A semi-systematic review on hypertension and dyslipidemia care in Egypt—highlighting evidence gaps and recommendations for better patient outcomes

Abstract Background Both hypertension and dyslipidemia are considered as major modifiable risk factors of cardiovascular diseases (CVDs), and their prevalence in Egypt has increased in recent years. Evidence-based systematic evaluation of data on hypertension and dyslipidemia is critical for effective patient-centric management to reduce the overall risk of CVDs in Egypt. This semi-systematic review aimed to quantify and identify data gaps in the prevalence and distribution of patient journey touchpoints including awareness, screening, diagnosis, treatment, adherence, and control of hypertension and dyslipidemia to provide the basis for research prioritization, practice guidance, and health care reforms in Egypt. Main body Structured search was conducted on MEDLINE and Embase to identify articles published in English between January 2010 and December 2019 that reported key patient journey touchpoints in hypertension and dyslipidemia management. Unstructured search was conducted on public or government websites with no date restriction. Data from all sources were extracted and presented descriptively. In total, 22 studies published between 1995 and 2020 on hypertension and dyslipidemia were included in the final analyses. The prevalence of hypertension in Egypt ranged from 12.1 to 59%. Studies reported awareness (37.5% and 43.9%), diagnosis (42% and 64.7%), treatment (24% and 54.1%), and adherence to antihypertensive medication (51.9%) to be low. Furthermore, the percentage of patients who had their blood pressure controlled ranged from 8 to 53.2%. The prevalence of dyslipidemia varied in the general population (range 19.2–36.8%) but was higher in patients with acute coronary syndrome (ACS) (50.9% and 52.5%) and coronary artery disease (58.7%). A national report indicated that 8.6% of the general population was screened for dyslipidemia; however, no data was available on the diagnosis and treatment rates. Among ACS patients, 73.9% were treated for dyslipidemia. Data indicated low levels of medication adherence (59%) among dyslipidemia patients, with overall low control rates ranging from 5.1 to 34.4% depending on CVD risk in populations including ACS patients. Conclusion Data on patient journey touchpoints of hypertension and dyslipidemia are limited in Egypt, indicating the need for more systematic and high-quality evidence-based studies covering different aspects of patient-centric management for better management of CVD and its risk factors.

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Population Analysis of a Hemophilia Treatment (HTC) for Prevalence and Outcome of Cardiovascular Disease (CVD) in Patients with Congenital Bleeding Disorders (PWBD).

Blood ◽

10.1182/blood.v104.11.3999.3999 ◽

2004 ◽

Vol 104 (11) ◽

pp. 3999-3999

Author(s):

Rekha Parameswaran ◽

A. Greist ◽

H. S. Lynn ◽

C. P. Roberson ◽

J. Kirk ◽

...

Keyword(s):

