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PubMed1995

Cardiovascular disease prevention: talking occurs at all levels--does understanding?

The magnitude of the health problems posed by cardiovascular disease is well known and represents a major public health challenge. Traditionally programmes of prevention have had a 'lifestyle' orientation, focusing on individual behaviours. Ironically, it may well be that profound societal changes, notably the agricultural and industrial revolutions, have largely been responsible in the most fundamental sense for the modern epidemic of cardiovascular disease. Thus attempts to deal with individually expressed behaviours alone may not be the most effective way to prevent the development of cardiovascular disease in our society. Ultimately, it will be the creation of social environments in which healthy behaviours are the norm that will have the most profound effect on the community's cardiovascular health. Misunderstandings abound. Politicians, while speaking favourably about the importance of prevention, do not match their rhetoric with resources. Many health professionals mistake 'risk-factor identification' with 'prevention'. Private industry has often confused or distorted public understanding in the process of marketing products deemed to have cardiovascular benefits. The public's awareness of many of the basic epidemiological realities concerning the prevention of cardiovascular disease is often sadly lacking. In spite of the misunderstandings, preventive approaches have played a significant role in the reduction of cardiovascular disease, a role that should become more prominent in the future.

Cardiovascular Diseases↗
PubMed2006

Associations between major depression, bipolar disorders, dysthymia and cardiovascular diseases in the general adult population.

BACKGROUND: Cardiovascular diseases (CVD) and affective disorders are both very prevalent in the general population. However, it is unclear on a population level if the prevalence of different subtypes of affective disorders like unipolar major depression or dysthymia is different in individuals with specific CVDs. METHODS: In 4,181 participants of the general population, lifetime prevalences for affective disorders were assessed through the Composite International Diagnostic Interview and cardiovascular diseases by self-report and subsequent physician-verified diagnosis. Multivariable logistic regression was used in the analysis. RESULTS: Prevalences of unipolar depression, bipolar disorder and dysthymia were significantly higher in participants with coronary heart disease or stroke compared to those without these CVDs. Dysthymia had a stronger (OR = 2.03; 95% CI = 1.21-3.39) association with coronary heart disease than unipolar depression (OR = 1.58; 95% CI = 1.09-2.30) or any depression (OR = 1.92; 95% CI = 1.37-2.70). In contrast, unipolar depression (OR = 2.27; 95% CI = 1.29-3.99) showed a significant OR for the relation with stroke compared to dysthymia that reached no statistical significance. The commonly used category 'any depression' revealed higher odds (OR = 2.50; 95% CI = 1.46-4.28) for the relationship with stroke than unipolar depression or dysthymia, but lower odds than bipolar I disorder (OR = 5.71, 95% CI = 1.23-26.66). CONCLUSIONS: Classification into diagnostic subgroups of affective disorders is important for an improved clinical and pathophysiological understanding of their relationship with CVDs. Dysthymia, in particular, plays an important role regarding the relation of affective disorders and CVDs. Future research on biological models may elucidate the pathophysiological link between subtypes of affective disorders and CVDs.

Adolescent↗
PubMed2006

Nutraceuticals--an emerging era in the treatment and prevention of cardiovascular diseases.

Foods and nutrients play a vital role in normal functioning of the body. They are helpful in maintaining the health of the individual and in reducing the risk of various diseases. Worldwide acceptance of this fact formed a recognition link between "nutrition" and "health" and the concept of "nutraceuticals" was evolved. Nutraceuticals are medicinal foods that play a role in maintaining well being, enhancing health, modulating immunity and thereby preventing as well as treating specific diseases. Thus the field of nutraceuticals can be envisioned as one of the missing blocks in the health benefit of an individual. More than any other disease, the etiology of cardiovascular disease reveals many risk factors that are amenable to nutraceutical intervention. The scientific literature shows that several ingredients marketed for use in dietary supplements address each of these. The ability of nutraceuticals to positively influence cardiovascular risk factors should be recognized as an enormous opportunity in the treatment of a highly prevalent disease. Nutraceuticals hold promise in clinical therapy as they have the potential to significantly reduce the risk of side effects associated with chemotherapy along with reducing the global health care cost. In this review, an attempt has been made to summarize some of the recent research findings on garlic, omega-3-fatty acids, soy products, dietary fibres, vitamins, antioxidants, plant sterols, flavonoids, prebiotics and probiotics that have beneficial effects on the heart, in order to update the practising clinician on the benefit of using nutraceuticals for the management of cardiovascular diseases.

