Road injuries represent the third leading cause of death and disability.Table 1 Leading causes of death in 1990 and 2017 1990 2017 Lower respiratory infections Stroke Haemorrhagic and other ...non-ischaemic disease Ischaemic heart disease Preterm birth complications Lung cancer Congenital anomalies Chronic obstructive pulmonary disease Childhood diseases preventable by vaccine (DPT, measles, chicken pox) Alzheimer’s disease Tuberculosis Diabetes Diarrhoea Liver cirrhosis Drowning Road injuries Iron-deficiency anaemia Lower respiratory infections Unipolar depressive disorders Tuberculosis DPT, diphtheria, pertussis, tetanus. In terms of prevalence, table 3 showed that liver and lung cancer represent the most prevalent cancers in men while breast and colorectal cancer are the most prevalent cancers in women.Table 3 Cancer prevalence in Vietnam Population Males Females Both sexes 47 755 412 48 735 730 96 491 142 Number of new cancer cases 90 822 73 849 164 671 Risk of developing cancer before the age of 75 years (%) 19.0 12.8 15.6 Number of cancer deaths 70 888 43 983 114 871 Age-standardised mortality rate (World) 142.6 71.8 104.4 Risk of dying from cancer before the of age 75 years (%) 15.1 7.8 11.1 5-year prevalent cases 138 602 161 431 300 033 Top five most frequent cancers excluding non-melanoma skin cancer (ranked by cases) Liver Breast Liver Lung Colorectum Lung Stomach Lung Stomach Colorectum Stomach Breast Nasopharynx Liver Colorectum Disease factors Hypertension Vietnam Heart Association adopted the definition of American College of Cardiology/American Heart Association of prehypertension as systolic pressure between 120 to 139 mm Hg or diastolic pressure between 80 to 89 mm Hg and hypertension as systolic pressure more than 140 mm Hg or diastolic pressure more than 90 mm Hg.8 High blood pressure both prehypertension (41.8%) and hypertension (20.7%) prevalence is high in Vietnam, with men showing higher prevalence than women and inhabitants of rural areas showing the highest prevalence rate. Like many Asian diets, the Vietnamese diet is low in fat, with small amounts of meat and fish, and rich in vegetables, with regional variation and a higher consumption of vegetables in the northern regions.11 12 The healthy profile of the traditional Vietnamese diet from the cardiovascular point of view is confirmed by the data from the 2015 national survey on the risk factors for non-communicable disease that indicate that Vietnamese adults have low average levels of serum cholesterol (181.8 mg/dL in women and 166.3 mg/dL in men). On the contrary consumption of vegetables has gradually decreased from 214 g/capita/day in 1985 to 190 g/capita/day in 2010.13 The recent wave of fast food products brought into the country by international operators is imposing a significant and rapid shift in the dietary habits of Vietnamese and a further worsening of the traditional habits of men and women, especially in the young age groups.
Individuals with vascular or valvular calcification are at increased risk for coronary events, but the relationship between calcium consumption and cardiovascular events is uncertain. We evaluated ...the risk of coronary and cerebrovascular events in the Women's Health Initiative randomized trial of calcium plus vitamin D supplementation.
We randomized 36,282 postmenopausal women 50 to 79 years of age at 40 clinical sites to calcium carbonate 500 mg with vitamin D 200 IU twice daily or to placebo. Cardiovascular disease was a prespecified secondary efficacy outcome. During 7 years of follow-up, myocardial infarction or coronary heart disease death was confirmed for 499 women assigned to calcium/vitamin D and 475 women assigned to placebo (hazard ratio, 1.04; 95% confidence interval, 0.92 to 1.18). Stroke was confirmed among 362 women assigned to calcium/vitamin D and 377 assigned to placebo (hazard ratio, 0.95; 95% confidence interval, 0.82 to 1.10). In subgroup analyses, women with higher total calcium intake (diet plus supplements) at baseline were not at higher risk for coronary events (P=0.91 for interaction) or stroke (P=0.14 for interaction) if assigned to active calcium/vitamin D.
Calcium/vitamin D supplementation neither increased nor decreased coronary or cerebrovascular risk in generally healthy postmenopausal women over a 7-year use period.
Context: Conflicting findings have been reported regarding the effect of menstrual cycle phase and sex hormones on insulin sensitivity.
