Undiagnosed Risk Factors Research Articles

Abstract 10498: The Use of a Digital Telehealth Platform to Understand the Prevalence and Control of Cardiovascular Disease Risk and Risk Factors in the Indian Population - A Pilot Study

Introduction: Despite the enormous & growing burden of CVD in India, there is still lack of awareness about the importance of guideline based prevention and risk factor control. Objectives: To understand the feasibility & utilization pattern of an open-to-public digital health (mHealth) platform designed to assess CVD risk, risk factors (RF), RF control and adequacy of prevention, and provide appropriate education and guidance based on the assessment. Methods: Data was collected over 2 months through the mHealth platform that was open to all adults aged 25-80 years. It was accessible at no cost via all web browsers on smart phones, computers & tablets with internet connectivity and was available in 2 languages. Utilization of the platform was significantly higher in males - 93.7% (251/268) respondents. Therefore, the study population for this study comprised of 251 males (age 45.4 + 11.7 yrs). Females were not included due to the small sample size; hence the corresponding results will be published once adequate sample size is reached. 10 year CVD Risk was calculated using the Framingham Risk Score (FRS). RF, RF control and adequacy of prevention were assessed using national & international guidelines, as appropriate. Statin indicated conditions were atherosclerotic disease, diabetes mellitus, familial hyperlipidemia and FRS-CVD risk >=10%. Results: Results are summarized in Fig 1. Overall 186 subjects met the criteria of having statin indicated conditions; however, only 37.6% of them reported taking a Statin. The commonest RFs were hypertension (68.5%) & sedentary lifestyle (57%). Rates of undiagnosed RFs were high -diabetes 45.7%, hypertension 20%, high normal BP 28%, and pre-diabetes 24.9%. RF control was poor with only 23.2% of people with hypertension reporting BP <130/80, 38.9% of diabetics reporting HbA1c <7% and 26.2% of those taking Statins reporting LDL <70 mg/dL. Conclusion: The use of a digital health tool for CVD prevention is feasible and reveals a large unmet need.

A Field-Based Study of the Magnitude of Risk Factors and Health Habits in Young Volunteers in the Community.

ObjectiveA field study is more informative in terms of epidemiological data than a hospital-based study. Undiagnosed risk factors may be discovered in an asymptomatic group. This study aimed to estimate if the community was well informed about the risk factors for coronary artery disease and if that affected the prevalence and the anthropometric among those who participated in the study.Materials and methodsA cross-sectional study was conducted, using a consecutive sampling technique. Individuals were interviewed in terms of the risk factors and clinical signs and symptoms. The anthropometric measurements were done on-site to identify asymptomatic risk factors. The survey was utilized to increase the awareness among the participants.ResultsIn total, 193 individuals participated in this study. The mean age of the sample was 36.3 ± 12.4 years, with 53% male. Smoking was the most frequent risk factor (31.6%), followed by dyslipidemia (22.5%), hypertension (16.6%), and diabetes mellitus (14.5%). Almost half of the sample participated in sports for one to two hours per week (40%). Almost all consumed fast food at least once a week, and 16.6% consumed fast food more than four times a week. The average systolic blood pressure was 129.41 ± 22.5 mmHg and the average body mass index (BMI) 27.6 ± 7.2 kg/m2.ConclusionDyslipidemia was the most prevalent risk factor. Hypertension and diabetes mellitus are on top of the risk factor pyramid in commonality. An early diagnosis is important to decrease the incidence of cardiovascular disease. The consumption of fast food and obesity are relatively high and require educational interventions and more available healthy food. Screening through social media and primary health care centers may avert a negative outcome.

