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1.
Herz ; 2022 Jan 14.
Article in German | MEDLINE | ID: mdl-35029736

ABSTRACT

This article summarizes the innovations and most important points of the recently published and updated ESC guidelines 2021 on the prevention of cardiovascular diseases. Developments in risk stratification and further developments with respect to targets and options for the treatment of risk factors necessitated an update of the guidelines from 2016. The innovations incorporate a staged and individualized approach to the prevention targets, an implementation of the systematic coronary risk evaluation 2 (SCORE 2 update) and the SCORE 2­older persons (OP) systems on risk stratification, including age-dependent estimations for young (<50 years old) and older people (≥70 years old) as well as for patients with diabetes mellitus and atherosclerotic cardiovascular diseases. Furthermore, specific recommendations are given for coronary heart disease, heart failure and chronic kidney insufficiency. In addition to recommendations on individualized treatment, the relevance of cardiovascular prevention at the population level, including environmental protection is underlined.

2.
Korean Circ J ; 52(1): 1-33, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34989192

ABSTRACT

In primary prevention for cardiovascular diseases, there are significant barriers to adherence including freedom from symptoms, long latency for therapeutic benefits, life-long duration of treatment, and need for combined lifestyle changes. However, to implement more systematic approaches, the focus on adherence improvement needs to be shifted away from patient factors to the effects of the treatment team and healthcare system. In addition to conventional educational approaches, more patient-oriented approaches such as patient-centered clinical communication skills, counseling using motivational strategies, decision-making by patient empowerment, and a multi-disciplinary team approach should be developed and implemented. Patients should be involved in a program of self-monitoring, self-management, and active counseling. Because most effective interventions on adherence improvement demand greater resources, the health care system and educational or training system of physicians and healthcare staff need to be supported for systematic improvement.

3.
Methodist Debakey Cardiovasc J ; 17(4): 79-86, 2021.
Article in English | MEDLINE | ID: mdl-34824684

ABSTRACT

Compelling results from clinical trials supporting intensive risk-reduction therapies to reduce associated morbidity and mortality in patients with established atherosclerotic cardiovascular disease (ASCVD) provided the impetus for medical societies to integrate these evidence-based results into clinical practice guidelines. Current evidence, however, points toward gaps in the management of patients with established ASCVD. Some of these gaps are related to barriers to guideline implementation, and strategies are needed to overcome these barriers. In this review, we propose a framework incorporating comprehensive tools for enhanced guideline-directed management in secondary prevention of ASCVD. This aid includes a 13-point checklist with supporting educational and system-based tools for effective evidence-based pharmacological and nonpharmacological care. This proposed tool targets primary care providers and cardiologists in the outpatient setting who provide direct medical care for patients with established ASCVD.


Subject(s)
Atherosclerosis , Cardiovascular Diseases , Atherosclerosis/diagnosis , Atherosclerosis/prevention & control , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Checklist , Humans , Outpatients , Secondary Prevention
4.
Ann Palliat Med ; 10(10): 10425-10433, 2021 10.
Article in English | MEDLINE | ID: mdl-34763488

ABSTRACT

BACKGROUND: The purpose of this study was to compare the clinical efficacy and safety of post-treatment nursing intervention (NI) with routine nursing care (RC) of patients with cardiovascular disease (CVD). METHODS: PubMed, EMBASE, the Cochrane Library, the China National Knowledge database, and other databases were used to comprehensively evaluate post-treatment NI versus RC for patients with CVD. Review Manager 5.0 was used to assess the impact of the results in the selected articles. Forest map analysis, sensitivity analysis, and bias analysis were performed on the collected data. RESULTS: In total, eight studies met the inclusion criteria. The systolic blood pressure in the RC group was higher than that in the NI group (MD =-3.72, 95% CI: -4.64 to -2.80, P<0.00001, I2=92%). The diastolic blood pressure in the NI group was lower than that in the RC group (MD =-5.36, 95% CI: -6.55 to -4.16, P<0.00001, I2=96%). There was a significant difference in fasting blood glucose levels between the NI group and the RC group (MD =-5.00, 95% CI: -9.47 to -0.52, P=0.03, I2=88%). The total cholesterol in the NI group was lower than that in the RC group (MD =-9.99, 95% CI: -14.52 to -5.45, P<0.0001, I2=85%). The triglyceride value of the NI group was lower than that of the RC group, with significant heterogeneity (MD =-24.24, 95% CI: -26.25 to -22.23, P<0.0001, I2=96%). A sensitivity analysis and funnel plot indicated that the study was reliable and publication bias was limited. DISCUSSION: The results showed that the efficacy and safety of NI were superior to RC after treatment of CVD. NI is worth popularizing.


