Archive
Racial/Ethnic Disparities in the Awareness, Treatment, and Control of Hypertension — United States, 2003–201 0
Source: Morbidity and Mortality Weekly Report (CDC)
Hypertension is a leading cause of cardiovascular disease and affects nearly one third of U.S. adults (1,2). Because the risk for cardiovascular disease mortality increases as blood pressure increases, clinical recommendations for persons with stage 2 hypertension (systolic blood pressure [SBP] ≥160 mmHg or diastolic blood pressure [DBP] ≥100 mmHg) include a more extensive treatment and follow-up regime than for those with stage 1 hypertension (SBP 140–159 mmHg or DBP 90–99 mmHg) (3). Although racial/ethnic disparities in the prevalence of hypertension have been well documented (4); ethnic disparities in the awareness, treatment, and control within blood pressure stages have not. To examine racial/ethnic disparities in awareness, treatment, and control of high blood pressure by hypertension stages, CDC analyzed data from the National Health and Nutrition Examination Survey (NHANES) for the period 2003–2010. This report describes the results of that analysis, which indicated that the proportion of Mexican-Americans and blacks with stage 1 and stage 2 hypertension was greater than for whites.* Among those with stage 1 hypertension, treatment with medication was significantly lower for Mexican-Americans compared with their non-Hispanic counterparts. Although treatment among persons with stage 2 hypertension did not differ by race/ethnicity, less than 60% of those with stage 2 hypertension were treated with medication. More efforts are needed to reduce barriers to accessing health care and low-cost medication, as well as increasing clinicians’ hypertension treatment knowledge and adherence to clinical guidelines.
Sodium Intake in Populations: Assessment of Evidence
Sodium Intake in Populations: Assessment of Evidence
Source: Institute of Medicine
From press release:
Recent studies that examine links between sodium consumption and health outcomes support recommendations to lower sodium intake from the very high levels some Americans consume now, but evidence from these studies does not support reduction in sodium intake to below 2,300 mg per day, says a new report from the Institute of Medicine.
Despite efforts over the past several decades to reduce dietary intake of sodium, a main component of table salt, the average American adult still consumes 3,400 mg or more of sodium a day – equivalent to about 1 ½ teaspoons of salt. The current Dietary Guidelines for Americans urge most people ages 14 to 50 to limit their sodium intake to 2,300 mg daily. People ages 51 or older, African Americans, and people with hypertension, diabetes, or chronic kidney disease – groups that together make up more than 50 percent of the U.S. population – are advised to follow an even stricter limit of 1,500 mg per day. These recommendations are based largely on a body of research that links higher sodium intakes to certain “surrogate markers” such as high blood pressure, an established risk factor for heart disease.
The expert committee that wrote the new report reviewed recent studies that in contrast examined how sodium consumption affects direct health outcomes like heart disease and death. “These new studies support previous findings that reducing sodium from very high intake levels to moderate levels improves health,” said committee chair Brian Strom, George S. Pepper Professor of Public Health and Preventive Medicine at the University of Pennsylvania Perelman School of Medicine. “But they also suggest that lowering sodium intake too much may actually increase a person’s risk of some health problems.”
Primary Prevention of Cardiovascular Disease with a Mediterranean Diet
Primary Prevention of Cardiovascular Disease with a Mediterranean Diet
Source: New England Journal of Medicine
The risk of stroke was reduced significantly in the two Mediterranean-diet groups. This is consistent with epidemiologic studies that showed an inverse association between the Mediterranean diet or olive-oil consumption and incident stroke.
Our results compare favorably with those of the Women’s Health Initiative Dietary Modification Trial, wherein a low-fat dietary approach resulted in no cardiovascular benefit.35 Salient components of the Mediterranean diet reportedly associated with better survival include moderate consumption of ethanol (mostly from wine), low consumption of meat and meat products, and high consumption of vegetables, fruits, nuts, legumes, fish, and olive oil. 36,37 Perhaps there is a synergy among the nutrient-rich foods included in the Mediterranean diet that fosters favorable changes in intermediate pathways of cardiometabolic risk, such as blood lipids, insulin sensitivity, resistance to oxidation, inflammation, and vasoreactivity.
