scholarly journals Primary Prevention of Cardiovascular Risk in Lithuania—Results from EUROASPIRE V Survey

Medicina ◽  
2020 ◽  
Vol 56 (3) ◽  
pp. 134
Author(s):  
Gediminas Urbonas ◽  
Lina Vencevičienė ◽  
Leonas Valius ◽  
Ieva Krivickienė ◽  
Linas Petrauskas ◽  
...  

Background and Objectives: Cardiovascular disease (CVD) prevention guidelines define targets for lifestyle and risk factors for patients at high risk of developing CVD. We assessed the control of these factors, as well as CVD risk perception in patients enrolled into the primary care arm of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE V) survey in Lithuania. Materials and Methods: Data were collected as the part of the EUROASPIRE V survey, a multicenter, prospective, cross-sectional observational study. Adults without a documented CVD who had been prescribed antihypertensive medicines and/or lipid-lowering medicines and/or treatment for diabetes (diet and/oral antidiabetic medicines and/or insulin) were eligible for the survey. Data were collected through the review of medical records, patients’ interview, physical examination and laboratory tests. Results: A total of 201 patients were enrolled. Very few patients reached targets for low-density lipoprotein cholesterol (LDL-C) (4.5%), waist circumference (17.4%) and body mass index (15.4%). Only 31% of very high CVD risk patients and 52% of high-risk patients used statins. Blood pressure target was achieved by 115 (57.2%) patients. Only 21.7% of patients at very high actual CVD risk and 27% patients at high risk correctly estimated their risk. Of patients at moderate actual CVD risk, 37.5% patients accurately self-assessed the risk. About 60%–80% of patients reported efforts to reduce the intake of sugar, salt or alcohol; more than 70% of patients were current nonsmokers. Only a third of patients reported weight reduction efforts (33.3%) or regular physical activity (27.4%). Conclusions: The control of cardiovascular risk factors in a selected group of primary prevention patients was unsatisfactory, especially in terms of LDL-C level and body weight parameters. Many patients did not accurately perceive their own risk of developing CVD.

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
David M Kern ◽  
Sanjeev Balu ◽  
Ozgur Tunceli ◽  
Swetha Raparla ◽  
Deborah Anzalone

Introduction: This study aimed to compare the demographic and clinical characteristics of patients with different risk factors for CHD as defined by NCEP ATP III guidelines. Methods: Dyslipidemia patients (≥1 medical claim for dyslipidemia, ≥1 pharmacy claim for a statin, or ≥1 LDL-C value ≥100 mg/dL [index date]) aged ≥18 y were identified from the HealthCore Integrated Research Environment from 1/1/2007-7/31/2012. Patients were classified as low risk (0 or 1 risk factor): hypertension, age ≥45 y [men] or ≥55 y [women], or low HDL-C), moderate/moderately high risk (≥2 risk factors), high risk (having CHD or CHD risk equivalent), or very high risk (having ACS or other established cardiovascular disease plus diabetes or metabolic syndrome). Demographics, comorbidities, medication use and lipid levels during the 12 months prior, and statin use during the 6 months post-index date were compared across risk groups (very high vs each other risk group). Results: There were 1,524,351 low-risk (mean age: 47 y; 45% men), 242,357 moderate-risk (mean age: 58 y; 59% men), 188,222 high-risk (mean age: 57 y; 52% men), and 57,469 very-high-risk (mean age: 63 y; 61% men) patients identified. Mean Deyo-Charlson comorbidity score differed greatly across risk strata: 0.20, 0.33, 1.26, and 2.22 from low to very high risk (p<.0001 for each). Compared with high-risk patients, very-high-risk patients had a higher rate of ischemic stroke: 5.4% vs 4.1%; peripheral artery disease: 17.1% vs 11.6%; coronary artery disease: 8.5% vs 8.2%; and abdominal aortic aneurysm: 2.3% vs 2.0% (p<.05 for each). Less than 1% of the total population had a prior prescription for each non-statin lipid-lowering medication (bile acid sequestrants, fibrates, ezetimibe, niacin, and omega-3). Very-high-risk patients had lower total cholesterol (very-high-risk mean: 194 mg/dL vs 207, 205, and 198 mg/dL for low-, moderate-/moderately-high-, and high-risk patients, respectively) and LDL-C (very-high-risk mean: 110 mg/dL vs 126, 126, and 116 mg/dL for the other risk groups; p<.0001 for each); higher triglycerides (TG) (very-high-risk mean: 206 mg/dL vs 123, 177, and 167 mg/dL for the other groups; p<.0001 for each); and lower HDL-C (very-high-risk mean: 45 mg/dL vs 57 [p<.0001], 45 [p=.006], and 51 mg/dL [p<.0001]). Statin use was low overall (15%), but higher in the very-high-risk group (45%) vs the high- (29%), moderate-/moderately-high- (18%), and low- (12%) risk groups (p<.0001 for each). Conclusions: Despite a large proportion of patients having high lipid levels, statin use after a dyslipidemia diagnosis was low: ≥80% of all patients (and more than half at very high risk) failed to receive a statin, indicating a potentially large population of patients who could benefit from statin treatment. Prior use of non-statin lipid-lowering medications was also low considering the high TG and low HDL-C levels among high-risk patients.