Subject(s)
Cardiovascular Diseases , Blood Pressure , Humans , Life Style , Primary Prevention , Triglycerides
5.
Public Health ; 200: 59-70, 2021 Nov.
Article in English | MEDLINE | ID: mdl-34700187

ABSTRACT

OBJECTIVES: This study aimed to summarise the effect of community-based intervention programmes on the prevention of cardiovascular disease (CVD) by reducing cardiometabolic risk factors. STUDY DESIGN: This was a systematic review and meta-analysis. METHODS: A systematic search in the PubMed database and screening of reference lists aimed to identify community-based CVD prevention programmes from inception up to April 2020. The mean differences and standard deviations for CVD risk factors, including blood pressure, lipid profile, blood glucose and body weight indices, were extracted and pooled using a random effects model. RESULTS: Screening of 11,889 titles/abstracts and full texts resulted in 48 studies being included in this review. The meta-analysis showed that community-based programmes have led to considerable decreases in systolic blood pressure (weighted mean difference [WMD] = -2.90 mm Hg, 95% confidence interval [95% CI]: -3.63, -2.16), diastolic blood pressure (WMD = -2.21 mm Hg, 95% CI: -3.12, -1.29), serum levels of low-density lipoprotein cholesterol (LDL-C; WMD = -8.88 mg/dl, 95% CI: -12.84, -4.92), triglycerides (WMD = -8.40 mg/dl, 95% CI: -12.10, -4.70), total cholesterol (WMD = -2.96 mg/dl, 95% CI: -3.10, -2.81) and fasting blood glucose (WMD = -2.06 mg/dl, 95% CI: -3.02, -1.10). A moderate decrease in body weight was also found with community-based CVD prevention programmes. However, community-based CVD prevention programmes were not associated with any significant changes in serum levels of high-density lipoprotein. CONCLUSIONS: The present study indicates that community-based strategies have successfully led to an improvement in CVD risk factors, particularly by reducing blood pressure, serum levels of LDL-C and triglycerides, obesity indices and blood glucose. The impact of these programmes on CVD is modified by the type of intervention and by different cultural and physical environments.


Subject(s)
Cardiovascular Diseases , Blood Pressure , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Cholesterol, LDL , Humans , Lipids , Risk Factors , Triglycerides
6.
Age Ageing ; 2021 Oct 26.
Article in English | MEDLINE | ID: mdl-34718378

ABSTRACT

BACKGROUND: translation of the available evidence concerning primary cardiovascular prevention into clinical guidance for the heterogeneous population of older adults is challenging. With this review, we aimed to give an overview of the thresholds and targets of antihypertensive drug therapy for older adults in currently used guidelines on primary cardiovascular prevention. Secondly, we evaluated the relationship between the advised targets and guideline characteristics, including guideline quality. METHODS: we systematically searched PubMed, Embase, Emcare and five guideline databases. We selected guidelines with (i) numerical thresholds for the initiation or target values of antihypertensive drug therapy in context of primary prevention (January 2008-July 2020) and (ii) specific advice concerning antihypertensive drug therapy in older adults. We extracted the recommendations and appraised the quality of included guidelines with the AGREE II instrument. RESULTS: thirty-four guidelines provided recommendations concerning antihypertensive drug therapy in older adults. Twenty advised a higher target of systolic blood pressure (SBP) for octogenarians in comparison with the general population and three advised a lower target. Over half of the guidelines (n = 18) recommended to target a SBP <150 mmHg in the oldest old, while four endorsed targets of SBP lower than 130 or 120 mmHg. Although many guidelines acknowledged frailty, only three gave specific thresholds and targets. Guideline characteristics, including methodological quality, were not related with the recommended targets. CONCLUSION: the ongoing debate concerning targets of antihypertensive treatment in older adults, is reflected in an inconsistency of recommendations across guidelines. Recommended targets are largely set on chronological rather than biological age.