Objective: The aim was to determine the pattern of insulin ...resistance over the menstrual cycle and whether variations in sex hormones explain these patterns.
Design: The BioCycle study is a longitudinal study that measured hormones at different phases of the menstrual cycle. Participants had up to eight visits per cycle; each visit was timed using fertility monitors to capture sensitive windows of hormonal changes.
Setting: The study was conducted in the general community of the University at Buffalo (Buffalo, NY).
Participants: A total of 257 healthy, premenopausal women (age, 27 ± 8 yr; body mass index, 24 ± 4 kg/m2) participated in the study.
Main Outcome Measures: We measured fasting insulin, glucose, and insulin resistance by the homeostasis model of insulin resistance (HOMA-IR).
Results: Significant changes in HOMA-IR were observed over the menstrual cycle; from a midfollicular phase level of 1.35, levels rose to 1.59 during the early luteal phase and decreased to 1.55 in the late-luteal phase. HOMA-IR levels primarily reflected changes in insulin and not glucose. After adjustment for age, race, cycle, and other sex hormones, HOMA-IR was positively associated with estradiol (β = 0.082; P < 0.001) and progesterone (β = 0.025; P < 0.001), and inversely associated with FSH (adjusted β = −0.040; P < 0.001) and SHBG (β = −0.085; P < 0.001). LH was not associated with HOMA-IR. Further adjustment for BMI weakened the association with SHBG (β = −0.057; P = 0.06) but did not affect other associations.
Conclusion: Insulin exhibited minor menstrual cycle variability. Estradiol and progesterone were positively associated with insulin resistance and should be considered in studies of insulin resistance among premenopausal women.
Among premenopausal women, estradiol and progesterone are positively associated with insulin resistance and should be considered in clinical studies of insulin resistance and related traits.
The aim of the current study was to examine the possible relationship between the mutual effects of smoking and low cholesterol on all-cause, non-cardiovascular, and cardiovascular mortalities in ...males. This is a prospective cohort study of 30,179 males sampled from the Risk Factors and Life Expectancy (RIFLE) studies in the Italian population. The RIFLE data are from 19 different large-scale studies over a 9.5-year follow-up period. The Cox Proportional Hazard model was applied to analyze the data. The associations are presented as hazard ratios (HRs) with 95% confidence interval (CI). Cholesterol data were reported in categories. There were significant mortality risk mutual associations for never-smokers and those in the low cholesterol category (<160 mg/dl) for all-cause (HR = 3.13, 95% CI 1.69, 5.80), and non-cardiovascular disease (CVD) (HR = 6.51, 95% CI 2.19, 19.33) mortality in men with an insignificant risk for CVD mortality (HR = 1.90, 95% CI 0.85, 4.22).
There were significant mortality risk associations of the mutual effects of ex-smokers and low cholesterol for non-CVD in the first to third cholesterol categories (HR = 2.50, 95% CI 1.40, 4.46; HR = 2.65, 95% CI 1.50, 4.71; HR = 2.12, 95% CI 1.17, 3.82, respectively), but no significant findings for all-cause and CVD deaths.
Furthermore, there were significant mortality risk association of mutual effects of current-smokers and low cholesterol for non-CVD (HR = 1.56, 95% CI 1.11, 2.28) in the first category of cholesterol level, but insignificant risk associations for all-cause deaths (HR = 1.21, 95% CI 0.89, 1.66). Interestingly, findings indicate a mutual protective association for current-smokers and low cholesterol (<160 mg/dl) for CVD risk in males (HR = 0.42, 95% CI 0.19, 0.91).
Findings of this study identified significant mortality risk association for mutual effects of never-smokers, ex-smokers, and low cholesterol for non-CVD. However, there is significant protective association for current-smokers and low cholesterol for CVD.
The Women's Health Initiative (WHI) Estrogen Alone trial assessed the balance of benefits and risks of hormone use in healthy postmenopausal women. The trial was stopped prematurely because there was ...no benefit for coronary heart disease and an increased risk of stroke. This report provides a thorough analysis of the stroke finding using the final results from the completed trial database.
