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One of the tasks of primary health care is the prevention of disease. Cardiovascular disease is still the leading cause of death, and there are several sets of guidelines dealing with both primary and secondary prevention. The article overviews the risk factors for cardiovascular disease and the strategies for primary prevention.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
With improvements in life expectancy and as more and more people have access to modern medicine, non-communicable diseases are emerging as a health problem in both urban and rural communities in Myanmar. Of all non-communicable diseases, cardiovascular diseases (CVD) are known to be the major health problem. Since many studies that have been conducted in both developed and developing countries have shown a difference between rural and urban communities with regard to cardiovascular diseases, our study had the objective of finding out the prevalence of ischemic heart disease, hypertensive heart disease and rheumatic heart disease in a rural and urban community. The risk of obesity and smoking in the occurrence of CVD was also studied. A cross-sectional survey was conducted in three urban townships of Yangon City (Sanchaung, Latha and Pabedan) and one rural township of Hmawbi. The results showed that CVD were a health problem in both the urban and rural communities. Coronary heart disease was seen to be more prevalent in the urban townships than in the rural Hmawbi Township, but hypertension (HT) and rheumatic heart diseases (RHD) were more prevalent in the rural township of Hmawbi. Obesity which has been blamed as the major risk factor for CHD and HT in the developed countries was not found to be a risk factor in the study townships, but smoking was.
CONTEXT: Whether parental cardiovascular disease confers increased risk independent of other risk factors remains controversial. Prior studies relied on offspring report, without complete validation of parental events. OBJECTIVE: To determine whether parental cardiovascular disease predicts offspring events independent of traditional risk factors, using a prospective design for both parents and offspring, and uniform criteria to validate events. DESIGN: Inception cohort study. SETTING: Framingham Heart Study, a US population-based epidemiologic cohort begun in 1948 with the offspring cohort established in 1971. PARTICIPANTS: All Framingham Offspring Study participants (aged > or =30 years) who were free of cardiovascular disease and both parents in the original Framingham cohort. MAIN OUTCOME MEASURES: We examined the association of parental cardiovascular disease with 8-year risk of offspring cardiovascular disease, using pooled logistic regression. RESULTS: Among 2302 men and women (mean age, 44 years), 164 men and 79 women had cardiovascular events during follow-up. Compared with participants with no parental cardiovascular disease, those with at least 1 parent with premature cardiovascular disease (onset age <55 years in father, <65 years in mother) had greater risk for events, with age-adjusted odds ratios of 2.6 (95% confidence interval [CI], 1.7-4.1) for men and 2.3 (95% CI, 1.3-4.3) for women. Multivariable adjustment resulted in odds ratios of 2.0 (95% CI, 1.2-3.1) for men and 1.7 (95% CI, 0.9-3.1) for women. Nonpremature parental cardiovascular disease and parental coronary disease were weaker predictors. Addition of parental information aided in discriminating event rates, notably among offspring with intermediate levels of cholesterol and blood pressure, as well as intermediate predicted multivariable risk. CONCLUSIONS: Using validated events, we found that parental cardiovascular disease independently predicted future offspring events in middle-aged adults. Addition of parental information may help clinicians and patients with primary prevention of cardiovascular disease, when treatment decisions may be difficult in patients at intermediate risk based on levels of single or multiple risk factors. These data also support further research into genetic determinants of cardiovascular risk.
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Cardiovascular complications are common inpatients with kidney disease. Regulating the lipid levels in these patients is important so that the risks of kidney and cardiovascular complications can be minimized. Lipid regulation decreases the incidence of coronary vascular events and other vascular complications in patients with kidney disease; however, whether lipid regulation slows progression of kidney disease is not yet known. Additional studies of the implications of dyslipidemia in patients with kidney disease are needed.