Trends in High LDL Cholesterol, Cholesterol-lowering Medication Use, and Dietary Saturated-fat Intake: United St ates, 1976–2010
Source: National Center for Health Statistics
Key findings
Data from the National Health and Nutrition Examination Survey, 1976–1980, 1988–1994, 2001–2004, and 2007–2010
For adults aged 40–74:
- The prevalence of high low-density lipoprotein cholesterol, or LDL–C, decreased from 59% to 27% from the late 1970s through 2007–2010.
- The percentage of adults using cholesterol-lowering medication increased from 5% to 23% from the late 1980s through 2007–2010.
- The percentage of adults consuming a diet low in saturated fat increased from 25% to 41% from the late 1970s through 1988–1994.
- No significant changes in the percentage of adults consuming a diet low in saturated fat were observed from 1988–1994 through 2007–2010.
Each year, more than 2 million Americans suffer from acute cardiovascular events that account for approximately one-fourth of the total cost of inpatient hospital care (1). Control of low-density lipoprotein cholesterol (LDL–C) has been shown to substantially reduce cardiovascular disease morbidity and mortality (2). High LDL–C is LDL cholesterol above the treatment goals established by the National Cholesterol Education Program’s Adult Treatment Panel III guidelines. It can be managed with lifestyle changes, medications, or a combination of these approaches (3). A diet low in saturated fat is recognized as one of the most effective lifestyle changes to decrease high LDL–C (4). This report evaluates the trends in high LDL–C, use of cholesterol-lowering medication, and low dietary saturated-fat intake from 1976–1980 through 2007–2010 among adults aged 40–74.
EU — New Cardiovascular Diseases Statistics 2012
New Cardiovascular Diseases Statistics 2012
Source: European Heart Network
From press release (PDF):
New figures released to mark World Heart Day (29th September) show a significant improvement in Europe’s heart health. The European Society of Cardiology (ESC) and the European Heart Network (EHN) are releasing up to date statistics1 on the burden of heart disease in Europe and in the EU today. These figures represent the first comprehensive overview of the impact of cardiovascular disease (CVD) since 2008.
The statistics show that efforts to reduce heart disease deaths are successful, with mortality now falling in most of the continent. At the same time, the report shows the huge burden CVD presents to Europe’s health, and suggests that underlying factors may cause CVD to increase in the near future.
The figures show some good news. Since the 2008 report there has been a substantial drop in the number of deaths attributed to heart disease. CVD is now responsible for four million European deaths annually, down from 4.3 million in 2008 (which represents a drop from 48% to 47% of total European deaths). Within the EU, it is responsible for 1.9 million deaths per year, down from two million in 2008 (40% of all EU deaths, down from 42%)
See: World Heart Day: New European statistics released on heart disease and stroke (EurekAlert!)
HRT taken for 10 years significantly reduces risk of heart failure and heart attack
HRT taken for 10 years significantly reduces risk of heart failure and heart attack
Source: British Medical Journal
Women who take HRT for 10 years following menopause have a significantly reduced risk of mortality, heart failure and heart attack without any increased risk of cancer, DVT or stroke, a study published today on bmj.com suggests.
HRT therapy has been subject to much discussion due to both positive effects (reduced risk of cardiovascular disease) and negative effects (increased risk of breast cancer). A paper published in the BMJ Group’s Journal of Family Planning and Reproductive Healthcare back in January cast doubt on the “unreliable” Million Women Study which associated HRT with an increased risk of breast cancer.
Conflicting results have led clinicians to believe that time since menopause until HRT is initiated can account for differences in cardiovascular outcome. So authors from Denmark carried out a randomised trial over 10 years with additional six years of follow-up to establish whether HRT can reduce cardiovascular risk if it is started early after menopause.
1006 women (504 in HRT group and 502 in non-HRT group) were included in the study and all were white, healthy, recently menopausal and aged 45-58 years old. Women who’d had a hysterectomy were only included if they were aged 45-52. Exclusion criteria were if they had a history of bone disease, uncontrolled chronic disease, previous or current cancer, current or previous use of HRT within the past three months and alcohol or drug addiction. All data on diagnoses or death were taken from the Danish Civil Registration System and National Hospital Discharge Register. The primary end-point was a combination of death and hospitalisation for a heart attack or heart failure.
