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CDC Grand Rounds: Preventing Hospital-Associated Venous Thromboembolism

March 11, 2014 Comments off

CDC Grand Rounds: Preventing Hospital-Associated Venous Thromboembolism
Source: Morbidity and Mortality Weekly Report (CDC)

Deep venous thrombosis (DVT) is a blood clot in a large vein, usually in the leg or pelvis. Sometimes a DVT detaches from the site of formation and becomes mobile in the blood stream. If the circulating clot moves through the heart to the lungs it can block an artery supplying blood to the lungs. This condition is called pulmonary embolism. The disease process that includes DVT and/or pulmonary embolism is called venous thromboembolism (VTE). Each year in the United States, an estimated 350,000–900,000 persons develop incident VTE, of whom approximately 100,000 die, mostly as sudden deaths, the cause of which often goes unrecognized. In addition, 30%–50% of persons with lower-extremity DVT develop postthrombotic syndrome (a long-term complication that causes swelling, pain, discoloration, and, in severe cases, ulcers in the affected limb). Finally, 10%–30% of persons who survive the first occurrence of VTE develop another VTE within 5 years.

VTE can result from three pathogenic mechanisms: hypercoagulability (increased tendency of blood to clot), stasis or slow blood flow, and vascular injury to blood vessel walls. Individual characteristics include congenital and acquired factors, such as advanced age or cancer, and interact with external factors, such as hospitalization or surgery (Table). Hospitalization is an important risk factor in the latter two mechanisms; injury and surgery are causes of vascular injury, and prolonged bed rest can cause stasis. Approximately half of new VTE cases occur during a hospital stay or within 90 days of an inpatient admission or surgical procedure, and many are not diagnosed until after discharge.

As a health-care–associated condition, VTE is receiving increased attention from patient safety experts, the Agency for Healthcare Research and Quality (AHRQ), and the Centers for Medicare & Medicaid Services (CMS). Despite that recognition, the number of secondary diagnoses of VTE in hospital patients has increased, and during 2007–2009, an average of nearly 550,000 adult hospital stays each year had a discharge diagnosis of VTE (8). Nonetheless, VTE often is not recognized as an issue of public health importance. No ongoing surveillance system monitors the occurrence of VTE at the population level, and public education and awareness is limited.

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The Systolic Blood Pressure Difference Between Arms and Cardiovascular Disease in the Framingham Heart Study

March 5, 2014 Comments off

The Systolic Blood Pressure Difference Between Arms and Cardiovascular Disease in the Framingham Heart Study
Source: American Journal of Medicine

Background
An increased interarm systolic blood pressure difference is an easily determined physical examination finding. The relationship between interarm systolic blood pressure difference and risk of future cardiovascular disease is uncertain. We described the prevalence and risk factor correlates of interarm systolic blood pressure difference in the Framingham Heart Study (FHS) original and offspring cohorts and examined the association between interarm systolic blood pressure difference and incident cardiovascular disease and all-cause mortality.

Methods
An increased interarm systolic blood pressure difference was defined as ≥10 mm Hg using the average of initial and repeat blood pressure measurements obtained in both arms. Participants were followed through 2010 for incident cardiovascular disease events. Multivariable Cox proportional hazards regression analyses were performed to investigate the effect of interarm systolic blood pressure difference on incident cardiovascular disease.