The WHI Estrogen Alone hormone trial is a multicenter, double-blind, placebo-controlled, randomized clinical trial in 10,739 women aged 50 to 79 years who were given daily conjugated equine estrogen (CEE; 0.625 mg; n=5310) or placebo (n=5429). During an average follow-up of 7.1 years, there were 168 strokes in the CEE group and 127 in the placebo group; 80.3% of strokes were ischemic. For all stroke the intention-to-treat hazard ratio HR (95% CI) for CEE versus placebo was 1.37 (1.09 to 1.73). The HR (95% CI) was 1.55 (1.19 to 2.01) for ischemic stroke and 0.64 (0.35, 1.18) for hemorrhagic stroke. The HRs indicate excess risk of ischemic stroke was apparent in all categories of baseline stroke risk, including younger and more recently menopausal women and in women with prior or current use of statins or aspirin.
CEE increases the risk of ischemic stroke in generally healthy postmenopausal women. The excess risk appeared to be present in all subgroups of women examined, including younger and more recently menopausal women. There was no convincing evidence to suggest that CEE had an effect on the risk of hemorrhagic stroke.
Left ventricular hypertrophy (LVH) is a common diagnosis in patients with cardiovascular disease (CVD). The prevalence of LVH among patients with Type-2 Diabetes Mellitus (T2DM), high blood pressure ...and aging is higher than the healthy population and has been independently associated with an increased risk for future cardiac event, including stroke. The aim of this study is to identify the prevalence of LVH among T2DM subjects and evaluate its association with related risk factors of CVD patients in the metropolis of Shiraz, Iran. The novelty of this study is that there has been no known published epidemiological study related to the relationship of LVH and T2DM on this unique population.
This cross-sectional study was designed based on collected data of 7715 free dwelling subjects in the community-based Shiraz Cohort Heart Study (SCHS) from 2015 to 2021, ages 40-70 years. Overall, 1118 subjects with T2DM were identified in the SCHS and after exclusion criteria, 595 subjects remained eligible for study. Subjects with electrocardiography (ECG) results, which are appropriate and diagnostics tools, were evaluated for the presence of LVH. Thus, the variables related to LVH and non-LVH in subjects with diabetes were analyzed using version-22 statistical package for social sciences software program to ensure consistency, accuracy, reliability, and validity for final analysis. Based upon related variables and identifying LVH and non-LVH subjects, the relevant statistical analysis was implemented to ensure its consistency, accuracy, reliability, and validity for final analysis.
Overall, the prevalence of diabetic subjects was 14.5% in the SCHS study. Furthermore, the prevalence of hypertension in the study subjects aged 40-70 years was 37.8%. The prevalence of hypertension history in T2DM study subjects for LVH compared to non-LVH was (53.7% vs. 33.7%). The prevalence of LVH among patients with T2DM as the primary target of this study was 20.7%. Analytical findings comparing both LVH and non-LVH subjects who have T2DM identified significance for variables in the older (≥ 60) mean and categorical age group (P < 0.0001), history of hypertension (P < 0.0001), mean and categorical duration of hypertension in years (P < 0.0160), status of controlled versus uncontrolled hypertension level (P < 0.0120), the mean systolic blood pressure (P < 0.0001) as well as mean duration years of T2DM and categorical duration of diabetes in years (< 0.0001 and P < 0.0060), mean fasting blood sugar (< 0.0307) and categorical status of FBS Level (mg/dl): controlled and uncontrolled FBS status of controlled vs. uncontrolled FBS levels P < 0.0020). However, there were no significant findings for gender (P = 0.3112), diastolic blood pressure mean (P = 0.7722) and body mass index (BMI) mean and categorical BMI (P = 0.2888 and P = 0.4080, respectively).
The prevalence of LVH in the study increases significantly among T2DM patients with hypertension, older age, years of hypertension, years of diabetes, and higher FBS. Thus, given the significant risk of diabetes and CVD, evaluation of LVH through reasonable diagnostic testing with ECG can help reduce the risk of future complications through the development of risk factor modifications and treatments guidelines.
Background: In the Periodontitis and Vascular Events (PAVE) pilot study, periodontal therapy was provided as an intervention in a secondary cardiac event prevention model through five coordinated ...cardiac–dental centers.
Methods: Subjects were randomized to either community care or protocol provided scaling and root planing to evaluate effects on periodontal status and systemic levels of high‐sensitivity C‐reactive protein (hs‐CRP).
