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Risk factors in cardiovascular patients:Challenges and opportunities to improve secondary prevention
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作者 Rahima Gabulova Anna Marzà-Florensa +12 位作者 Uzeyir Rahimov Mahluga Isayeva Shahana Alasgarli Afag Musayeva Sona Gahramanova Firdovsi Ibrahimov Farid Aliyev Galib Imanov Rahmana Rasulova Ilonca Vaartjes Kerstin Klipstein-Grobusch Ian Graham Diederick E Grobbee 《World Journal of Cardiology》 2023年第7期342-353,共12页
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 i... 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. 展开更多
关键词 Coronary heart disease Cardiovascular risk factors secondary prevention Clinical practice guidelines Clinical audit Survey of risk factors
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Myocardial infarction secondary prevention study (MISPS) 被引量:14
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作者 Hongcai SHANG Guohua DAI Junhua HANG Yaozu XIANG Yang WANG Junping ZHANG Wuxun DU Jingyuan MAO Chen YAO Weiliang WENG Tiancai WEN Boli ZHANG 《Journal of Geriatric Cardiology》 SCIE CAS CSCD 2006年第2期116-119,共4页
Background Traditional Chinese medicine (TCM), especially herbal medicine, has been widely used in China and now is also being increasingly used in other countries for the treatment of cardiovascular diseases. Althoug... Background Traditional Chinese medicine (TCM), especially herbal medicine, has been widely used in China and now is also being increasingly used in other countries for the treatment of cardiovascular diseases. Although many studies have demonstrated that certain Chinese herbal products are effective and safe for the treatment of cardiovascular diseases, most of these lack sufficient quality. Therefore, large randomized clinical trials and further scientific research to determine its safety, effectiveness are necessary.QiShen YiQi Dripping Pills (QSYQDP) is a herbal preparation clinically used in the treatment and prevention of coronary artery disease. Preliminary observations have shown its safety and effectiveness. Methods/Design This randomized, controlled trial will recruit 3600 patients with a history of myocardial infarction. Patients will be randomized into two groups by a Centr-Randomized System. One group receives QSYQDP, the other group receive aspirin. This trial protocol will describe eligibility criteria, detailed information on the treatment definition, blinding, endpoints, statistical methods, sample size determination, data management, legal aspects, and the current status of the trial. Discussion This trial is one of the first randomized, controlled clinical trial to evaluate the efficacy and safety of traditional Chinese herbal medicine in the treatment and secondary prevention of coronary artery disease. The results of this study should help to define the role of TCM in modern medical care, as well as to provide the management strategy for CAD patients in China and other countries. 展开更多
关键词 Myocardial infarction secondary prevention study MISPS MACE
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Cardiac rehabilitation and its essential role in the secondary prevention of cardiovascular diseases 被引量:9
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作者 Petr Winnige Robert Vysoky +1 位作者 Filip Dosbaba Ladislav Batalik 《World Journal of Clinical Cases》 SCIE 2021年第8期1761-1784,共24页
Cardiovascular diseases are the most common causes of mortality worldwide.They are frequently the reasons for patient hospitalization,their incapability for work,and disability.These diseases represent a significant s... Cardiovascular diseases are the most common causes of mortality worldwide.They are frequently the reasons for patient hospitalization,their incapability for work,and disability.These diseases represent a significant socio-economic burden affecting the medical system as well as patients and their families.It has been demonstrated that the etiopathogenesis of cardiovascular diseases is significantly affected by lifestyle,and so modification of the latter is an essential component of both primary and secondary prevention.Cardiac rehabilitation(CR)represents an efficient secondary prevention model that is especially based on the positive effect of regular physical activity.This review presents an overview of basic information on CR with a focus on current trends,such as the issue of the various training modalities,utilization,and barriers to it or the use of telemedicine technologies.Appropriate attention should be devoted to these domains,as CR continues evolving as an effective and readily available intervention in the future. 展开更多
