’s exact test was also used to study the statistical significance of variables. Spearman rank correlation was used to study the relationship between HbA1C and other CV risk factors. ResultsThe mean age was 58 (± 13) years; females were 57% of the sample. Around 92% were smokers, 84% had a sedentary lifestyle, 72% had dyslipidemia, 58% were obese, 30% were overweight, 58% reported poorly control of their diabetes, 50% had hypertension and 32% had pre-hypertension. Furthermore, 89% of participants had two or more CVR factors other than DM-II. We found a significant association between high body mass index, dyslipidemia, high systolic blood pressure and pulse pressure (p<0.05) with HbA1C.ConclusionThe majority of participants had two or more cardiovascular risk factors in addition to DM-II. Poor control of DM-II and cardiovascular risk factors cannot be ignored and primary to tertiary prevention must be the top priority when managing the diabetic population in order to prevent devastating outcomes and progression of reversible morbidity.

Risk Factors for Poor Pain Control in Zoster-Associated Pain: A Retrospective Study.

The objective was to investigate the risk factors for poor pain control in patients with herpes zoster (HZ)-associated neuropathic pain treated with drugs combined with nerve block therapy. Neuropathic pain commonly follows HZ. Nerve block therapy is the most commonly used clinical treatment for such pain, combining anti-inflammation and analgesia to prevent peripheral sensitization of nerve. Using clinical practice data from a cohort study at our research center, we established a multivariate logistic regression model to investigate potential risk factors for poor control of zoster-associated pain (ZAP) treated with drugs plus nerve block therapy, including demographic characteristics, complications, laboratory tests, and characteristics of HZ attacks. Of the 429 patients with ZAP who received drugs plus nerve block therapy, 95 (22.14%) had poor pain control after treatment. The risk of poor pain control was closely related to presence of cancer (odds ratio (OR) 4.173, 95% confidence interval (CI) 1.342-12.970), numerical rating scale score on admission (OR 1.929, 95%CI 1.528-2.434), and red blood cell count (OR 0.560, 95%CI 0.328-0.954). Area under the receiver operator characteristic curve was 0.730. Goodness of fit (Hosmer-Lemeshow) was 0.874. The risk of poor pain control in patients with ZAP increased as a result of certain patient characteristics and complications, especially severe pain before treatment and cancer.

Perceptions about the Management of Patients with DM2 and COVID-19 in the Hospital Care Setting.

Background: COVID-19 entails a higher rate of complications in subjects with type 2 diabetes mellitus (T2DM). Likewise, COVID-19 infection can cause alterations in glucose metabolism that may lead to worse control. The aim of the study was to analyse the perceptions of a large group of Spanish physicians about the relationship between COVID-19 and T2DM, as well as the management, monitoring, and treatment of both diseases. Methods: A cross-sectional multicenter national project was conducted based on a survey which included opinion, attitude, and behavior (OAB) questions. Physicians specialised in internal medicine or endocrinology, whose usual clinical practices included the management of T2DM, responded to the survey between March and April 2021. Results: A total of 112 participants responded to the survey, from which 64.3% believed that COVID-19 entailed a higher risk of glycaemic decompensation irrespective of the presence of previously known T2DM. Obesity was considered a risk factor for poor control of T2DM by 57.7% and for a worse course of COVID-19 by 61.0%. Treatment intensification in not-on-target patients was considered by 57.1% in the presence of COVID-19 and by 73.2% in the absence of COVID-19. No participants considered the suspension of dipeptidyl peptidase 4 inhibitors (DPP-4i) in ambulatory patients, 85.7% declared that this therapeutic approach in hospitalized patients should be kept, and 88.4% supported the option of maintaining DPP-4i when corticosteroids were prescribed. Conclusion: The physicians involved in the management of T2DM and COVID-19 are aware of the bidirectional relationship between both conditions. However, the monitoring and therapeutic management of patients with T2DM who are infected by SARS-CoV-2 needs improvement through the following of the current recommendations and available evidence.