After 10 years of randomised treatment the women were encouraged to discontinue the use of HRT due to the results from the Women’s Health Initiative and the Million Women Study. During this period, 26 women in the non-HRT group died and 33 died or experienced a cardiovascular end-point, compared to 15 deaths and 16 deaths or cardiovascular end-points in the HRT group.
Full Paper (open access)
Bisphenol A and Peripheral Arterial Disease: Results from the NHANES
Bisphenol A and Peripheral Arterial Disease: Results from the NHANES
Source: Environmental Health Perspectives
Background: Bisphenol A (BPA) is a common chemical used in the manufacture of polycarbonate
plastics and epoxy resins, and > 93% of U.S. adults have detectable levels of urinary BPA. Recent animal studies have suggested that BPA exposure may have a role in several mechanisms involved in the development of cardiovascular disease (CVD), including weight gain, insulin resistance, thyroid dysfunction, endothelial dysfunction, and oxidative stress. However, few human studies have examined
the association between markers of BPA exposure and CVD. Peripheral arterial disease (PAD) is a subclinical measure of atherosclerotic vascular disease and a strong independent risk factor for CVD and mortality.Objective: We examined the association between urinary BPA levels and PAD in a nationally representative sample of U.S. adults.
Methods: We analyzed data from 745 participants in the National Health and Nutritional Examination Survey 2003–2004. We estimated associations between urinary BPA levels (in tertiles) and PAD (ankle–brachial index < 0.9, n = 63) using logistic regression models adjusted for potentialconfounders (age, sex, race/ethnicity, education, smoking, body mass index, diabetes mellitus, hypertension, urinary creatinine, estimated glomerular filtration rate, and serum cholesterol levels).
Results: We observed a significant, positive association between increasing levels of urinary BPA and PAD before and after adjusting for confounders. The multivariable-adjusted odds ratio for PAD associated with the highest versus lowest tertile of urinary BPA was 2.69 (95% confidence interval: 1.02, 7.09; p-trend = 0.01).
Conclusions: Urinary BPA levels were significantly associated with PAD, independent of traditional CVD risk factors.
Prevalence of Cholesterol Screening and High Blood Cholesterol Among Adults — United States, 2005, 2007, and 2009
Prevalence of Cholesterol Screening and High Blood Cholesterol Among Adults — United States, 2005, 2007, and 2009
Source: Morbidity and Mortality Weekly Report (CDC)
High blood cholesterol is a leading risk factor in the development of atherosclerosis and coronary heart disease (CHD) (1,2). The risks associated with high blood cholesterol can be reduced by screening and early intervention (3). Current clinical practice guidelines provide evidenced-based standards for detection, treatment, and control of high blood cholesterol (4). Healthy People 2020 monitors national progress related to screening and controlling high blood cholesterol through the National Health Interview Survey and the National Health and Nutrition Examination Survey (NHANES). State-level estimates of self-reported cholesterol screening and high blood cholesterol prevalence are available using Behavioral Risk Factor Surveillance System (BRFSS) data. To assess recent trends in the percentage of adults aged ≥18 years who had been screened for high blood cholesterol during the preceding 5 years, and the percentage among those who had been screened within the previous 5 years and who were ever told they had high blood cholesterol, CDC analyzed BRFSS data from 2005, 2007, and 2009. The results of that analysis showed that the percentage of adults reporting having been screened for high blood cholesterol within the preceding 5 years increased overall from 72.7% in 2005 to 76.0% in 2009. In addition, the percentage who had ever been told they had high cholesterol increased from 33.2% to 35.0%. Both self-reported screening and high cholesterol varied by state and sociodemographic subgroup. To reach the Healthy People 2020 target for cholesterol screening, public health practitioners should emphasize the importance of screening, especially among younger adults, men, Hispanics, and persons with lower levels of education.