Cardiovascular Diseases↗
PubMed2006

Microalbuminuria and risk for cardiovascular disease: Analysis of potential mechanisms.

Microalbuminuria is a strong and independent indicator of increased cardiovascular risk among individuals with and without diabetes. Therefore, microalbuminuria can be used for stratification of risk for cardiovascular disease. Once microalbuminuria is present, cardiovascular risk factor reduction should be more "aggressive." The nature of the link between microalbuminuria and cardiovascular risk, however, remains poorly understood. There is no strong evidence that microalbuminuria causes atherothrombosis or that atherothrombosis causes microalbuminuria. Many studies have tested the hypothesis that a common risk factor underlies the association between microalbuminuria and cardiovascular disease but, again, have found no strong evidence in favor of this contention. At present, the most likely possibility is that a common pathophysiologic process, such as endothelial dysfunction, chronic low-grade inflammation, or increased transvascular leakage of macromolecules, underlies the association between microalbuminuria and cardiovascular disease, but more and prospective studies of these hypotheses are needed.

Albuminuria↗
PubMed1980

Controlling risk factors in cardiovascular diseases.

In response to community demands to do something about the highest rates of cardiovascular diseases in the world that were found in the country of North Karelia, Finland, a comprehensive community control programme was set up in 1972. The main objective was to reduce the high rates by reducing level of smoking, serum cholesterol and blood pressure. The success of the programme was evaluated by examining independent representative population samples in 1972 and in 1977 in North Karelia and a matched control county. A decrease in the individual risk factors was found among the population aged 25-29 at the outset. This reduction was mainly based on favourable changes in lifestyle that took place through the whole community. In low as well as in high socioeconomic groups risk factor reductions occurred. At the same time morbidity and mortality from cardiovascular diseases fell in North Karelia. The intensified health education was not accompanied by adverse emotional or psychosomatic reactions that could be measured. Since there are results from a series of experimental and controlled studies on success of risk factor reduction, this evidence should be used in development and implementation of prevention programmes for cardiovascular diseases. Primary prevention of cardiovascular diseases today requires efficient programmes because they are forming the leading cause of death in majority of the countries where reliable mortality statistics are available.

Adult↗
PubMed1992

[Changes of nutritional factors related to regional differences in the mortality of cardiovascular disease between 1966 and 1985 in Japan].

Cardiovascular disease has been the leading cause of death since 1946 in Japan. In this paper, the relationship between mortality and nutritional factors was analyzed by 12 different regions in Japan during the period 1966-1985. Data in the Reports of the National Nutritional Survey in Japan were used as the nutritional factors, and calculation was made of age-adjusted mortality from ischemic heart disease (IHD), cerebral hemorrhage (CH) and cerebral infarction (CI). The results obtained were as follows: 1. Correlation coefficients were calculated based on the average value of 20 years in each 12 different regions. Correlation coefficients between the mortality from IHD and intake of total fat and n3-polyunsaturated fatty acids were positively significant for both sexes. Between the mortality from CH and vegetable protein and salt, they were positively significant (p < 0.01) while cholesterol was negatively significant (p < 0.01). Between the mortality from CI and vegetable protein, salt and carbohydrate, they were positively significant (p < 0.01). 2. Correlation coefficients between slopes of CH and slopes of nutrients intakes, indicated cholesterol to be negatively significant (p < 0.05) for women from 1966-1970, and salt to be positively significant for men (p < 0.01) and women (p < 0.05) from 1974-1985. In the period 1966-1970, the correlation coefficient between slopes of IHD and those of Keys' factor was positively significant (p < 0.05) for women. 3. To clarify changes in the relationship between mortality and nutrients, correlation coefficients were calculated each year from 1966 to 1985. Significant positive correlation coefficients for IHD were found with animal protein and saturated fat starting from about 1975. Salt was associated with IHD in the 1960s but not following 1970. Those of nutrients for CH and CI did not change markedly during 18 years. 4. Multiple regression analysis with intake of salt and Keys' factor indicated that the influence of salt on cardiovascular disease to decreased and that that of low serum cholesterol on CH declined. Multiple correlation coefficients with salt and Keys' factor decreased for IHD (men) and CH (women).

Cardiovascular Diseases↗
PubMed2005

HDL as a target in the treatment of atherosclerotic cardiovascular disease.

