scholarly journals Management of Hypertension: A Bangladeshi Perspective

1970 ◽  
Vol 39 (1) ◽  
pp. 40-43
Author(s):  
SM Mustafa Zaman ◽  
Mohammad Salman ◽  
Kaniz Fatema
Keyword(s):  
Cardiovascular Disease ◽  
Fruits And Vegetables ◽  
Lifestyle Modification ◽  
Clinical Care ◽  
Cost Effective ◽  
Developed Countries ◽  
Population Based ◽  
Lifestyle Changes ◽  
Optimum Level ◽  
Lifestyle Modifications

Hypertension is a silent killer. Bangladeshis are racially predisposed to cardiovascular disease, and the increasing burden of hypertension has only added to the problem. Economic constraints and the allure of additional benefits without adverse effects have made lifestyle modifications an attractive proposition in developing and developed countries alike. Blood pressure is a continuum and any increase above optimum level confers additional independent risk of cardiovascular disease. We review screening, diagnosis and management using lifestyle measures and pharmacotherapy. We then discuss the barriers and challenges to implementing this approach and what can be done regarding prevention, screening, lifestyle modification and pharmacotherapy in our country. By adopting a comprehensive population based approach including policy level interventions directed at promoting lifestyle changes; a healthy diet (appropriate calories, low in saturated fats and salt and rich in fruits and vegetables), increased physical activity, and a smoking free society, properly balanced with a high risk approach of cost effective clinical care, Bangladesh can effectively control hypertension and improve public health. DOI: 10.3329/bmj.v39i1.6232 Bangladesh Medical Journal 2010; 39(1): 40-43

Lifestyle intervention to prevent diabetes in men and women with impaired glucose tolerance is cost-effective

2007 ◽  
Vol 23 (2) ◽  
pp. 177-183 ◽  
Author(s):  
Peter Lindgren ◽  
Jaana Lindström ◽  
Jaakko Tuomilehto ◽  
Matti Uusitupa ◽  
Markku Peltonen ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cost Saving ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Lifestyle Intervention ◽  
Intervention Program ◽  
Lifestyle Modification ◽  
Screening Program ◽  
Cost Effective ◽  
Population Based

Objectives: The Finnish Diabetes Prevention Study (DPS) was a randomized intervention program that evaluated the effect of intensive lifestyle modification on the development of diabetes mellitus type 2 in patients with impaired glucose tolerance. As such, a program is demanding in terms of resources; it is necessary to assess whether it would be money well spent. This determination was the purpose of this study.Methods: We developed a simulation model to assess the economic consequences of an intervention like the one studied in DPS in a Swedish setting. The model used data from the trial itself to assess the effect of intervention on the risk of diabetes and on risk factors for cardiovascular disease. Results from the United Kingdom Prospective Diabetes Study were used to estimate the risk of cardiovascular disease and stroke. Cost data were derived from Swedish studies. The intervention was assumed to be applied to eligible patients from a population-based screening program of 60-year-olds in the County of Stockholm from which the baseline characteristics of the patients was used.Results: The model predicted that implementing the program would be cost-saving from the healthcare payers' perspective. Furthermore, it was associated with an increase in estimated survival of .18 years. Taking into consideration the increased consumption by patients due to their longer survival, the predicted cost-effectiveness ratio was 2,363€ per quality-adjusted life-year gained.Conclusions: Lifestyle intervention directed toward high-risk subjects would be cost-saving for the healthcare payer and highly cost-effective for society as a whole.

Abstract W P153: HEALS Hypertension Control Program for Stroke Prevention in African American Communities

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Sunita Dodani ◽  
Sahel Arora ◽  
Dale Kraemer
Keyword(s):  
Healthy Eating ◽  
Stroke Prevention ◽  
Lifestyle Modification ◽  
Control Program ◽  
Cost Effective ◽  
Complete Information ◽  
Lifestyle Changes ◽  
Evidence Based ◽  
Church Members ◽  
Randomized Controlled Studies