Results
We examined 3390 (56.3% female) participants aged 40 years and older, free of cardiovascular disease at baseline, mean age of 61.1 years, who attended a FHS examination between 1991 and 1994 (original cohort) and from 1995 to 1998 (offspring cohort). The mean absolute interarm systolic blood pressure difference was 4.6 mm Hg (range 0-78). Increased interarm systolic blood pressure difference was present in 317 (9.4%) participants. The median follow-up time was 13.3 years, during which time 598 participants (17.6%) experienced a first cardiovascular event, including 83 (26.2%) participants with interarm systolic blood pressure difference ≥10 mm Hg. Compared with those with normal interarm systolic blood pressure difference, participants with an elevated interarm systolic blood pressure difference were older (63.0 years vs 60.9 years), had a greater prevalence of diabetes mellitus (13.3% vs 7.5%,), higher systolic blood pressure (136.3 mm Hg vs 129.3 mm Hg), and a higher total cholesterol level (212.1 mg/dL vs 206.5 mg/dL). Interarm systolic blood pressure difference was associated with a significantly increased hazard of incident cardiovascular events in the multivariable adjusted model (hazard ratio 1.38; 95% CI, 1.09-1.75). For each 1-SD-unit increase in absolute interarm systolic blood pressure difference, the hazard ratio for incident cardiovascular events was 1.07 (95% CI, 1.00-1.14) in the fully adjusted model. There was no such association with mortality (hazard ratio 1.02; 95% CI 0.76-1.38).

Conclusions
In this community-based cohort, an interarm systolic blood pressure difference is common and associated with a significant increased risk for future cardiovascular events, even when the absolute difference in arm systolic blood pressure is modest. These findings support research to expand clinical use of this simple measurement.

Mortality from road crashes in 193 countries: a comparison with other leading causes of death

February 26, 2014 Comments off

Mortality from road crashes in 193 countries: a comparison with other leading causes of death
Source: Transportation Research Institute (University of Michigan)

This study compared, for each country of the world, the fatalities per population from road crashes with fatalities per population from three leading causes of death (malignant neoplasm, ischaemic heart disease, and cerebrovascular disease), and from all causes. The data, applicable to 2008, came from the World Health Organization. The main findings are as follows:
(1) For the world, there are 18 fatalities from road crashes per 100,000 population, as compared with 113 for malignant neoplasm, 108 for ischaemic heart disease, and 91 for cerebrovascular disease. The highest fatality rate from road crashes is in Namibia (45) and the lowest in the Maldives (2).
(2) For the world, fatalities from road crashes represent 2.1% of fatalities from all causes. The highest percentage is in the United Arab Emirates (15.9%) and the lowest in the Marshall Islands (0.3%).
(3) For the world, fatalities from road crashes represent 15.9% of fatalities from malignant neoplasm. The highest percentage is in Namibia (153.9%) and the lowest in the Maldives (1.7%).
(4) For the world, fatalities from road crashes represent 16.7% of fatalities from ischaemic heart disease. The highest percentage is in Qatar (123.9%) and the lowest in Malta (1.9%).
(5) For the world, fatalities from road crashes represent 19.6% of fatalities from cerebrovascular disease. The highest percentage is in Qatar (529.7%) and the lowest in the Marshall Islands (2.3%). The appendixes list the rates and percentages for each individual country.

Disability Status as an Antecedent to Chronic Conditions: National Health Interview Survey, 2006–2012

February 24, 2014 Comments off

Disability Status as an Antecedent to Chronic Conditions: National Health Interview Survey, 2006–2012
Source: Preventing Chronic Disease (CDC)

Introduction
A strong relationship exists between disability and poor health. This relationship could exist as a result of disabilities emerging from chronic conditions; conversely, people with disabilities may be at increased risk of developing chronic conditions. Studying health in relation to age of disability onset can illuminate the extent to which disability may be a risk factor for future poor health.

Methods
We used data from the 2006–2012 National Health Interview Survey and conducted weighted logistic regression analyses to compare chronic conditions in adults with lifelong disabilities (n = 2,619) and adults with no limitations (n = 122,395).

Results
After adjusting for sociodemographic differences, adults with lifelong disabilities had increased odds of having the following chronic conditions compared with adults with no limitations: coronary heart disease (adjusted odds ratio [AOR] = 2.92; 95% confidence interval [CI], 2.33–3.66) cancer (AOR = 1.61; 95% CI, 1.34–1.94), diabetes (AOR = 2.57; 95% CI, 2.10–3.15), obesity (AOR = 1.81; 95% CI, 1.63–2.01), and hypertension (AOR = 2.18; 95% CI, 1.94–2.45). Subpopulations of people with lifelong disabilities (ie, physical, mental, intellectual/developmental, and sensory) experienced similar increased odds for chronic conditions compared with people with no limitations.