7.
Nutrients ; 13(10)2021 Sep 28.
Article in English | MEDLINE | ID: mdl-34684423

ABSTRACT

INTRODUCTION: The 2019 American College of Cardiology/American Heart Association (ACC/AHA) Prevention Guidelines emphasize reduction in dietary sodium, cholesterol, refined carbohydrates, saturated fat and sweetened beverages. We hypothesized that implementing this dietary pattern could reduce cardiovascular risk in a cohort of volunteers in an urban African American (AA) community church, during a 5-week ACC/AHA-styled nutrition intervention, assessed by measuring risk markers and adherence, called HEART-LENS (Helping Everyone Assess Risk Today Lenten Nutrition Study). METHODS: The study population consisted of 53 volunteers who committed to eat only home-delivered non-dairy vegetarian meals (average daily calories 1155, sodium 1285 mg, cholesterol 0 mg; 58% carbohydrate, 17% protein, 25% fat). Body mass index (BMI) and fasting serum markers of cardiometabolic and risk factors were measured, with collection of any dietary deviation. RESULTS: Of 53 volunteers, 44 (mean age 60.2 years, 37 women) completed the trial (88%); 1 was intolerant of the meals, 1 completed both blood draws but did not eat delivered food, and 7 did not return for the tests. Adherence to the diet was reported at 93% in the remaining 44. Cardiometabolic risk factors improved significantly, highlighted by a marked reduction in serum insulin (-43%, p = 0.000), hemoglobin A1c (6.2% to 6.0%, p = 0.000), weight and BMI (-10.2 lbs, 33 to 31 kg/m2, p = 0.000), but with small reductions of fasting glucose (-6%, p = 0.405) and triglyceride levels (-4%, p = 0.408). Additionally, improved were trimethylamine-N-oxide (5.1 to 2.9 µmol/L, -43%, p = 0.001), small dense low-density lipoprotein cholesterol (LDL) (24.2 to 19.1 mg/dL, -21%, p = 0.000), LDL (121 to 104 mg/dL, -14%, p = 0.000), total cholesterol (TC) (190 to 168 mg/dL, -12%, p = 0.000), and lipoprotein (a) (LP(a)) (56 to 51 mg/dL, -11%, p = 0.000); high sensitivity C-reactive protein (hs-CRP) was widely variable but reduced by 16% (2.5 to 2.1 ng/mL, p = NS) in 40 subjects without inflammatory conditions. Soluble urokinase plasminogen activator (suPAR) levels were not significantly changed. The ACC/AHA pooled cohort atherosclerotic cardiovascular disease (ASCVD) risk scores were calculated for 41 and 36 volunteers, respectively, as the ASCVD risk could not be calculated for 3 subjects with low lipid fractions at baseline and 8 subjects after intervention (p = 0.184). In the remaining subjects, the mean 10-year risk was reduced from 10.8 to 8.7%, a 19.4% decrease (p = 0.006), primarily due to a 14% decrease in low-density lipoprotein cholesterol and a 10 mm Hg (6%) reduction in systolic blood pressure. CONCLUSIONS: In this prospective 5-week non-dairy vegetarian nutrition intervention with good adherence consistent with the 2019 ACC/AHA Guidelines in an at-risk AA population, markers of cardiovascular risk, cardiometabolism, and body weight were significantly reduced, including obesity, low-density lipoprotein cholesterol (LDLc) density, LP(a), inflammation, and ingestion of substrates mediating production of trimethylamine-N-oxide (TMAO). Albeit reduced, hs-CRP and suPAR, were not lowered consistently. This induced a significant decrease in the 10-year ASCVD risk in this AA cohort. If widely adopted, this could dramatically reduce and possibly eradicate, the racial disparity in ASCVD events and mortality, if 19% of the 21% increase is eliminated by this lifestyle change.