Lipid abnormalities are among the key risk factors for cardiovascular disease. Indeed, lipid-modifying drugs - in particular, the statins, which primarily lower plasma levels of low-density lipoprotein (LDL) cholesterol - considerably reduce the risk of cardiovascular events, leading to their widespread use. Nevertheless, it seems that there might be limits to the degree of benefit that can be achieved by lowering LDL-cholesterol levels alone, which has led to increased interest in targeting other lipid-related risk factors for cardiovascular disease, such as low levels of high-density lipoprotein (HDL) cholesterol. In this article, we first consider the mechanisms that underlie the protective effect of HDL cholesterol, and then discuss several strategies that have recently emerged to increase levels of HDL cholesterol to treat cardiovascular disease, including nuclear receptor modulation, inhibition of cholesteryl ester transfer protein and infusion of apolipoprotein/phospholipid complexes.

Animals↗
PubMed2005

Genetic therapies for cardiovascular diseases.

Recent advances in understanding the molecular and cellular basis of cardiovascular diseases, together with the availability of tools for genetic manipulation of the cardiovascular system, offer possibilities for new treatments. Gene therapies have demonstrated potential usefulness for treating complex cardiovascular diseases, such as hypertension, atherosclerosis and myocardial ischemia, in various animal models. Some of these experimental therapies are now undergoing clinical evaluation in patients with cardiovascular disease. However, the successful transition of these therapies into mainstream clinical practice awaits further improvements to vector platforms and delivery tools and the documentation of clinical feasibility, safety and efficacy through multi-center randomized trials.

Animals↗
PubMed2006

Effect of folic acid supplementation on risk of cardiovascular diseases: a meta-analysis of randomized controlled trials.

CONTEXT: Epidemiologic studies have suggested that folate intake decreases risk of cardiovascular diseases. However, the results of randomized controlled trials on dietary supplementation with folic acid to date have been inconsistent. OBJECTIVE: To evaluate the effects of folic acid supplementation on risk of cardiovascular diseases and all-cause mortality in randomized controlled trials among persons with preexisting cardiovascular or renal disease. DATA SOURCES: Studies were retrieved by searching MEDLINE (January 1966-July 2006) using the Medical Subject Headings cardiovascular disease, coronary disease, coronary thrombosis, myocardial ischemia, coronary stenosis, coronary restenosis, cerebrovascular accident, randomized controlled trial, clinical trials, homofolic acid, and folic acid, and the text words folic acid and folate. Bibliographies of all retrieved articles were also searched, and experts in the field were contacted. STUDY SELECTION: From 165 relevant retrieved reports, 12 randomized controlled trials compared folic acid supplementation with either placebo or usual care for a minimum duration of 6 months and with clinical cardiovascular disease events reported as an end point. DATA EXTRACTION: Data on study design, characteristics of participants, changes in homocysteine levels, and cardiovascular disease outcomes were independently abstracted by 2 investigators using a standardized protocol. DATA SYNTHESIS: Studies including data from 16 958 participants with preexisting vascular disease were analyzed using a random-effects model. The overall relative risks (95% confidence intervals) of outcomes for patients treated with folic acid supplementation compared with controls were 0.95 (0.88-1.03) for cardiovascular diseases, 1.04 (0.92-1.17) for coronary heart disease, 0.86 (0.71-1.04) for stroke, and 0.96 (0.88-1.04) for all-cause mortality. The relative risk was consistent among participants with preexisting cardiovascular or renal disease. CONCLUSIONS: Folic acid supplementation has not been shown to reduce risk of cardiovascular diseases or all-cause mortality among participants with prior history of vascular disease. Several ongoing trials with large sample sizes might provide a definitive answer to this important clinical and public health question.

Cardiovascular Diseases↗
PubMed1995

Suppression of mevalonate pathway activities by dietary isoprenoids: protective roles in cancer and cardiovascular disease.

