Most important advances in preventive cardiology during this past decade: Viewpoint from the American Society for Preventive Cardiology.

The rapidly expanding field of preventive cardiology has brought with it several major advances in the past decade. Changes in guidelines for cholesterol mangement focusing on the identification of "statin eligible groups" and removal of actual low-density lipoprotein cholesterol (LDL-C) targets, in particular, as well as lower targets for blood pressure in updated hypertension guidelines, have made a major impact on healthcare. The availability of the sodium glucose transport protein-2 (SGLT2) inhibitors and glucagon-like peptide -1 receptor antagonists (GLP1-RA) for managing diabetes have shifted our focus in diabetes care beyond glucose lowering to addressing cardiovascular risk reduction. While many prior trials of fish oil therapy have failed to show benefit, the recent Reduction of Cardiovascular Events With EPA - Intervention Trial (REDUCE-IT) testing the efficacy of icosapent ethyl has shown dramatic benefit in further addressing residual atherosclerotic cardiovascular disease (ASCVD) risk beyond statin therapy not only in those with known ASCVD, but also in diabetic patients with multiple risk factors. The past decade also ushered in confirmation of the inflammation hypothesis of atherosclerosis with the Canakinumab Anti-Inflammatory Thrombosis Outcomes Study (CANTOS) using canakinumab, despite the fact the therapy was not approved by the Food and Drug Administration (FDA) for cardiovascular risk reduction. Also, to improve our understanding of heart disease in women, the emergence of novel concepts of ischemia or myocardial infarction in those with normal or nonobstructive atherosclerotic disease has been a major advance. Moreover, the past decade brought the emergence of proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibody therapy and the cardiovascular risk reduction benefits seen in the Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk (FOURIER) and Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab (ODYSSEY OUTCOMES) trials, providing further evidence-based therapy for additional reduction of ASCVD risk beyond statin therapy. The PCSK9 monoclonal antibodies have facilitated the attainment of LDL-C levels never previously thought possible. Finally with the mRNA interference therapy inclisiran in development, we may soon have a "vaccine-like" approach for addressing dyslipidemia and atherosclerosis.

Change in newly diagnosed Graves' disease phenotype between the twentieth and the twenty-first centuries: meta-analysis and meta-regression.

PURPOSE: According to a few recent studies, the clinical phenotype of Graves' disease (GD) at onset is becoming milder in recent years, in terms of prevalence and severity of hyperthyroidism, goiter and overt eye disease. The aim of this study was to assess the change in GD phenotype across the late twentieth and the early twenty-first centuries. MATERIALS AND METHODS: We carried out a systematic search of studies published between 1/1/1980 and 12/31/2017 describing naïve GD patients at diagnosis. We collected epidemiological, clinical, biochemical and serological data reported in the selected studies, and (1) conducted a single-arm meta-analysis to compare clinical and biochemical characteristics of naïve GD patients before and after year 2000 and (2) performed a meta-regression to identify the trend of the observed clinical presentations. RESULTS: Eighty selected articles were related to the period before the year 2000, 30 to the years 2000-2017. According to demographics, the two defined populations were homogeneous at meta-analysis: overall estimated female prevalence was 81% [95% CI 79-82], mean estimated age of the entire population was 39.8 years [95% CI 38.4-41.1], with no significant differences between pre- and post-2000 groups (p > 0.05). The overall estimated prevalence of smokers was 40% [95% CI 33-46], with no significant difference between the two groups (p > 0.05). Mean estimated free thyroxine (FT4) and free triiodothyronine (FT3) levels at diagnosis were higher in the pre-2000 group: 4.7 ng/dl [95% CI 4.5-4.9] for FT4 and 14.2 pg/ml [95% CI 13.3-15.1] for FT3, as compared to the post-2000 group: 3.9 ng/dl [95% CI 3.6-4.2] for FT4 and 12.1 pg/ml [95% CI 11.0-13.3] for FT3 (all p < 0.01). Goiter estimated prevalence was higher in the pre-2000 group, 87% [95% CI 84-90], than in the post-2000 group, 56% [95% CI 45-67]. Estimated prevalence for Graves' Orbitopathy (GO) was 34% [95% CI 27-41] in the pre-2000 group and 25% [95% CI 19-30] in the post-2000 group (p = 0.03). Accordingly, meta-regression adjusted for covariates showed an average annual reduction of FT4 (- 0.040 ± 0.008 ng/dl, p < 0.0001), FT3 (- 0.316 ± 0.019 pg/ml, p < 0.0001), goiter prevalence (- 0.023 ± 0.008%, p = 0.006), and goiter size (- 0.560 ± 0.031 ml, p < 0.0001). CONCLUSIONS: Our meta-analysis and meta-regression confirmed that GD phenotype at diagnosis is nowadays milder than in the past; we hypothesize that conceivable factors involved in this change are iodoprophylaxis, worldwide decrease in smoking habits, larger use of contraceptive pill and micronutrient supplementation, as well as earlier diagnosis and management.