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BACKGROUND: Patients with asthma have an increased risk of death from causes other than asthma. A study was undertaken to identify whether severity of asthma, its treatment, or associated co-morbidity were associated with increased risk of death from other causes. METHODS: Eighty five deaths from all causes occurring within three years of discharge from hospital in a cohort of 2242 subjects aged 16-64 years admitted for asthma were compared with a random sample of 61 controls aged <45 years and 61 aged >/=45 years from the same cohort. RESULTS: Deaths from asthma were associated with a history of clinically severe asthma (OR 6.29 (95% CI 1.84 to 21.52)), chest pain (OR 3.78 (95% CI 1.06 to 13.5)), biochemical or haematological abnormalities at admission (OR 4.12 (95% CI 1.36 to 12.49)), prescription of ipratropium bromide (OR 4.04 (95% CI 1.47 to 11.13)), and failure to prescribe inhaled steroids on discharge (OR 3.45 (95% CI 1.35 to 9.10)). Deaths from chronic obstructive pulmonary disease (COPD) were associated with lower peak expiratory flow rates (OR 2.56 (95% CI 1.52 to 4.35) for each 50 l/min change), a history of smoking (OR 5.03 (95% CI 1.17 to 21.58)), prescription of ipratropium bromide (OR 7.75 (95% CI 2.21 to 27.14)), and failure to prescribe inhaled steroids on discharge (OR 3.33 (95% CI 0.95 to 11.10)). Cardiovascular deaths were more common among those prescribed ipratropium bromide on discharge (OR 3.55 (95% CI 1.05 to 11.94)) and less likely in those admitted after an upper respiratory tract infection (OR 0.21 (95% CI 0.05 to 0.95)). Treatment with ipratropium bromide at discharge was associated with an increased risk of death from asthma even after adjusting for peak flow, COPD and cardiovascular co-morbidity, ever having smoked, and age at onset of asthma. CONCLUSIONS: Prescription of inhaled steroids on discharge is important even for those patients with co-existent COPD and asthma. Treatment with ipratropium at discharge is associated with increased risk of death from asthma even after adjustment for a range of markers of COPD. These results need to be tested in larger studies.
It has long been recognized that reduced lung function is a major risk factor for cardiac death. It has also become clear that cardiac events are the major cause of death for patients with chronic obstructive pulmonary disease (COPD) with all stages of disease. These associations could be from shared risk factors, most notably cigarette smoking. However, there are mechanistic and physiologic relationships that could account for these associations. This raises the possibility that treatment of COPD could benefit cardiac risks. Despite this, the monitoring of lung function in cardiac patients is not routine. Neither is optimization of lung function, although it may greatly benefit exercise training designed to minimize cardiac risks and symptoms. Conversely, many patients with COPD are at greater risk for cardiac disease than may be recognized, because their COPD is often undiagnosed. Recognition of increased risk could impact the aggressiveness with which other risk factors, hypertension, and hypercholesterolemia are managed. Finally, the interactions between cardiac and pulmonary disease have important implications for the development of novel therapies. It is plausible that treatment of pulmonary inflammation characteristic of COPD will alter cardiac risk. Such an approach would offer a novel approach for the development of treatments for these common conditions.
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The priority trend in the activity of health service is prevention of the principal noncontagious diseases, cardiovascular diseases being a major part among them. The foundation of the All-Union Cardiology Research Centre of the Academy of Medical Sciences of the USSR and of Cardiology Institutes in the Union Republics has contributed significantly to studies of the prevalence of cardiovascular diseases, in the population of various regions of the country, and to development of organizational forms of mass prophylaxis. Organization of a unified cardiology service in the country has formed the basis for introduction of the research data to public health practice.
This two-part article provides an overview of the global burden of atherothrombotic cardiovascular disease. Part I initially discusses the epidemiological transition which has resulted in a decrease in deaths in childhood due to infections, with a concomitant increase in cardiovascular and other chronic diseases; and then provides estimates of the burden of cardiovascular (CV) diseases with specific focus on the developing countries. Next, we summarize key information on risk factors for cardiovascular disease (CVD) and indicate that their importance may have been underestimated. Then, we describe overarching factors influencing variations in CVD by ethnicity and region and the influence of urbanization. Part II of this article describes the burden of CV disease by specific region or ethnic group, the risk factors of importance, and possible strategies for prevention.
It is our central hypothesis that periodontal diseases, which are chronic Gram-negative infections, represent a previously unrecognized risk factor for atherosclerosis and thromboembolic events. Previous studies have demonstrated an association between periodontal disease severity and risk of coronary heart disease and stroke. We hypothesize that this association may be due to an underlying inflammatory response trait, which places an individual at high risk for developing both periodontal disease and atherosclerosis. We further suggest that periodontal disease, once established, provides a biological burden of endotoxin (lipopolysaccharide) and inflammatory cytokines (especially TxA2, IL-1 beta, PGE2, and TNF-alpha) which serve to initiate and exacerbate atherogenesis and thromboembolic events. A cohort study was conducted using combined data from the Normative Aging Study and the Dental Longitudinal Study sponsored by the United States Department of Veterans Affairs. Mean bone loss scores and worst probing pocket depth scores per tooth were measured on 1,147 men during 1968 to 1971. Information gathered during follow-up examinations showed that 207 men developed coronary heart disease (CHD), 59 died of CHD, and 40 had strokes. Incidence odds ratios adjusted for established cardiovascular risk factors were 1.5, 1.9, and 2.8 for bone loss and total CHD, fatal CHD, and stroke, respectively. Levels of bone loss and cumulative incidence of total CHD and fatal CHD indicated a biologic gradient between severity of exposure and occurrence of disease.