2018 ◽  
Vol 3 (2) ◽  
pp. 19-25
Author(s):  
VV V Simerzin ◽  
OV V Fatenkov ◽  
IV V Gagloeva ◽  
MA A Galkina ◽  
YaA A Panisheva

This article is devoted to the problems of residual risk of cardiovascu1ar comp1ications deve1opment for high and very high risk patients under adequate lipid-fowering pharmacotherapy in spite of c^lestera! and tow-density 1ipoproteins target level achievement. Afong with classic risk factors the special atte^ton is given to 1ipoprotein (a) [LP (a)] as the most aggressive factor of cardwvascular system atherosclerotic diseases devetopment and their comp1ications. Great importance is attached to 1ipidopheresis.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Dyrbus ◽  
M Gasior ◽  
M Skrzypek ◽  
T Osadnik ◽  
P Desperak ◽  
...  

Abstract Background The latest guidelines from the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) introduced a new “ultra-high risk” category of patients, for whom a low-density lipoprotein cholesterol (LDL-C) level <55 mg/dL (1.4 mmol/L) is advised. Purpose Based on the above, we aimed to identify the proportion of patients, who are at ultra-high/extremely-high cardiovascular (CV) risk. Method Finally, we analyzed the data of 19,781 consecutive patients included in theHyperlipidaemia Therapy in the tERtiary Cardiological cEnTer (TERCET) Registry admitted to the Polish tertiary cardiovascular centre between 2006 and 2018. Among them, there were 7,319 patients admitted with ACS: 3,085 due to ST-segment elevation myocardial infarction (STEMI), 2,256 due to non-ST-segment elevation myocardial infarction (NSTEMI), and 1,978 due to unstable angina (UA), as well as 12,462 due to stable angina (SA). According to the European Society of Cardiology (ESC), all patients included in the Registry are at very high CV risk. All of the patients included in the registry underwent coronary angiography during the hospital stay. On the basis of the multivariate analysis, we aimed at determining the subgroup of the patients with the most unfavourable 12-month outcomes and therefore to indicate the risk factors responsible for extremely-high CV risk. Results According to the results of the multivariate analysis performed with stepwise backward regression, we identified the following risk factors: LVEF<40% (odds ratio [OR]=3.51, 95% CI: 2.87–4.29), prior stroke (OR=2.28, 95% CI: 1.65–3.01), diabetic nephropathy (OR=2.16, 95% CI: 1.68–2.77), age>75 years (OR=1.84, 95% CI: 1.33–2.55), atrial fibrillation (OR=1.81, 95% CI: 1.45–2.25), acute MI at admission (OR=1.56, 95% CI: 1.26–1.95), multivessel CAD (OR=1.40, 95% CI: 1.15–1.72), prior MI (OR=1.31, 95% CI: 1.07–1.60) and lower body-mass index (OR=1.02 per 1 kg/m2+ less, 95% CI: 1.00–1.04) that might help to define the group of very high risk patients, who should be considered as of extremely-high cardiovascular risk (all p<0.05). The aggregate summary of risk factors associated with “ultra-high” risk is presented in the attached Figure. Multivariate analysis results Conclusions To our best knowledge, the presented study is the first such an analysis conducted on such a large population of very-high cardiovascular risk patients gathered in the registry of secondary cardiovascular prevention. In very-high cardiovascular risk patients, potential risk factors were identified that might help to establish the group of individuals at extremely high CV risk what contributes to higher 12-month mortality. Acknowledgement/Funding None