Advance for Cardiovascular Health in China.

As the most populous country worldwide, China has ≈ 290 million patients with cardiovascular diseases (CVDs), representing the leading cause of death in Chinese population. The morbidity and mortality of CVDs are continuously rising. Here, we will first summarize the recent advance in the management of CVDs such as coronary arterial disease, arrhythmia, and heart failure in China. In particular, we will introduce the development of chest pain centers and indicate the novel techniques and methods applied for the management of CVDs. Then, we will discuss and point out the importance of improving the clinical and basic research for Traditional Chinese medicine in the treatment of CVDs. Finally, we will emphasize the efforts made to promote cardiac rehabilitation and cardiovascular prevention system in China. We are striving to establish a practical prevention-treatment-rehabilitation system and looking forward to a bright future with reduced morbidity and mortality from CVDs in China.

[Fragmented Heterogeneity as Leitmotiv of Public Health Practice in Germany? - Plenary Lecture at the Forum Future Public Health, Berlin 2016]. / Zersplitterte Heterogenität als Leitmotiv der Public-Health-Praxis in Deutschland?

Heterogeneity is a constitutive element of public health practice in Germany. The Public Health Service as a traditional field of public health is - like the currently booming health promotion and disease prevention landscape - faced with major challenges in its attempt to create more health for vulnerable population groups. Additional expenditure on small-scale prevention concepts and interventions and vastly differentiated job profiles are not per se beneficial to achieve this aim. The future of public health practice lies rather in the development of integrated communal concepts of action such as prevention chains.

Use of m-Health Technology for Preventive Interventions to Tackle Cardiometabolic Conditions and Other Non-Communicable Diseases in Latin America- Challenges and Opportunities.

In Latin America, cardiovascular disease (CVD) mortality rates will increase by an estimated 145% from 1990 to 2020. Several challenges related to social strains, inadequate public health infrastructure, and underfinanced healthcare systems make cardiometabolic conditions and non-communicable diseases (NCDs) difficult to prevent and control. On the other hand, the region has high mobile phone coverage, making mobile health (mHealth) particularly attractive to complement and improve strategies toward prevention and control of these conditions in low- and middle-income countries. In this article, we describe the experiences of three Centers of Excellence for prevention and control of NCDs sponsored by the National Heart, Lung, and Blood Institute with mHealth interventions to address cardiometabolic conditions and other NCDs in Argentina, Guatemala, and Peru. The nine studies described involved the design and implementation of complex interventions targeting providers, patients and the public. The rationale, design of the interventions, and evaluation of processes and outcomes of each of these studies are described, together with barriers and enabling factors associated with their implementation.

Technology for Diagnosis, Treatment, and Prevention of Cardiometabolic Disease in India.

Cardiometabolic diseases (CMD) are a major cause of mortality, morbidity and disability worldwide. Among Indians, CMD onset is at a much younger age and is prevalent in all sections of the society. Prevention, control and management of CMD and its risk factors is a major public health challenge, and alternative approaches need to be explored and integrated into public health programs. Advancements in the fields of computers, electronics, telecommunication and medicine have resulted in the rapid development of health-related technology. In this paper we provide an overview of the major technological advances in diagnosis, treatment and prevention within the field of CMD in the last few decades. This non-exhaustive review focuses on the most promising technologies that the authors feel might be of relevance in the Indian context. Some of the techniques detailed include advances in imaging and mobile phone technology, surgical techniques, electronic health records, Nano medicine, telemedicine and decision support systems.

Fundamentos para un nuevo paradigma en el abordaje de la prevención de enfermedades / No disponible

No disponible

[Cardiovascular Diseases in the Context of Russia's Long-Term Socio-Economic Development Priorities].

The paper presents results of a comprehensive analysis of the cardiovascular diseases (CVD) situation, both in the global and Russian contexts. It introduces original data illustrating the declining mortality rate from CVD, and the diminishing contribution of these diseases to overall mortality rate--globally and, to a larger extent, in developed countries. The paper also analyses the reasons for continuing CVD epidemic in Russia. Based on factual evidence, it argues that those include insufficient expenditures on treating CVD patients, and critically inadequate funding of prevention programmes. Unsatisfactory use of these funds to subsidise Russian regions (without taking into account their actual needs determined by the CVD mortality rate) only makes the problem worse. Through modelling, "average" efficiency of the Russian health care system in reducing CVD mortality was revealed. The paper describes various scenarios for future development of the Russian CVD situation. In the context of innovation-based scenario, the advantages of technologicalforesight are analysed; specifically, the authors summarise major S & T development trends in the health sector (using data of the Russian S & T Foresight 2030), which could significantly contribute to stopping the CVD epidemic in Russia.

Mercy health promoter: a paradigm for just health care.