Conclusion
Adults with lifelong disabilities were more likely to have chronic conditions than adults with no limitations, indicating that disability likely increases risk of developing poor health. This distinction is critical in understanding how to prevent health risks for people with disabilities. Health promotion efforts that target people living with a disability are needed.

AHA/ASA Guidelines for the Prevention of Stroke in Women

February 7, 2014 Comments off

AHA/ASA Guidelines for the Prevention of Stroke in Women
Source: Stroke

Purpose
The aim of this statement is to summarize data on stroke risk factors that are unique to and more common in women than men and to expand on the data provided in prior stroke guidelines and cardiovascular prevention guidelines for women. This guideline focuses on the risk factors unique to women, such as reproductive factors, and those that are more common in women, including migraine with aura, obesity, metabolic syndrome, and atrial fibrillation.

Methods
Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council’s Scientific Statement Oversight Committee and the AHA’s Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through May 15, 2013. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA Stroke Council methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee.

Results
We provide current evidence, research gaps, and recommendations on risk of stroke related to preeclampsia, oral contraceptives, menopause, and hormone replacement, as well as those risk factors more common in women, such as obesity/metabolic syndrome, atrial fibrillation, and migraine with aura.

Conclusions
To more accurately reflect the risk of stroke in women across the lifespan, as well as the clear gaps in current risk scores, we believe a female-specific stroke risk score is warranted.

Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men

February 5, 2014 Comments off

Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men
Source: PLoS ONE

Background
An association between testosterone therapy (TT) and cardiovascular disease has been reported and TT use is increasing rapidly.

Methods
We conducted a cohort study of the risk of acute non-fatal myocardial infarction (MI) following an initial TT prescription (N = 55,593) in a large health-care database. We compared the incidence rate of MI in the 90 days following the initial prescription (post-prescription interval) with the rate in the one year prior to the initial prescription (pre-prescription interval) (post/pre). We also compared post/pre rates in a cohort of men prescribed phosphodiesterase type 5 inhibitors (PDE5I; sildenafil or tadalafil, N = 167,279), and compared TT prescription post/pre rates with the PDE5I post/pre rates, adjusting for potential confounders using doubly robust estimation.

Results
In all subjects, the post/pre-prescription rate ratio (RR) for TT prescription was 1.36 (1.03, 1.81). In men aged 65 years and older, the RR was 2.19 (1.27, 3.77) for TT prescription and 1.15 (0.83, 1.59) for PDE5I, and the ratio of the rate ratios (RRR) for TT prescription relative to PDE5I was 1.90 (1.04, 3.49). The RR for TT prescription increased with age from 0.95 (0.54, 1.67) for men under age 55 years to 3.43 (1.54, 7.56) for those aged ≥75 years (ptrend = 0.03), while no trend was seen for PDE5I (ptrend = 0.18). In men under age 65 years, excess risk was confined to those with a prior history of heart disease, with RRs of 2.90 (1.49, 5.62) for TT prescription and 1.40 (0.91, 2.14) for PDE5I, and a RRR of 2.07 (1.05, 4.11).

Discussion
In older men, and in younger men with pre-existing diagnosed heart disease, the risk of MI following initiation of TT prescription is substantially increased.