2012 ◽  
Vol 11 (4) ◽  
pp. 70-78 ◽  
Author(s):  
R. G. Oganov ◽  
V. V. Kukharchuk ◽  
G. P. Arutyunov ◽  
A. S. Galyavich ◽  
V. S. Gurevich ◽  
...  

The high prevalence of persistent dyslipidemia in primary and specialized care patients treated with statins justifies the need to identify its reasons and develop the recommendations on the treatment optimization. At present, Russian studies focusing on the achievement of target lipid levels remain scarce, which emphasizes the importance of the problem and its further investigation.Aim.Cross-sectional epidemiological study which assessed the prevalence of persistent dyslipidemia in statin-treated patients and analysed the predictors of the achievement of target lipid levels.Material and methods.The lipid profile parameters were analysed in 1586 statin-treated out-patients with varied levels of cardiovascular risk, taking into account the type of lipid-lowering therapy and its doses. The assessment of the cardiovascular event (CVE) risk and the definition of target levels of low-density lipoprotein cholesterol (LDL–CH), as well as normal levels of triglycerides (TG) and high-density lipoprotein cholesterol (HDL–CH), was based on the clinical recommendations by the European Society of Cardiology (ESC 2007) and by the European Society of Cardiology and the European Atherosclerosis Society (ESC/EAS 2011).Results.The analysis based on the ESC 2007 recommendations has demonstrated that the target levels of LDL–CH (<2,5 mmol/l for high-risk patients) were not achieved in 53,5% of the participants. The elevation of LDL–CH levels could be isolated or combined with the HDL–CH decrease and/or the TG increase. Low levels of HDL–CH were observed in 32,3% of the patients, while high TG levels were registered in 55,6% of the participants. The achievement of target LDL–CH levels was predicted by the higher-dose statin therapy (odds ratio 0,44). The analysis based on the ESC/EAS 2011 recommendations has shown that the prevalence of target LDL–CH levels was 12,2% in very high-risk patients (<1,8 mmol/l), 30,3% in high-risk patients (<2,5 mmol/l), and 53,4% in moderate-risk patients (<3,0 mol/l).Conclusion.Over a half of the statin-treated patients failed to achieve target levels of LDL–CH. The lowest prevalence of target LDL–CH levels was observed in very high-risk and high-risk patients. The predictors of target LDL–CH level achievement included moderate cardiovascular risk and higher-dose statin therapy. The obtained results suggest that the correction of persistent dyslipidemia in statin-treated patients could be achieved via increasing the satin dose and combining lipid-lowering medications.


2021 ◽  
Vol 20 (7) ◽  
pp. 3073
Author(s):  
O. A. Ivanova ◽  
S. G. Kuklin ◽  
S. S. Sizova ◽  
T. A. Novoselova ◽  
L. R. Gaifullina

Aim. To study lipid-lowering therapy in patients with high and very high risk of cardiovascular events (CVEs) at the outpatient and inpatient care stages in Irkutsk.Material and methods. We analyzed 260 discharge summaries of patients with hypertension of high and very high risk of CVEs for the second half of 2019: 145  — from a hospital; 115  — from outpatient records. Patient adherence to statin therapy, achievement of target lowdensity lipoprotein cholesterol (LDL-C) levels in each patient subgroup was assessed.Results. The proportion of patients who reached the recommended LDL-C levels in accordance with the 2017 guidelines tends to increase in comparison with prior data. High adherence to lipid-lowering therapy was accompanied by an increase in the proportion of patients reaching the recommended LDL-C levels. In most cases, regardless of cardiovascular risk, low-dose statin therapy were used. A detailed analysis of adherence to statin therapy using questionnaires revealed that more than half of patients in high-risk categories (64%) did not comply with lipid-lowering therapy.Conclusion. Favorable trends were revealed in relation to an increase in the proportion of high-risk patients reaching target LDL-C levels. Adherence to statin therapy remains low. Previously established problems in managing such patients remains: stereotyped lipid-lowering therapy prescriptions without taking into account cardiovascular risk, the use of low-dose therapy, and the frequent prescription of statins with a lower lipid-lowering effect. Inpatients use higher statin doses than outpatients.


