POTENTIAL ADVANTAGES ANDBARRIERS OF POLYPILLAND CARDIOVUSCULAR RISK: A NARRATIVE REVIEW

Comprehensive approaches are followed in chronic disease prevention. Polypharmacy or using fixed dose combination of polypill is an element under the comprehensive approach. This narrative review is carried out in intent to summarise the potential advantages and barriers of using Polypill in cardiovascular risk prevention. There is potential to benefit the high risk group for non communicable diseases in terms of primary prevention but secondary prevention is not certainly indicated. Available Drugs are noted.

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Comparative risk assessment for the development of cardiovascular diseases in the Hungarian general and Roma population

Scientific Reports ◽

10.1038/s41598-021-82689-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Peter Piko ◽

Zsigmond Kosa ◽

Janos Sandor ◽

Roza Adany

Keyword(s):

Risk Factors ◽

Risk Assessment ◽

Cardiovascular Risk ◽

Cardiovascular Diseases ◽

High Risk ◽

Risk Group ◽

High Risk Group ◽

Average Risk ◽

Cvd Risk ◽

Roma Population

AbstractCardiovascular diseases (CVDs) are the number one cause of death globally, and the early identification of high risk is crucial to prevent the disease and to reduce healthcare costs. Short life expectancy and increased mortality among the Roma are generally accepted (although not indeed proven by mortality analyses) which can be partially explained by the high prevalence of cardiovascular risk factors (CVRF) among them. This study aims to elaborate on the prevalence of the most important CVD risk factors, assess the estimation of a 10-year risk of development of fatal and nonfatal CVDs based on the most used risk assessment scoring models, and to compare the Hungarian general (HG) and Roma (HR) populations. In 2018 a complex health survey was accomplished on the HG (n = 380) and HR (n = 347) populations. The prevalence of CVRS was defined and 10-year cardiovascular risk was estimated for both study populations using the following systems: Framingham Risk Score for hard coronary heart disease (FRSCHD) and for cardiovascular disease (FRSCVD), Systematic COronary Risk Evaluation (SCORE), ACC/AHA Pooled Cohort Equations (PCE) and Revised Pooled Cohort Equations (RPCE). After the risk scores had been calculated, the populations were divided into risk categories and all subjects were classified. For all CVD risk estimation scores, the average of the estimated risk was higher among Roma compared to the HG independently of the gender. The proportion of high-risk group in the Hungarian Roma males population was on average 1.5–3 times higher than in the general one. Among Roma females, the average risk value was higher than in the HG one. The proportion of high-risk group in the Hungarian Roma females population was on average 2–3 times higher compared to the distribution of females in the general population. Our results show that both genders in the Hungarian Roma population have a significantly higher risk for a 10-year development of cardiovascular diseases and dying from them compared to the HG one. Therefore, cardiovascular interventions should be focusing not only on reducing smoking among Roma but on improving health literacy and service provision regarding prevention, early recognition, and treatment of lipid disorders and diabetes among them.

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Multiple Myeloma Patients Undergoing Carfilzomib: Development and Validation of a Risk Score for Cardiovascular Adverse Events Prediction

Cancers ◽

10.3390/cancers13071631 ◽

2021 ◽

Vol 13 (7) ◽

pp. 1631

Author(s):

Anna Astarita ◽

Giulia Mingrone ◽

Lorenzo Airale ◽

Fabrizio Vallelonga ◽

Michele Covella ◽

...

Keyword(s):