Subject(s)
African Americans , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Early Intervention, Educational , Early Medical Intervention , Eating , Aged , Biomarkers , Cardiovascular Diseases/etiology , Diet , Female , Guidelines as Topic , Heart Disease Risk Factors , Humans , Male , Middle Aged , Primary Prevention/methods , United States/epidemiology
8.
Public Health ; 198: 340-347, 2021 Sep.
Article in English | MEDLINE | ID: mdl-34509859

ABSTRACT

OBJECTIVE: This study aimed to evaluate a national vitamin D supplementation program's cost-effectiveness among Iranian adolescents to prevent cardiovascular diseases (CVDs) in adulthood. STUDY DESIGN: A cost-effectiveness analytical study. METHODS: A decision tree model was adopted to evaluate the cost per quality-adjusted life-year (QALY) of monthly intake of nine pearls of 50,000 IU vitamin D for nine months to prevent CVD a one-year horizon compared to no intervention. The analysis was conducted in Iranian adolescents in first or second high school grades of 47 climatically different Iran regions. RESULTS: Our analytical analysis estimated the 1090$ cost per QALY gained of the monthly intake of 50,000 IU vitamin D for nine months among adolescents over a one-year horizon. Based on the incremental cost-effectiveness ratio (ICER) threshold of 1032-2666, vitamin D supplementation was cost-effective for adolescents to prevent adulthood CVD. It means that vitamin D supplementation costs were substantially less than the costs of CVD treatments compared to the no intervention. CONCLUSIONS: Based on these findings, the national program of vitamin D supplementation in adolescents would be cost effective to prevent CVD development in adulthood. From an economic perspective, vitamin D supplementation, especially in adolescents with vitamin D deficiency, would be administrated.


Subject(s)
Cardiovascular Diseases , Vitamin D , Adolescent , Adult , Cardiovascular Diseases/prevention & control , Cost-Benefit Analysis , Dietary Supplements , Humans , Iran , Quality-Adjusted Life Years
10.
Circ Cardiovasc Qual Outcomes ; 14(9): e007183, 2021 09.
Article in English | MEDLINE | ID: mdl-34546786

ABSTRACT

BACKGROUND: Despite using identical evidence to support practice guidelines for lipid-lowering treatment in primary prevention of cardiovascular disease (CVD), it is unclear to what extent the 2018 American Heart Association/American College of Cardiology/Multisociety, 2016 US Preventive Services Task Force (USPSTF), 2020 Department of Veterans Affairs/Department of Defense, 2021 Canadian Cardiovascular Society, and 2019 European Society of Cardiology/European Atherosclerosis Society guidelines differ in grading and assigning levels of evidence and classes of recommendations (LOE/class) at a population level. METHODS: We included 7262 participants, aged 45 to 75 years, without history of CVD from the prospective population-based Rotterdam Study. Per guideline, proportions of the population recommended statin therapy by LOE/class, sensitivity and specificity for CVD events, and numbers needed to treat at 10 years were calculated. RESULTS: Mean age was 61.1 (SD 6.9) years; 58.2% were women. American Heart Association/American College of Cardiology/Multisociety, USPSTF, Department of Veterans Affairs/Department of Defense, Canadian Cardiovascular Society, and European Society of Cardiology/European Atherosclerosis Society strongly recommended statin initiation in respective 59.4%, 40.2%, 45.2%, 73.7%, and 42.1% of the eligible population based on high-quality evidence. Sensitivity for CVD events for treatment recommendations supported with strong LOE/class was 86.3% for American Heart Association/American College of Cardiology/Multisociety (IA or IB), 69.4% for USPSTF (USPSTF-B), 74.5% for Department of Veterans Affairs/Department of Defense (strong for), 93.3% for Canadian Cardiovascular Society (strong), and 66.6% for European Society of Cardiology/European Atherosclerosis Society (IA). Specificity was highest for the USPSTF at 45.3% and lowest for European Society of Cardiology/European Atherosclerosis Society at 10.0%. Estimated numbers needed to treat at 10 years for those with the strongest LOE/class were ranging from 20 to 26 for moderate-intensity and 12 to 16 for high-intensity statins. CONCLUSIONS: Sensitivity, specificity, and numbers needed to treat at 10 years for assigned LOE/class varied greatly among 5 CVD prevention guidelines. The level of variability seems to be driven by differences in how the evidence is graded and translated into LOE/class underlying the treatment recommendations by different professional societies. Efforts towards harmonizing evidence grading systems for clinical guidelines in primary prevention of CVD may reduce ambiguity and reinforce updated evidence-based recommendations.


