The impact of clinical and population strategies on coronary heart disease mortality: an assessment of Rose’s big idea

Background Coronary heart disease (CHD), the leading cause of death worldwide, has declined in many affluent countries but it continues to rise in industrializing countries. Objective To quantify the relative contribution of the clinical and population strategies to the decline in CHD mortality in affluent countries. Design Meta-analysis of cross-sectional and prospective studies. Data sources PubMed and Web of Science from January 1, 1970 to December 31, 2019. Method We combined and analyzed data from 22 cross-sectional and prospective studies, representing 500 million people, to quantify the relative decline in CHD mortality attributable to the clinical strategy and population strategy. Result The population strategy accounted for 48% (range = 19 to 73%) of the decline in CHD deaths and the clinical strategy accounted for 42% (range = 25 to 56%), with moderate inconsistency of results across studies. Conclusion Since 1970, a larger fraction of the decline in CHD deaths in industrialized countries was attributable to reduction in CHD risk factors than medical care. Population strategies, which are more cost-effective than clinical strategies, are under-utilized.

Effectiveness of education using ha-man module on self-efficacy of adults in preventing coronary heart disease

Every year, there is a significant increase in deaths caused by coronary heart disease (CHD). Many programs have been implemented to reduce the morbidity and mortality of CHD. Early detection and control of CHD risk factors is a challenge in educating adults about lifestyle changes. Also, it is recognized that self-efficacy is a vital factor in initiating and maintaining healthy behaviors. Health education is given as an effort to increase self-efficacy, but educational media that are innovative in promoting CHD health are limited. This study aimed to determine differences in the self-efficacy of adults in preventing coronary heart disease before and after given health education. This was a quasi-experimental study with a pretest-posttest control group design. The sample were 60 respondents which were grouped into 30 respondents in the intervention group and control group through purposive sampling. The HA-Man education intervention was given 3 times for a-week, self-efficacy was evaluated through a structured questionnaire interview. The results showed that there were differences in self-efficacy before and after intervention in the intervention group (p <0.05). This research is expected to provide information in the development of educational media in increasing awareness and self-efficacy of people who are at risk of CHD

Incidence and risk factors of congenital heart disease in Qingdao: a prospective cohort study

Background Many studies have been conducted to assess the incidence of congenital heart disease (CHD). However, results were greatly inconsistent among these studies with a broad range of findings. Methods A prospective census-based cohort study was conducted in Qingdao, China, from August 1, 2018 to April 30, 2019. All of the local registered pregnant women were continuously investigated and followed from 15 to 20 weeks of gestation to delivery, tracking the CHD cases in both the fetal and neonatal stages. A logistic regression model was applied to assess the association between CHD and possible risk factors. Results The positive rate of prenatal CHD screening was 14.36 per 1000 fetuses and the incidence of CHD was 9.38 per 1000 live births. Results from logistic regression indicated that, living in the countryside (odds ratio, (OR): 0.771; 95% confidence interval, (CI): 0.628–0.946) and having a childbearing history (OR: 0.802; 95%CI: 0.676–0.951) were negatively associated with CHD. However, twin pregnancy (OR: 1.957, 95% CI: 1.245–3.076), illness in the first trimester (OR: 1.306; 95% CI: 1.048–1.628), a family history of CHD (OR: 7.156; 95% CI: 3.293–15.552), and having a child with a birth defect (OR: 2.086; 95% CI: 1.167–3.731) were positively associated with CHD. Conclusion CHD is a serious health problem in Qingdao. The CHD incidence found in this study was similar to existing research. The positive rate of prenatal CHD screening was higher than the incidence of neonatal CHD. Moreover, CHD risk factors were identified in our study, and our findings may have great implications for formation CHD intervention strategies.

Patient education interventions for health behaviour change in adults diagnosed with coronary heart disease: a systematic review and meta-analysis

Funding Acknowledgements Type of funding sources: None. Background Patient education is recommended to increase disease-related knowledge and modify coronary heart disease (CHD) risk factors. Although the importance has been established, there is a lack of knowledge of its efficacy and relative impact of duration on disease-related knowledge and health behaviour outcomes. Purpose It aimed to assess the efficacy of structured patient education on those outcomes in adults with CHD for short-term (less than six months) and long-term (six to 12 months) effect. Methods Eligible randomised controlled trials published in English, Simplified Chinese, Spanish, and Portuguese were searched in seven electronic databases from database inception through 2020. Reference lists, relevant conference lists, and keywords from the Internet were also searched. Outcomes included disease-related knowledge, smoking cessation, medication adherence, physical activity, and healthy dietary behaviour. Results Overall, 73 studies reporting 71 unique trials were included. Participants (n = 24,985) were aged mean 60.5 ± 5.7 years, mostly male (72.5%). About 74% of studies used more than one mode for education delivery, with phone calls and booklets being used the most frequent. Patient education was associated with significant improvement in all outcomes measured in meta-analyses (P &lt; 0.05). In addition, regression analyses showed that a prolonged intervention duration does not significantly improve the outcomes, except for the disease knowledge (p = 0.009) and physical activity (p = 0.026). Conclusions Structured patient education, in a variety of modes and intensities, improves disease-related knowledge and health behaviours in adults with CHD. The findings can be used to guide design of cardiac programs, particularly related to intervention duration in clinical practice. Abstract Figure 1. PRISMA flow diagram

The Reversion of DNA Methylation at Coronary Heart Disease Risk Loci in Response to Prevention Therapy

