Background: In clinical practice, anthropometric measures other than BMI are rarely measured yet may be more predictive of cardiovascular (CV) risk. We analyzed the placebo group of the REWIND CV ...outcomes trial to compare several anthropometric measures as baseline predictors for cardiovascular disease (CVD)-related outcomes in participants with type 2 diabetes. Methods: Data from the REWIND trial placebo group (N=4952) were analyzed. All participants had T2D, were aged >50, and had either a previous CV event or CV risk factors and a BMI of >23 kg/m2. Cox proportional hazard models were used to investigate if BMI, waist-to-hip ratio (WHR), and waist circumference (WC) were significant risk factors for major adverse CV events (MACE)-3, CVD-related mortality, all-cause mortality, and heart failure (HF). Models were adjusted for age and sex, and additional baseline factors selected by LASSO method. Results are presented for 1 standard deviation increase of the respective anthropometric factor. Results: There were 663 MACE-3 events, 346 CVD-related deaths, 592 all-cause deaths, and 226 events of HF during the median follow-up of 5.4 years. WHR and WC, but not BMI, were identified as independent risk factors for MACE-3 (hazard ratio HR for WHR: 1.11 95% CI 1.03 to 1.21; p=0.009; HR for WC: 1.12 95% CI 1.02 to 1.22; p=0.012). WC adjusted for hip circumference (HC) showed the strongest association with MACE-3 compared to WHR, WC, or BMI unadjusted for each other (HR: 1.25 95% CI 1.06 to 1.49; p=0.009). Results for CVD-related mortality and all-cause mortality were similar. HF was predicted by WC and BMI, but not WHR (HR for WC: 1.34 95% CI 1.16 to 1.54; p<0.001; HR for BMI: 1.33 95% CI 1.17 to 1.50; p<0.001). Conclusions: In this post hoc analysis of the REWIND placebo group, WHR and WC were predictors of MACE-3, CVD-related mortality, and all-cause mortality; BMI was not. These findings indicate the need for anthropometric measures that consider body fat distribution when assessing CV risk.
Cardiovascular diseases (CVDs) are the global public health problem which has been associated with increasing prevalence of modifiable CVDs risk factors. This study aimed to describe the prevalence ...and knowledge of modifiable CVDs risk factors among vulnerable population of Central Tanzania.
A community-based cross-sectional study design was employed. A total of 749 participants were interviewed. The socio-demographic information and modifiable CVDs risk factors (behavioral and biological) were measured using a modified World Health Organization (WHO) STEPwise approach for chronic disease risk factor surveillance. Knowledge of modifiable CVDs risk factors was measured by comprehensive heart disease knowledge questionnaire. Descriptive statistics were used to describe the knowledge and prevalence of modifiable CVDs risk factors. Logistic regression analysis was used to determine the factors associated with adequate knowledge of CVDs risk factors.
The prevalence of béhavioral risk factors were; current smokers and alcohol consumers were 4.4% and 18.0% respectively, use of raw salt was 43.7%, consumption of fruit/vegetables < 5 days per week was 56.9%. The prevalence of Biological CVDs risk factors was as follows: Overall, 63.5% (33.3% overweight and 29.9% obese) were overweight or obese, 4.5% were diabetic and 43.4% were hypertensive. Only 35.4% of participants had adequate knowledge of CVDs risk factors. Being a male (AOR = 1.44, 95%CI = 1.01-2.06, p < .05), having primary education (AOR = 6.43, 95%CI = 2.39-17.36, p < .0001), being employed (AOR = 1.59, 95%CI = 1.00-2.52, p < .05), ever checked blood pressure (AOR = 0.59, 95%CI = 0.42-0.84, p < .001), family history of hypertension (AOR = 0.38, 95%CI = 0.25-0.57, p < .0001) determined adequate knowledge of CVDs risk factors.
This study has revealed a high prevalence of modifiable CVDs risk factors and low knowledge of CVDs risk factors. Community health promotion interventions to increase population knowledge of CVDs risk factors are recommended for the efficacious reduction of CVDs in the country.