Subject(s)
Atherosclerosis , Cardiology , Cardiovascular Diseases , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Veterans , American Heart Association , Atherosclerosis/diagnosis , Atherosclerosis/drug therapy , Atherosclerosis/epidemiology , Canada , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Female , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Middle Aged , Primary Prevention , Prospective Studies , United States/epidemiology
11.
Nutrients ; 13(9)2021 Aug 25.
Article in English | MEDLINE | ID: mdl-34578814

ABSTRACT

Dietary counselling has been identified as one of the nutritional strategies to alleviate cardiometabolic health conditions. Its effectiveness however may vary due to factors such as intensity level and provider while this has not been comprehensively studied. This systematic review and meta-analysis aimed to assess the effects of dietary counselling on the cardiometabolic health in middle-aged and older adults and the sub-group analyses with dietary counselling intensity and the provider were also assessed. Four databases including PubMed, CINAHL Plus with Full Text, Cochrane Library and EMBASE were systematically searched. Data from 22 randomised controlled trials (RCTs) were compiled and those from 9 RCTs were utilised for meta-analysis. Dietary counselling lowered total cholesterol (TC) and fasting blood sugar (FBS) but had no impact on triglycerides (TG) and low-density lipoprotein (LDL). Sub-group analysis revealed significant lowering effect of high intensity dietary counselling for TG (weighted mean difference (WMD): -0.24 mmol/L, 95% confidence intervals (CIs): -0.40 to -0.09), TC (WMD: -0.31 mmol/L, 95% CIs: -0.49 to -0.13), LDL (WMD: -0.39 mmol/L, 95% CIs: -0.61 to -0.16) and FBS (WMD: -0.69 mmol/L, 95% CIs: -0.99 to -0.40) while medium or low intensity dietary counselling did not show favouring effects. Counselling provider showed differential responses on cardiometabolic health between dietitian and all other groups. The findings from this systematic review and meta-analysis suggest that dietary counselling is a beneficial dietary strategy to improve cardiometabolic health in middle-aged and older adults with the emphasis on the counselling intensity.


Subject(s)
Cardiovascular Diseases/prevention & control , Counseling/methods , Diet, Healthy/methods , Health Promotion/methods , Metabolic Diseases/prevention & control , Aged , Counseling/statistics & numerical data , Female , Health Promotion/statistics & numerical data , Humans , Male , Middle Aged
12.
Nutrients ; 13(9)2021 Aug 30.
Article in English | MEDLINE | ID: mdl-34578911

