Trends in cardiovascular disease: Are we winning the war?
23 Jun 2009-Canadian Medical Association Journal (Canadian Medical Association)-Vol. 180, Iss: 13, pp 1285-1286
TL;DR: See related research paper by Tu and colleagues, page [E118][1] for more details.
Abstract: See related research paper by Tu and colleagues, page [E118][1]
Cardiovascular disease generates a substantial burden of illness in Canada and beyond. Yet recent epidemiologic trends have been very encouraging. Deaths and rates of morbidity from cardiovascular disease fell by at least 50% in most
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TL;DR: The introduction of abdominal aortic aneurysm screening to men aged 65 years is estimated to reduce premature death from ruptured AAAs by up to 50% over the next 10 years, and outcomes in the first 150,000 men are described.
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TL;DR: Screening reduced the number of ruptured AAAs in Gloucestershire during the 20 years of the program, with a significant reduction of men with an abnormal aorta, as the mean aortic diameter of the 65-year-old male has reduced over 20 years.
103 citations
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TL;DR: The latest meta-analysis suggests that screening reduces AAA-related mortality by 45 per cent (number needed to screen 238), with a strong trend to a reduction in all-cause mortality7.
Abstract: Abdominal aortic aneurysm (AAA) is a degenerative process with many features in common with other atherosclerotic arterial disorders (Fig. 1). Until recently, the prevalence of AAA has risen in many Western countries1. Much is known about how and why AAAs develop2. Their aetiology is explained in detail in the video of the Kinmonth Lecture, ‘Changing management of aneurysms’, that accompanies this article on the BJS website (http://bcove.me/36izd6n6). A number of papers in this month’s BJS also focus on aortic aneurysms3–6. The main victims of ruptured AAA are men over 65 years old. It is one of the most common killers of elderly men, causing approximately 6000 premature deaths in England and Wales every year. In the 1990s four large randomized trials showed that ultrasound screening of men could reduce the risk of AAA rupture. The latest meta-analysis, with at least 10 years of follow-up, suggests that screening reduces AAA-related mortality by 45 per cent (number needed to screen 238), with a strong trend to a reduction in all-cause mortality7. This has raised interest in screening, as most AAAs are asymptomatic until they rupture. Risk of rupture increases with aortic diameter and, as aneurysms are easily detected on ultrasound imaging, screening is an obvious way to prevent rupture. Several countries have started population screening programmes in elderly men. The National Health Service Abdominal Aortic Aneurysm Screening Programme (NAAASP) is being Fig. 1 Abdominal aortic aneurysm
40 citations
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TL;DR: Investigation of neighborhood geographic disparities in myocardial infarction (MI) and stroke mortality risks in middle Tennessee identified determinants of observed disparities and found evidence of geographical variability of all regression coefficients implying that local models complement the findings of the global models.
20 citations
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TL;DR: A conceptual model is proposed that delineates the pathways by which abuse may increase CVD risk among women and depressive symptoms are proposed as a mediator between Lifetime abuse and CVD as well as between lifetime abuse andCVD risk behaviors.
Abstract: BACKGROUND:: Cardiovascular disease (CVD) is one of the most serious health challenges facing women today. Investigations into CVD risk factors specific to women have focused primarily on sex-based differences, with little attention paid to gender-based influences. Abuse, such as child abuse, intimate partner violence, and sexual assault, is a serious gendered issue affecting one quarter to one-half of all women within their lifetime. Despite beginning evidence that abuse may increase CVD risk in women, the biological, behavioral, and psychological pathways linking abuse to CVD have received little attention from researchers and clinicians. PURPOSE:: The aim of this study was to propose a conceptual model that delineates the pathways by which abuse may increase CVD risk among women. Within the model, lifetime abuse is positioned as a chronic stressor affecting CVD risk through direct and indirect pathways. Directly, abuse experiences can cause long-term biophysical changes within the body, which increase the risk of CVD. Indirectly, smoking and overeating, known CVD risk behaviors, are common coping strategies in response to abuse. In addition, women with abuse histories frequently report depressive symptoms, which can persist for years after the abusive experience. Depressive symptoms are a known predictor of CVD and can potentiate CVD risk behaviors. Therefore, depressive symptoms are proposed as a mediator between lifetime abuse and CVD as well as between lifetime abuse and CVD risk behaviors. CONCLUSIONS AND CLINICAL IMPLICATIONS:: To better promote cardiovascular health among women and direct appropriate interventions, nurses need to understand the complex web by which abuse may increase the risk for CVD. In addition, nurses need to not only pay attention to an abuse history and symptoms of depression for women presenting with CVD symptoms but also address CVD risk among women with abusive histories. Language: en
20 citations
References
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TL;DR: Abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits, vegetables, and alcohol, and regular physical activity account for most of the risk of myocardial infarction worldwide in both sexes and at all ages in all regions.
10,387 citations
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TL;DR: In this paper, the authors applied a previously validated statistical model, Impact, to data on the use and effectiveness of specific cardiac treatments and on changes in risk factors between 1980 and 2000 among U.S. adults 25 to 84 years old.
Abstract: BACKGROUND Mortality from coronary heart disease in the United States has decreased substantially in recent decades. We conducted a study to determine how much of this decrease could be explained by the use of medical and surgical treatments as opposed to changes in cardiovascular risk factors. METHODS We applied a previously validated statistical model, IMPACT, to data on the use and effectiveness of specific cardiac treatments and on changes in risk factors between 1980 and 2000 among U.S. adults 25 to 84 years old. The difference between the observed and expected number of deaths from coronary heart disease in 2000 was distributed among the treatments and risk factors included in the analyses. RESULTS From 1980 through 2000, the age-adjusted death rate for coronary heart disease fell from 542.9 to 266.8 deaths per 100,000 population among men and from 263.3 to 134.4 deaths per 100,000 population among women, resulting in 341,745 fewer deaths from coronary heart disease in 2000. Approximately 47% of this decrease was attributed to treatments, including secondary preventive therapies after myocardial infarction or revascularization (11%), initial treatments for acute myocardial infarction or unstable angina (10%), treatments for heart failure (9%), revascularization for chronic angina (5%), and other therapies (12%). Approximately 44% was attributed to changes in risk factors, including reductions in total cholesterol (24%), systolic blood pressure (20%), smoking prevalence (12%), and physical inactivity (5%), although these reductions were partially offset by increases in the body-mass index and the prevalence of diabetes, which accounted for an increased number of deaths (8% and 10%, respectively). CONCLUSIONS Approximately half the decline in U.S. deaths from coronary heart disease from 1980 through 2000 may be attributable to reductions in major risk factors and approximately half to evidence-based medical therapies.
2,354 citations
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TL;DR: Over the decade studied, the 37 populations in the WHO MONICA Project showed substantial contributions from changes in survival, but the major determinant of decline in CHD mortality is whatever drives changing coronary-event rates.
1,398 citations
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TL;DR: These two population-based intervention strategies could therefore substantially reduce mortality from chronic diseases, and make a major (and affordable) contribution towards achievement of the global goal to prevent and control chronic diseases.
597 citations