Opportunistic screening of cardiovascular disease risk factors in community pharmacies in Nigeria: a cross-sectional study

Background Early identification and treatment of cardiovascular disease (CVD) risk factors through screening are crucial in the primary prevention of CVD and reduction in healthcare-related costs. Use of Non-Physician Healthcare-workers including Community Pharmacists has been advocated as an effective and cost-efficient model of healthcare delivery. In Nigeria the use of community pharmacists for mass screening of CVD risk factors has not been explored. Objective We sought to investigate the possibility of mass CVD risk factor screening in community pharmacies by pharmacists. Setting Lagos, Nigeria. Methods Between October and December 2018 eight hundred and eighty-nine apparently healthy participants were screened for obesity, hypertension, diabetes and hypercholesterolaemia in ten community pharmacies. Diabetes and hypercholesterolaemia were screened for using point-of-care testing modalities. A structured questionnaire was used to obtain the socio-demographic data of the participants. Main outcome measures Prevalence of overweight/obesity, hypertension, diabetes, hypercholesterolaemia, smoking and alcohol intake. Results Mean age of the subjects was 56.8 ± 21.1years. Majority (57.4%) were females. Prevalence of smoking and alcohol intake were 4.3% and 26.7% respectively. 59.7% and 71.5% of males and females were either overweight (BMI ≥ 25kg/m2) or obese (BMI ≥ 30kg/m2) respectively. Prevalence of hypertension was 28.2% in all subjects, 30.9% in males and 26.3% in females, p < 0.001. Using BP > 130/80mmHg prevalence of hypertension was 55.1%. Diabetes was detected in 3% of the subjects while 45.3% had hypercholesterolaemia. In total, 64.1% of the subjects were diagnosed with CVD risk factors for the first time. Conclusion Opportunistic screening for CVD risk factors is possible in community pharmacies and has the ability to detect previously undiagnosed risk factors. This community pharmacy based model could serve as a cost-effective approach to primary prevention of CVD.

Fatal Stroke in Pregnancy and the Puerperium.

Background and Purpose- Fatal stroke during pregnancy and the puerperium is rare. Pregnancy-related hypertension and vascular abnormalities underlie significant proportions of pregnancy-related stroke, but up to one-quarter are of no known cause. Methods- Case series of fatal pregnancy-related stroke. All cases where the cause of death was attributed to stroke during pregnancy/postpartum were retrieved from the National Coronial Information System database (January 1, 2009 to December 31, 2016). Results- Fourteen fatal strokes were identified, all hemorrhagic in origin. Underlying causes included pregnancy-related hypertension, rupture of vascular malformations, vasculitis, and cardiomyopathy. Conclusions- Fatal pregnancy-related stroke occurred secondary to hemorrhages of heterogeneous causes, including pregnancy-related hypertension and previously undiagnosed risk factors.

Stroke Risk and Risk Factors in Patients With Central Retinal Artery Occlusion

Central retinal artery occlusion (CRAO) is mechanistically similar to a stroke. Current guidelines recommend a standardized and systematic evaluation of risk factors for patients who have had a stroke. This study evaluates the yield of this evaluation in patients with CRAO and frequency of stroke in this population. Cohort study. We evaluated the diagnostic yield of an expedited inpatient evaluation of cerebrovascular risk factors in a cohort of patients presenting with an acute CRAO within the period from 2009 to 2017 at an academic hospital. Vital signs and laboratory parameters, including low-density lipoprotein level, hemoglobin A1c fraction, erythrocyte sedimentation rate, C-reactive protein level, platelet count, and troponin level, were collected. Echocardiography, cardiac telemetry, magnetic resonance imaging (MRI), and cerebrovascular imaging were obtained to screen for strokes and vascular risk factors. All new diagnoses and clinical treatments stemming from the inpatient evaluation were documented. Outcomes included the frequency of stroke on MRI, hypertensive emergency, critical carotid disease, or critical cardiac disease, including high-grade valvular lesions, new myocardial infarction, or arrhythmias. We documented the frequency of a change in medication, acute surgical intervention, or new diagnosis of systemic disease as a result of the inpatient evaluation. Finally, we evaluated the rate of symptomatic stroke, myocardial infarct, and death risk in the 24months after CRAO. In this cohort of 103 patients with CRAO and systematic risk factor screening, 36.7% of patients had critical carotid disease, 37.3% had coincident acute stroke, 33.0% presented with hypertensive emergency, 20.0% had a myocardial infarction or critical structural cardiac disease, 25% underwent an urgent surgical intervention, and 93% had a change in medication as a result of the inpatient evaluation. Patients with CRAO had similar risk of subsequent stroke, myocardial infarction, and death as patients with high-risk transient ischemic attack. Patients with CRAO are at significant risk of future cardiovascular and cerebrovascular events and often have undiagnosed risk factors that may be modifiable.

