scholarly journals Cardiovascular disease risk management for Maori in New Zealand general practice

2014 ◽  
Vol 6 (4) ◽  
pp. 286 ◽  
Author(s):  
Yulong Gu ◽  
Jim Warren ◽  
John Kennelly ◽  
Pat Neuwelt ◽  
Matire Harwood
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
New Zealand ◽  
Medication Adherence ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Hdl Cholesterol ◽  
Mortality And Morbidity ◽  
Cholesterol Ratio ◽  
General Practices

INTRODUCTION: Maori are overrepresented in cardiovascular disease (CVD) mortality and morbidity statistics in New Zealand (NZ). AIM: To examine cardiovascular risk (CVR) assessment and management for Maori, utilising Caring Does Matter (CDM) initiative data. METHODS: Using 16 general practices? electronic medical records ? which include ethnicity data ? the rate of CVR screening, CVD medication treatment and adherence levels, and physiological measures for Maori patients at high CVR (=15% five-year risk of a cardiovascular event) were compared to findings for Pacific and non-Maori/non-Pacific patients. RESULTS: Records for 72 351 adults (10 358 Maori; 14%) showed that Maori patients have a poorer CVR assessment rate (46% at guideline-indicated age) than Pacific and non-Maori/non-Pacific groups; when assessed, a greater proportion of Maori patients (38%) were at high CVR. The proportion of high-CVR Maori patients being treated with oral antidiabetic medication (42%) was lower than for Pacific patients but higher than for non-Maori/non-Pacific patients. Lower rates of antihypertensive adherence were found for high-CVR Maori patients than for non-Maori/non-Pacific patients (although higher than for Pacific patients). The high-CVR Maori patients who adhered to CVD medications had lower blood pressure, total-to-HDL cholesterol ratio and HbA1c than non-adherers. DISCUSSION: The association between higher medication adherence and better control of risk factors suggests that adherence should be further promoted by clinicians. More active CVR assessment, treatment and support of medication adherence in Maori attending general practices is justified, given their high mortality rate from CVD in comparison to the overall NZ population. KEYWORDS: Antihypertensives; blood pressure; cardiovascular diseases; haemoglobin A, glycosylated; medication adherence

scholarly journals Total cholesterol/HDL-cholesterol ratio discordance with LDL-cholesterol and non-HDL-cholesterol and incidence of atherosclerotic cardiovascular disease in primary prevention: The ARIC study

2019 ◽  
Vol 27 (15) ◽  
pp. 1597-1605 ◽  
Author(s):  
Renato Quispe ◽  
Mohamed B Elshazly ◽  
Di Zhao ◽  
Peter P Toth ◽  
Rishi Puri ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Ldl Cholesterol ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cholesterol Ratio ◽  
Additional Information ◽  
Atherosclerotic Cardiovascular Disease Risk

Aims The total cholesterol (TC)/high-density lipoprotein (HDL) cholesterol ratio may carry additional information not available in more commonly used single cholesterol measures. Analysis of discordance between lipid parameters might help assess the impact of such additional information on the risk of atherosclerotic cardiovascular disease. We aimed to investigate the role of the TC/HDL-cholesterol ratio in determining atherosclerotic cardiovascular disease risk when discordant with low-density lipoprotein (LDL) cholesterol and non-HDL-cholesterol. Methods We studied 14,403 Atherosclerosis Risk in Communities (ARIC) study participants who were free of atherosclerotic cardiovascular disease at baseline. TC/HDL-cholesterol discordance with LDL-cholesterol (estimated by the novel Martin/Hopkins method) and non-HDL-cholesterol was assessed at five visits and determined by being at or above the median for each lipid parameter. We constructed Cox proportional hazard models to estimate the risk for incident atherosclerotic cardiovascular disease events associated with each lipid concordance/discordance category using a time-varying approach. Results Mean age of participants was 54.1 years, 56% women and 25% black. There were 2634 atherosclerotic cardiovascular disease events over a median (interquartile range) follow-up of 24.2 (16.0–25.4) years. Among individuals with LDL-cholesterol and non-HDL-cholesterol less than the median, 26% and 21% had discordant TC/HDL-cholesterol at or above the median, respectively. These individuals had a 24% (hazard ratio (HR) 1.24, 95% confidence interval (CI) 1.09, 1.41) and 29% (HR 1.29, 95% CI 1.13, 1.46) greater risk of incident atherosclerotic cardiovascular disease, respectively, compared to those with TC/HDL-cholesterol less than the median after multivariable adjustment. In individuals with diabetes with LDL-cholesterol or non-HDL-cholesterol less than the median, discordant TC/HDL-cholesterol at or above the median was more prevalent at 48% and 38%, respectively. Conclusion Clinically significant discordance exists between TC/HDL-cholesterol, available from the standard lipid profile, and the routinely used non-HDL-cholesterol and LDL-cholesterol. Such discordance may help inform atherosclerotic cardiovascular disease risk management, particularly in individuals with diabetes in whom discordance is more common.

scholarly journals Metabolic Syndrome Features and Excess Weight Were Inversely Associated with Nut Consumption after 1-Year Follow-Up in the PREDIMED-Plus Study

2020 ◽  
Vol 150 (12) ◽  
pp. 3161-3170
Author(s):  
Alicia Julibert ◽  
Maria del Mar Bibiloni ◽  
Laura Gallardo-Alfaro ◽  
Manuela Abbate ◽  
Miguel Á Martínez-González ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Energy Intake ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Virgin Olive Oil ◽  
Hdl Cholesterol ◽  
Excess Weight ◽  
Study Cohort

ABSTRACT Background High nut consumption has been previously associated with decreased prevalence of metabolic syndrome (MetS) regardless of race and dietary patterns. Objectives The aim of this study was to assess whether changes in nut consumption over a 1-y follow-up are associated with changes in features of MetS in a middle-aged and older Spanish population at high cardiovascular disease risk. Methods This prospective 1-y follow-up cohort study, conducted in the framework of the PREvención con DIeta MEDiterránea (PREDIMED)-Plus randomized trial, included 5800 men and women (55–75 y old) with overweight/obesity [BMI (in kg/m2) ≥27 and <40] and MetS. Nut consumption (almonds, pistachios, walnuts, and other nuts) was assessed using data from a validated FFQ. The primary outcome was the change from baseline to 1 y in features of MetS [waist circumference (WC), glycemia, HDL cholesterol, triglyceride (TG), and systolic and diastolic blood pressure] and excess weight (body weight and BMI) according to tertiles of change in nut consumption. Secondary outcomes included changes in dietary and lifestyle characteristics. A generalized linear model was used to compare 1-y changes in features of MetS, weight, dietary intakes, and lifestyle characteristics across tertiles of change in nut consumption. Results As nut consumption increased, between each tertile there was a significant decrease in WC, TG, systolic blood pressure, weight, and BMI (P < 0.05), and a significant increase in HDL cholesterol (only in women, P = 0.044). The interaction effect between time and group was significant for total energy intake (P < 0.001), adherence to the Mediterranean diet (MedDiet) (P < 0.001), and nut consumption (P < 0.001). Across tertiles of increasing nut consumption there was a significant increase in extra virgin olive oil intake and adherence to the MedDiet; change in energy intake, on the other hand, was inversely related to consumption of nuts. Conclusions Features of MetS and excess weight were inversely associated with nut consumption after a 1-y follow-up in the PREDIMED-Plus study cohort. This trial was registered at isrctn.com as ISRCTN89898870.

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