Stroke is the 4th leading cause of death and a leading cause of severe, long-term disability in US. African Americans (AAs) are at an elevated risk for cerebrovascular diseases. An approach of proven efficacy is to target a major modifiable risk factor for stroke, hypertension (HTN), and to do so using lifestyle changes (i.e., diet and exercise). The objective of this study was to implement and assess the efficacy of an evidence-based, socio-culturally tailored, lifestyle intervention called HEALS (Healthy Eating And Living Spiritually) adopted and modified from PREMIER and DASH studies in AA churches in Northeast Florida. Methods: 3- months HEALS program was delivered by trained church members to the high risk church members who were; a) church parishioners 25-75 years; and b) newly or known diagnosed with HTN/pre-HTN as per JNC-7 criteria. The outcomes were analyzed using ANOVA and Wilcoxon rank tests. Results: Of the 36 eligible, 32 (90%) provided complete information on outcomes and were included in the analysis. At baseline, 15 (42%) participants were pre-HTN, 9 (25%) had Stage 1 HTN, and 12 (33%) had Stage 2 HTN. Retention of 89% was observed at the end of 3- month HEALs intervention. After the completion of the 3-months intervention, the mean reduction in systolic blood pressure (SBP) and diastolic BP (DBP) were 6.72mmHg (p=.0425) and 4.00 mmHg (p=.0073), respectively. A mean weight reduction of 1.7 kg was also significant (p=0.0023). Further, positive trends in healthy eating occurred for the majority of the participants (60%), more than half consumed dark green or other vegetables frequently, while 75% consumed at least one fruit daily or weekly. Lower percentages (44%) reported consumption of 100% fruit juices or cooked beans regularly. Conclusion: The study provided much-needed information on the translation and sustainability of evidence-based lifestyle modification in community-based settings, particularly within churches, which represent the most influential institution in the community lives of AA. HEALS program can serve as a cost-effective model for stroke prevention. Future longitudinal randomized controlled studies on HEALS effectiveness are needed.

Abstract TMP81: Regional, Race-Ethnic and Sex Disparities in Lifestyle Interventions: Data from the Florida Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) Study - the NINDS Stroke Prevention Intervention Research Program

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Maria A Ciliberti-Vargas ◽  
Kefeng Wang ◽  
Sofia Oluwole ◽  
Erika Marulanda-Londoño ◽  
Maranatha Ayodele ◽  
...  
Keyword(s):  
Weight Loss ◽  
Lifestyle Modification ◽  
Lifestyle Changes ◽  
Lifestyle Interventions ◽  
Lifestyle Modifications ◽  
Sodium Diet ◽  
Low Sodium Diet ◽  
Low Sodium ◽  
Diet Counseling ◽  
To Receive

Background: As key components of the AHA Life’s Simple 7 campaign, lifestyle modifications play an integral role in the prevention of vascular disease. Little is known about the prevalence of lifestyle modification counseling in patients with acute ischemic stroke (AIS). We sought to investigate disparities in the delivery of lifestyle interventions to AIS patients in the large NINDS-funded FL-PR CReSD Registry of Get With The Guidelines-Stroke (GWTG-S) data. Methods: GWTG-S collects data on the provision of several lifestyle interventions including counseling on exercise/weight loss, Therapeutic Lifestyle Changes (TLC) diet, diabetes (DM) education and antihypertensive (low sodium) diet. 80,598 AIS cases were prospectively included from 82 sites (69 FL; 13 PR) from 2010-2016. Multilevel logistic regression models adjusted for age, race, and aphasia were used to evaluate differences in the provision of lifestyle interventions as indicated for patients prior to hospital discharge. Results: Among AIS cases, 51% were men, 62% non-Hispanic White (NHW), 18% NH-Black (NHB), 13% FL-Hispanic (FLH), and 6% PR-Hispanic (PRH). Mean age was 71±14 years. The highest mean BMI was in PRH (29±7 kg/m 2 ), with the lowest in NHW (27±6 kg/m 2 ) and FLH (28±6 kg/m 2 ). Despite this, PRH were less likely to receive exercise/weight loss counseling compared to NHW (OR 0.43, 95% CI 0.20-0.90) and FLH (OR 0.46, 95% CI 0.22-0.97). PRH also had lower odds of receiving TLC diet counseling compared to NHW and FLH (OR 0.32, 95% CI 0.15-0.68). Though NHB presented with higher rates of DM compared to NHW (38% vs. 25%), they were less likely to receive DM education (OR 0.95, 95% CI 0.91-0.99). Women were less likely to receive TLC diet counseling (OR 0.94, 95% CI 0.90-0.98) and DM education (OR 0.94, CI 0.92-0.97) compared to men. Despite higher HTN frequency in women and NHB (67% and 69%), both were less likely to receive low sodium diet recommendations as compared to men (OR 0.94, 95% CI 0.92-0.97) and NHW (OR 0.95, 95% CI 0.91-0.99). Conclusion: Overall, disparities were identified in the provision of several lifestyle interventions in AIS patients. These interventions can benefit all and providers should continue counseling patients regarding modifiable risk factors to prevent future stroke.