Bronchial Asthma Control Among School Children in Abha City, Saudi Arabia

Background: Asthma is a chronic disease known to have an increasing incidence and severity among children. The parents of children with bronchial asthma have an essential role in managing the disease. Therefore, the burden of this disease needs to be explored.&#x0D; Objective: To assess the control of bronchial asthma among secondary school students in Saudi Arabia.&#x0D; Methods: A cross-sectional study of 487 secondary schools in Abha City was done during the 2017 academic year. The data collected using an interviewer-administered questionnaire included personal characteristics, identified precipitants of asthmatic attacks and the Asthma Control Test.&#x0D; Results: The most frequent allergens included dust (95.6%), smoke (80%) and incense (65.9%). The disease was not controlled in 80% of the asthmatic respondents. The prevalence of the disease was significantly higher among cigarette smokers than non-smokers (20.7% vs 8.5%, p = 0.028). Students who were allergic to incense had a significantly higher prevalence of uncontrolled asthma than those who were not allergic to incense (p = 0.021).&#x0D; Conclusions: Most cases of asthma are not controlled, and some cases have seasonality, mainly during winter and autumn. Allergy to Arabian incense is a risk factor for poor control of bronchial asthma in the population studied.

Insomnia was associated with increased risk of recurrent cardiovascular events in coronary heart disease patients

Abstract Funding Acknowledgements Type of funding sources: None. Background Insomnia is highly prevalent in coronary heart disease (CHD) patients. However, the potential effect of insomnia on the risk of recurrent major adverse cardiovascular events (MACE) remains uncertain. Purpose To estimate the prospective association of insomnia and the risk of recurrent MACE in a CHD population from routine clinical practice. Methods This prospective cohort study included 1082 consecutive patients 2-36 (mean 16) months after a myocardial infarction and/or a coronary revascularization procedure. Data on insomnia, coronary risk factors and comorbidity were collected at baseline. Insomnia was assessed by Bergen insomnia scale (BIS), based on sleep symptoms per week during the past three months. BIS is constructed from the clinical diagnostic criteria for primary insomnia in DSM-IV TR. The primary composite endpoint of MACE defined as cardiovascular death, hospitalization due to myocardial infarction, revascularization, stroke or heart failure was obtained from the hospital records on average 4.2 (SD 0.3) years after the baseline study. Data were analysed using Cox proportional hazard regression on a multiple imputated dataset stratified by prior coronary events. Results At baseline, mean age was 62 (range 31-80) years, 21% were females, 90% were revascularized, 47% had participated in cardiac rehabilitation and the prescription rate of antiplatelets (97%) and statins (93%) were high. A total of 364 MACE (21%, 95% CI 19%-24%) occurred in 225 patients, including 39 CV deaths. Almost half of the patients (45%) suffered from insomnia at baseline and 24% used sleep medication the past week. For insomnia, the relative risk (RR) of recurrent MACE was 1.62 (95% confidence interval (CI) 1.24-2.11, p-value&amp;lt;0.001) in age and gender adjusted analysis, 1.49 (95% CI 1.14, 1.97, p-value=0.004) in analysis also adjusted for coronary risk factors and 1.48 (95% CI 1.12, 1.96, p-value=0.006) in a multi-adjusted analysis including age, gender, coronary risk factors and cardiovascular comorbidity. When also adjusted for symptoms of anxiety and depression the RR of insomnia on recurrent MACE remained significant at 1.41 (95% CI 1.05, 1.89, p-value=0.023). Insomnia accounted for 16% of the MACE in attributable risk fraction analyses, being third in importance after smoking (27%) and low physical activity (21%). Obstructive sleep apnea (Berlin Questionnaire) was not associated with recurrent MACE. Conclusions Insomnia was associated with increased risk of recurrent MACE in this prospective cohort following CHD patients from routine clinical practice. The association remained significant even after adjustments for the major coronary risk factors, comorbidity and symptoms of anxiety and depression, indicating that the effects of insomnia is not mediated through poor risk factor control and other psychosocial factors alone. These results emphasize the importance of identifying patients with insomnia as part of coronary rehabilitation.