Trends in the Prevalence of Excess Dietary Sodium Intake — United States, 2003–2010

December 23, 2013 Comments off

Trends in the Prevalence of Excess Dietary Sodium Intake — United States, 2003–2010
Source: Morbidity and Mortality Week Report (CDC)

Excess sodium intake can lead to hypertension, the primary risk factor for cardiovascular disease, which is the leading cause of U.S. deaths (1). Monitoring the prevalence of excess sodium intake is essential to provide the evidence for public health interventions and to track reductions in sodium intake, yet few reports exist. Reducing population sodium intake is a national priority, and monitoring the amount of sodium consumed adjusted for energy intake (sodium density or sodium in milligrams divided by calories) has been recommended because a higher sodium intake is generally accompanied by a higher calorie intake from food (2). To describe the most recent estimates and trends in excess sodium intake, CDC analyzed 2003–2010 data from the National Health and Nutrition Examination Survey (NHANES) of 34,916 participants aged ≥1 year. During 2007–2010, the prevalence of excess sodium intake, defined as intake above the Institute of Medicine tolerable upper intake levels (1,500 mg/day at ages 1–3 years; 1,900 mg at 4–8 years; 2,200 mg at 9–13 years; and 2,300 mg at ≥14 years) (3), ranged by age group from 79.1% to 95.4%. Small declines in the prevalence of excess sodium intake occurred during 2003–2010 in children aged 1–13 years, but not in adolescents or adults. Mean sodium intake declined slightly among persons aged ≥1 year, whereas sodium density did not. Despite slight declines in some groups, the majority of the U.S. population aged ≥1 year consumes excess sodium.

2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults

December 19, 2013 Comments off

2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults
Source: Journal of the American Medical Association

Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes.

There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes.

Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.

Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force

December 18, 2013 Comments off

Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force
Source: Annals of Internal Medicine

Background: Vitamin and mineral supplements are commonly used to prevent chronic diseases.

Purpose: To systematically review evidence for the benefit and harms of vitamin and mineral supplements in community-dwelling, nutrient-sufficient adults for the primary prevention of cardiovascular disease (CVD) and cancer.

Data Sources: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects were searched from January 2005 to 29 January 2013, with manual searches of reference lists and gray literature.

Study Selection: Two investigators independently selected and reviewed fair- and good-quality trials for benefit and fair- and good-quality trials and observational studies for harms.

Data Extraction: Dual quality assessments and data abstraction.

Data Synthesis: Two large trials (n = 27 658) reported lower cancer incidence in men taking a multivitamin for more than 10 years (pooled unadjusted relative risk, 0.93 [95% CI, 0.87 to 0.99]). The study that included women showed no effect in that group. High-quality studies (k = 24; n = 324 653) of single and paired nutrients (such as vitamins A, C, or D; folic acid; selenium; or calcium) were scant and heterogeneous and showed no clear evidence of benefit or harm. Neither vitamin E nor β-carotene prevented CVD or cancer, and β-carotene increased lung cancer risk in smokers.

Limitations: The analysis included only primary prevention studies in adults without known nutritional deficiencies. Studies were conducted in older individuals and included various supplements and doses under the set upper tolerable limits. Duration of most studies was less than 10 years.

Conclusion: Limited evidence supports any benefit from vitamin and mineral supplementation for the prevention of cancer or CVD. Two trials found a small, borderline-significant benefit from multivitamin supplements on cancer in men only and no effect on CVD.

The relation between total joint arthroplasty and risk for serious cardiovascular events in patients with moderate-severe osteoarthritis: propensity score matched landmark analysis

November 15, 2013 Comments off

The relation between total joint arthroplasty and risk for serious cardiovascular events in patients with moderate-severe osteoarthritis: propensity score matched landmark analysis
Source: British Medical Journal

Objective
To examine whether total joint arthroplasty of the hip and knee reduces the risk for serious cardiovascular events in patients with moderate-severe osteoarthritis.

Design
Propensity score matched landmark analysis.

Setting
Ontario, Canada.

Participants
2200 adults with hip or knee osteoarthritis aged 55 or more at recruitment (1996-98) and followed prospectively until death or 2011.

Main outcome measure
Rates of serious cardiovascular events for those who received a primary total joint arthroplasty compared with those did not within an exposure period of three years after baseline assessment.