Diet-cancer and diet-cardiovascular disease interrelationships may be explained by the mevalonate-suppressive action of isoprenoid end products of plant secondary metabolism. Assorted monoterpenes, sesquiterpenes, carotenoids and tocotrienols posttranscriptionally down regulate 3-hydroxy-3-methylglutaryl coenzyme A reductase activity, a key activity in the sterologenic pathway. The modest decrease in cholesterol synthesis is associated with a concomitant lowering of low-density lipoprotein cholesterol. The reductase activity in tumor tissues differs from that of liver in being resistant to sterol feedback regulation. Tumor reductase activity retains sensitivity to posttranscriptional regulation. As a consequence, the isoprenoid-mediated suppression of mevalonate synthesis depletes tumor tissues of two intermediate products, farnesyl pyrophosphate and geranylgeranyl pyrophosphate, which are incorporated posttranslationally into growth control-associated proteins. At 10-fold higher concentrations, monoterpenes inhibit the protein isoprenyl transferases that catalyze this incorporation. At levels of intake likely provided by a diet based on Food Pyramid guidelines, assorted isoprenoids decrease cardiovascular disease risk and suppress the growth of initiated cells. At pharmacological levels of intake, isoprenoids block the initiation phase of chemical carcinogenesis. Isoprenoids targeted to the inhibition of the isoprenylation of oncogenic forms of ras proteins may offer a novel approach to chemotherapy. Adjunctive isoprenoids might decrease the level of competitive inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase required to manage hypercholesterolemia.

Animals↗
PubMedDate not supplied

A review of five major community-based cardiovascular disease prevention programs. Part II: Intervention strategies, evaluation methods, and results.

Major community-based cardiovascular disease prevention programs have been conducted in North Karelia, Finland; the state of Minnesota; Pawtucket, Rhode Island; and in three communities and more recently in five cities near Stanford, California. The main hypothesis is that community intervention will reduce the prevalence of cardiovascular disease risk factors and consequently reduce cardiovascular disease incidence, morbidity, and mortality. Intervention strategies include community mobilization, social marketing, school-based health education, worksite health promotion, screening and referral of those at high risk, education of health professionals, direct education of adults, and modification of physical environments. Formative evaluation provides short-term feedback to program managers about immediate effects of intervention strategies. Outcome evaluation examines the effects of intervention on longitudinally sampled cohorts and compares cardiovascular risk status and morbidity and mortality in intervention and comparison communities. Results from North Karelia and the Stanford Three Community Study indicate that this model is efficacious and cost-effective. The National Heart, Lung, and Blood Institute biomedical research spectrum envisions research in knowledge transfer and innovation diffusion as the last link in the causal chain whereby research affects the health of the population, but research in this area remains undeveloped compared to other aspects of cardiovascular disease prevention. This is Part II of a two part article; Part I appeared in Volume 4, Number 3.

California↗
PubMed1996

Antioxidants in cardiovascular disease: randomized trials.

The hypothesis that antioxidant vitamins might reduce cardiovascular disease risk is based on a large body of both basic and human epidemiologic research. One of the most consistent findings in dietary research is that those who consume higher amounts of fruits and vegetables have lower rates of heart disease and stroke as well as cancer. Recent attention has focused on the antioxidant content of fruits and vegetables as a possible explanation for the apparent protective effects. Basic research provides a plausible mechanism by which antioxidants might reduce the risk of atherosclerosis. A large number of descriptive, case-control and cohort studies provide data suggesting that consumption of antioxidant vitamins is associated with reduced risks of cardiovascular disease. These data raise the question of a possible role of antioxidants, such as vitamins C and E, and beta carotene, in the primary prevention of cardiovascular disease but do not provide a definitive answer. Results from several large-scale randomized trials of antioxidant supplements are now available; however, results are not entirely consistent. The results of the major trials do not prove or disprove the value of antioxidant vitamins, nor do they incriminate them as harmful. They do, however, raise the possibility that some of the benefits from observational epidemiology may have been overestimated and that there may be some adverse effects. At this point randomized trial data are not yet sufficient to fully assess the risk-to-benefit ratios for antioxidant supplements. More reliable data should be forthcoming in the near future which will better define the role of antioxidants in the primary and secondary prevention of atherosclerotic disease as well as cancer.

Antioxidants↗
PubMed1989

Accuracy of diagnosis on death certificates for underlying causes of death in a long-term autopsy-based population study in Hisayama, Japan; with special reference to cardiovascular diseases.

Major categorical diagnosis by International Classification of Diseases and type-specific diagnosis for cardiovascular diseases in death certificates were compared to the diagnosis made at autopsy in 864 consecutive autopsy cases aged 20 or over, among the Japanese residents in Hisayama town. Cerebral stroke was correctly diagnosed in 84%, malignant neoplasms in 78% and cardiac disease in 66%. Cerebral stroke and cardiac disease tended to be overdiagnosed, while malignant neoplasms were underdiagnosed. The validation of certified diagnosis was less reliable in the aged population, and in type-specific diagnosis of cardiovascular diseases. Cerebral hemorrhage with false negative or false positive diagnoses was usually classified into type unspecified stroke or different categories of cerebral stroke, while those misdiagnosed as cases of cerebral infarction frequently had no significant lesions in the autopsied brain. Finally, the relationship between the validation of diagnosis on the death certificates and the secular trend in cardiovascular disease in the Japanese vital statistics was discussed.