Risk Factors ◽

General Population ◽

Patient Population ◽

Bleeding Disorders ◽

Cvd Risk ◽

Type Iii ◽

Coronary Syndrome ◽

Type 3

Abstract CVD, acute coronary syndrome (ACS)/cerebrovascular accident (CVA), is a leading cause of morbidity and mortality in the US. Risk factors are hypertension, hypercholesterolemia (HC), smoking and diabetes. Therapeutic advances allow PWBD to live longer; CVD may emerge as in the general population. No data address prevalence and treatment of CVD in PWBD. Previous data suggest that hemophilia may protect against CVD. A single HTC analysis of PWBD for CVD prevalence and outcome was performed. Query of HTC database identified patients with hemophilia/ von Willebrand disease(vWD) with CVD and retrospective chart analysis performed for risk factors. Coronary risk assessment score, expressed as a percentage(Framingham model), was calculated; unknown HC values assigned level 1 (scale maximum level 3) to avoid bias. Age at CVD event was used for risk comparison to age/ sex matched general population. HTC population was analyzed for bleeding disorder, severity, age ≥ 40 yrs, sex and utilized as the denominator for population event analysis. PWBD demographics ≥ 40 yrs revealed 146 with FVIII deficiency (60 severe, 18 moderate, 68 mild); 99 with FIX deficiency (20 severe, 52 moderate, 27 mild); 164 vWD (106 Type 1, 48 Type 2, 10 Type 3). Twenty-four PWBD, all ≥ 40 yrs of age, had experienced 26 CVD events. These PWBD included 8 FVIII (0 severe, 1 moderate, 7 mild), 6 FIX (2 severe, 4 moderate, 0 mild), and 10 vWD (5 Type 1, 4 Type 2, 1 Type 3). Events included 20 ACS; 6 were CVA; two patients each had both ACS and CVA. Six were deceased at time of analysis; five deaths due to CVD; one death (type III vWD) due to lung cancer. Framingham risk scores were comparable to expected general population scores. Eight patients received anti-platelet therapy. Of these, two had major bleeds (CNS and GI bleed); one had a minor bleed (epistaxis). Approximately one in 20 US population over age 40 yrs has CVD. Given this prevalence, we would expect 20 patients with CVD in our patient population. If bleeding disorders, specifically hemophilia and vWD, conferred protection against CVD, then we would expect decreased prevalence of CVD in our patient population. This putative protective effect would likely manifest in PWBD with severe deficiencies than in PWBD with mild deficiencies. Interestingly, we identified three patients with severe deficiency (two severe FIX; one type III vWD) with CVD; one of whom (type III vWD) had a higher calculated CVD risk score that age matched general population. CVD patients with mild/moderate deficiencies appear more similar to the general population for CVD risk than their severely affected counterparts. CVD prevalence in the former group could approach expected general population prevalence given Framingham scores equal to or higher than expected compared to the general population. In fact, Framingham score for identified CVD patients revealed 10 year comparative risk of CVD similar to general population risk. Accurate prevalence rates will be determined through prospective risk factor screening/CVD evaluation in PWBD over 40 yrs. Further study is warranted as prophylaxis becomes more widely utilized converting patients with severe disease to a more moderate disease state and possibly altering CVD prevalence. Invasive procedure outcome and optimal CVD therapy in PWBD require prospective investigation. This single center analysis represents the largest reported registry of PWBD analyzed for CVD to date.

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Rates and risk factors for suicidal ideation, suicide attempts and suicide deaths in persons with HIV: a systematic review and meta-analysis

General Psychiatry ◽

10.1136/gpsych-2020-100247 ◽

2021 ◽

Vol 34 (2) ◽

pp. e100247

Author(s):

Matt Pelton ◽

Matt Ciarletta ◽

Holly Wisnousky ◽

Nicholas Lazzara ◽

Monica Manglani ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Suicidal Ideation ◽

General Population ◽

Suicide Attempts ◽

Advanced Disease ◽

Meta Analysis ◽

People Living With Hiv ◽

Meta Regression ◽

Living With Hiv

BackgroundPeople living with HIV/AIDS (PLWHA) must contend with a significant burden of disease. However, current studies of this demographic have yielded wide variations in the incidence of suicidality (defined as suicidal ideation, suicide attempt and suicide deaths).AimsThis systematic review and meta-analysis aimed to assess the lifetime incidence and prevalence of suicidality in PLWHA.MethodsPublications were identified from PubMed (MEDLINE), SCOPUS, OVID (MEDLINE), Joanna Briggs Institute EBP and Cochrane Library databases (from inception to before 1 February 2020). The search strategy included a combination of Medical Subject Headings associated with suicide and HIV. Researchers independently screened records, extracted outcome measures and assessed study quality. Data were pooled using a random-effects model. Subgroup and meta-regression analyses were conducted to explore the associated risk factors and to identify the sources of heterogeneity. Main outcomes were lifetime incidence of suicide completion and lifetime incidence and prevalence of suicidal ideation and suicide attempt.ResultsA total of 185 199 PLWHA were identified from 40 studies (12 cohorts, 27 cross-sectional and 1 nested case-control). The overall incidence of suicide completion in PLWHA was 10.2/1000 persons (95%CI: 4.5 to 23.1), translating to 100-fold higher suicide deaths than the global general population rate of 0.11/1000 persons. The lifetime prevalence of suicide attempts was 158.3/1000 persons (95%CI: 106.9 to 228.2) and of suicidal ideation was 228.3/1000 persons (95%CI: 150.8 to 330.1). Meta-regression revealed that for every 10-percentage point increase in the proportion of people living with HIV with advanced disease (AIDS), the risk of suicide completion increased by 34 per 1000 persons. The quality of evidence by Grading of Recommendations, Assessment, Development and Evaluations for the suicide deaths was graded as ‘moderate’ quality.ConclusionsThe risk of suicide death is 100-fold higher in people living with HIV than in the general population. Lifetime incidence of suicidal ideation and attempts are substantially high. Suicide risk assessments should be a priority in PLWHA, especially for those with more advanced disease.