Results
The propensity score matched cohort consisted of 153 matched pairs of participants with moderate-severe arthritis. Over a median follow-up period of seven years after the landmark date (start of the study), matched participants who underwent a total joint arthroplasty during the exposure period were significantly less likely than those who did not to experience a cardiovascular event (hazards ratio 0.56, 95% confidence interval 0.43 to 0.74, P<0.001). Within seven years of the exposure period the absolute risk reduction was 12.4% (95% confidence interval 1.7% to 23.1%) and number needed to treat was 8 (95% confidence interval 4 to 57 patients).

Conclusions
Using a propensity matched landmark analysis in a population cohort with advanced hip or knee osteoarthritis, this study found a cardioprotective benefit of primary elective total joint arthroplasty.

New ACC/AHA Prevention Guidelines Address Blood Cholesterol, Obesity, Healthy Living and Risk Assessment

November 13, 2013 Comments off

New ACC/AHA Prevention Guidelines Address Blood Cholesterol, Obesity, Healthy Living and Risk Assessment
Source: American College of Cardiology/American Heart Association

The ACC and the American Heart Association (AHA), in collaboration with the National Heart, Lung, and Blood Institute (NHLBI) and other specialty societies, have released four guidelines focused on the assessment of cardiovascular risk, lifestyle modifications to reduce cardiovascular risk and management of elevated blood cholesterol and body weight in adults.

These four prevention guidelines released Nov. 12 were among five initially commissioned by NHLBI starting in 2008 and transitioned to the ACC and AHA in June 2013 as part of a collaborative arrangement to facilitate their completion and publication. A fifth guideline addressing hypertension will be initiated in early 2014. Each provides important updated guidance for primary care providers, nurses, pharmacists and specialty medicine providers on how best to manage care of individuals at risk for cardiovascular-related diseases based on the latest scientific evidence.

Burden of Depressive Disorders by Country, Sex, Age, and Year: Findings from the Global Burden of Disease Study 2010

November 7, 2013 Comments off

Burden of Depressive Disorders by Country, Sex, Age, and Year: Findings from the Global Burden of Disease Study 2010
Source: PLoS Medicine

Background
Depressive disorders were a leading cause of burden in the Global Burden of Disease (GBD) 1990 and 2000 studies. Here, we analyze the burden of depressive disorders in GBD 2010 and present severity proportions, burden by country, region, age, sex, and year, as well as burden of depressive disorders as a risk factor for suicide and ischemic heart disease.

Methods and Findings
Burden was calculated for major depressive disorder (MDD) and dysthymia. A systematic review of epidemiological data was conducted. The data were pooled using a Bayesian meta-regression. Disability weights from population survey data quantified the severity of health loss from depressive disorders. These weights were used to calculate years lived with disability (YLDs) and disability adjusted life years (DALYs). Separate DALYs were estimated for suicide and ischemic heart disease attributable to depressive disorders.

Depressive disorders were the second leading cause of YLDs in 2010. MDD accounted for 8.2% (5.9%–10.8%) of global YLDs and dysthymia for 1.4% (0.9%–2.0%). Depressive disorders were a leading cause of DALYs even though no mortality was attributed to them as the underlying cause. MDD accounted for 2.5% (1.9%–3.2%) of global DALYs and dysthymia for 0.5% (0.3%–0.6%). There was more regional variation in burden for MDD than for dysthymia; with higher estimates in females, and adults of working age. Whilst burden increased by 37.5% between 1990 and 2010, this was due to population growth and ageing. MDD explained 16 million suicide DALYs and almost 4 million ischemic heart disease DALYs. This attributable burden would increase the overall burden of depressive disorders from 3.0% (2.2%–3.8%) to 3.8% (3.0%–4.7%) of global DALYs.

Conclusions
GBD 2010 identified depressive disorders as a leading cause of burden. MDD was also a contributor of burden allocated to suicide and ischemic heart disease. These findings emphasize the importance of including depressive disorders as a public-health priority and implementing cost-effective interventions to reduce its burden.