Adult↗
PubMed2000

Medical management of the patient with cardiovascular disease.

Cigarette smoking, hypertension, hypercholesterolemia, and periodontal disease have been established as major risk factors for cardiovascular disease. Dentists and physicians should work aggressively to educate periodontitis patients about this relationship in an effort to improve the quality of health and contribute to their long-term survival. Blood pressure should be checked at the initial dental visit and at each subsequent visit in patients whose blood pressure is found to be high and/or has a history of hypertension. Dental and medical assistants should receive in-service training to assure competency in measuring blood pressures. All staff should be certified in basic cardiopulmonary resuscitation. Emergency protocol procedures should be in writing and rehearsed regularly. Patients should take their blood pressure medication as usual on the day of the dental procedure. It is helpful for the patients to bring all medications to the office for review at the time of the dental procedure. Good communication should be established between the dentist and physician to maximize good dental and physical health. Because the patient with periodontal disease is at an increased risk for cardiovascular disease, a standardized form should be developed for the convenient exchange of vital information, including but not limited to: blood pressure, medications, allergies, medical conditions and pertinent highlights of dental procedures. Minimize stress in patients with coronary artery disease. This includes providing solid local anesthesia, avoidance of intravascular medication injections, and encouraging relaxation techniques. Antibiotic prophylaxis is indicated in patients with valvular heart disease but does not guarantee the prevention of endocarditis. These patients should be alerted to monitor any symptoms such as fever, chills or shortness of breath. It has also been documented that toothbrushing, flossing and home plaque removers can cause transient bacteremia in periodontal patients. Epinephrine use should be avoided or utilized cautiously in patients with pacemakers or automatic defibrillator devices because of the possibility of refractory arrhythmia. Consultation with patient's cardiologist is advised. Anticoagulation with coumadin is not a contraindication to dental procedures. The prothrombin time or international normalized ratio laboratory values should be checked on the day of the procedure to assure that it is in an acceptable range. Aspirin therapy is not a problem unless the patient is on very high doses for severe arthritis. Continuing medical and dental education credits should emphasize cross-training in both areas to insure comprehensive treatment of the patient with periodontal disease. Smoking cessation, regular exercise, a low-fat diet and good dental hygiene contribute to a healthy cardiovascular system. Patients should understand as best we know the relationship between periodontal and cardiovascular disease to afford them an opportunity to improve their overall dental and physical health.

Anti-Arrhythmia Agents↗
PubMed2005

Association between pulse pressure and cardiovascular disease in renal transplant patients.

Elevated pulse pressure in general population has been shown to be associated with cardiovascular disease, which is the main cause of death in renal transplant patients. We investigated the effect that a wider pulse pressure range may have on cardiovascular disease after renal transplantation in 532 transplant patients with functioning graft for more than 1 year. Patients were classified into two groups depending on 1-year pulse pressure (< or >/=65 mmHg) and we analyzed patient and graft survival, post-transplant cardiovascular disease and main causes of death. Higher pulse pressure was associated with older recipient age (40.8 +/- 10.8 vs. 50 +/- 11.3), higher systolic blood pressure (132.7 +/- 16.1 vs. 164.5 +/- 16), lower blood diastolic pressure (84.5 +/- 11.6 vs. 84.4 +/- 11.2), higher prevalence of diabetes (12% vs. 23%) and total cardiovascular disease (20.9% vs. 33.6%). Five- and 10-year patient survivals were lower in the group with higher pulse pressure, being vascular disease the main cause of death in both groups. In a Cox regression model increased pulse pressure was associated with higher cardiovascular disease (RR = 1.73, 95% CI: 1.13-2.32 p < 0.01). In conclusion, pulse pressure was an independent risk factor for increased cardiovascular morbidity and mortality in renal transplant patients.

Adult↗
PubMed1999

Evaluating cardiovascular disease prevention programs in African American communities.

This article reports on an evaluation of community cardiovascular disease prevention projects. The evaluation protocol involved a monitoring system for documenting community activities. It showed improvements in cardiovascular disease prevention services, community actions, planned products, and new or modified community programs to prevent cardiovascular disease. Reports from focus group sessions provided analyses of participants' perceived behaviors and satisfaction with eight community-based cardiovascular disease prevention projects in African American communities. Modest improvements in blood pressure, blood cholesterol, dietary intake, and physical activity among a convenience sample of participants in the community were noted.