关键词 Cardiac rehabilitation secondary prevention Cardiovascular diseases UTILIZATION Barriers TELEREHABILITATION
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Awareness intervention for Beijing neurologists regarding secondary prevention of cerebral infarction/transient ischemia Cross-sectional investigation 被引量:2
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作者 Ruihua Ma Chunxue Wang +15 位作者 Xianwei Wang Yuhui Zhang Yongjun Wang Yilong Wang Xingquan Zhao Jingjing Li Ying Lu Mingjie Xu Zhuo Zhang Li Wang Weiwei Zhang Lang Lin Jiping Tan Yao Li Ming Wei Hongtao Li 《Neural Regeneration Research》 SCIE CAS CSCD 2008年第3期333-336,共4页
BACKGROUND: Stroke prevention guidelines should be made available application to aid in uniformity, timing, preciseness, and acceptance of disease. OBJECTIVE: To investigate the awareness of neurologists in some Bei... BACKGROUND: Stroke prevention guidelines should be made available application to aid in uniformity, timing, preciseness, and acceptance of disease. OBJECTIVE: To investigate the awareness of neurologists in some Beijing secondary prevention of cerebral infarction/transient ischemia. DESIGN: Cross-sectional study. to neurologists for clinical hospitals of intervention in SETTING: Beijing Tiantan Hospital, Beijing Anzhen Hospital, General Hospital of Beijing Military Area, Command of Chinese PLA, Beijing Chuiyangliu Hospital, Beijing 6^th Hospital, Beijing Hepingli Hospital, and Beijing Daxing District Hospital. PARTICIPANTS: A total of 28 (associate) chief physicians, 58 attending physicians, and 54 resident physicians who engaged in clinical treatment of cerebrovascular diseases were selected from 8 hospitals in Beijing from March to April 2007. All physicians provided informed consent. METHODS: Self-made closed questionnaires were provided for data collection, consisting of 16 questions that were single choice or multiple choice. Specifically, questions 1-7 focused on awareness of blood pressure regulation in different patients and first choice of decompression drug; questions 8-12 focused on awareness of lipid regulation; and questions 13-16 focused on awareness of anti-blood platelet drugs applied in secondary prevention. The scores ranged from 0-100 points, and each question was worth 6.25 points. The scores positively correlated with the awareness rate. To test leveling real-time, the survey lasted for a maximum of 20 minutes. One questionnaire was independently finished by each subject in the survey. MAIN OUTCOME MEASURES: Awareness intervention among neurologists during secondary prevention of cerebral infarction/transient ischemia and questionnaire scores. RESULTS: 140 subjects were included in the final analysis. ① The awareness rate among neurologists for intervention during secondary prevention of cerebral infarction/transient ischemia ranged from 0.7-57.9%, the scores ranged between 0-56 points, and the mean score was 26 points.② Scores of resident physicians were 0-56 points with a mean score of 26 points; attending physicians scored 6-50 points, with a mean score of 26 points; and chief physicians scored 6-50 points, with a mean score of 23 points. There were no significant differences among the various physicians (F = 0.771, t = 0.465, P 〉 0.05). CONCLUSION: Awareness among neurologists of intervention during secondary prevention of cerebral infarction/transient ischemia is not ideal. However, there was no significant difference between professional titles. 展开更多
关键词 secondary prevention cerebral infarction transient ischemic attack cross-sectional study
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Physical activity in primary and secondary prevention of cardiovascular disease:Overview updated 被引量:6
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作者 Alberto J Alves Joao L Viana +5 位作者 Suiane L Cavalcante Nórton L Oliveira JoséA Duarte Jorge Mota JoséOliveira Fernando Ribeiro 《World Journal of Cardiology》 2016年第10期575-583,共9页