scholarly journals All-cause and cause-specific mortality following non-traumatic spinal cord injury: evidence from a population-based cohort study in Switzerland

Spinal Cord ◽  
2019 ◽  
Vol 58 (2) ◽  
pp. 157-164 ◽  
Author(s):  
A. Buzzell ◽  
◽  
J. D. Chamberlain ◽  
I. Eriks-Hoogland ◽  
K. Hug ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cohort Study ◽  
Clinical Care ◽  
Population Based ◽  
Future Research ◽  
Cord Injury ◽  
Specific Mortality ◽  
National Cohort

Abstract Study design Observational cohort study. Objective To benchmark all-cause and cause-specific mortality following NTSCI to the general population (GP). Setting Specialized rehabilitation centers in Switzerland. Methods Longitudinal data from the Swiss Spinal Cord Injury (SwiSCI) Medical Record study were probabilistically linked with cause of death (CoD) information from the Swiss National Cohort. Standardized mortality ratios (SMRs) were estimated for all-cause and cause-specific mortality. Competing risk frameworks were used to estimate the probability of death due to specific CoD. Results One thousand five hundred and one individuals were admitted for first rehabilitation with NTSCI between 1990–2011; CoD information was available for 454 individuals of the 525 individuals that died. Overall, the mortality rate for persons with NTSCI was 1.6 times greater than that of the GP. Deaths due to cardiovascular disease (39.8%), neoplasms (22%), and infection (9.9%) were most often reported. Individuals with an SCI due to a vascular etiology indicated the greatest burden of mortality from infection compared with the GP (SMR 5.4; 95% CI, 3.1 to 9.2). Conclusions Cause-specific SMRs varied according to etiology. This supports the need for targeted clinical care and follow-up. Cardiovascular disease, neoplasms, and infection, emerged as main causes of death following NTSCI and should thus be targets for future research and differential clinical management approaches.

scholarly journals Sodium Consumption: An Individual's Choice?

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Norm R. C. Campbell ◽  
Jillian A. Johnson ◽  
Tavis S. Campbell
Keyword(s):  
Developing Economies ◽  
Behavioural Change ◽  
International Health ◽  
Cost Effective ◽  
Developed Countries ◽  
Population Based ◽  
Dietary Salt ◽  
Dominant Source ◽  
International Health Organizations ◽  
Improve Health

Excess intake of dietary salt is estimated to be one of the leading risks to health worldwide. Major national and international health organizations, along with many governments around the world, have called for reductions in the consumption of dietary salt. This paper discusses behavioural and population interventions as mechanisms to reduce dietary salt. In developed countries, salt added during food processing is the dominant source of salt and largely outside of the direct control of individuals. Population-based interventions have the potential to improve health and to be cost saving for these countries. In developing economies, where salt added in cooking and at the table is the dominant source, interventions based on education and behaviour change have been estimated to be highly cost effective. Regardless, countries with either developed or developing economies can benefit from the integration of both population and behavioural change interventions.

scholarly journals Experiment in vivo: How COVID-19 Lifestyle Modifications Affect Migraine

2021 ◽  
Vol 12 ◽  
Author(s):  
Vesselina Grozeva ◽  
Ane Mínguez-Olaondo ◽  
Marta Vila-Pueyo
Keyword(s):  
Dietary Habits ◽  
Lifestyle Modification ◽  
Lifestyle Changes ◽  
Long Term Effects ◽  
Lifestyle Modifications ◽  
Short Term ◽  
Beneficial Effects ◽  
Compliance To Treatment