Vital Signs: Awareness and Treatment of Uncontrolled Hypertension Among Adults — United States, 2003–2010
Vital Signs: Awareness and Treatment of Uncontrolled Hypertension Among Adults — United States, 2003–2010
Source: Morbidity and Mortality Weekly Report (CDC)
Background: Hypertension is a leading risk factor for cardiovascular disease and a significant cause of morbidity and mortality. This report uses data from the National Health and Nutrition Examination Survey (NHANES) to examine awareness and pharmacologic treatment of uncontrolled hypertension among U.S. adults with hypertension and focuses on three groups: those who are unaware of their hypertension, those who are aware but not treated with medication, and those who are aware and pharmacologically treated with medication but still have uncontrolled hypertension.
Methods: CDC analyzed data from the NHANES 2003–2010 to estimate the prevalence of hypertension awareness and treatment among adults with uncontrolled hypertension. Hypertension was defined as an average systolic blood pressure (SBP) ≥140 mmHg or an average diastolic blood pressure (DBP) ≥90 mmHg, or currently using blood pressure (BP)–lowering medication. Uncontrolled hypertension was defined as an average SBP ≥140 mmHg or an average DBP ≥90 mmHg, among those with hypertension.
Results: The overall prevalence of hypertension among U.S. adults aged ≥18 years in 2003−2010 was 30.4% or an estimated 66.9 million. Among those with hypertension, an estimated 35.8 million (53.5%) did not have their hypertension controlled. Among these, an estimated 14.1 million (39.4%) were not aware of their hypertension, an estimated 5.7 million (15.8%) were aware of their hypertension but were not receiving pharmacologic treatment, and an estimated 16.0 million (44.8%) were aware of their hypertension and were being treated with medication. Of the 35.8 million U.S. adults with uncontrolled hypertension, 89.4% reported having a usual source of health care, and 85.2% reported having health insurance.
Implications for Public Health Practice: Nearly 90% of U.S. adults with uncontrolled hypertension have a usual source of health care and insurance, representing a missed opportunity for hypertension control. Improved hypertension control will require an expanded effort and an increased focus on BP from health-care systems, clinicians, and individuals.
Treatment Strategies for Women With Coronary Artery Disease
Treatment Strategies for Women With Coronary Artery Disease (PDF)
Source: Agency for Healthcare Research and Quality
Objectives. Although coronary artery disease (CAD) is the leading cause of death for women in the United States, treatment studies to date have primarily enrolled men and may not reflect the benefits and risks that women experience. Our systematic review of the medical literature assessed the comparative effectiveness of major treatment options for CAD specifically in women. The comparisons were (1) percutaneous coronary intervention (PCI) versus fibrinolysis/supportive pharmacologic therapy in ST elevation myocardial infarction (STEMI), (2) early invasive versus initial conservative management in non-ST elevation myocardial infarction (NSTEMI) or unstable angina, and (3) PCI versus coronary artery bypass surgery (CABG) versus optimal medical therapy in stable or unstable angina. The endpoints assessed were clinical outcomes, modifiers of effectiveness by demographic and clinical factors, and safety outcomes.
…
From a limited number of studies reporting results for women separately from the total study population, our findings confirm current practice and evidence for care in one of the three areas evaluated. For women with STEMI, we found that an invasive approach with immediate PCI is superior to fibrinolysis for reducing cardiovascular events, which is similar to findings in previous meta-analyses combining results for both women and men. For women with NSTEMI or unstable angina, evidence suggested that an early invasive approach reduces cardiovascular events; however, it was not statistically significant. Previous meta-analyses of studies comparing early invasive with initial conservative strategies on a combined population of men and women showed a significant benefit of early invasive therapy. We also found that the few trials reporting sex-specific data on revascularization compared with optimal medical therapy for stable angina showed a greater benefit with revascularization for women, while the men in the study fared equally well with either treatment. In contrast, previous meta-analyses that combined results for men and women found similar outcomes for either treatment.