Adult↗
PubMed1996

High mortality from cardiovascular disease and analysis of risk factors in Indian and Melanesian Fijians.

BACKGROUND: In recent years, developing populations such as the Pacific island nation of Fiji, have seen decreases in infectious diseases and increasing frequency of cardiovascular diseases (CVD), diabetes and cancer. However, cohort studies of mortality in these populations are scarce. Here we report 11-year all-cause and cause-specific mortality rates and risk factors for total, CVD and coronary heart disease (CHD) for indigenous Melanesian and Asian Indian people of Fiji. METHODS: Following a baseline risk factor survey in 1980, mortality surveillance continue until 1991 in a representative cohort of 1325 Melanesians and 1221 Indians from urban and rural areas of Fiji. Date and cause of death were recorded and total, CVD and CHD mortality rates calculated. Baseline predictors of mortality were assessed using Cox regression. RESULTS: Total mortality rates in Melanesians were 15.9 and 9.2/1000 person-years, and in Indians were 13.5 and 6.8/1000 person-years, in men and women respectively. Death due to CHD was more common in men than women, and in Indian than Melanesian men, although total CVD deaths were more common in Melanesian men. Deaths due to CHD were more common in the urban than the rural area. After adjusting for other risk factors Indian ethnicity was associated with a significantly reduced risk of total and CVD mortality in men, and total mortality in women. Age and systolic blood pressure were consistently and independently associated with mortality from all causes, as well as CVD and CHD (except in Indian women). In men associations were also identified for total cholesterol with CVD and CHD mortality in Melanesians, and 2-hour plasma glucose with total and CVD mortality in Indians. In women, 2-hour glucose was important for total, CVD and CHD mortality in both ethnic groups as was smoking in Indians. Obesity had inconsistent associations with mortality. CONCLUSION: Cardiovascular disease is now responsible for a large proportion of total mortality in both Indian and Melanesian Fijians. The major risk factors identified in Fijians are similar to those observed in developed populations.

Adult↗
PubMedDate not supplied

Established cardiovascular disease and CVD risk factors in a primary care population of middle-aged Irish men and women.

Contemporary Irish data on the prevalence of major cardiovascular disease (CVD) risk factors are sparse. The primary aims of this study were (1) to estimate the prevalence of major cardiovascular disease risk factors, including Type 2 Diabetes Mellitus, in the general population of men and women between the ages of 50 and 69 years; and (2) to estimate the proportion of individuals in this age group at high absolute risk of cardiovascular disease events on the basis of pre-existing cardiovascular disease or as defined by the Framingham equation. Participants were drawn from the practice lists of 17 general practices in Cork and Kerry using stratified random sampling. A total of 1018 people attended for screening (490 men, 48%) from 1473 who were invited, a response rate of 69.1%. Cardiovascular disease risk factors and glucose intolerance are common in the population of men and women aged between 50 and 69 years. Almost half the participants were overweight and a further quarter met current international criteria for obesity, one of the highest recorded prevalence rates for obesity in a European population sample. Forty per cent of the population reported minimal levels of physical activity and 19% were current cigarette smokers. Approximately half the sample had blood pressure readings consistent with international criteria for the diagnosis of hypertension, but only 38% of these individuals were known to be hypertensive. Eighty per cent of the population sample had a cholesterol concentration in excess of 5 mmol/l. Almost 4% of the population had Type 2 Diabetes Mellitus, of whom 30% were previously undiagnosed. A total of 137 participants (13.5%) had a history or ECG findings consistent with established cardiovascular disease. Of the remaining 881 individuals in the primary prevention population, a total of 20 high-risk individuals (19 male) had a risk of a coronary heart disease event > or = 30% over ten years according to the Framingham risk equation, giving an overall population prevalence of 2.0% (95% CI 1.3 - 3.0). At a risk level > or = 20% over ten years, an additional 91 individuals (8.9%) were identified. Thus a total of 24.4% of the population were at risk either through pre-existing CVD (13.5%) or an estimated 10-year risk exceeding 20% according to the Framingham risk equation (10.9%). Thus a substantial proportion of middle-aged men are at high risk of CVD. The findings emphasise the scale of the CVD epidemic in Ireland and the need for ongoing monitoring of risk factors at the population level and the need to develop preventive strategies at both the clinical and societal level.

Aged↗