Risk factors in cardiovascular patients:Challenges and opportunities to improve secondary prevention

BACKGROUND Effective management of major cardiovascular risk factors is of great importance to reduce mortality from cardiovascular disease(CVD).The Survey of Risk Factors in Coronary Heart Disease(SURF CHD)II study is a clinical audit of the recording and management of CHD risk factors.It was developed in collaboration with the European Association of Preventive Cardiology and the European Society of Cardiology(ESC).Previous studies have shown that control of major cardiovascular risk factors in patients with established atherosclerotic CVD is generally inadequate.Azerbaijan is a country in the South Caucasus,a region at a very high risk for CVD.AIM To assess adherence to ESC recommendations for secondary prevention of CVD based on the measurement of both modifiable major risk factors and their therapeutic management in patients with confirmed CHD at different hospitals in Baku(Azerbaijan).METHODS Six tertiary health care centers participated in the SURF CHD II study between 2019 and 2021.Information on demographics,risk factors,physical and laboratory data,and medications was collected using a standard questionnaire in consecutive patients aged≥18 years with established CHD during outpatient visits.Data from 687 patients(mean age 59.6±9.58 years;24.9%female)were included in the study.RESULTS Only 15.1%of participants were involved in cardiac rehabilitation programs.The rate of uncontrolled risk factors was high:Systolic blood pressure(BP)(SBP)(54.6%),low-density lipoprotein cholesterol(LDL-C)(86.8%),diabetes mellitus(DM)(60.6%),as well as overweight(66.6%)and obesity(25%).In addition,significant differences in the prevalence and control of some risk factors[smoking,body mass index(BMI),waist circumference,blood glucose(BG),and SBP]between female and male participants were found.The cardiovascular health index score(CHIS)was calculated from the six risk factors:Non-or ex-smoker,BMI<25 kg/m2,moderate/vigorous physical activity,controlled BP(<140/90 mmHg;140/80 mmHg for patients with DM),controlled LDL-C(<70 mg/dL),and controlled BG(glycohemoglobin<7%or BG<126 mg/dL).Good,intermediate,and poor categories of CHIS were identified in 6%,58.3%,and 35.7%of patients,respectively(without statistical differences between female and male patients).CONCLUSION Implementation of the current ESC recommendations for CHD secondary prevention and,in particular,the control rate of BP,are insufficient.Given the fact that patients with different comorbid pathologies are at a very high risk,this is of great importance in the management of such patients.This should be taken into account by healthcare organizers when planning secondary prevention activities and public health protection measures,especially in the regions at a high risk for CVD.A wide range of educational products based on the Clinical Practice Guidelines should be used to improve the adherence of healthcare professionals and patients to the management of CVD risk factors.

Sedentary lifestyle among adults in Jordan,2007

Objective:Sedentary lifestyle is a major risk factor for physical and mental problems,such as cardiovascular,musculoskeletal diseases,and psychological stress.About 60% of the world’s population is not sufficiently physically active in leisure time or during work and social activities.This study aimed to determine the prevalence of inactive Jordanian adults and describe their demo-graphic and behavioral characteristics.Methods:The study used data from the behavioral risk factors surveillance survey conducted in Jordan in 2007.The sample size was 3654.Respondents who were physically inactive for more than 240 min daily(sleep time not included)were considered to have a sedentary lifestyle.Data were analyzed with the program SPSS.Results:The prevalence of a sedentary lifestyle was 82.8%(2965 respondents),with a mean sedentary time of 587 min(95%confidence interval 581-594 min).Among the physically inactive adults,52.6% were men,one third of them aged 35-44 years.Sedentary lifestyle was reported by 30% of those with a secondary level of education or above.Of those with a sedentary lifestyle,37.6% were housewives and 37.5% were employees;66% of them were overweight and obese.Of the physically inactive people,2.5%had a history of heart failure and 1.3%had a history of cer-ebrovascular accidents;57.2% of them tried to engage more in physical activity and almost three quarters of them were interested in improving their dietary habits.Conclusion:Most Jordanian adults have a sedentary lifestyle,which emphasizes that there is a public health problem.Many of them are attempting to lead a healthier lifestyle.Therefore,there is an urgent need to launch an applicable national plan that enables people to practice a healthier lifestyle.