Blood Pressure ◽

Risk Assessment ◽

Multiple Myeloma ◽

Cardiovascular Risk ◽

High Risk ◽

Adverse Events ◽

Risk Score ◽

Risk Group ◽

High Risk Group ◽

Cardiovascular Risk Assessment

Cardiovascular adverse events (CVAEs) are linked to Carfilzomib (CFZ) therapy in multiple myeloma (MM); however, no validated protocols on cardiovascular risk assessment are available. In this prospective study, the effectiveness of the European Myeloma Network protocol (EMN) in cardiovascular risk assessment was investigated, identifying major predictors of CVAEs. From January 2015 to March 2020, 116 MM patients who had indication for CFZ therapy underwent a baseline evaluation (including blood pressure measurements, echocardiography and arterial stiffness estimation) and were prospectively followed. The median age was 64.53 ± 8.42 years old, 56% male. Five baseline independent predictors of CVAEs were identified: office systolic blood pressure, 24-h blood pressure variability, left ventricular hypertrophy, pulse wave velocity value and global longitudinal strain. The resulting ‘CVAEs risk score’ distinguished a low- and a high-risk group, obtaining a negative predicting value for the high-risk group of 90%. 52 patients (44.9%) experienced one or more CVAEs: 17 (14.7%) had major and 45 (38.7%) had hypertension-related events. In conclusion, CVAEs are frequent and a specific management protocol is crucial. The EMN protocol and the risk score proved to be useful to estimate the baseline risk for CVAEs during CFZ therapy, allowing the identification of higher-risk patients.

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Primary prevention lessons learned from those with HIV in Chennai, India

Sexual Health ◽

10.1071/sh10015 ◽

2011 ◽

Vol 8 (2) ◽

pp. 199 ◽

Cited By ~ 2

Author(s):

Ellen Setsuko Hendriksen ◽

A. K. Sri Krishnan ◽

Snigda Vallabhaneni ◽

Sethu Johnson ◽

Sudha Raminani ◽

...

Keyword(s):

Primary Prevention ◽

High Risk ◽

Risk Group ◽

Infected Individual ◽

High Risk Group ◽

Lessons Learned ◽

Transmission Risk ◽

Hiv Education ◽

Sexual Roles ◽

Male Clients

Background As each HIV-infected individual represents a breakdown of HIV primary prevention measures, formative data from representative individuals living with HIV can help shape future primary prevention interventions. Little is known about sexual behaviours and other transmission risk factors of high-risk group members who are already HIV-infected in Chennai, India. Methods: Semi-structured qualitative interviews were conducted with 27 HIV-infected individuals representing each high-risk group in Chennai (five men who have sex with men (MSM), five female commercial sex workers (CSW), four truckers and other men who travel for business, four injecting drug users (IDU), five married male clients of CSW, and four wives of CSW clients, MSM, truckers, and IDU). Results: Themes relevant to HIV primary prevention included: (1) HIV diagnosis as the entry into HIV education and risk reduction, (2) reluctance to undergo voluntary counselling and testing, (3) gender and sexual roles as determinants of condom use, (4) misconceptions about HIV transmission, and (5) framing and accessibility of HIV education messages. Conclusions: These qualitative data can be used to develop hypotheses about sexual risk taking in HIV-infected individuals in South India, inform primary prevention intervention programs, and improve primary prevention efforts overall.

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SPECIFICS OF ANTIHYPERTENSION THERAPY IN HYPERTENSIVES OF VARIOUS CARDIOVASCULAR RISK (BY THE REGISTRY OF CHRONIC NON-COMMUNICABLE DISEASES IN TYUMENSKAYA OBLAST)

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2018-3-4-10 ◽

2018 ◽

Vol 17 (3) ◽

pp. 4-10

Author(s):

A. Yu. Efanov ◽

Yu. A. Vyalkina ◽

Yu. A. Petrova ◽

Z. M. Safiullina ◽

O. V. Abaturova ◽

...

Keyword(s):