Introduction: The coronavirus disease 2019 (COVID-19) pandemic represents a unified lifestyle modification model, which was developed by the globally applied measures. The lockdowns designed the perfect study settings for observing the interaction between migraine and the adopted changes in lifestyle. An experiment in vivo took place unexpectedly to determine how the lockdown lifestyle modifications can influence migraine.Subsection 1: Overall lifestyle modifications during the pandemic: People stay home, and outdoor activities and public contacts are restricted. Sleep is disturbed. Media exposure and prolonged screen use are increased. Working conditions change. In-person consultations and therapies are canceled. The beneficial effects of short-term stress, together with the harmful effects of chronic stress, were observed during the pandemic.Subsection 2: Short-term effects: Substantial lifestyle changes happened, and knowing how vulnerable migraine patients are, one could hypothesize that this would have resulted in severe worsening of headache. Surprisingly, even though the impacts of changing social conditions were significant, some patients (including children) experienced a reduction in their migraine during the first lockdown.Subsection 3: Long-term effects: Unfortunately, headache frequency returned to the basal state during the second pandemic wave. The risk factors that could have led to this worsening are the long-term disruption of sleep and dietary habits, stress, anxiety, depression, non-compliance to treatment, and working during the pandemic.Discussion: Sudden short-term lifestyle changes taking migraine patients out of their usual routine may be beneficial for headache management. It is not necessary to have a natural disaster in place for a drastic lifestyle modification with 6–8-week duration, if we know that this will improve migraine.

scholarly journals Nutrients and Dietary Approaches in Patients with Type 2 Diabetes Mellitus and Cardiovascular Disease: A Narrative Review

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 4150
Author(s):  
Carlos Jiménez-Cortegana ◽  
Pedro Iglesias ◽  
Josep Ribalta ◽  
Teresa Vilariño-García ◽  
Laura Montañez ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Type 2 Diabetes Mellitus ◽  
Developed Countries ◽  
Lifestyle Changes ◽  
Dietary Recommendations ◽  
Common Cause

Cardiovascular disease (CVD) is the most common cause of morbidity and mortality in developed countries. The prevalence of CVD is much higher in patients with type 2 diabetes mellitus (T2DM), who may benefit from lifestyle changes, which include adapted diets. In this review, we provide the role of different groups of nutrients in patients with T2DM and CVD, as well as dietary approaches that have been associated with better and worse outcomes in those patients. Many different diets and supplements have proved to be beneficial in T2DM and CVD, but further studies, guidelines, and dietary recommendations are particularly required for patients with both diseases.

Abstract P040: HEALS Lifestyle intervention through African American churches to control hypertension

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Sunita Dodani ◽  
Sahel Arora ◽  
Carmen Smotherman ◽  
Dale Kraemer
Keyword(s):  
Fruits And Vegetables ◽  
Lifestyle Modification ◽  
Control Program ◽  
Lifestyle Changes ◽  
Evidence Based ◽  
Church Members ◽  
Program Leaders ◽  
Southeastern Us ◽  
Proven Efficacy ◽  
Stage 1

Objective: African Americans (AAs) living in the “Stroke Belt” (Southeastern US including Northeast Florida) are at elevated risk for cardiovascular diseases (CVDs). An approach of proven efficacy is to target hypertension (HTN) as the major modifiable risk factor for CVDs, and to do so by evidence-based lifestyle changes. Here we present the findings of faith-based socio-culturally tailored HEALS HTN control program (modified from PREMIER and DASH diets), offered to AA church parishioners living in the food dessert areas of Duval County, Florida. Methods: Large urban church (membership > 400) volunteered for 9-month HEALS program. Four church members were trained as program leaders called CHAs-Church health Advisors, who after 10 hours of receiving training on HEALS session from PREMIER experts delivered weekly HEALS sessions to high-risk church members. 35 church members who were 25-75 year old, self-described AAs and HTN - as defined by JNC-7 were recruited. Farmer Market trucks from Clara White Mission supplied fresh fruits and vegetables (FFVs) at the church. Outcome measures included change in blood pressure (BP), weight and change in consumption of FFVs (measured by increases in purchases). Results: The study is ongoing. At baseline, 22% members were pre-HTN, 50% had Stage 1 HTN, and 22% with Stage 2 HTN. After receiving 12 wks HEALS program, mean reduction in systolic and diastolic BP were -14.6 mmHg (±14.3, p= 0.0002) and -6 mmHg (± 9.6, p=0.019) respectively. Mean weight reduction was -3.38 Kg (± 2.23, p<0.0001). For the first two months, the total FFVs sales increased from $97.50 in the first month to $117.50 in the second month. Majority of the sale was on fruits such as watermelons (60%). Conclusion: The translation and sustainability of evidence-based lifestyle modification in community-based settings is possible, particularly within churches, which represent the most influential institution in the community lives of AA