ABSTRACT

Traditional regional diets are considered as sustainable dietary patterns, while many have been examined with regard to their health benefits. The aim of the present systematic review was to aggerate all evidence on the physiological effects of regional diets among adults at high risk for cardiovascular disease (CVD). Three databases were searched for randomized controlled trials (RCTs) implementing any regional diet (Mediterranean (MedD), Persian, Southern European Atlantic, Japanese, Chinese, new Nordic, or other) while examining cardiovascular risk factors among adults at increased risk. Primary outcomes included anthropometric indices and secondary outcomes involved blood lipid concentrations, glucose metabolism, inflammation and other markers of CVD progression. Twenty RCTs fulfilled the study's criteria and were included in the qualitative synthesis, with the majority implementing a MedD. Adherence to most of the regional diets induced a reduction in the BW and anthropometric indices of the participants. The majority of RCTs with blood pressure endpoints failed to note a significant reduction in the intervention compared to the comparator arm, with the exception of some new Nordic and MedD ones. Despite the interventions, inflammation markers remained unchanged except for CRP, which was reduced in the intervention groups of one new Nordic, the older Japanese, and the Atlantic diet RCTs. With regard to blood lipids, regional diet interventions either failed to induce significant differences or improved selective blood lipid markers of the participants adhering to the experimental regional diet arms. Finally, in the majority of RCTs glucose metabolism failed to improve. The body of evidence examining the effect of regional dietary patterns on CVD risk among high-risk populations, while employing an RCT design, appears to be limited, with the exception of the MedD. More research is required to advocate for the efficacy of most regional diets with regard to CVD.


Subject(s)
Cardiovascular Diseases/prevention & control , Diet/methods , Randomized Controlled Trials as Topic/statistics & numerical data , Diet, Mediterranean/statistics & numerical data , Europe , Humans , Japan , Mexico , Persia , Scandinavian and Nordic Countries
13.
Glob Heart ; 16(1): 55, 2021.
Article in English | MEDLINE | ID: mdl-34381676

ABSTRACT

Background: Cardiovascular mortality is decreasing but remains the leading cause of death world-wide. Respiratory infections such as influenza significantly contribute to morbidity and mortality in patients with cardiovascular disease. Despite of proven benefits, influenza vaccination is not fully implemented, especially in Latin America. Objective: The aim was to develop a regional consensus with recommendations regarding influenza vaccination and cardiovascular disease. Methods: A multidisciplinary team composed by experts in the management and prevention of cardiovascular disease from the Americas, convened by the Inter-American Society of Cardiology (IASC) and the World Heart Federation (WHF), participated in the process and the formulation of statements. The modified RAND/UCLA methodology was used. This document was supported by a grant from the WHF. Results: An extensive literature search was divided into seven questions, and a total of 23 conclusions and 29 recommendations were achieved. There was no disagreement among experts in the conclusions or recommendations. Conclusions: There is a strong correlation between influenza and cardiovascular events. Influenza vaccination is not only safe and a proven strategy to reduce cardiovascular events, but it is also cost saving. We found several barriers for its global implementation and potential strategies to overcome them.


Subject(s)
Cardiology , Cardiovascular Diseases , Influenza, Human , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Consensus , Humans , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Latin America/epidemiology , United States , Vaccination
14.
Ann Thorac Surg ; 112(5): 1707-1715, 2021 11.
Article in English | MEDLINE | ID: mdl-34370980

ABSTRACT

EXECUTIVE SUMMARY: Cardiothoracic surgical patients are at risk of increased coronavirus disease severity. Several important factors influence the administration of the coronavirus disease vaccine in the perioperative period. This guidance statement outlines current information regarding vaccine types, summarizes recommendations regarding appropriate timing of administration, and provides information regarding side effects in the perioperative period for cardiac and thoracic surgical patients.


Subject(s)
COVID-19 Vaccines/pharmacology , COVID-19/prevention & control , Cardiovascular Diseases/surgery , Perioperative Care/methods , Practice Guidelines as Topic , Thoracic Surgical Procedures , Vaccination/standards , COVID-19/epidemiology , Cardiovascular Diseases/epidemiology , Comorbidity , Humans , Pandemics
15.
J Pers Med ; 11(7)2021 Jul 14.
Article in English | MEDLINE | ID: mdl-34357125