Cardiovascular Risk ◽

High Risk ◽

Risk Group ◽

High Risk Group ◽

Risk Level ◽

Moderate Risk ◽

High Risk Patients ◽

Risk Patients ◽

Very High

Aim. To assess the specifics of antihypertension therapy (AHT) in hypertensives of various cardiovascular risk, in the registry of chronic non-communicable diseases in Tyumenskaya oblast.Material and methods. A random sample studied, of 1704 patients with hypertension, inhabitants of Tyumenskaya oblast (region), ascribed to dispensary follow-up. Mean age 62±7,5 y.o. Of those 31,5% (n=537) males. The prevalence and efficacy of AHT assessed according to cardiovascular risk level. The significance was evaluated with the criteria χ2.Results. AHT was characterized by the growth of the frequency of treatment approaches with cardiovascular risk consideration. Regular treatment took 33,9% patients of low and moderate risk vs 41,3% of high and very high (p<0,01). In the male group such tendency also took place. Gender specifics of AHT was characterized by that in the groups of high and very high risk females took medications significantly more commonly than males — 46,6% vs 29,1% in high risk group (p<0,01) and 47,5% vs 30% in very high risk group (p<0,01). With the increase of the risk level, there was decline of treatment efficacy — from 95% in low risk group to 32,5% in very high risk group; 53,1% of the participants were taking monotherapy, 32,9% — two drugs, 14,0% — ≥3 drugs. With the increase of risk grade there is tendency to increase of combinational AHT, however with no significant increase of efficacy. Treatment efficacy in high and very high risk patients comparing to patients with low and moderate risk was significantly lower — 33,1% vs 69,7% (p<0,01), respectively. Statins intake among the high and very high risk patients was 10,6-11,0% males and 7,8% females (p<0,05).Conclusion. AHT in hypertensives in Tymenskaya oblast, under dispensary follow-up, is characterized by insufficient usage of combinational drugs. With the raise of cardiovascular risk there is tendency to higher rate of combinational AHT. However there is no significant increase in efficacy of treatment with the increase of medications number. A very low rate of statins intake is noted. The obtained specifics witness for the necessity to optimize AHT among the high and very high risk patients — inhabitants of Tyumenskya oblast.

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Abstract P209: Effects of Blood Pressure Lowering on Vascular Outcomes in Different Cardiovascular Risk Groups Among Patients With Type 2 Diabetes: New Results From Advance

Circulation ◽

10.1161/circ.125.suppl_10.ap209 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Susan van Dieren ◽

Andre Pascal Kengne ◽

John Chalmers ◽

Joline Beulens ◽

Yvonne van der Schouw ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Risk ◽

High Risk ◽

Treatment Effects ◽

Disease Risk ◽

Risk Group ◽

Absolute Risk ◽

Risk Groups ◽

High Risk Group

Background/Aim: Although patients with type 2 diabetes constitute a high risk group there is a gradation in cardiovascular risk which may lead to differences in outcomes and effects of treatment. The objective of this study was to assess for differences in treatment effects of the fixed combination of perindopril-indapamide across subgroups of cardiovascular risk. Methods: 11,140 patients with type 2 diabetes, participating in the ADVANCE trial, were randomized to perindopril-indapamide or matching placebo. The UKPDS risk engine was used to calculate baseline 5-year coronary heart disease risk and to stratify patients into three risk groups (0-10%; 10–15%; >15%). Endpoints were composites of major macrovascular and microvascular events. Homogeneity of treatment effects across risk subgroups were tested by adding interaction terms to the Cox models. Results: The median estimated 5-year coronary heart disease risk at baseline was 10% (IQR 7%−16%). 1000 macrovascular and 916 microvascular events were recorded during a median follow-up of 4.3 years. The relative treatment effects were similar across all risk groups for all endpoints, with no heterogeneity (all P -values for heterogeneity ≥ 0.38). The hazard ratios for combined macro- and microvascular events were 0.89 (95% confidence interval: 0.77–1.03) for the moderate-high risk group and 0.92 (0.81–1.03) for the very high risk group. The absolute risk reductions were greater in the highest risk groups, with numbers needed to treat ranging from 38 to 244. Conclusions: Reductions in relative risk achieved with the fixed combination of perindopril-indapamide among patients with type 2 diabetes were consistent across subgroups defined by baseline cardiovascular risk, but reductions in absolute risk were greatest in those with the highest initial risk. Acknowledgements: This research was supported by a program grant from the National Health and Medical Research Council of Australia, the Center for Translational Molecular Medicine (CTMM) and the Netherlands Heart Foundation, Dutch Diabetes Research Foundation and Dutch Kidney Foundation (PREDICCt).