Abstract WMP52: Prevalence of Undiagnosed Risk Factors in Patients With First-Ever Ischemic Stroke

Introduction: Undiagnosed RF (URF) are a missed opportunity for primary stroke prevention. We sought to determine the prevalence of URF (RF newly diagnosed during inpatient evaluation) among first-ever ischemic stroke (IS) cases within a large, bi-racial population. Methods: Within the population-based Greater Cincinnati/Northern Kentucky (GCNK) stroke study catchment area of 1.3 million, we ascertained all hospitalized first-ever acute IS in 2010 among individuals ≥20 years old through screening of ICD-9 codes 430-436, with all cases verified by study physicians. We evaluated the prevalence of undiagnosed diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLD), and atrial fibrillation (AF) among all IS patients and those with each risk factor. We also evaluated the association between URF and insurance status (private, Medicaid/Medicare, or uninsured) for each RF using chi-square tests. Results: There were 1737 first-ever IS cases in the GCNK region in 2010 (55.8% female, 19.5% black, median age 71). Of these, 21% had at least one URF (Table), most commonly HLD (13%) or HTN (6%). Among patients with a given risk factor, 21% of those with HLD, 13% with AF, 9% with DM, and 7% with HTN were undiagnosed prior to inpatient evaluation for first-ever IS. Uninsured individuals (48%) were significantly more likely than those with private (22%) or government (20%) insurance to have at least one URF. Conclusions: One in five IS patients had at least one URF upon presentation with their first-ever stroke, and URF were more prevalent among uninsured individuals. Our data reinforce the importance of screening for URF during IS evaluation and highlight the importance of earlier detection of treatable RF. Future research should evaluate factors that may predict URF, such as insurance status, race, or sex.

Incorporation of suboptimal health status as a potential risk assessment for type II diabetes mellitus: a case-control study in a Ghanaian population.

Due to a paradigm shift in lifestyles, there is growing concern that type 2 diabetes mellitus (T2DM) will reach epidemic proportions in Ghana. However, specific characteristics of the disease are under explored in this region. More challenging are those yet to be diagnosed or who complain of poor health in the absence of a diagnosed disease-suboptimal health status (SHS). We conducted a study to examine various factors that characterise SHS and T2DM. Using a cross-sectional design, we recruited 264 people as controls and 241 T2DM patients from January to June 2016. The controls were categorised into high and low SHS based on how they rated on an SHS questionnaire-25 (SHSQ-25). Anthropometric and biochemical parameters: body mass index (BMI); blood pressure (BP); fasting plasma glucose (FPG); glycated haemoglobin (HbA1c); serum lipids [(total cholesterol, triglycerides (TG), high- and low-density lipoprotein-cholesterol (HDL-c and LDL-c)] were measured. The male to female ratio for T2DM and controls were 99:142 and 98:166, respectively, whilst the mean ages were 55.89 and 51.52years. Compared to controls, T2DM patients had higher FPG (8.96±4.18 vs. 6.08±1.79; p<0.0001) and HbA1c (8.23±2.09 vs. 5.45±1.00; p<0.0001). Primarily sedentary [adjusted odds ratio (aOR)=2.97 (1.38-6.39); p=0.034)], systolic blood pressure (SBP) (p=0.001) and diastolic blood pressure (DBP) (p=0.001) significantly correlated with high SHS. After adjusting for age and gender, central adiposity [aOR=1.74 (1.06-2.83); p=0.027)], underweight [aOR=5.82 (1.23-27.52); p=0.018)], high SBP [aOR=1.86 (1.14-3.05); p=0.012)], high DBP [aOR=2.39 (1.40-4.07); p=0.001)] and high TG [aOR=2.17 (1.09-4.33); p=0.029)] were found to be independent risk factors associated with high SHS. The management of T2DM in Ghana is suboptimal and undiagnosed risk factors remain prevalent. The SHSQ-25 can be translated and applied as a practical tool to screen at-risk individuals and hence prove useful for the purpose of predictive, preventive and personalised medicine.