Body Mass Index, Playing Position, Race, and the Cardiovascular Mortality of Retired Professional Football Players
Body Mass Index, Playing Position, Race, and the Cardiovascular Mortality of Retired Professional Football Players
Source: American Journal of Cardiology
Concern exists about cardiovascular disease (CVD) in professional football players. We examined whether playing position and size influence CVD mortality in 3,439 National Football League players with ≥5 pension-credited playing seasons from 1959 to 1988. Standardized mortality ratios (SMRs) compared player mortality through 2007 to the United States population of men stratified by age, race, and calendar year. Cox proportional hazards models evaluated associations of playing-time body mass index (BMI), race, and position with CVD mortality. Overall player mortality was significantly decreased (SMR 0.53, 95% confidence interval [CI] 0.48 to 0.59) as was mortality from cancer (SMR 0.58, 95% CI 0.46 to 0.72), and CVD (SMR 0.68, 95% CI 0.56 to 0.81). CVD mortality was increased for defensive linemen (SMR 1.42, 95% CI 1.02 to 1.92) but not for offensive linemen (SMR 0.70, 95% CI 0.45 to 1.05). Defensive linemen’s cardiomyopathy mortality was also increased (SMR 5.34, 95% CI 2.30 to 10.5). Internal analyses found that CVD mortality was increased for players of nonwhite race (hazard ratio 1.69, 95% CI 1.13 to 2.51). After adjusting for age, race, and calendar year, CVD mortality was increased for those with a playing-time BMI ≥30 kg/m2 (hazard ratio 2.02, 95% CI 1.06 to 3.85) and for defensive linemen compared to offensive linemen (hazard ratio 2.07, 95% CI 1.24 to 3.46). In conclusion, National Football League players from the 1959 through 1988 seasons had decreased overall mortality but those with a playing-time BMI ≥30 kg/m2 had 2 times the risk of CVD mortality compared to other players and African-American players and defensive linemen had higher CVD mortality compared to other players even after adjusting for playing-time BMI.
Prevalence of Uncontrolled Risk Factors for Cardiovascular Disease: United States, 1999–2010
Prevalence of Uncontrolled Risk Factors for Cardiovascular Disease: United States, 1999–2010
Source: National Center for Health Statistics
Key findings
Data from the National Health and Nutrition Examination Survey
- In 2009–2010, about 47% of adults had at least one of three risk factors for cardiovascular disease—uncontrolled high blood pressure, uncontrolled high levels of low-density lipoproteins (LDL) cholesterol, or current smoking.
- Men were more likely than women to have at least one of the three cardiovascular disease risk factors.
- From 1999–2000 through 2009–2010, a decrease was observed in the percentage of non-Hispanic white and Mexican-American adults who had at least one of the three risk factors for cardiovascular disease. However, this decrease was not found among non-Hispanic black adults.
- The prevalence of uncontrolled high blood pressure and of uncontrolled high LDL cholesterol declined between 1999–2000 and 2009–2010, but no significant change occurred in the percentage of adults who smoke cigarettes.
Compulsive carnival song whistling following cardiac arrest: a case study
Compulsive carnival song whistling following cardiac arrest: a case study
BackgroundCompulsivity is the repetitive, irresistible urge to perform a behavior, the experience of loss of voluntary control over this intense urge and the tendency to perform repetitive acts in a habitual or stereotyped manner. Compulsivity is part of obsessive-compulsive disorder (OCD), but may occasionally occur as stand-alone symptom following brain damage induced by cardiac arrest. In this case report, we describe a patient who developed compulsivity following cardiac arrest. We review diagnostic options, underlying mechanisms and possible treatments.Case presentationA 65-year-old man presented at our clinic with continuous compulsive whistling following cardiac arrest. Neither obsessive-compulsive symptoms, nor other psychiatric complaints were present prior to the hypoxic incident. An EEG showed diffuse hypofunction, mainly in baso-temporal areas. Treatment with clomipramine resulted in a decrease of whistling.DiscussionThis case report illustrates de novo manifestation of compulsivity following cardiac arrest and subsequent brain damage and gives additional information on diagnostic options, mechanisms and treatment options. Differential diagnosis between stereotypies, punding, or OCD is difficult. Compulsivity following brain damage may benefit from treatment with serotonin reuptake inhibitors. This finding enhances our knowledge of treatments in similar cases.