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Cardiovascular Risk Assessment: A Comparison of the Framingham, PROCAM, and DAD Equations in HIV-Infected Persons

The Scientific World JOURNAL ◽

10.1155/2013/969281 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 23

Author(s):

Max Weyler Nery ◽

Celina Maria Turchi Martelli ◽

Erika Aparecida Silveira ◽

Clarissa Alencar de Sousa ◽

Marianne de Oliveira Falco ◽

...

Keyword(s):

Cardiovascular Risk ◽

High Risk ◽

Risk Group ◽

Cross Sectional Study ◽

High Risk Group ◽

Cardiovascular Risk Assessment ◽

Cvd Risk ◽

Cross Sectional ◽

Group Data ◽

Low Hdl

This study aims to estimate the risk of cardiovascular disease (CVD) and to assess the agreement between the Framingham, Framingham with aggravating factors, PROCAM, and DAD equations in HIV-infected patients. A cross-sectional study was conducted in an outpatient centre in Brazil. 294 patients older than 19 years were enrolled. Estimates of 10-year cardiovascular risk were calculated. The agreement between the CVD risk equations was assessed using Cohen's kappa coefficient. The participants' mean age was 36.8 years (SD = 10.3), 76.9% were men, and 66.3% were on antiretroviral therapy. 47.8% of the participants had abdominal obesity, 23.1% were current smokers, 20.0% had hypertension, and 2.0% had diabetes. At least one lipid abnormality was detected in 72.8%, and a low HDL-C level was the most common. The majority were classified as having low risk for CV events. The percentage of patients at high risk ranged from 0.4 to 5.7. The PROCAM score placed the lowest proportion of the patients into a high-risk group, and the Framingham equation with aggravating factors placed the highest proportion of patients into the high-risk group. Data concerning the comparability of different tools are informative for estimating the risk of CVD, but accuracy of the outcome predictions should also be considered.

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АSSESMENT OF PRIMARY CARE PHYSICIAN ABOUT TOTAL CARDIOVASCULAR RISK

JOURNAL OF CARDIORESPIRATORY RESEARCH ◽

10.26739/2181-0974-2020-2-15 ◽

2020 ◽

Vol 2 (1) ◽

pp. 81-84

Author(s):

Sanjar Kholboyev ◽

Keyword(s):

Cardiovascular Risk ◽

High Risk ◽

Risk Evaluation ◽

Risk Group ◽

Clinical Manifestations ◽

High Risk Group ◽

Care Physician ◽

Coronary Risk ◽

Asymptomatic Patients ◽

Risk Scale

In practical medicine, the assessment of total cardiovascular risk (CVR) plays an important role in identifying a high-risk group among “asymptomatic” patients, that is, individuals without clinical manifestations of atherosclerosis. Currently, the most famous are the American Framingham Total Coronary Risk Scale, as well as the European SCORE (Systematic Coronary Risk Evaluation) scale, which predicts the 10-year fatal risk of all CVDs for European countries with low and high risk. The survey involved 66 doctors from various regions of Uzbekistan

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Cardiovascular risk and response to lipid lowering therapy in patients with HIV infection according to different recommendations

PLoS ONE ◽

10.1371/journal.pone.0244675 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244675

Author(s):

Agnieszka Pawlos ◽

Marlena Broncel ◽

Ewelina Wlazłowska ◽

Elżbieta Jabłonowska ◽

Paulina Gorzelak-Pabiś

Keyword(s):