The demographic, psychosocial and clinical characteristics associated with cardiac risk factor control: an analysis of secondary prevention in adults with established coronary heart disease

Abstract Funding Acknowledgements Type of funding sources: None. Background and Purpose Achieving risk factor (RF) control in patients with established coronary heart disease (CHD) reduces the risk of CHD events.(1) Cross-sectional studies have shown that the implementation of current prevention guidelines is poor, with most patients failing to meet recommended targets.(2,3) This study aims to identify demographic, psychosocial and clinical characteristics associated with the non-achievement of RF targets in a population with CHD. Methods In this post-hoc cross-sectional analysis, multivariable logistic regression identified characteristics significantly associated with poor RF control in participants of the iASPIRE study which recently assessed secondary CHD prevention in Ireland. Results An unhealthy diet (Odds Ratio [OR] 1.6, 95% CI 1.1-2.4, p=0.015), male sex (OR 1.8, 95% CI 1.2-2.8, p=0.007) and type of acute coronary syndrome event (OR 0.6, 95% CI 0.4-0.9, p=0.012) were associated with failure to achieve blood pressure recommendations. Female sex (OR 2.3, 95% CI 1.4-3.8, p=0.002), lack of high-intensity statin (OR 2.4, 95% CI 1.5-3.8, p&amp;lt;0.001) and recurrent hospitalisation for CHD (OR 1.9, 95% CI 1.3-2.8, p=0.001) were associated with poor LDL-C control. Decreasing age (OR 0.9, 95% CI 0.9-1.0, p=0.018), marriage (OR 4.3, 95% CI 1.5-12.1, p=0.007) and insulin use (OR 9.7, 95% CI 1.9-50.4, p=0.007) were associated with a HbA1c of ≥53mmol/mol. The absence of a longstanding illness or disability and decreasing resting heart rate were associated with composite RF control. Conclusion Several demographic, psychosocial and clinical characteristics are associated with achieving guideline-recommended RF targets. These findings will support the development of targeted solutions that will improve guideline implementation and the practice of CHD prevention in a high-risk population.

Not Just Blood: Brain Fluid Systems and Their Relevance to Cerebrovascular Diseases.

Not Just Blood: Brain Fluid Systems and Their Relevance to Cerebrovascular Diseases.

Abstract P190: Health Literacy And Cardiovascular Health: The Multi-Ethnic Study Of Atherosclerosis

Background: Limited health literacy (HL) is associated with individual cardiovascular risk factors and poor risk factor control. The association of HL to composite indices of cardiovascular health (CVH) has not been documented. Hypothesis: Limited HL is associated with suboptimal achievement of ideal CVH as identified by Life’s Simple 7 (LS7). Methods: Included in this analysis are 3766 participants of the Multi-Ethnic Study of Atherosclerosis who completed four HL questionnaire items via follow-up phone calls (2016-2018). Item scores were summed and dichotomized into adequate (≤10) or limited HL (&gt;10). Clinical measures of BMI, total cholesterol, blood pressure, and fasting blood glucose, along with self-reported smoking status, physical activity, and healthy diet were measured at baseline (2000-2002) and categorized by LS7 achievement criteria (poor, inadequate, ideal). LS7 metrics were incorporated into overall CVH (low, medium, high). Poisson regression with robust variance estimation was used to compute prevalence risk ratios and 95% confidence intervals (PRR[95% CI]) of high/medium CVH as well as intermediate/ideal LS7 comparing limited HL to adequate HL. Results: Participants were on average(SD) 59.4(9.13) years old at baseline, 46.0% male, and 58.0% non-white. Prevalence of limited HL was 15.0%. Compared to adequate HL, participants with limited HL were less likely to have medium CVH (0.90[0.84-0.97]) and high CVH achievement (0.53[0.39-0.73]) after adjusting for age, sex, race/ethnicity and field center ( Table ). These associations attenuated with further adjustment for education and income, to 0.94[0.88-1.02] for medium and 0.68[0.50-0.94] for high CVH. Of individual LS7 metrics, limited HL was significantly associated with high glucose levels. Conclusion: Limited HL was associated with suboptimal overall CVH as well as elevated blood glucose levels independent of education. Clinical trials are needed to assess whether improving health literacy enhances CVH.

Does Opium Consumption Have Shared Impact on Atherosclerotic Cardiovascular Disease and Cancer?