The foreign-born population in the United States, according to the "Current Populations Report" published in 2010, is estimated to exceed 39.9 million, or "12.9 percent of the U.S. population." The increase in foreign-born peoples and their need for health care is a complicated issue facing many cities, health systems and hospitals. Over the course of the past few years Mercy Hospital of Philadelphia has treated increasing numbers of foreign-born African patients. The majority have been presenting in the late stages of disease. The increase of foreign-born documented and undocumented African patients seen by Mercy Hospitals seems to reflect a foreign-born population "boom" in Philadelphia over the past decade. To meet the needs of this growing population, the Mercy Hospital Task Force on African Immigration and the Institute of Catholic Bioethics at Saint Joseph's University designed a program that centers on the third world concept of "Health Promoters." This program is intended to serve as one possible solution for hospitals to cost-effectively manage the care of this growing percentage of foreign-born individuals in the population. This notion of a "Health Promoter" program in Philadelphia is unique as one of those rare occasions when a third world concept is being utilized in a first world environment. It is also unique in that it can serve as a paradigm for other hospitals in the United States to meet the growing need of health care for the undocumented population. As of November 2012 the Mercy Hospital of Philadelphia clinic became operative for patients who were referred from the Health Promoter clinics. To date, a total of forty-two patients have actively participated in the screenings, sixteen of which have been referred to Mercy Hospital of Philadelphia clinic for further evaluation. More than 75% of patient referrals were a result of high blood pressure. According to the American Medical Association, readings of 140-159 mmHg and above are indicative of stage 1 hypertension. Among those who presented at the Health Promoter screenings the mean systolic pressure for males was 140 mmHg and for females was 140.48 mmHg.

[Implementing population-based integrated care for a region: a work-in-progress report on the project "Gesundes Kinzigtal"]. / Integrierte regionale Versorgung in der Praxis: Ein Werkstattbericht aus dem "Gesunden Kinzigtal"

The regional integrated care model "Gesundes Kinzigtal" pursues the idea of integrated health care with special focus on increasing the health gain of the served population. Physicians (general practitioners) and psychotherapists, physiotherapists, hospitals, nursing services, non-profit associations, fitness centers, and health insurance companies work closely together with a regional management company and its programs on prevention and care coordination and enhancement. The 10 year-project is run by a company that was founded by the physician network "MQNK" and "OptiMedis AG", a corporation with public health background specialising in integrated health care. The aim of this project is to enhance prevention and quality of health care for a whole region in a sustainable way, and to decrease costs of care. The article describes the special funding model of the project, the engagement of patients, and the different health and prevention programmes. The programmes and projects are developed, implemented, and evaluated by multidisciplinary teams.

Evaluation and management of bone health in children with epilepsy on long-term antiepileptic drugs: United Kingdom survey of paediatric neurologists.

BACKGROUND AND OBJECTIVE: Current evidence indicates long-term use of antiepileptic drugs (AEDs) is associated with impaired childhood bone health. The objective of this study was to ascertain the current clinical practice of paediatric neurologists managing children with epilepsy on long-term (>2 years) AED therapy, particularly against the UK Medicines and Healthcare products Regulatory Agency (MHRA) current recommendation of vitamin D supplementation in patients on long-term AEDs at-risk of impaired bone health. METHODS: An internet-based survey of UK paediatric neurologists who routinely see children with epilepsy (n = 95) covered clinicians' epilepsy case-load and reflection on their current clinical practice with estimation of the frequency with which they considered various bone health issues. Responses were graded as 'frequent'(≥50%), 'sometimes'(25%-50%) and 'infrequent'(<25%). RESULTS: Overall response rate was 72/95 (76%). 3% frequently recommend prophylactic calcium and vitamin D supplementation, 6% frequently perform bone screening investigations, 7% frequently give bone health advice and 10% frequently enquire about skeletal risk factors. Clinical practices were not associated with epilepsy caseload (p-values 0.44-1). 84% infrequently performed bone health screening investigations. 54% of respondents indicated that, if performed, 100% would undertake bone profile, 64% 25(OH) Vitamin D, 18% PTH, 49% dual energy X-ray absorptiometry (DEXA) scan and 13% bone X-ray. CONCLUSIONS: The majority of paediatric neurologists do not routinely consider bone health related issues in children on long-term AEDs. Greater emphasis should be placed on vitamin D supplementation in these children.

Comprehensive approach to fall prevention on a national level: New Zealand.

Individual assessment and treatment are important for older people at high risk of falls and injury. But falls are common. The problem cannot be addressed solely on an individual patient, individual clinician basis. Fall prevention programs that have broad coverage, good uptake and adherence, and can be seen to maintain independent living benefit individuals and help control health service costs. Two such programs have been successfully introduced in New Zealand: the home-based Otago Exercise Programme and tai chi classes. The difficulty now is in maintaining the nationwide commitment to these preventive measures.