Body Mass Index, Diabetes, Hypertension, and Short-Term Mortality: A Population-Based Observational Study, 2000–2006
Body Mass Index, Diabetes, Hypertension, and Short-Term Mortality: A Population-Based Observational Study, 2000–2006
Source: Journal of the American Board of Family Medicine
Background:
Published studies about the association of obesity with mortality have used body mass index (BMI) data collected more than 10 years ago, potentially limiting their current applicability, particularly given evidence of a secular decline in obesity-related mortality. The objective of this study was to examine the association between BMI and mortality in a representative, contemporary United States sample.Methods:
This was a population-based observational study of data from 50,994 adults aged 18 to 90 years who responded to the 2000 to 2005 Medical Expenditures Panel Surveys. Cox regression analyses were employed to model survival during up to 6 years of follow-up (ascertained via National Death Index linkage) by self-reported BMI category (underweight, <20 kg/m2; normal weight, 20-<25 [reference]; overweight, 25-<30; obese, 30-<35; severely obese, ≥35), without and with adjustment for diabetes and hypertension. Survival by BMI category also was modeled for diabetic and hypertensive individuals. All models were adjusted for sociodemographics, smoking, and Medical Expenditures Panel Surveys response year.Results:
In analyses not adjusted for diabetes or hypertension, only severe obesity was associated with mortality (adjusted hazard ratio, 1.26; 95% confidence interval, 1.00–1.59). After adjusting for diabetes and hypertension, severe obesity was no longer associated with mortality, and milder obesity (BMI 30-<35) was associated with decreased mortality (adjusted hazard ratio, 0.81; 95% confidence interval, 0.68–0.97). There was a significant interaction between diabetes (but not hypertension) and BMI (F [4, 235] = 2.71; P = .03), such that the mortality risk of diabetes was lower among mildly and severely obese persons than among those in lower BMI categories.Conclusions:
Obesity-associated mortality risk was lower than estimated in studies employing older BMI data. Only severe obesity (but not milder obesity or overweight) was associated with increased mortality, an association accounted for by coexisting diabetes and hypertension. Mortality in diabetes was lower among obese versus normal weight individuals.
See: Above-Normal Weight Alone Does Not Necessarily Increase Short-Term Risk of Death, U.S. Data Suggest (Science Daily)
Racial/Ethnic Disparities in the Prevalence of Selected Chronic Diseases Among US Air Force Members, 2008
Racial/Ethnic Disparities in the Prevalence of Selected Chronic Diseases Among US Air Force Members, 2008
Source: Preventing Chronic Disease (CDC)
Introduction
Few studies have evaluated possible racial/ethnic disparities in chronic disease prevalence among US Air Force active-duty members. Because members have equal access to free health care and preventive screening, the presence of health disparities in this population could offer new insight into the source of these disparities. Our objective was to identify whether the prevalence of 4 common chronic diseases differed by race/ethnicity in this population.Methods
We compiled de-identified clinical and administrative data for Air Force members aged 21 or older who had been on active duty for at least 12 months as of October 2008 (N = 284,850). Multivariate logistic regression models were used to determine the prevalence of hypertension, dyslipidemia, type 2 diabetes, and asthma by race/ethnicity, controlling for rank and sex.Results
Hypertension was the most prevalent chronic condition (5.3%), followed by dyslipidemia (4.6%), asthma (0.9%), and diabetes (0.3%). Significant differences were noted by race/ethnicity for all conditions. Compared with non-Hispanic whites, the prevalence of all chronic diseases was higher for non-Hispanic blacks; disparities for adults of other minority race/ethnicity categories were evident but less consistent.Conclusion
The existence of racial/ethnic disparities among active-duty Air Force members, despite equal access to free health care, indicates that premilitary health risks continue after enlistment. Racial and ethnic disparities in the prevalence of these chronic diseases suggest the need to ensure preventive health care practices and community outreach efforts are effective for racial/ethnic minorities, particularly non-Hispanic blacks.
Recommended Use of Aspirin and Other Antiplatelet Medications Among Adults — National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, United States, 2005–2008
Recommended Use of Aspirin and Other Antiplatelet Medications Among Adults — National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, United States, 2005–2008
Source: Morbidity and Mortality Weekly Report (CDC)
Cardiovascular disease (CVD) is the most highly prevalent disease in the United States and remains the leading cause of death among adults aged ≥18 years despite advancements in treatment and prevention in recent decades (1). Each year, approximately 800,000 persons die from CVD, which includes coronary heart disease (CHD) (1,2); the majority of those persons who die from CVD had underlying atherosclerosis. Approximately 7.9 million U.S. adults have a history of heart attack, approximately 7 million U.S. adults have a history of stroke (1), and, approximately 16 million U.S. adults have received a diagnosis of CHD (2). CVD and CHD cause a substantial economic burden in the United States. In 2010, the estimated annual cost (direct and indirect) of CVD in the United States was approximately $450 billion, including $109 billion for CHD and $54 billion for stroke alone (3).