Previously undiagnosed risk factors and medication nonadherence are prevalent in young adults with first-ever stroke.

The incidence of stroke and prevalence of traditional vascular risk factors (VRFs) in young adults (age<55y) are both increasing. Young patients tend to be unaware of their VRFs and to have lower medication adherence. We examined how age affects the prevalence of previously undiagnosed VRFs and the extent of medication nonadherence among stroke patients. Using Taiwan's National Health Insurance Research Database, we identified consecutive adult patients with first-ever stroke between 2000 and 2013. Diagnosis of hypertension, diabetes, and hyperlipidemia was ascertained using validated methods. We investigated (1) the proportion of patients who had undiagnosed VRFs within 3years before stroke and (2) the proportion of nonadherence to medications among patients who had a previously diagnosed VRF. Among stroke patients with hypertension (n=9722), diabetes (n=4751), and hyperlipidemia (n=4486), 24.9%, 20.8%, and 55.0%, respectively, had not been diagnosed before stroke, whereas 56.0%, 66.7%, and 32.5%, respectively, had been diagnosed at least 1year before stroke. The proportions of medication nonadherence were 71.5%, 64.3%, and 88.4% in patients with previously diagnosed hypertension, diabetes, and hyperlipidemia, respectively. In multivariate analysis, younger age was independently associated with undiagnosed hypertension before stroke as well as medication nonadherence in patients with previously diagnosed hypertension or diabetes. Previously undiagnosed hypertension and nonadherence to treatment of hypertension and diabetes were more prevalent in young adult patients with first-ever stroke in Taiwan. Interventions targeting young people to promote early detection and adequate control of VRFs should be encouraged.

Community screening for cardiovascular risk factors and levels of treatment in a rural Māori cohort

To document levels of cardiovascular disease (CVD), diagnosed and undiagnosed risk factors and clinical management of CVD risk in rural Māori. Participants (aged 20-64 years), of Māori descent and self-report, were randomly sampled to be representative of age and gender profiles of the community. Screening clinics included health questionnaires, fasting blood samples, blood pressure and anthropometric measures. Data were obtained from participants' primary care physicians regarding prior diagnoses and current clinical management. New Zealand Cardiovascular Guidelines were used to identify new diagnoses at screening and Bestpractice electronic-decision support software used to estimate 5-year CVD risk. Mean age of participants (n=252) was 45.7 ± 0.7, 8% reported a history of cardiac disease, 43% were current smokers, 22% had a healthy BMI, 30% were overweight and 48% obese. Hypertension was previously diagnosed in 25%; an additional 22% were hypertensive at screening. Dyslipidaemia was previously diagnosed in 14% and an additional 43% were dyslipidaemic at screening. Type-2 diabetes was previously diagnosed in 11%. Glycaemic control was achieved in only 21% of those with type-2 diabetes. Blood pressure and cholesterol were above recommended targets in more than half of those with diagnosed CVD risk factors. High levels of diagnosed and undiagnosed CVD risk factors, especially hypertension, dyslipidaemia and diabetes were identified in this rural Māori community. There is a need for opportunistic screening and intensified management of CVD risk factors in this indigenous population group.