Climate change has been identified as the biggest global health threat of the twenty-first century. Hundreds of millions of people around the world currently suffer from allergic diseases such as ...asthma and allergic rhinitis (hay fever), and the prevalence of these diseases is increasing. This book is the first authoritative and comprehensive assessment of the many impacts of climate change on allergens, such as pollen and mould spores, and allergic diseases. The international authorship team of leaders in this field explore the topic to a breadth and depth far beyond any previous work. This book will be of value to anyone with an interest in climate change, environmental allergens, and related allergic diseases. It is written at a level that is accessible for those working in related physical, biological, and health and medical sciences, including researchers, academics, clinicians, and advanced students.
Musculoskeletal Disorders (MSDs) have a significant impact on people's lives as well as their workplaces, organizations, families, society, and national economy. Therefore, the main objective of this ...study is to investigate the impacts of different risk factors in developing MSD problems. Structural equation modelling has been used to examine the effects of different risk factors on developing MSD problems. Five hypotheses were developed for workplace, personal, biomechanical, psychosocial, and organisational risk factors to examine the positive relation with MSD problems generation. Results showed that biomechanical risk factors, including repetitive motion, vibration, force, posture, and deviation from neutral body alignment, have significant impacts on the development of MSD problems. Similar results were found for workplace, personal, psychosocial, and organisational risk factors. Therefore, either the single risk factor or collectively contributes significantly to MSD problems generation. Decision-makers can use this study to analyse the impacts of different factors on the generation of MSD problems within their industries or organizations. To the best of the author's knowledge, this study is the first and foremost approach to determine the impacts of the critical risk factors on developing MSD problems through an organised and scientific approach.
Abstract
Background
Data on risk factors for coronavirus disease 2019 (COVID-19)–associated hospitalization are needed to guide prevention efforts and clinical care. We sought to identify factors ...independently associated with COVID-19–associated hospitalizations.
Methods
Community-dwelling adults (aged ≥18 years) in the United States hospitalized with laboratory-confirmed COVID-19 during 1 March–23 June 2020 were identified from the COVID-19–Associated Hospitalization Surveillance Network (COVID-NET), a multistate surveillance system. To calculate hospitalization rates by age, sex, and race/ethnicity strata, COVID-NET data served as the numerator and Behavioral Risk Factor Surveillance System estimates served as the population denominator for characteristics of interest. Underlying medical conditions examined included hypertension, coronary artery disease, history of stroke, diabetes, obesity, severe obesity, chronic kidney disease, asthma, and chronic obstructive pulmonary disease. Generalized Poisson regression models were used to calculate adjusted rate ratios (aRRs) for hospitalization.
Results
Among 5416 adults, hospitalization rates (all reported as aRR 95% confidence interval) were higher among those with ≥3 underlying conditions (vs without) (5.0 3.9–6.3), severe obesity (4.4 3.4–5.7), chronic kidney disease (4.0 3.0–5.2), diabetes (3.2 2.5–4.1), obesity (2.9 2.3–3.5), hypertension (2.8 2.3–3.4), and asthma (1.4 1.1–1.7), after adjusting for age, sex, and race/ethnicity. Adjusting for the presence of an individual underlying medical condition, higher hospitalization rates were observed for adults aged ≥65 or 45–64 years (vs 18–44 years), males (vs females), and non-Hispanic black and other race/ethnicities (vs non-Hispanic whites).
Conclusions
Our findings elucidate groups with higher hospitalization risk that may benefit from targeted preventive and therapeutic interventions.
Severe obesity, chronic kidney disease, diabetes, obesity, hypertension, asthma, age ≥45 years, male sex, and non-Hispanic black and other race/ethnicity are associated with increased risk of coronavirus disease 2019–associated hospitalizations.
Background While there have been several school‐based physical activity (PA) interventions targeting improvement in cardiovascular disease (CVD) risk factors, few have assessed long‐term effects. The ...aim of this paper was therefore to determine intervention effects on CVD risk factors 5 years after cessation. Methods Two schools were assigned to intervention (n = 125) or control (n = 134). The intervention school offered 210 min/week more PA than the control school over two consecutive years (fourth and fifth grades). Follow‐up assessment was conducted 5‐year post‐intervention (10th grade) where 180–210 (73%–85%) children provided valid data. Outcomes were CVD risk factors: triglyceride, total‐to‐high‐density‐lipoprotein‐cholesterol ratio (TC:HDL ratio), insulin resistance, blood pressure (BP), waist circumference, and cardiorespiratory fitness (VO2peak). Variables were analyzed individually and as a composite score through linear mixed models, including random intercepts for children. Results Analyses revealed significant sustained 5‐year intervention effects for HDL (effect sizes ES = 0.22), diastolic BP (ES = 0.48), VO2peak (ES = 0.29), and composite risk score (ES = 0.38). These effects were similar to the immediate results following the intervention. In contrast, while TC:HDL ratio initially decreased post‐intervention (ES = 0.27), this decrease was not maintained at 5‐year follow‐up (ES = 0.09), whereas WC was initially unchanged post‐intervention (ES = 0.02), but decreased at 5‐year follow‐up (ES = 0.44). Conclusion The significant effects of a 2‐year school‐based PA intervention remained for CVD risk factors 5 years after cessation of the intervention. As cardiometabolic health can be maintained long‐term after school‐based PA, this paper demonstrates the sustainability and potential of schools in the primary prevention of future CVD risk in children.