Preventive care and lifestyle interventions have proven to be effective in reducing atherosclerotic CVD (4,5). Taking aspirin or other antiplatelet medications is one of several preventive interventions that can provide substantial benefit for patients with ischemic vascular disease and is strongly recommended in practice guidelines (6,7). This report summarizes the estimated prevalence of physician prescription of aspirin and other antiplatelet medications for patients with or without ischemic vascular disease as recommended by the U.S. Preventive Services Task Force (USPSTF) and other major guidelines (8–15). Previous research has indicated that the use of aspirin among eligible patients is suboptimal, even for those patients at highest risk (16). In persons who do not have a history of ischemic vascular disease, the net benefit is dependent upon the patient’s risk for suffering a stroke or myocardial infarction compared with their chances of harm from treatment.
The information in this report is intended for clinicians who treat patients with ischemic vascular disease and patients who are at high risk for suffering cardiovascular disease and stroke. In addition, this information can serve as a baseline to monitor progress and measure the impact of use of recommended clinical preventive services.
Posttraumatic Stress Disorder Prevalence and Risk of Recurrence in Acute Coronary Syndrome Patients: A Meta-analytic Review
Source: PLoS ONE
Background
Acute coronary syndromes (ACS; myocardial infarction or unstable angina) can induce posttraumatic stress disorder (PTSD), and ACS-induced PTSD may increase patients’ risk for subsequent cardiac events and mortality. Objective: To determine the prevalence of PTSD induced by ACS and to quantify the association between ACS-induced PTSD and adverse clinical outcomes using systematic review and meta-analysis. Data Sources: Articles were identified by searching Ovid MEDLINE, PsycINFO, and Scopus, and through manual search of reference lists.
Methodology/Principal Findings
Observational cohort studies that assessed PTSD with specific reference to an ACS event at least 1 month prior. We extracted estimates of the prevalence of ACS-induced PTSD and associations with clinical outcomes, as well as study characteristics. We identified 56 potentially relevant articles, 24 of which met our criteria (N = 2383). Meta-analysis yielded an aggregated prevalence estimate of 12% (95% confidence interval [CI], 9%–16%) for clinically significant symptoms of ACS-induced PTSD in a random effects model. Individual study prevalence estimates varied widely (0%–32%), with significant heterogeneity in estimates explained by the use of a screening instrument (prevalence estimate was 16% [95% CI, 13%–20%] in 16 studies) vs a clinical diagnostic interview (prevalence estimate was 4% [95% CI, 3%–5%] in 8 studies). The aggregated point estimate for the magnitude of the relationship between ACS-induced PTSD and clinical outcomes (ie, mortality and/or ACS recurrence) across the 3 studies that met our criteria (N = 609) suggested a doubling of risk (risk ratio, 2.00; 95% CI, 1.69–2.37) in ACS patients with clinically significant PTSD symptoms relative to patients without PTSD symptoms.
Conclusions/Significance
This meta-analysis suggests that clinically significant PTSD symptoms induced by ACS are moderately prevalent and are associated with increased risk for recurrent cardiac events and mortality. Further tests of the association of ACS-induced PTSD and clinical outcomes are needed.
Road Traffic Noise and Incident Myocardial Infarction: A Prospective Cohort Study
Road Traffic Noise and Incident Myocardial Infarction: A Prospective Cohort Study
Source: PLoS ONE
Background
Both road traffic noise and ambient air pollution have been associated with risk for ischemic heart disease, but only few inconsistent studies include both exposures.
Methods
In a population-based cohort of 57 053 people aged 50 to 64 years at enrolment in 1993–1997, we identified 1600 cases of first-ever MI between enrolment and 2006. The mean follow-up time was 9.8 years. Exposure to road traffic noise and air pollution from 1988 to 2006 was estimated for all cohort members from residential address history. Associations between exposure to road traffic noise and incident MI were analysed in a Cox regression model with adjustment for air pollution (NOx) and other potential confounders: age, sex, education, lifestyle confounders, railway and airport noise.