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Platelet function and cardiovascular risk in adult HIV-infected patients on HAART: a protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2017-019468 ◽

2017 ◽

Vol 7 (12) ◽

pp. e019468 ◽

Cited By ~ 2

Author(s):

Bongani Brian Nkambule ◽

Zibusiso Mkandla ◽

Tinashe Mutize ◽

Phiwayinkosi Vusi Dludla

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Cardiovascular Risk ◽

Platelet Activation ◽

Meta Analysis ◽

People Living With Hiv ◽

Qualitative Synthesis ◽

Cvd Risk ◽

Increased Risk ◽

Statistical Heterogeneity

IntroductionThe incidence of cardiovascular disease (CVD) is now at least threefold higher in HIV-infected patients as compared with the general population. Although platelet activation and reactivity are implicated in the development of CVDs in HIV-infected patients, its precise role remains inconclusive. We aim to assess the association between platelet activation and selected cardiovascular risk factors in HIV-1-infected individuals on highly active antiretroviral treatment (HAART).MethodsThis will be a systematic review and meta-analysis of published studies evaluating the association between platelet activation and CVD risk factors in HAART-treated adults. The search strategy will include medical subject headings words for MEDLINE, and this will be adapted to Embase search headings (Emtree) terms for the EMBASE database. The search will cover literature published between 1 January 1996 to 30 April 2017. Studies will be independently screened by two reviewers using predefined criteria. Relevant eligible full texts will be screened; data will be extracted, and a qualitative synthesis will be conducted. Data extraction will be performed using Review Manager V.5.3. To assess the quality and strengths of evidence across selected studies, the Grading of Recommendations Assessment Development and Evaluation approach will be used. The Cochran’s Q statistic and the I2statistics will be used to analyse statistical heterogeneity between studies. If included studies show high levels of homogeneity, a random effects meta-analysis will be performed using R statistical software.Ethics and disseminationThis will be a review of existing studies and will not require ethical approval. The findings will be disseminated through peer-reviewed publication and presented at local and international conferences. An emerging patient management dilemma is that of the increased incidence of CVD in people living with HIV on HAART. This review may inform treatment and cardiovascular risk stratification of HIV-infected patients at increased risk of developing CVD.PROSPERO registration numberCRD42017062393.

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Abstract TMP48: Stroke Symptoms and Risk of Future Hospitalization: Implications for an Easy and Quick Screening for an Important Patient-Centered Outcome

Stroke ◽

10.1161/str.44.suppl_1.atmp48 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Virginia J Howard ◽

J. D Rhodes ◽

Suzanne E Judd ◽

Dawn O Kleindorfer ◽

Anne W Alexandrov ◽

...

Keyword(s):

Risk Factors ◽

General Population ◽

Proportional Hazards ◽

Perceived Health ◽

Population Based ◽

Perceived Health Status ◽

Cvd Risk ◽

Patient Centered ◽

Stroke Symptom ◽

Regards Study

Background: Stroke symptoms in the general population are common (≈18% of adults 45+) and are associated with future stroke. These symptoms may also identify a broad spectrum of clinically-undetected vascular conditions. Methods: Stroke symptoms (sudden weakness, numbness, unilateral or general loss of vision, and loss of ability to communicate or understand) and time to self-reported hospitalization for any cardiovascular (CVD) reason (heart, stroke, or TIA) or stroke were assessed in the REGARDS Study (a national, population-based, longitudinal study of 30,239 African-American and white adults > 45 years enrolled 2003-2007). The symptom-hospitalization association was assessed by proportional hazards analysis in persons stroke/TIA-free at baseline, with adjustment for demographics (age, race and sex), further adjustment for SES (income and education), CVD risk factors (smoking, hypertension, diabetes, dyslipidemia, atrial fibrillation and heart disease), and “perceived health status.” Results: Over an average follow-up of 5.6 years, presence of any stroke symptom was associated with greater risk of hospitalization for stroke (11% versus 6%; HR = 1.68; 95% CI: 1.52 - 1.85), a risk only modestly attenuated by adjustment for SES (HR = 1.59; 95% CI: 1.44 - 1.76), risk factors (HR = 1.44; 95% CI: 1.29 - 1.60), and perceived health (HR = 1.37; 95% CI: 1.23 - 1.53). However, presence of any stroke symptom was more strongly related to hospitalization for CVD (42% vs. 24%; HR = 1.92; 95 CI: 1.82 - 2.03), only modestly mediated by adjustment for SES (HR = 1.82; 95% CI: 1.73 - 1.93), risk factors (HR = 1.66; 95% CI: 1.57 - 1.76), and perceived health (HR = 1.57; 95% CI: 1.48 - 1.66). Conclusions: Stroke symptoms appear to be a marker not only for stroke risk, but also for general CVD. Simple questions can identify 18% of the general population that have over a 40% chance of hospitalization for CVD over a 5-year horizon. Implications for potential intervention to reduce risk are profound.

