Prioritising risk assessment and management for cardiovascular disease

2020 ◽  
Vol 26 (9) ◽  
pp. 244-247
Author(s):  
Beverley Bostock
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Risk Assessment ◽  
At Risk ◽  
Multidisciplinary Management ◽  
Risk Assessment And Management

With evidence supporting the link between cardiovascular disease and myriad risk factors, Beverley Bostock considers how best to identify and support at-risk individuals through long-term, multidisciplinary management.

scholarly journals In-hospital delirium risk assessment, diagnosis and management; medications to avoid

2013 ◽  
pp. 98-102
Author(s):  
Andrew Clegg ◽  
John Young
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
At Risk ◽  
Medication Review ◽  
Adverse Outcomes ◽  
Severe Illness ◽  
Term Care ◽  
Prevention Interventions ◽  
Delirium Prevention

Background: Delirium is a common, but potentially preventable complication of acute illness that is associated with important adverse outcomes including increased length of hospital admission, risk of dementia and admission to long-term care. In-hospital risk assessment and diagnosis: Age over 65, severe illness, current hip fracture and presence of cognitive impairment or dementia are important risk factors for delirium. Assess people with any of these risk factors for recent changes or fluctuations in behaviour that might indicate delirium. If any indicators are present, complete a full cognitive assessment to confirm the diagnosis of delirium. In-hospital risk management: Multicomponent delirium prevention interventions can reduce the incidence of delirium in hospital by around one third and should be provided to people with any of the important risk factors that do not have delirium at admission. A medication review that considers both the number and type of prescribed medications is an important part of the multicomponent delirium prevention intervention. Which medications to avoid in people at risk of delirium: For people at risk of delirium, avoid new prescriptions of benzodiazepines or consider reducing or stopping these medications where possible. Opioids should be prescribed with caution in people at risk of delirium but this should be tempered by the observation that untreated severe pain can itself trigger delirium. Caution is also required when prescribing dihydropyridines and antihistamine H1 antagonists for people at risk of delirium and considered individual patient assessment is advocated. Conclusion: Delirium is common, distressing to patients, relatives and carers and is associated with important adverse outcomes. Multicomponent delirium prevention interventions can reduce the incidence of delirium by approximately one third and usually incorporate a medication review. Identification of which medications to avoid in people at risk of delirium will help guide evidence-based decision making.

scholarly journals Peripheral atherosclerosis and abdominal aortic aneurysm as a new risk factors of upper gastrointestinal bleeding in patients with stable CAD receiving long-term antithrombotic therapy

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
V Korobkova ◽  
AL Komarov ◽  
OO Shakhmatova ◽  
MV Andreevskaya ◽  
EB Yarovaya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Antithrombotic Therapy ◽  
Upper Gastrointestinal Bleeding ◽  
Atherosclerotic Burden ◽  
Abdominal Aortic ◽  
Stable Cad ◽  
Upper Gastrointestinal

Abstract Funding Acknowledgements Type of funding sources: None. Background Upper gastrointestinal bleeding (UGIB) is the most common hemorrhagic complication in stable CAD patients receiving antithrombotic therapy. It seems that atherosclerotic burden may increase the overall bleeding frequency. However, this factor has never been taken into account with UGIB risk assessment. We aimed to assess the predictive value of atherosclerotic burden (peripheral atherosclerosis – PAD and abdominal aortic aneurysm - AAA) for UGIB in patients with stable CAD receiving long-term antithrombotic therapy. Patients and Methods. A single center prospective Registry of Long-term AnTithrombotic TherApy (REGATTA-1 NCT04347200) included 934 pts with stable CAD (78.6% males, median age 61 [IQR 53-68] yrs). 77,3 %  of patients received dual antiplatelet therapy due to recent PCI with a switch to aspirin monotherapy after 6 months. 17,6% of patients received aspirin only, 5,1 % of patients received oral anticoagulants because of concomitant atrial fibrillation. Risk assessment of UGIB was performed according to the 2015 European Society of Cardiology guidelines (we were not able to identify only Helicobacter pylori infection). Additional ultrasound screening for PAD (lower limbs and cerebrovascular beds) and AAA was applied. The primary outcome was any overt UGIB (BARC ≥2). Results  The frequency of PAD was 18,8%, AAA – 2,4%, PAD and/or AAA -  20,5%. In a total 2335 person-years of follow-up (median follow-up - 2,5 yrs, IQR 1,1 – 5.1), UGIB occurred in 51 patients (incidence at 1 year 1,9 per 100 patients).  The median time to first occurrence of UGIB was 72 [IQR 13-214] days. Comparing the Kaplan-Meyer curves, the UGIB developed three times more often in patients with coexisted PAD and/or AAA vs isolated CAD (19.8% vs 6.5%, Log-Rank p = 0.00006). The difference remains consisted in regression model taking in account 2015 ESC panel of UGIB risk factors (OR 3.4; CI 1.7–6.9, p = 0,0005). Conclusions Atherosclerotic burden (concomitant PAD and/or AAA) is an independent predictor of UGIB in patients with stable CAD receiving long-term antithrombotic therapy.

A Registry to Evaluate Cardiovascular Disease Risk Factors in At-risk Youth

2018 ◽  
Vol 32 ◽  
pp. 43
Author(s):  
Luke Hamilton ◽  
Alejandro de la Torre ◽  
Lisa Guerra ◽  
Amelia Vinson ◽  
Lauren Williams ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
At Risk ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Cardiovascular Disease Risk Factors ◽  
At Risk Youth

scholarly journals 30-Year Cardiovascular Disease in Type 1 Diabetes: Risk and Risk Factors Differ by Long-Term Patterns of Glycemic Control

2021 ◽  
Author(s):  
Rachel G. Miller ◽  
Trevor J. Orchard ◽  
Tina Costacou
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Latent Class ◽  
Diabetes Duration ◽  
Cvd Risk ◽  
High Hba1c

<b>Objective:</b> We hypothesized that there is heterogeneity in long-term patterns of glycemic control with respect to cardiovascular disease (CVD) development in type 1 diabetes and that risk factors for CVD differ by glycemic control pattern. Thus, we estimated associations between data-derived latent HbA1c trajectories and 30-year CVD risk in the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood-onset (<17 years old) type 1 diabetes.<b> </b> <p><b>Research Design and Methods: </b>Participants (n=536 with ≥2 HbA1c measurements [median 6] and CVD-free at baseline; mean age 27 and diabetes duration 18 years) were followed from 1986-88 to 2016-18 to ascertain CVD incidence (CVD death, myocardial infarction, stroke, coronary revascularization or blockage ≥50%, ischemic ECG, or angina). Latent HbA1c trajectories and their association with time-to-CVD incidence were simultaneously assessed using Joint Latent Class Mixed Models.</p> <p><b>Results:</b> Two HbA1c trajectories with respect to differential CVD risk were identified: Low (HbA1c ~8% [64 mmol/mol] and improving over follow-up, 76% of cohort) and High (HbA1c ~10% [86 mmol/mol] and stable, 24%). Overall, 30-year CVD incidence was 47.4% (n=253); MACE incidence 31.0% (n=176). High HbA1c was associated with 3-fold increased CVD risk versus Low HbA1c. Both groups had similar age and diabetes duration. Non-HDLc and estimated glomerular filtration rate were associated with CVD risk only in Low HbA1c; albumin excretion rate was associated with CVD risk only in High HbA1c.<b> </b></p> <p><b>Conclusions: </b>These risk factor differences suggest that pathways to CVD may differ by glycemic control, potentially resulting in important implications for prognosis in type 1 diabetes.</p>

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