Coronary heart disease (CHD) is preventable, but the methods for assessing risk and monitoring response rely on imprecise lipid-based assessments. Recently, we have shown that an integrated genetic–epigenetic test that includes three methylation-sensitive digital PCR assays predicts 3-year risk for incident CHD better than lipid-based methods. However, whether methylation sites change in response to therapies that alter CHD risk is not known. Therefore, we assessed methylation at these three incident CHD-related sites in DNA from 39 subjects before and after three months of biochemically verified smoking cessation, then analyzed the relationship between change in methylation at each of the sites to the change in smoking intensity as assessed by cg05575921 methylation. We found that, in those who quit smoking, methylation change at one CHD risk marker (cg00300879) was significantly associated with change in cg05575921 methylation (p < 0.04). We conclude that changes in incident CHD-related methylation occur within three months of cessation of smoking, a major risk factor for CHD. This suggests that the effectiveness of treatment of other CHD risk factors, such as high cholesterol, may be similarly quantifiable using epigenetic approaches. Further studies to determine the relationship of changes of methylation status in response to treatment of other CHD risk factors are indicated.

A Healthy Nordic diet score and risk of incident coronary heart disease among men: the Kuopio Ischaemic Heart Disease Risk Factor Study

Healthy Nordic diet has been beneficially associated with coronary heart disease (CHD) risk factors, but few studies have investigated risk of developing CHD. We investigated the associations of healthy Nordic diet with major CHD risk factors, carotid atherosclerosis, and incident CHD in middle-aged and older men from eastern Finland. A total of 1981 men aged 42-60 years and free of CHD at baseline in 1984-1989 were investigated. Diet was assessed with 4-d food recording and the healthy Nordic diet score was calculated based on the Baltic Sea Diet Score. Carotid atherosclerosis was assessed by ultrasonography of the common carotid artery intima-media thickness in 1053 men. Analysis of covariance and Cox proportional hazards regression analyses were used for analyses. Healthy Nordic diet score associated with lower serum C-reactive protein concentrations (multivariable-adjusted extreme-quartile difference 0.69 mg/L, 95% confidence interval 0.15-1.22 mg/L), but not with serum lipid concentrations, blood pressure, or carotid atherosclerosis. During the average follow-up of 21.6 years (SD 8.3 years), 407 men had a CHD event, of which 277 were fatal. The multivariable-adjusted hazard ratios (95% confidence interval) in the lowest vs. the highest quartile of the healthy Nordic diet score were 1.10 (0.85-1.45) for any CHD event (P-trend 0.429) and 1.38 (0.95-2.00) (P-trend 0.119) for fatal CHD event. We did not find evidence that adherence to a healthy Nordic diet would be associated with a lower risk of CHD or with carotid atherosclerosis or major CHD risk factors, except for an inverse association with serum C-reactive protein concentrations.

Association of Risk Factors of Coronary Heart Diseases and Socio-demographic Characteristics of Civil Employees of Combined Military Hospital Dhaka

Introduction: Risk factors are the most ruinous and mischievous ingredient to develop coronary heart diseases (CHD). Factors contributing to develop CHD and their associates are, therefore, of prime importance. It needs endless splurge to address the issue. Objectives: To identify the attributing risk factors and socio-demographic characteristics of coronary heart disease among civilian employees of Combined Military Hospital (CMH) Dhaka. Materials and Methods: This observational study was conducted on 287 civil employees of CMH, Dhaka from September to December 2011. Data were collected by interview using questionnaire and check list which includes blood pressure measurement, anthropometric measurement and biochemical examinations. Results: Respondent’s age range was 23 to 59 years, educational level up to class VIII were 56.4 % and more than that were 36.6%, illiterate were 7%. Regarding income low, medium and high income group were 40.4%, 56.8% and 2.8% respectively. It was found that 68.6% had normal BP, 61.3% practices moderate exercise. Among the respondents 72.2% has got 1-5 risk factors of CHD. Risk factors (p <0.001) were significantly associated with age. Conclusion: This study finding is suggestive of association between risk factors of CHD and socio-demographic characteristics among the study population. Care through motivation, avoidance of risk behaviour, addressing clinical conditions can resist risk factors of CHD thus coronary heart disease can be prevented. JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 175-177

Explaining the increment in coronary heart disease mortality in Mexico between 2000 and 2012

Background Mexico is still in the growing phase of the epidemic of coronary heart disease (CHD), with mortality increasing by 48% since 1980. However, no studies have analyzed the drivers of these trends. We aimed to model CHD deaths between 2000 and 2012 in Mexico and to quantify the proportion of the mortality change attributable to advances in medical treatments and to changes in population-wide cardiovascular risk factors. Methods We performed a retrospective analysis using the previously validated IMPACT model to explain observed changes in CHD mortality in Mexican adults. The model integrates nationwide data at two-time points (2000 and 2012) to quantify the effects on CHD mortality attributable to changes in risk factors and therapeutic trends. Results From 2000 to 2012, CHD mortality rates increased by 33.8% in men and by 22.8% in women. The IMPACT model explained 71% of the CHD mortality increase. Most of the mortality increases could be attributed to increases in population risk factors, such as diabetes (43%), physical inactivity (28%) and total cholesterol (24%). Improvements in medical and surgical treatments together prevented or postponed 40.3% of deaths; 10% was attributable to improvements in secondary prevention treatments following MI, while 5.3% to community heart failure treatments. Conclusions CHD mortality in Mexico is increasing due to adverse trends in major risk factors and suboptimal use of CHD treatments. Population-level interventions to reduce CHD risk factors are urgently needed, along with increased access and equitable distribution of therapies.