Cardiovascular Risk ◽

High Risk ◽

Risk Group ◽

High Risk Group ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

High Cardiovascular Risk ◽

Hiv Patients ◽

Lowering Therapy ◽

Very High

Background HIV patients are at increased cardiovascular risk while available European cardiovascular recommendations are ambiguous. Methods Retrospective analysis of 389 HIV-patients was conducted. Cardiovascular risk was determined by D:A:D, Framingham and SCORE scales. Patients were divided into risk groups as recommended by EACS 2019, PTN AIDS 2019 and ESC/EAS 2019 Guidelines and hypolipemic treatment was evaluated. Results In total, 389 HIV-positive patients took part in the study, most of whom were men (n = 312, 80.4%), mean age 41.69±10years. Mean lipid levels among all HIV patients: Tch:177.2±36mg/dl, HDL:48.9±18mg/dl, LDL:103.8±31mg/dl, TG:143.3±81mg/dl, AIP:0.45±0.3, non-HDL:129.2±36 mg/dl. Most of the participants (n = 360, 92.5%) were assigned to the high cardiovascular risk group according to ESC/EAS and PTN AIDS guidelines. The achievement of therapeutic LDLs according to ESC/EAS was 10.3% for those at very high cardiovascular risk (8.7% on lipid lowering treatment vs. 16.7% without hypolipemic drugs) and 12.0% (5.8% treated vs. 13.6% untreated) at high cardiovascular risk; according to PTN AIDS,17.2% achievement was noted by the very high-risk group (13% treated vs. 33.3% untreated), and 45.9% for the high-risk group (37.7% treated vs. 48.0% untreated); according to EACS Guidelines, 2.5% achievement in secondary prevention (3.8% treatedvs. 0% untreated) and 24.7% in primary prevention (22.2% treated vs. 26.1% untreated). Mean doses of statins were 8.75mg±6mg (Rosuvastatin) and 22.35±19mg (Atorvastatin). Conclusions The achievement of therapeutic LDLs by all recommendations is unsatisfactory, and generally worse in patients on lipid lowering therapy. Hypolipemic treatment of our HIV patients is based on low doses of statins, even in secondary prevention.

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ATORVASTATIN IN PRIMARY PREVENTION AMONG MEN WITH HIGH CORONARY RISK LEVELS

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2013-1-54-59 ◽

2013 ◽

Vol 12 (1) ◽

pp. 54-59

Author(s):

I. V. Osipova ◽

N. V. Pyrikova ◽

O. N. Antropova ◽

A. G. Zaltsman ◽

A. I. Miroshnichenko ◽

...

Keyword(s):

Primary Prevention ◽

High Risk ◽

Ldl Cholesterol ◽

Preventive Intervention ◽

Risk Group ◽

High Risk Group ◽

Prevention Programme ◽

Coronary Risk ◽

Risk Levels ◽

Score Risk

Aim.To assess the effectiveness of a complex programme of primary cardiovascular prevention, including statin therapy (Liptonorm), among men from an occupational sample who have high coronary risk levels.Material and methods.The occupational sample included male train drivers and train driver assistants, aged 40–55 yeas. The primary prevention programme included the assessment of the risk factors (RFs) and SCORE risk levels; the development of an individual prevention plan; the Workplace Health School, with Self-Control Diary distribution; and the 6-month administration of Liptonorm (mean dose 14,7±5,1 mg/d) in the high-risk group.Results.In 2010–2011, 224 men participated in the primary prevention programme. The high-risk group, as assessed by the SCORE scale, comprised 14,3%. The results of preventive measures, including the 6-month Liptonorm therapy, are presented for the high-risk group. In particular, 29,4% of the men stopped smoking. The daily number of cigarettes smoked at workplace decreased by 5,1. Consumption of >2 drinks per day, overweight, and abdominal obesity prevalence decreased by 12,5%. The prevalence of insufficient rest time and night sleep <7 hours decreased by 28,1%. Fifty per cent of men increased their physical activity levels, while 34,4% increased their consumption of vegetables. Mean levels of blood pressure reduced by 5 mm Hg. Liptonorm therapy was associated with the achievement of target levels of low-density lipoprotein (LDL) cholesterol (in 84,4%) and the reduction in the levels of triglycerides (by 0,2 mmol/l), total cholesterol (by 1,3 mmol/l), and LDL cholesterol (by 0,7 mmol/l). As a result, the levels of total cardiovascular risk decreased by 1,7%. Therefore, at baseline, out of 224 men, 14,3% had high SCORE levels; after the preventive intervention, this proportion was only 3,6%, as 10,7% moved into the category of moderate SCORE risk.Conclusion.The workplace administration of the complex preventive programme, including statin administration, facilitates modification of behavioural RFs, achievement of target blood lipid levels, and total coronary risk reduction.

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