FDA takes step to further reduce trans fats in processed foods

November 7, 2013 Comments off

FDA takes step to further reduce trans fats in processed foods
Source: U.S. Food and Drug Administration

The U.S. Food and Drug Administration announced its preliminary determination that partially hydrogenated oils (PHOs), the primary dietary source of artificial trans fat in processed foods, are not “generally recognized as safe” for use in food. The FDA’s preliminary determination is based on available scientific evidence and the findings of expert scientific panels.

The agency has opened a 60-day comment period on this preliminary determination to collect additional data and to gain input on the time potentially needed for food manufacturers to reformulate products that currently contain artificial trans fat should this determination be finalized.

“While consumption of potentially harmful artificial trans fat has declined over the last two decades in the United States, current intake remains a significant public health concern,” said FDA Commissioner Margaret A. Hamburg, M.D. “The FDA’s action today is an important step toward protecting more Americans from the potential dangers of trans fat. Further reduction in the amount of trans fat in the American diet could prevent an additional 20,000 heart attacks and 7,000 deaths from heart disease each year – a critical step in the protection of Americans’ health.”

Consumption of trans fat raises low-density lipoprotein (LDL), or “bad” cholesterol, increasing the risk of coronary heart disease. The independent Institute of Medicine (IOM) has concluded that trans fat provides no known health benefit and that there is no safe level of consumption of artificial trans fat. Additionally, the IOM recommends that consumption of trans fat should be as low as possible while consuming a nutritionally adequate diet.

Hypertension Among Adults in the United States: National Health and Nutrition Examination Survey, 2011–2012

November 4, 2013 Comments off

Hypertension Among Adults in the United States: National Health and Nutrition Examination Survey, 2011–2012
Source: National Center for Health Statistics

Key findings
Data from the National Health and Nutrition Examination Survey, 2011–2012

  • The age-adjusted prevalence of hypertension among U.S. adults aged 18 and over was 29.1% in 2011–2012, similar to the prevalence in 2009–2010.
  • The prevalence of hypertension was similar for men and women at nearly one-third. The prevalence increased with age and was highest among older adults; it was also highest among non-Hispanic black adults, at approximately 42%.
  • Among adults with hypertension, nearly 83% were aware, nearly 76% were taking medication to lower their blood pressure, and nearly 52% were controlled. There was no change in awareness, treatment, and control from 2009–2010 to 2011–2012.
  • Controlled hypertension was similar across race and Hispanic origin groups, but the percentage controlled was higher for women and older adults.

Posttraumatic Stress Disorder and Cardiometabolic Disease

October 31, 2013 Comments off

Posttraumatic Stress Disorder and Cardiometabolic Disease
Source: Cardiology

The need for addressing posttraumatic stress disorder (PTSD) among combat veterans returning from Afghanistan and Iraq is a growing public health concern. Current PTSD management addresses psychiatric parameters of this condition. However, PTSD is not simply a psychiatric disorder. Traumatic stress increases the risk for inflammation-related somatic diseases and early mortality. The metabolic syndrome reflects the increased health risk associated with combat stress and PTSD. Obesity, dyslipidemia, hypertension, diabetes mellitus, and cardiovascular disease are prevalent among PTSD patients. However, there has been little appreciation for the need to address these somatic PTSD comorbidities. Medical professionals treating this vulnerable population should screen patients for cardiometabolic risk factors and avail themselves of existing preventive diet, exercise, and pharmacologic modalities that will reduce such risk factors and improve overall long-term health outcomes and quality of life. There is the promise that cardiometabolic preventive therapy complementing psychiatric intervention may, in turn, help improve the posttraumatic stress system dysregulation and favorably impact psychiatric and neurologic function. © 2013 S. Karger AG, Basel

Total and High-density Lipoprotein Cholesterol in Adults: National Health and Nutrition Examination Survey, 2011–2012