Background
It is important that population cohorts at increased risk of hospitalisation and death following a COVID‐19 infection are identified and protected.
Objectives
We identified risk factors ...associated with increased risk of hospitalisation, intensive care unit (ICU) admission and mortality in inner North East London (NEL) during the first UK COVID‐19 wave.
Methods
Multivariate logistic regression analysis on linked primary and secondary care data from people aged 16 or older with confirmed COVID‐19 infection between 01/02/2020 and 30/06/2020 determined odds ratios (OR), 95% confidence intervals (CI) and P‐values for the association between demographic, deprivation and clinical factors with COVID‐19 hospitalisation, ICU admission and mortality.
Results
Over the study period, 1781 people were diagnosed with COVID‐19, of whom 1195 (67%) were hospitalised, 152 (9%) admitted to ICU and 400 (23%) died. Results confirm previously identified risk factors: being male, or of Black or Asian ethnicity, or aged over 50. Obesity, type 2 diabetes and chronic kidney disease (CKD) increased the risk of hospitalisation. Obesity increased the risk of being admitted to ICU. Underlying CKD, stroke and dementia increased the risk of death. Having learning disabilities was strongly associated with increased risk of death (OR = 4.75, 95% CI = 1.91, 11.84, P = .001). Having three or four co‐morbidities increased the risk of hospitalisation (OR = 2.34, 95% CI = 1.55, 3.54, P < .001; OR = 2.40, 95% CI = 1.55, 3.73, P < .001 respectively) and death (OR = 2.61, 95% CI = 1.59, 4.28, P < .001; OR = 4.07, 95% CI = 2.48, 6.69, P < .001 respectively).
Conclusions
We confirm that age, sex, ethnicity, obesity, CKD and diabetes are important determinants of risk of COVID‐19 hospitalisation or death. For the first time, we also identify people with learning disabilities and multi‐morbidity as additional patient cohorts that need to be actively protected during COVID‐19 waves.
European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V in primary care was carried out by the European Society of Cardiology EURObservational Research ...Programme in 2016-2018. The main objective was to determine whether the 2016 Joint European Societies' guidelines on cardiovascular disease prevention in people at high cardiovascular risk have been implemented in clinical practice.
The method used was a cross-stional survey in 78 centres from 16 European countries. Patients without a history of atherosclerotic cardiovascular disease either started on blood pressure and/or lipid and/or glucose lowering treatments were identified and interviewed ≥ 6 months after the start of medication.
A total of 3562 medical records were reviewed and 2759 patients (57.6% women; mean age 59.0 ± 11.6 years) interviewed (interview rate 70.0%). The risk factor control was poor with 18.1% of patients being smokers, 43.5% obese (body mass index ≥30 kg/m2) and 63.8% centrally obese (waist circumference ≥88 cm for women, ≥102 cm for men). Of patients on blood pressure lowering medication 47.0% reached the target of <140/90 mm Hg (<140/85 mm Hg in people with diabetes). Among treated dyslipidaemic patients only 46.9% attained low density lipoprotein-cholesterol target of <2.6 mmol/l. Among people treated for type 2 diabetes mellitus, 65.2% achieved the HbA1c target of <7.0%.
The primary care arm of the EUROASPIRE V survey revealed that large proportions of people at high cardiovascular disease risk have unhealthy lifestyles and inadequate control of blood pressure, lipids and diabetes. Thus, the potential to reduce the risk of future cardiovascular disease throughout Europe by improved preventive cardiology programmes is substantial.
PDF