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Factor analysis for the clustering of cardiometabolic risk factors and sedentary behavior, a cross-sectional study

PLoS ONE ◽

10.1371/journal.pone.0242365 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242365

Author(s):

Tsung-Ying Tsai ◽

Pai-Feng Hsu ◽

Chung-Chi Lin ◽

Yuan-Jen Wang ◽

Yaw-Zon Ding ◽

...

Keyword(s):

Risk Factors ◽

Factor Analysis ◽

General Population ◽

Sedentary Behavior ◽

Cardiometabolic Risk ◽

Cardiometabolic Risk Factors ◽

Validation Group ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Clustering Pattern

Background Few studies have reported on the clustering pattern of CVD risk factors, including sedentary behavior, systemic inflammation, and cadiometabolic components in the general population. Objective We aimed to explore the clustering pattern of CVD risk factors using exploratory factor analysis to investigate the underlying relationships between various CVD risk factors. Methods A total of 5606 subjects (3157 male, 51.5±11.7 y/o) were enrolled, and 14 cardiovascular risk factors were analyzed in an exploratory group (n = 3926) and a validation group (n = 1676), including sedentary behaviors. Results Five factor clusters were identified to explain 69.4% of the total variance, including adiposity (BMI, TG, HDL, UA, and HsCRP; 21.3%), lipids (total cholesterol and LDL-cholesterol; 14.0%), blood pressure (SBP and DBP; 13.3%), glucose (HbA1C, fasting glucose; 12.9%), and sedentary behavior (MET and sitting time; 8.0%). The inflammation biomarker HsCRP was clustered with only adiposity factors and not with other cardiometabolic risk factors, and the clustering pattern was verified in the validation group. Conclusion This study confirmed the clustering structure of cardiometabolic risk factors in the general population, including sedentary behavior. HsCRP was clustered with adiposity factors, while physical inactivity and sedentary behavior were clustered with each other.

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Abstract P113: Female Gender is Associated with a Low Ankle Brachial Index in the General Population

Circulation ◽

10.1161/circ.133.suppl_1.p113 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Ridhima Kapoor ◽

Colby Ayers ◽

Jacquelyn Kulinski

Keyword(s):

Risk Factors ◽

Gender Differences ◽

General Population ◽

Ankle Brachial Index ◽

Hdl Cholesterol ◽

Female Gender ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Health And Nutrition ◽

And Gender

Background: The ankle-brachial index (ABI) is a predictor of cardiovascular events, mortality and functional status. Gender differences in ABI have been reported in some population studies. Differences in height might account for these observed gender differences, but findings are conflicting. Objective: This study investigated the association between gender, height and ABI in the general population, independent of traditional cardiovascular disease (CVD) risk factors. Methods: Participants ≥ 40 years from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 with ABI data, were included. A low ABI was defined as a value < 1.0 (including borderline values). Sample-weighted multivariable logistic regression modeling was performed with low ABI as the dependent variable and height and gender as primary predictor variables of interest. A backward elimination model selection technique was performed to identify significant covariates. Results: There were 3,052 participants with ABI data (mean age 57, 51% female (1570 of 3052). The sample-weighted mean (±SE) ABI was 1.09 (±0.006) and 1.13 (±0.005) for females and males, respectively. Women were more likely to have a low ABI compared to men, 42% (659 of 1570) versus 28% (415 of 1482), respectively (p<0.0001). Female gender was associated with a low ABI (OR 1.34, [95% CI, 1.04-1.72]; p=0.025), independent of traditional CVD risk factors (see Figure). Age, diabetes, tobacco use, known CVD, BMI and black race were also associated with a low ABI (all p<0.003). Self-reported hypertension and non-HDL cholesterol levels, however, were not associated with a low ABI. An interaction between height and body mass index (BMI) was identified. Conclusions: Female gender is associated with a low ABI in the general population. This association appears to be independent of height and other traditional CVD risk factors and warrants further investigation.