Results: After 6 months, there was a significant reduction in mean probing depth and extent of 4‐ or 5‐mm pockets. However, there were no significant differences in attachment levels, bleeding upon probing, or extent of subgingival calculus comparing subjects assigned to protocol therapy (n = 151) to those assigned to community care (n = 152). Using intent‐to‐treat analyses, there was no significant effect on serum hs‐CRP levels at 6 months. However, 48% of the subjects randomized to community care received preventive or periodontal treatments. Secondary analyses demonstrated that consideration of any preventive or periodontal care (i.e., any treatment) compared to no treatment showed a significant reduction in the percentage of people with elevated hs‐CRP (values >3 mg/l) at 6 months. However, obesity nullified the periodontal treatment effects on hs‐CRP reduction. The adjusted odds ratio for hs‐CRP levels >3 mg/l at 6 months for any treatment versus no treatment among non‐obese individuals was 0.26 (95% confidence interval: 0.09 to 0.72), adjusting for smoking, marital status, and gender.
Conclusion: This pilot study demonstrated the critical role of considering obesity as well as rigorous preventive and periodontal care in trials designed to reduce cardiovascular risk.
OBJECTIVE:--To assess coronary heart disease (CHD) risk within levels of the joint distribution of non-HDL and LDL cholesterol among individuals with and without diabetes. RESEARCH DESIGN AND ...METHODS--We used four publicly available data sets for this pooled post hoc analysis and confined the eligible subjects to white individuals aged >/=30 years and free of CHD at baseline (12,660 men and 6,721 women). Diabetes status was defined as either "reported by physician-diagnosed and on medication" or having a fasting glucose level >/=126 mg/dl at the baseline examination. The primary end point was CHD death. Within diabetes categories, risk was assessed based on lipid levels (in mg/dl): non-HDL <130 and LDL <100 (group 1); non-HDL <130 and LDL >/=100 (group 2); non-HDL >/=130 and LDL <100 (group 3); and non-HDL >/=130 and LDL >/=100 (group 4). Group 1 within those without diabetes was the overall reference group. RESULTS:--Of the subjects studied, approximately6% of men and 4% of women were defined as having diabetes. A total of 773 CHD deaths occurred during the average 13 years of follow-up time. A Cox proportional hazard model was used to estimate the relative risk (RR) of CHD death. Those with diabetes had a 200% higher RR than those without diabetes. In a multivariate model, CHD risk in those with diabetes did not increase with increasing LDL, whereas it did increase with increasing non-HDL: RR (95% confidence interval) for group 1: 5.7 (2.0-16.8); group 2: 5.7 (1.6-20.7); group 3: 7.2 (2.6-19.8); and group 4: 7.1 (3.7-13.6). CONCLUSIONS:--Non-HDL is a stronger predictor of CHD death among those with diabetes than LDL and should be given more consideration in the clinical approach to risk reduction among diabetic patients.
Background: Understanding of longitudinal characteristics of periodontal disease in older females is limited. This study examined 5‐year changes in periodontal disease measures among postmenopausal ...females.
Methods: Participants were 1,025 postmenopausal, 53‐ to 83‐year‐old females who completed baseline (1997 to 2001) and 5‐year follow‐up (2002 to 2006) whole‐mouth oral examinations in a study ancillary to the Women's Health Initiative. Periodontal disease was characterized using probing depth (PD), clinical attachment level (CAL), alveolar crest height (ACH), and tooth loss. Differences in measures between examinations were used to characterize patterns of change.
Results: Baseline prevalence of none/mild, moderate, and severe periodontal disease defined using criteria of the Centers for Disease Control and Prevention was 27%, 58%, and 15%, respectively. Tooth loss attributable to periodontitis occurred in 13% of females. Mean ± SD changes in whole‐mouth mean measures showed progression when based on ACH (−0.19 ± 0.49 mm) yet relatively stable disease when based on PD (0.11 ± 0.42 mm) and CAL (0.06 ± 0.58 mm). Mean change in worst‐site ACH was greater (P <0.001) in females with severe periodontitis and osteoporosis at baseline and with tooth loss during follow‐up. Periodontal changes did not differ according to baseline age, hormone therapy use, smoking status, or age at menopause.
Conclusions: Five‐year changes in periodontal measures among generally healthy postmenopausal females were, on average, small and did not suggest a consistent pattern of disease progression. Females with history of severe periodontitis or osteoporosis may experience accelerated oral bone loss despite stability or small improvement in routine probing measures.
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