Although atherosclerotic cardiovascular disease (ASCVD) and cancer are seemingly different types of disease, they have multiple shared underlying mechanisms and lifestyle-related risk factors like smoking, unhealthy diet, excessive alcohol consumption, and inadequate physical activity. Opium abuse is prevalent in developing countries, especially the Middle East region and many Asian countries. Besides recreational purposes, many people use opium based on a traditional belief that opium consumption may confer protection against heart attack and improve the control of the risk factors of ASCVD such as diabetes mellitus, hypertension, and dyslipidemia. However, scientific reports indicate an increased risk of ASCVD and poor control of ASCVD risk factors among opium abusers compared with nonusers. Moreover, there is accumulating evidence that opium consumption exerts potential carcinogenic effects and increases the risk of developing various types of cancer. We conducted a review of the literature to review the current evidence on the relationship between opium consumption and ASCVD as well as various kinds of cancer. In addition, we will discuss the potential shared pathophysiologic mechanisms underlying the association between opium abuse and both ASCVD and cancer.

Poor risk factor control among stroke survivors - A cross-sectional survey

Objectives: A cross-sectional survey was done to find out the prevalence and control status of cardiovascular risk factors among stroke survivors within a post-stroke period of 3 months to 1 year. Methodology: The data on the prevalence of risk factors were taken from past medical history and medical records. The risk factor control is defined as achieving the targeted levels of blood pressure, blood sugars and cholesterol. Data on a diet, physical activity, tobacco use, and alcohol consumption were also collected. Standard instruments were used to measure blood pressure, weight, height, and waist circumference (WC). The blood sugar and lipid values were taken from labratory reports. Results: Stroke survivors (N = 240) participated. Around 75% of the participants were obese or overweight. Normal WC was found only in 25% of the participants. Majority of the participants were not following a healthy diet (62.5%) or doing recommended physical activity (87.1%). The prevalence of diabetes (61.2%), hypertension (88.6%), and dyslipidemia (96%) were high among stroke survivors. The targeted level of diabetic control and hypertension control level was achieved by 26% and 36.2, respectively, while around 72% attained lipid control. Conclusion: The prevalence of cardiovascular risk factors is very high among stroke survivors, and it is poorly controlled.

Survey of risk factors in coronary heart disease (SURF CHD) II: rationale, methods for a novel recruitment strategy and preliminary results

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): European Association of Preventive Cardiology Introduction SURF CHD (Survey of Risk Factors in Coronary Heart Disease) is a clinical audit on risk factors and secondary prevention among CHD patients. The first wave of the study showed usefulness of the tool and poor control of risk factors, however the centres were identified by personal contacts. A more formal recruitment strategy was required to increase representativeness in the second wave of the study (SURF CHD II). Purpose: SURF CHD II aims to simplify recording and assessment of risk factor management and medication in CHD patients, while using a novel recruitment strategy that improves representativeness of results and provides a wider picture of secondary prevention of CHD. Methods: The survey is conducted electronically during routine outpatient visits. Data on demographics, risk factors, laboratory and physical measurements and medications is collected and summarized. The novel recruitment strategy is based on the pre-existing network of a renowned association of preventive cardiology, which designates a National Cardiovascular disease Prevention Coordinator (NCPC) for several countries. NCPCs were invited to participate in the clinical audit; selected national cardiac societies were invited to pilot recruitment in countries without a designated NCPC; and clinicians that independently showed interest in SURF were welcome to participate too. The SURF team and interested country representatives held meetings to discuss a tailor-made approach for the implementation of the audit in each country. Results: A total of 48 NCPCs, 11 national cardiac societies and 9 individual contacts were invited to SURF. In 18 meetings with country representatives, enrolment of centres adapting to the countries’ characteristics were discussed. To date, 95 centres in 31 countries have agreed to participate and have enrolled 6145 participants: 88 in Eastern Mediterranean, 4786 in Europe, 108 in the Americas, 1069 in South East Asia and 13 in Western Pacific. 80.11% of the centres are public and 96.73% are located in urban areas. 25.21% of participants were female and mean age was 63.82 ± 18 years. 75.99% of the study population were overweight or obese and 16.6% were smokers. Blood pressure lower than &amp;lt;140/90mmHg was reported in 61.05% of participants, 20.58% had LDL &amp;lt;1.8 mmol/l and 39.58% had HbA1c &amp;lt; 7%. 27.15% of participants attended cardiac rehabilitation. South East Asia recorded the lowest prevalence of overweight and obesity and LDL levels. Lowest use of statins was recorded in Europe (78.94%), and of angiotensin-converting enzyme inhibitors in the Americas (14.18%). Conclusions: The recruitment strategy based on the preventive cardiology association’s network is successful. Preliminary results indicate regional variations in risk factors and secondary prevention. SURF will continue to collaborate with NCPCs national cardiac societies to promote the survey and achieve a broader insight on secondary prevention of CHD with a simplified tool.