Author(s):  
Ana Sánchez-Taínta ◽  
Ramón Estruch ◽  
Mónica Bulló ◽  
Dolores Corella ◽  
Enrique Gómez-Gracia ◽  
...  

Background The Mediterranean food pattern (MeDiet) has been suggested to have beneficial effects on cardiovascular risk factors. Scarcity of assessment of this effect on large samples of patients at high risk is, however, observed. Our objective was to estimate the association between adherence to MeDiet and the prevalence of risk factors in 3204 asymptomatic high-risk patients. Design Cross-sectional assessment of baseline characteristics of participants in a primary prevention trial. Methods Participants were assessed by their usual primary-care physicians to ascertain the prevalence of diet-related cardiovascular risk factors (diabetes, hypertension, dyslipidemia, or obesity) using standard diagnostic criteria. A dietitian interviewed each participant to obtain a 14-point score measuring the degree of adherence to MeDiet. Results Adherence to MeDiet was inversely associated with individual risk factors and, above all, with the clustering of them. The multivariate adjusted odds ratio to present simultaneously the four risk factors for those above the median value of the MeDiet score was 0.67 (95% confidence interval: 0.53–0.85). The multivariate odds ratios for successive categories of adherence to MeDiet were 1 (ref.), 1.03, 0.85, 0.70 and 0.54 ( P for trend ≤0.001). Conclusion Following a MeDiet was inversely associated with the clustering of hypertension, diabetes, obesity, and hypercholesterolemia among high-risk patients.


Author(s):  
Anh Binh Ho

Đặt vấn đề: Tổn thương thận cấp do thuốc cản quang là một trong những biến chứng quan trọng mà nếu dự đoán sớm các YTNC chúng ta có biện pháp phòng ngừa. Gần đây các nhà nghiên cứu còn đề xuất ra nhiều bảng điểm để xác định nguy cơ xuất hiện tổn thương thận cấp do thuốc cản quang như: điểm nguy cơ Mehran tỉ số giữa lượng thuốc cản quang và mức lọc cầu thận ước đoán. Chúng tôi nghiên cứu đề tài với mục tiêu: Đánh giá mối liên quan giữa các yếu tố nguy cơ tim mạch, điểm Mehran với tổn thương thận cấp do thuốc cản quang Đối tượng: 221 BN bệnh động mạch vành có chỉ định chụp, can thiệp động mạch vành. Phương pháp nghiên cứu: Mô tả cắt ngang, tiến cứu. Kết quả: Hạ huyết áp quanh thủ thuật là YTNC độc lập của tổn thương thận cấp do thuốc cản quang với OR = 5,299, khoảng tin cậy 95% 1,177-23,854 và P = 0,030. Nồng độ NT-proBNP là YTNC độc lập của tổn thương thận cấp do thuốc cản quang với OR = 1,000, khoảng tin cậy 95% 1,000-1,000 và P = 0,018. Điểm nguy cơ Mehran ở nhóm nguy cơ cao (11-15 điểm) là YTNC độc lập của tổn thương thận cấp do thuốc cản quang với OR = 7,983, khoảng tin cậy 95% 1,080-58,990 và P = 0,042. Điểm nguy cơ Mehran ở nhóm nguy cơ rất cao (≥ 16 điểm) là YTNC độc lập của tổn thương thận cấp do thuốc cản quang với OR = 53,821, khoảng tin cậy 95% 3,046-951,033 và P = 0,007. Kết luận: Hạ huyết áp quanh thủ thuật, nồng độ NT-proBNP, điểm Mehran ở nhóm nguy cơ cao và rất cao là YTNC độc lập của tổn thương thận cấp do thuốc cản quang. Từ khóa: Điểm nguy cơ Mehran, tổn thương thận cấp, thuốc cản quang, động mạch vành. ABSTRACT STUDY OF RELATIONSHIP BETWEEN CARDIOVASCULAR RISK FACTORS, MEHRAN SCORE AND CONTRAST - ASSOCIATED ACUTE KIDNEY INJURY Background: Contrast - associated acute kidney injury which is one of the major complications of percutaneous coronary intervention (PCI) can be prevented if it is predicted through risk factors. In recent years, researchers suggest many risk scores to determine the risk of contrast - induced acute kidney injury such as: Mehran risk score, the ratio between the amount of contrast, and estimated GFR. So we implement the study to find out the relationship between cardiovascular risk factors and contrast - associated acute kidney injury Objects: 221 patients who were diagnosed with coronary disease and treated by PCI. Methods: Prospective observational study. Results: Hypotension during the procedure is a independent risk factor of contrast-associated acute kidney injury with OR = 5,299, 95%CI 1,177-23,854 (p = 0,030). NT-proBNP is is a independent risk factor of contrast-associated acute kidney injury with OR = 1,000, 95%CI 1,000-1,000 (p = 0,018). Mehran score for the high risk patients (11-15 points) is an independent risk factor of contrast-associated acute kidney injury with OR = 7,983, 95%CI 1,080-58,990 (P = 0,042). Mehran score for the very high risk patients (≥ 16 points) is an independent risk factor of contrast-associated acute kidney injury with OR = 53,821, 95%CI 3,046-951,033 (P = 0,007). Conclusion: Intraoperative hypotension, NT-proBNP, Mehran score in high and very high risk groups are independent risk factors of contrast-associated acute kidney injury.