ABSTRACT

INTRODUCTION: Adverse effects on personalized care and outcomes of cardiovascular diseases (CVD) could occur if health systems do not work in an efficient manner. The pandemic caused by COVID-19 has opened new perspectives for the execution and advancement of cardiovascular tests through telemedicine platforms. OBJECTIVE: This study aimed to analyze the usefulness of telemedical systems for providing personal care in the prevention of CVD. METHODS: A systematic review analysis was conducted on the literature available from libraries such as PubMed (Medline), Scopus (Embase), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Data available in the last 10 years (2011-2020) were also examined by PRISMA guidelines. The selected studies were divided into two categories: (1) benefits of telemedicine in CVD prevention, and (2) recent progress in telemedical services for personalized care of CVD. RESULTS: The literature search produced 587 documents, and 19 articles were considered in this review. Results highlighted that the timely delivery of preventive care for CVD which can be implemented virtually can benefit and modify morbidity and mortality. This could also reduce the pressure on hospitals by decreasing acute CVD occurrence among the general population. The use of these technologies can also help to reduce access to hospitals and other medical devices when not necessary. CONCLUSIONS: Telemedicine platforms can be used for regular checkups for CVD and contribute to preventing the occurrence of acute events and more in general the progression of CVD.

16.
BMJ ; 374: n1493, 2021 08 11.
Article in English | MEDLINE | ID: mdl-34380627

ABSTRACT

Cardiovascular disease is the leading cause of death globally. While pharmacological advancements have improved the morbidity and mortality associated with cardiovascular disease, non-adherence to prescribed treatment remains a significant barrier to improved patient outcomes. A variety of strategies to improve medication adherence have been tested in clinical trials, and include the following categories: improving patient education, implementing medication reminders, testing cognitive behavioral interventions, reducing medication costs, utilizing healthcare team members, and streamlining medication dosing regimens. In this review, we describe specific trials within each of these categories and highlight the impact of each on medication adherence. We also examine ongoing trials and future lines of inquiry for improving medication adherence in patients with cardiovascular diseases.


Subject(s)
Cardiovascular Diseases/drug therapy , Drug Costs/legislation & jurisprudence , Medication Adherence/statistics & numerical data , Patient Education as Topic/methods , Cardiovascular Agents/economics , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/mortality , Clinical Trials as Topic , Cognitive Behavioral Therapy/statistics & numerical data , Comorbidity , Humans , Patient Care Team/ethics , Polypharmacy , Practice Guidelines as Topic , Professional Role/psychology , Reminder Systems/instrumentation
17.
Nutr Metab Cardiovasc Dis ; 31(10): 2860-2869, 2021 09 22.
Article in English | MEDLINE | ID: mdl-34353703

ABSTRACT

BACKGROUND AND AIM: Addressing chronic problems requires a model of care that promotes self-management of the disease and facilitates adherence to treatment. This project was designed to enhance patient's clinical and functional outcomes through a Comprehensive Model to be implemented in our health system and to evaluate the results. METHODS AND RESULTS: Different population stratification tools were tested and designed to classify subjects according to different variables. We have developed a program to detect and screen cardiometabolic risk by integrating most of the Chronic Care Model recommendations through in-house developed management software (MoviHealth®). From the results, 1317 subjects were evaluated (27% of the whole population) during the first year of follow-up which significantly improved for all variables along the follow-up period. The blood pressure of the hypertensive population in 2010 and 2015 showed the importance of enrollment of subjects and the optimization of the blood pressure control. The result of HbA1c observed in 2010 decreased progressively to 7.1 ± 1.4% in 2015, and dyslipidemia levels improved gradually. The number of cardiovascular events requiring hospitalization decreased significantly (48%), from 1.9 events per 100 subjects in 2011 to 0.98 in 2015. CONCLUSION: Our program has combined strategies for the prevention and control of non-communicable diseases, incorporating interventions to control risk factors and to reduce morbidity and mortality. It also had improvements in life quality, accessibility to health-care services, and the promotion of self-care.