Prevention in cardiovascular disease and rehabilitation

ESC CardioMed ◽  
2018 ◽  
pp. 892-898
Author(s):  
Ugo Corrà
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cardiovascular Prevention ◽  
Cost Effective ◽  
Lifestyle Changes ◽  
Therapeutic Interventions ◽  
Prolong Life Expectancy ◽  
Life Therapy ◽  
Risk Cost ◽  
The Impact

A major goal in cardiovascular medicine is to prolong life expectancy, and maintain quality of life. Therapy for cardiovascular disease (CVD) and for prevention should be administered according to guidelines, together with lifestyle interventions. CVD prevention is defined as a coordinated set of actions that are aimed at eliminating or minimizing the impact of CVDs and their related disabilities. Prevention of CVD, either by implementation of lifestyle changes or use of medication, is cost-effective in many scenarios: cost-effectiveness depends on baseline cardiovascular risk, cost of protective drugs or other therapeutic interventions, reimbursement procedures, and implementation of preventive strategies. Cardiovascular risk profile guides the preventive priorities, and management: the higher the risk, the more intense the action should be. Patients with documented CVD are at very high risk. Nonetheless, the increasing awareness of the importance of cardiovascular prevention is not yet matched by the resources and actions within healthcare systems, and referral and long-term compliance remain critical challenges, also for patients with documented CVD.

scholarly journals Diagnostic yield and financial implications of a nationwide electrocardiographic screening programme to detect cardiac disease in the young

EP Europace ◽  
2021 ◽  
Author(s):  
Harshil Dhutia ◽  
Aneil Malhotra ◽  
Gherardo Finnochiaro ◽  
Sameer Parpia ◽  
Raghav Bhatia ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Lifestyle Modification ◽  
Diagnostic Yield ◽  
Evaluation Process ◽  
Cost Effective ◽  
Fold Increase ◽  
Medical Intervention ◽  
Health Questionnaire ◽  
Limited Information ◽  
Select Group

Abstract Aims There is limited information on the role of screening with electrocardiography (ECG) for identifying cardiovascular diseases associated with sudden cardiac death (SCD) in a non-select group of adolescents and young adults in the general population. Methods and results Between 2012 and 2014, 26 900 young individuals (aged 14–35 years) were prospectively evaluated with a health questionnaire and ECG. Individuals with abnormal results underwent secondary investigations, the costs of which were being based on the UK National Health Service tariffs. Six hundred and seventy-five (2.5%) individuals required further investigation for an abnormal health questionnaire, 2175 (8.1%) for an abnormal ECG, and 114 (0.5%) for both. Diseases associated with young SCD were identified in 88 (0.3%) individuals of which 15 (17%) were detected with the health questionnaire, 72 (81%) with ECG and 2 (2%) with both. Forty-nine (56%) of these individuals received medical intervention beyond lifestyle modification advice in the follow-up period of 24 months. The overall cost of the evaluation process was €97 per person screened, €17 834 per cardiovascular disease detected, and €29 588 per cardiovascular disease associated with SCD detected. Inclusion of ECG was associated with a 36% cost reduction per diagnosis of diseases associated with SCD compared with the health questionnaire alone. Conclusion The inclusion of an ECG to a health questionnaire is associated with a five-fold increase in the ability to detect disease associated with SCD in young individuals and is more cost effective for detecting serious disease compared with screening with a health questionnaire alone.

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