October 29, 2013 Comments off

Total and High-density Lipoprotein Cholesterol in Adults: National Health and Nutrition Examination Survey, 2011–2012
Source: National Center for Health Statistics

Key findings
Data from the National Health and Nutrition Examination Survey, 2011–2012

  • In 2011–2012, an estimated 12.9% of U.S. adults aged 20 and over (11.1% of men and 14.4% of women) had high total cholesterol, which is unchanged since 2009–2010.
  • Approximately 17% of adults (just over one-quarter of men and less than 10% of women) had low high-density lipoprotein (HDL) cholesterol during 2011–2012. The percentage of adults with low HDL cholesterol has decreased 20% since 2009–2010.
  • Nearly 70% of adults (67% of men and nearly 72% of women) had been screened for cholesterol, which is unchanged since 2009–2010.

Residential exposure to aircraft noise and hospital admissions for cardiovascular diseases: multi-airport retrospective study

October 10, 2013 Comments off

Residential exposure to aircraft noise and hospital admissions for cardiovascular diseases: multi-airport retrospective study
Source: British Medical Journal

Objective
To investigate whether exposure to aircraft noise increases the risk of hospitalization for cardiovascular diseases in older people (≥65 years) residing near airports.

Design
Multi-airport retrospective study of approximately 6 million older people residing near airports in the United States. We superimposed contours of aircraft noise levels (in decibels, dB) for 89 airports for 2009 provided by the US Federal Aviation Administration on census block resolution population data to construct two exposure metrics applicable to zip code resolution health insurance data: population weighted noise within each zip code, and 90th centile of noise among populated census blocks within each zip code.

Setting
2218 zip codes surrounding 89 airports in the contiguous states.

Participants
6 027 363 people eligible to participate in the national medical insurance (Medicare) program (aged ≥65 years) residing near airports in 2009.

Main outcome measures
Percentage increase in the hospitalization admission rate for cardiovascular disease associated with a 10 dB increase in aircraft noise, for each airport and on average across airports adjusted by individual level characteristics (age, sex, race), zip code level socioeconomic status and demographics, zip code level air pollution (fine particulate matter and ozone), and roadway density.

Results
Averaged across all airports and using the 90th centile noise exposure metric, a zip code with 10 dB higher noise exposure had a 3.5% higher (95% confidence interval 0.2% to 7.0%) cardiovascular hospital admission rate, after controlling for covariates.

Conclusions
Despite limitations related to potential misclassification of exposure, we found a statistically significant association between exposure to aircraft noise and risk of hospitalization for cardiovascular diseases among older people living near airports.

See also: Aircraft noise and cardiovascular disease near Heathrow airport in London: small area study

Sodium Intake in Populations: Assessment of Evidence

September 17, 2013 Comments off

Sodium Intake in Populations: Assessment of Evidence
Source: Institute of Medicine

Despite efforts over the past several decades to reduce sodium intake in the United States, adults still consume an average of 3,400 mg of sodium every day. A number of scientific bodies and professional health organizations, including the American Heart Association, the American Medical Association, and the American Public Health Association, support reducing dietary sodium intake. These organizations support a common goal to reduce daily sodium intake to less than 2,300 milligrams and further reduce intake to 1,500 mg among persons who are 51 years of age and older and those of any age who are African-American or have hypertension, diabetes, or chronic kidney disease.

A substantial body of evidence supports these efforts to reduce sodium intake. This evidence links excessive dietary sodium to high blood pressure, a surrogate marker for cardiovascular disease (CVD), stroke, and cardiac-related mortality. However, concerns have been raised that a low sodium intake may adversely affect certain risk factors, including blood lipids and insulin resistance, and thus potentially increase risk of heart disease and stroke. In fact, several recent reports have challenged sodium reduction in the population as a strategy to reduce this risk.