Subject(s)
Cardiovascular Diseases/prevention & control , Diabetes Mellitus/therapy , Dyslipidemias/therapy , Hypertension/therapy , Metabolic Syndrome/therapy , Preventive Health Services , Adult , Aged , Aged, 80 and over , Argentina/epidemiology , Biomarkers/blood , Blood Glucose/metabolism , Blood Pressure , Cardiometabolic Risk Factors , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Dyslipidemias/diagnosis , Dyslipidemias/epidemiology , Female , Follow-Up Studies , Glycated Hemoglobin A/metabolism , Health Status , Humans , Hypertension/diagnosis , Hypertension/epidemiology , Lipids/blood , Male , Metabolic Syndrome/diagnosis , Metabolic Syndrome/epidemiology , Middle Aged , Prognosis , Program Evaluation , Protective Factors , Quality of Life , Risk Assessment , Time Factors , Young Adult
18.
Eur J Vasc Endovasc Surg ; 62(3): 450-461, 2021 09.
Article in English | MEDLINE | ID: mdl-34389230

ABSTRACT

OBJECTIVE: Statin therapy is indicated in patients with peripheral arterial disease (PAD). National Institute for Health and Care Excellence guidelines suggest the use of "high intensity" statins, although evidence with PAD specific data are lacking. The effect of statin therapy and dose on outcomes in PAD is investigated. DATA SOURCES: Studies measuring statin use in PAD patients and outcomes were identified based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The EMBASE and MEDLINE databases were interrogated from January 1957 until February 2020. Twenty-two observational cohort studies and two randomised control trials were included (n = 268 611). REVIEW METHODS: Pooled estimates of dichotomous outcome data were calculated using the odds/hazard ratios (OR/HR) and 95% confidence interval (CI). Meta-analysis was conducted using the inverse variance or Mantel-Haenszel method. Outcomes included all cause mortality (ACM), cardiovascular mortality (CVM), major adverse cardiac events (MACE), and amputation. Subgroup analysis was performed on studies comparing patients taking high dose vs. combined low and moderate doses of statins. The GRADE criteria assessed the quality of evidence for outcomes. RESULTS: Statin therapy (vs. no statins) was significantly protective for ACM: OR 0.68 (95% CI 0.60 - 0.76) (number needed to treat [NNT] = 48), HR 0.74 (95% CI 0.70 - 0.78) (NNT = 10 - 91); MACE: OR 0.84 (95% CI 0.78 - 0.92) (NNT = 53), HR 0.78 (95% CI 0.65 - 0.93) (NNT = 167); and amputations: OR 0.59 (95% CI 0.33 - 1.07) (NNT = 333), HR 0.74 (95% CI 0.62 - 0.89) (NNT = 50). High doses of statins (vs. combined low and moderate doses) were significantly better protective against ACM OR 0.69 (95% CI 0.43 - 1.09) (NNT = 17), HR 0.74 (95% CI 0.62 - 0.89) (NNT = 16 - 200) but work less significantly for MACE OR 0.77 (95% CI 0.49 - 1.21) (NNT = 25). Amputations were less frequent in patients on high doses HR 0.78 (95% CI 0.69 - 0.90) (NNT = 53 - 1 000). CONCLUSION: Higher dosing of statins confers a significant improvement in patient outcomes, especially ACM and amputations, although the quality of the evidence was variable. Such findings require confirmation in larger, PAD specific trials.


Subject(s)
Cardiovascular Diseases/prevention & control , Dyslipidemias/drug therapy , Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage , Peripheral Arterial Disease/drug therapy , Aged , Aged, 80 and over , Amputation , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/mortality , Cause of Death , Dyslipidemias/diagnosis , Dyslipidemias/mortality , Female , Heart Disease Risk Factors , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Male , Middle Aged , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/mortality , Primary Prevention , Risk Assessment , Secondary Prevention , Treatment Outcome
20.
J Fam Pract ; 70(4): 189-204, 2021 05.
Article in English | MEDLINE | ID: mdl-34339362

ABSTRACT

The Task Force has expanded the age range for screening for hepatitis C virus infection in adolescents and adults, and now endorses behavioral counseling for all adults with any CVD risk factors.


Subject(s)
Behavior Therapy/standards , Cardiovascular Diseases/prevention & control , Cardiovascular Diseases/therapy , Hepatitis C/diagnosis , Mass Screening/standards , Practice Guidelines as Topic , Preventive Medicine/standards , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Risk Factors , United States , Young Adult
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