2020 ◽  
Vol 4 (Issue 4) ◽  
Author(s):  
Ryskul Kydyralieva ◽  
Kanzaada Dzhorupbekova ◽  
Almazbek Akunov

Objective:  An analysis of the current situation in the Kyrgyz Republic demonstrates that the areas of concern in care system for patients with cardiovascular diseases (CVD) are the insufficient and untimely identification of cardiovascular risk factors, as well as their ineffective management due to the incomplete implementation of existing risk stratification guidelines and decision-making. This study assesses distribution of total cardiovascular risk among the population of the Kyrgyz Republic using the WHO/ISH risk scale.  In addition, the distribution of the main risk factors separately is calculated, as well as the frequency of some additional CVD risk factors that are not included into the WHO/ISH evaluation scale is estimated. Methods: This research was carried out within the framework of the international project "STEPS". The survey used a questionnaire developed by WHO and adapted to the Kyrgyz Republic. Overall, 2417 people were selected at the age of 25 to 65 years, of which 59.0% are women and 41.0% are men. The mean age in general was 43.9 (11.5) years. Of these, mean age for  men was 44.0 (11.2) years and for  women - 43.8  (11.7) years (p˃0.05). Results: According to the WHO / ISH chart, the proportion of low, medium, high and very high risk for age group of 40-65 years was 73.9%, 4.6% and 21.4%, respectively. According to the results of the study, among respondents aged 40 to 65 years, a high prevalence of the main risk factors for CVD was revealed (arterial hypertension - 61.5%, hypercholesterolemia - 31.6%, smoking - 19.0%, diabetes mellitus 11.1%) and other additional risk factors for CVD (insufficient intake of fruits and vegetables - 75.4%, obesity - 36.5%, physical inactivity - 29.3% and excessive salt intake - 14.0%). Conclusion:  Thus, very high-risk of CVD in our population was presented in 21.4% of individuals, while low risk prevailed – 73.9%.  The most frequent risk factors were arterial hypertension, hypercholesterolemia, obesity and physical inactivity, insufficient consumption of fruit and vegetables followed by smokin, diabetes and excessive salt consumption.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Peter Piko ◽  
Zsigmond Kosa ◽  
Janos Sandor ◽  
Roza Adany

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.


Sign in / Sign up

Export Citation Format

Share Document