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Abstract 049: Mitochondrial DNA Copy Number and Incident Atrial Fibrillation: The Atherosclerosis Risk in Communities Study (ARIC)

Circulation ◽

10.1161/circ.137.suppl_1.049 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Di Zhao ◽

Eliseo Guallar ◽

Ryan Longchamps ◽

Christina Castellani ◽

Yunsoo Hong ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Mitochondrial Dna ◽

General Population ◽

Mitochondrial Function ◽

Copy Number ◽

Cvd Risk Factors ◽

Dna Copy Number ◽

Cvd Risk ◽

Mitochondrial Dna Copy Number

Background: Atrial fibrillation (AF) is the most common clinical arrhythmia. Molecular studies suggest that mitochondrial dysfunction is associated with increased risk of AF through reduced production of adenosine triphosphate and increased production of reactive oxidative species. Mitochondrial DNA copy number (mtDNA CN), a marker of mitochondrial function, has been found to be associated with sudden cardiac death and cardiovascular disease (CVD) in ARIC. However, the association between mtDNA CN and incident AF in the general population is unknown. Objective: To examine the prospective association between mtDNA CN and the risk of incident AF. Methods: Cohort study of 10,764 ARIC participants without AF at baseline (1987-89) and followed through December 31, 2014. AF were identified through electrocardiograms, review of hospital discharge codes, and death certificates. DNA samples were isolated from buffy coat. mtDNA CN was calculated from probe intensities on the Affymetrix Genome-Wide Human single nucleotide polymorphisms (SNP) Array and standardized using the residual method. Cox proportional hazards models adjusted for demographics and CVD risk factors were used to estimate hazard ratios (HR) for AF comparing the four lowest quintiles of mtDNA CN to the highest quintile. Results: The mean (SD) age was 57.4 (6.0) years. During 21 years of median follow-up, 1,946 participants developed AF. In fully-adjusted models, the HRs (95% CI) for AF comparing quintiles 1 - 4 to quintile 5 of mtDNA CN were 1.17 (1.00, 1.37), 1.17 (0.99, 1.37), 0.92 (0.78, 1.10) and 1.05 (0.89, 1.24), respectively (p-trend 0.044; Figure). The HR for AF comparing 10 th vs 90 th percentile of mtDNA-CN was 1.16 (1.04, 1.30). Conclusions: mtDNA CN was inversely associated with the risk of AF independent of traditional CVD risk factors. Decline in mitochondrial function may be a novel mechanism underlying biological changes that increase the risk of AF in the general population. mtDNA CN may provide potential for novel AF prevention strategies.

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The Prevalence of Cardiovascular Risk Factors in Different Occupational Groups in New Zealand

Annals of Work Exposures and Health ◽

10.1093/annweh/wxaa040 ◽

2020 ◽

Vol 64 (6) ◽

pp. 645-658

Author(s):

Lucy A Barnes ◽

Amanda Eng ◽

Marine Corbin ◽

Hayley J Denison ◽

Andrea ‘t Mannetje ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

New Zealand ◽

General Population ◽

Population Survey ◽

High Cholesterol ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Occupational Groups ◽

General Population Survey

Abstract Objectives Although cardiovascular disease (CVD) risk has been shown to differ between occupations, few studies have specifically evaluated the distribution of known CVD risk factors across occupational groups. This study assessed CVD risk factors in a range of occupational groups in New Zealand, stratified by sex and ethnicity. Methods Two probability-based sample surveys of the general New Zealand adult population (2004–2006; n = 3003) and of the indigenous people of New Zealand (Māori; 2009–2010; n = 2107), for which occupational histories and lifestyle factors were collected, were linked with routinely collected health data. Smoking, body mass index, deprivation, diabetes, high blood pressure, and high cholesterol were dichotomized and compared between occupational groups using age-adjusted logistic regression. Results The prevalence of all known CVD risk factors was greater in the Māori survey than the general population survey, and in males compared with females. In general for men and women in both surveys ‘Plant and machine operators and assemblers’ and ‘Elementary workers’ were more likely to experience traditional CVD risk factors, while ‘Professionals’ were less likely to experience these risk factors. ‘Clerks’ were more likely to have high blood pressure and male ‘Agricultural and fishery workers’ in the general survey were less likely to have high cholesterol, but this was not observed in the Māori survey. Male Māori ‘Trades workers’ were less likely to have high cholesterol and were less obese, while for the general population survey, this was not observed. Conclusions This study showed differences in the distribution of known CVD risk factors across occupational groups, as well as between ethnic groups and males and females.

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