Sodium Intake in Populations recognizes the limitations of the available evidence, and explains that there is no consistent evidence to support an association between sodium intake and either a beneficial or adverse effect on most direct health outcomes other than some CVD outcomes (including stroke and CVD mortality) and all-cause mortality. Some evidence suggested that decreasing sodium intake could possibly reduce the risk of gastric cancer. However, the evidence was too limited to conclude the converse—that higher sodium intake could possibly increase the risk of gastric cancer. Interpreting these findings was particularly challenging because most studies were conducted outside the United States in populations consuming much higher levels of sodium than those consumed in this country. Sodium Intake in Populations is a summary of the findings and conclusions on evidence for associations between sodium intake and risk of CVD-related events and mortality.

Vital Signs: Avoidable Deaths from Heart Disease, Stroke, and Hypertensive Disease — United States, 2001–2010

September 9, 2013 Comments off

Vital Signs: Avoidable Deaths from Heart Disease, Stroke, and Hypertensive Disease — United States, 2001–2010
Source: Morbidity and Mortality Weekly Report (CDC)

Background: Deaths attributed to lack of preventive health care or timely and effective medical care can be considered avoidable. In this report, avoidable causes of death are either preventable, as in preventing cardiovascular events by addressing risk factors, or treatable, as in treating conditions once they have occurred. Although various definitions for avoidable deaths exist, studies have consistently demonstrated high rates in the United States. Cardiovascular disease is the leading cause of U.S. deaths (approximately 800,000 per year) and many of them (e.g., heart disease, stroke, and hypertensive deaths among persons aged <75 years) are potentially avoidable.

Methods: National Vital Statistics System mortality data for the period 2001–2010 were analyzed. Avoidable deaths were defined as those resulting from an underlying cause of heart disease (ischemic or chronic rheumatic), stroke, or hypertensive disease in decedents aged <75 years. Rates and trends by age, sex, race/ethnicity, and place were calculated.

Results: In 2010, an estimated 200,070 avoidable deaths from heart disease, stroke, and hypertensive disease occurred in the United States, 56% of which occurred among persons aged <65 years. The overall age-standardized death rate was 60.7 per 100,000. Rates were highest in the 65–74 years age group, among males, among non-Hispanic blacks, and in the South. During 2001–2010, the overall rate declined 29%, and rates of decline varied by age.

Conclusions: Nearly one fourth of all cardiovascular disease deaths are avoidable. These deaths disproportionately occurred among non-Hispanic blacks and residents of the South. Persons aged <65 years had lower rates than those aged 65–74 years but still accounted for a considerable share of avoidable deaths and demonstrated less improvement.

Clinical Digest — Spotlight on a Modality: Omega-3 Fatty Acids

September 9, 2013 Comments off

Clinical Digest — Spotlight on a Modality: Omega-3 Fatty Acids
Source: National Center for Complementary and Alternative Medicine

Omega-3 fatty acids have been in the news lately, after a new study raises concern about the association of omega-3s and an increased risk of prostate cancer. Omega-3s are a popular supplement used by many Americans. In fact, according to the 2007 National Health Interview Survey, which included a comprehensive survey on the use of complementary health practices by Americans, fish oil/omega-3/DHA supplements are the natural product (excluding vitamins and minerals) most commonly taken by adults, and the second most commonly taken by children.

Moderate evidence has emerged about the health benefits of consuming seafood, but the health benefits of omega-3s in supplement form are less clear. For example, the findings of individual studies on omega-3 supplements and heart disease have been inconsistent, and in 2012, two combined analyses of the results of these studies did not find convincing evidence that omega-3s protect against heart disease.

There is some evidence that omega-3s are modestly helpful in relieving symptoms in rheumatoid arthritis. Omega-3s may also be helpful for age-related macular degeneration (AMD; an eye disease that can cause loss of vision in older people). For most other conditions for which omega-3s are being studied, definitive conclusions cannot yet be reached. This issue of the digest provides information on what the science says about omega-3’s effectiveness and safety for several conditions for which there is the most evidence, including heart disease, rheumatoid arthritis, infant development, and diseases of the eye and brain.

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