Trajectories in HbA1c and other risk factors among adults with type 1 diabetes by age at onset

IntroductionIn type 1 diabetes, potential loss of life-years is greatest in those who are youngest at the time of onset. Using data from a nationwide cohort of patients with type...

Different Indicators of Adiposity and Fat Distribution and Cardiometabolic Risk Factors in Patients with Type 2 Diabetes.

This study aimed to evaluate the effect of adiposity and fat distribution on the odds of elevated cardiovascular risk factors among adults with type 2 diabetes mellitus. The present cross-sectional study included 2,427 adults with type 2 diabetes mellitus. Body fat was assessed by dual-energy x-ray absorptiometry. Multivariate-adjusted logistic regression was used to estimate effects of adiposity parameters on elevated hemoglobin A1c (HbA1c , ≥7.0%), hypertension (blood pressure ≥140/90 mmHg), and elevated low-density lipoprotein (LDL) cholesterol (≥2.6 mmol/L). The multivariable-adjusted odds ratio (OR) for elevated HbA1c was 0.82 (95% CI: 0.70-0.96) for each SD increase in leg fat mass. The multivariable-adjusted OR for hypertension was 1.15 (95% CI: 1.00-1.32) for each SD increase in android fat mass. Multivariable-adjusted ORs for elevated LDL cholesterol ranged from 1.16 (95% CI: 1.00-1.35) to 1.27 (95% CI: 1.06-1.51) for each SD increase in arm and android fat mass and percentage of total, truncal, arm, and android fat. Each SD increase in BMI, truncal-to-leg fat ratio, and android-to-gynoid fat ratio was significantly associated with increased risks of elevated HbA1c , hypertension, and elevated LDL cholesterol. Subcutaneous fat in the lower body was associated with a more favorable glycemic profile, but not blood pressure or lipid profile, whereas central adiposity was associated with poor control of cardiovascular risk factors among patients with type 2 diabetes mellitus.

Therapeutic inertia in the management of dyslipidaemia and hypertension in incident type 2 diabetes and the resulting risk factor burden: Real-world evidence from primary care.

To investigate trends in the prevalence of hypertension and dyslipidaemia in incident type 2 diabetes (T2DM), time to antihypertensive (AHT) and lipid-lowering therapy (LLT), and the association with systolic blood pressure (SBP) and lipid control. Using The Health Improvement Network UK primary care database, 254 925 people with incident T2DM and existing dyslipidaemia or hypertension were identified. Among those without atherosclerotic cardiovascular disease (ASCVD) history and not on AHT or LLT at diagnosis, the adjusted median months to initiating an AHT or an LLT, and the probabilities of high SBP or lipid levels over 2 years in people initiating therapy within or after 1 year were evaluated according to high and low ASCVD risk status. At diabetes diagnosis, 66% and 66% had dyslipidaemia and hypertension, respectively. During 2005 to 2016, dyslipidaemia prevalence increased by 10% in people aged <60 years, while hypertension prevalence remained stable in all age groups. Among those with high ASCVD risk status in the age groups 18 to 39, 40 to 49, and 50 to 59 years, the median number of months to initiation of therapy were 20.4 (95% confidence interval [CI] 20.3-20.5), 10.9 (95% CI 10.8-11.0), and 9.5 (95% CI 9.4-9.6) in the dyslipidaemia subcohort, and 28.1 (95% CI 28.0-28.2), 19.2 (95% CI 19.1-19.3), and 19.9 (95% CI 19.8-20.0) in the hypertension subcohort. Among people with high and low ASCVD risk status, respectively, compared to early LLT initiators, those who initiated LLT after 1 year had a 65.3% to 85.3% and a 65.0% to 85.3% significantly higher probability of failing lipid control at 2 years of follow-up, while late AHT initiators had a 46.5% to 57.9% and a 40.0% to 58.7% significantly higher probability of failing SBP control. Significant delay in initiating cardioprotective therapies was observed, and time to first prescription was similar in the primary prevention setting, irrespective of ASCVD risk status across all T2DM diagnosis age groups, resulting in poor risk factor control at 2 years of follow-up.