Results
We found that residential exposure to road traffic noise (Lden) was significantly associated with MI, with an incidence rate ratio IRR of 1.12 per 10 dB for both of the two exposure windows: yearly exposure at the time of diagnosis (95% confidence interval (CI): 1.02–1.22) and 5-years time-weighted mean (95% CI: 1.02–1.23) preceding the diagnosis. Visualizing of the results using restricted cubic splines showed a linear dose-response relationship.
Conclusions
Exposure to long-term residential road traffic noise was associated with a higher risk for MI, in a dose-dependent manner.
Venous Thromboembolism in Adult Hospitalizations — United States, 2007–2009
Venous Thromboembolism in Adult Hospitalizations — United States, 2007–2009
Source: Morbidity and Mortality Weekly Report (CDC)
Deep vein thrombosis (DVT) is a blood clot that occurs in a deep vein of the body; pulmonary embolism (PE) occurs when a clot breaks free and enters the arteries of the lungs. DVT and PE comprise venous thromboembolism (VTE), an important and growing public health concern (1,2). Hospitalization is a major risk factor for VTE, and many VTE events that occur among hospitalized patients can be prevented (2,3). A new program of the U.S. Department of Health and Human Services (Partnership for Patients: Better Care, Lower Costs) aims to reduce the number of preventable VTE cases in hospitals (4). To estimate the number of hospitalizations with VTE each year in the United States, CDC analyzed 2007–2009 data from the National Hospital Discharge Survey (NHDS). The results of that analysis determined that an estimated average of 547,596 hospitalizations with VTE occurred each year among those aged ≥18 years in the United States. DVT was diagnosed in an estimated annual average of 348,558 hospitalizations, and PE was diagnosed in 277,549; both DVT and PE were diagnosed in 78,511 hospitalizations. Estimates of the rates of hospitalizations with VTE were substantially higher among adults aged ≥60 years compared with those aged 18–59 years. These findings underscore the need to promote implementation of evidence-based prevention strategies to reduce the number of preventable cases of VTE among hospitalized patients.
Adverse Metabolic Response to Regular Exercise: Is It a Rare or Common Occurrence?
Adverse Metabolic Response to Regular Exercise: Is It a Rare or Common Occurrence?
Source: PLoS ONE
Background
Individuals differ in the response to regular exercise. Whether there are people who experience adverse changes in cardiovascular and diabetes risk factors has never been addressed.Methodology/Principal Findings
An adverse response is defined as an exercise-induced change that worsens a risk factor beyond measurement error and expected day-to-day variation. Sixty subjects were measured three times over a period of three weeks, and variation in resting systolic blood pressure (SBP) and in fasting plasma HDL-cholesterol (HDL-C), triglycerides (TG), and insulin (FI) was quantified.1 The technical error (TE) defined as the within-subject standard deviation derived from these measurements was computed. An adverse response for a given risk factor was defined as a change that was at least two TEs away from no change but in an adverse direction. Thus an adverse response was recorded if an increase reached 10 mm Hg or more for SBP, 0.42 mmol/L or more for TG, or 24 pmol/L or more for FI or if a decrease reached 0.12 mmol/L or more for HDL-C. Completers from six exercise studies were used in the present analysis: Whites (N = 473) and Blacks (N = 250) from the HERITAGE Family Study; Whites and Blacks from DREW (N = 326), from INFLAME (N = 70), and from STRRIDE (N = 303); and Whites from a University of Maryland cohort (N = 160) and from a University of Jyvaskyla study (N = 105), for a total of 1,687 men and women. Using the above definitions, 126 subjects (8.4%) had an adverse change in FI. Numbers of adverse responders reached 12.2% for SBP, 10.4% for TG, and 13.3% for HDL-C. About 7% of participants experienced adverse responses in two or more risk factors.Conclusions/Significance
Adverse responses to regular exercise in cardiovascular and diabetes risk factors occur. Identifying the predictors of such unwarranted responses and how to prevent them will provide the foundation for personalized exercise prescription.