Post-myocardial infarction rehabilitation and secondary prevention in hospitals.

Norwegian studies have documented poor cardiovascular risk factor control and a high incidence of new cardiovascular events in myocardial infarction patients. There is little knowledge about the scope of secondary prevention treatment and cardiac rehabilitation in Norwegian hospitals. Therefore, we wanted to conduct a survey of discharge routines and outpatient follow-up after myocardial infarction. In October 2018, the heads of cardiology departments and nurse managers/physiotherapists at cardiology outpatient clinics at all Norwegian hospitals (N = 51) were contacted and asked to take part in a telephone interview. A total of 40 doctors (78%) and 51nurses/physiotherapists (100%) conducted the telephone interview. Eleven hospitals used standardised discharge summary templates with treatment targets and expected follow-up. Ten hospitals offered routine outpatient follow-up. A total of 47hospitals (92%) offered multidisciplinary cardiac rehabilitation, 'heart school' classes or cardiac exercise training, and of these 9 (18%) offered multidisciplinary comprehensive cardiac rehabilitation in line with international recommendations. The survey revealed considerable differences in reported discharge routines and the provision of cardiac rehabilitation and outpatient follow-up at Norwegian hospitals.

Risk factor profile associated with major ischemic stroke subtypes in patients managed in a comprehensive stroke unit

Objective — to determine risk factor profiles associated with major ischemic stroke (IS) subtypes in patients managed in a comprehensive stroke unit (CSU).Methods and subjects. 612 patients with IS (mean age 68.1 years, 44.4 % of women) admitted CSU in 2011 — 2018 were enrolled in a retrospective observational study. Patients’ medical history included detailed information about risk factors, and all necessary auxiliary investigations were carried out according to current guidelines, which allowed us to determine the subtype of IS. The c2 criterion was used to compare qualitative indicators in major IS subtypes (posterior comparison was performed using the Marascuilo method), and the Kruskal‑Wallis test was used to compare the quantitative indicators (posterior comparison was performed according to the Dunn’s test). All statistical analysis was performed in MedCalc v. 19.2 software.Results. Risk factors were highly prevalent in IS patients: 86.5 % had arterial hypertension (AH), 59.9 % were elderly or old, 41.1 % had hyperlipidemia, 37.1 % had atrialfibrillation (AF), 30.3 % had diabetesmellitus (DM), and 24.7 % were smokers. 254 patients were assigned to atherothrombotic (AT), 270 to cardioembolic (CE), and 35 to lacunar (LI) subtypesof IS, whereas 53 subjects were diagnosed with IS of otheretiology. In 369 (60.3 %) patients, AH was uncontrolled (only 31 % of the study participants were taking antihypertensive drugs regularly), 163 (60.4 %) patients with CE had not taken anticoagulants. AT was significantly (p &lt; 0.05) associated with AH, smoking, and malesex, CE correlated with older age, female sex, and high rate of AF, while individuals with LI had higher levels of total and low density lipoproteincholesterol. Significant relationships of IS subtypes with the duration of AH or DM, cholesterolor high densityl ipoproteincholesterol levels, obesity, control of AH or a family history of stroke were not found.Conclusions. High prevalence and poor control of risk factors in IS patients was documented, and risk factor profiles associated with major IS subtypes were determined. Identification of the sub patterns may contribute to the further improvement of stroke prevention strategies in Ukraine.