Although the observed progress in the cardiovascular disease treatment, the incidence of new and recurrent coronary artery disease remains elevated and constitutes the leading cause of death in the developed countries... Although the observed progress in the cardiovascular disease treatment, the incidence of new and recurrent coronary artery disease remains elevated and constitutes the leading cause of death in the developed countries. Three-quarters of deaths due to cardiovascular diseases could be prevented with adequate changes in lifestyle, including increased daily physical activity. New evidence confirms that there is an inverse dose-response relationship between physical activity and cardiovascular disease and mortality risk. However, participation in moderate to vigorous physical activity may not fully attenuate the independent effect of sedentary activities on increased risk for cardiovascular diseases. Physical activity also plays an important role in secondary prevention of cardiovascular diseases by reducing the impact of the disease, slowing its progress and preventing recurrence. Nonetheless, most of eligible cardiovascular patients still do not benefit from secondary prevention/cardiac rehabilitation programs. The present review draws attention to the importance of physical activity in the primary and secondary prevention of cardiovascular diseases. It also addresses the mechanisms by which physical activity and regular exercise can improve cardiovascular health and reduce the burden of the disease. 展开更多
关键词 Physical activity Primary prevention secondary prevention Cardiovascular disease Health care evaluation mechanisms
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A Commentary on the Chinese Coronary Secondary Prevention Study
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作者 陆宗良 《Chinese Journal of Integrated Traditional and Western Medicine》 2006年第2期85-87,共3页
Chinese coronary secondary prevention study (CCSPS) is a key project in the field of medicine of the Ninth Five-year Plan of China, and is also called the Study of Xuezhikang Capsule (血脂康胶囊, XZK)in regulating... Chinese coronary secondary prevention study (CCSPS) is a key project in the field of medicine of the Ninth Five-year Plan of China, and is also called the Study of Xuezhikang Capsule (血脂康胶囊, XZK)in regulating blood lipids for secondary prevention of coronary heart diseases .Since the results of the study was publicized in June 2004 at the news release and deliberation by experts took place in the Great Hall of the People in Beijing, wide attention and high opinions have been gotten, and at the same time, 展开更多
关键词 FIGURE LDL A Commentary on the Chinese Coronary secondary prevention Study
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Function of health education on secondary prevention of coronary heart disease
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作者 李海梅 《中国组织工程研究与临床康复》 CAS CSCD 2001年第19期154-,共1页
关键词 Function of health education on secondary prevention of coronary heart disease
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Exploring the Role of Nutraceuticals (Red Yeast Rice) in Secondary Prevention: A New Pathway Can Be Opened
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作者 Santiago de Dios Eduardo Fernandez Carrion +4 位作者 Javier Antona Makoshi Juan Jose Parra Fuertes Hector Fleites Eduardo Zatarain Jose Luis Zamorano Gomez 《World Journal of Cardiovascular Diseases》 2022年第1期24-29,共6页
<strong>Background:</strong><span style="white-space:normal;font-family:;" "=""> Long</span><span style="white-space:normal;font-family:;" "=&quo... <strong>Background:</strong><span style="white-space:normal;font-family:;" "=""> Long</span><span style="white-space:normal;font-family:;" "="">-</span><span style="white-space:normal;font-family:;" "="">term survival in acute coronary syndrome has increased steadily in the last decades. Follow-up studies developed in this patient clearly reveal that they are at risk of suffering a new event, placing them in a new stage, secondary prevention. Assuming this increased risk, the control target of their cardiovascular risk factors become more ambitious. In this field, control of Cholesterol levels, particularly LDL-C, ha</span><span style="white-space:normal;font-family:;" "="">s</span><span style="white-space:normal;font-family:;" "=""> arisen as a priority objective in patients with coronary arterial disease. In this sense, management of </span><span style="white-space:normal;font-family:;" "="">dyslipidemia </span><span style="white-space:normal;font-family:;" "="">guidelines, recently recognise</span><span style="white-space:normal;font-family:;" "="">s</span><span style="white-space:normal;font-family:;" "=""> the role of functional food, highlighting among them </span><span style="white-space:normal;font-family:;" "="">is </span><span style="white-space:normal;font-family:;" "="">the Red Yeast Rice (RYR). The aim of the study is to establish the potential role of functional food, in secondary prevention</span><span style="white-space:normal;font-family:;" "="">,</span><span style="white-space:normal;font-family:;" "=""> while deter</span><span style="white-space:normal;font-family:;" "="">mining its additional capacity to reduce LDL-C in patients that despite optimal classic treatment (maximum tolerated dose of stain plus Ezetimibe) </span><span style="white-space:normal;font-family:;" "="">is</span><span style="white-space:normal;font-family:;" "=""> still out of control objectives. <b>Results and Discussion:</b> 88 patients were included and after 3 months of treatment with RYR, their lipid profiles were compared with the baseline. The variation of T-Col, LDL-C and Trig were statistically significant. A reduction in LDL-C was 10.73</span><span style="white-space:normal;font-family:;" "=""> </span><span style="white-space:normal;font-family:;" "="">mg/dL, which means a 10.93% of additional reduction over the standard therapy the patients were receiving. Concerning security, no relevant side effects were reported when adding RYR, even in a relevant percentage (35.4%)</span><span style="white-space:normal;font-family:;" "="">,</span><span style="white-space:normal;font-family:;" "=""> myalgia disappeared (especially when reduc</span><span style="white-space:normal;font-family:;" "="">ing the </span><span style="white-space:normal;font-family:;" "="">titrating dose </span><span style="white-space:normal;font-family:;" "="">of </span><span style="white-space:normal;font-family:;" "="">the statin). <b>Conclusion:</b> Adding</span><span style="white-space:normal;font-family:;" "=""> RYR in secondary prevention patients in combination with the usual treatment, seems </span><span style="white-space:normal;font-family:;" "="">to be </span><span style="white-space:normal;font-family:;" "="">an effective alternative to optimi</span><span style="white-space:normal;font-family:;" "="">z</span><span style="white-space:normal;font-family:;" "="">e LDL levels and thus get</span><span style="white-space:normal;font-family:;" "="">s</span><span style="white-space:normal;font-family:;" "=""> closer to the target set in the</span><span style="white-space:normal;font-family:;" "=""> </span><span style="white-space:normal;font-family:;" "="">guidelines, without adding relevant side effects, </span><span style="white-space:normal;font-family:;" "="">and </span><span style="white-space:normal;font-family:;" "="">even improving tolerance to the statins.</span> 展开更多
关键词 LIPIDS NUTRACEUTICALS Coronary Artery Disease secondary prevention
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Use of Evidence-Based Pharmacotherapy for Secondary Prevention of Coronary Heart Disease:A Chinese Medicine Hospital Versus A General Hospital 被引量:4
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作者 徐慧敏 蔡宏文 +5 位作者 戴海斌 颜小锋 周权 徐耕 黄兆铨 毛威 《Chinese Journal of Integrative Medicine》 SCIE CAS 2014年第5期375-380,共6页
Objective: To determine differences in adherence to secondary prevention guidelines (pharmacological interventions) among coronary heart disease (CHD) patients between a Chinese medicine (CM) hospital and a gen... Objective: To determine differences in adherence to secondary prevention guidelines (pharmacological interventions) among coronary heart disease (CHD) patients between a Chinese medicine (CM) hospital and a general hospital in a Chinese city. Methods: Medical records of 200 patients consecutively discharged from the CM hospital and the general hospital for CHD were reviewed to determine the proportions of eligible patients who received antiplatelet agents, 13-blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and statins at discharge. The effects of patient characteristics and hospital type on the use of these medicines were estimated using logistic regression models. Results: Patients discharged from the CM hospitals were older; more likely females; had greater history of hyperlipidemia, cerebrovascular diseases and less smoker (P〈0.01 or P〈0.05). They were less likely to receive coronary angiography and percutaneous coronary intervention, and had a longer length of stay than those discharged from the general hospital (P〈0.01 or P〈0.05). There were no significant differences in antiplatelet agents (96% vs. 100%, P=0.121) or statins (97.9% vs. 100%, P=0.149) use between the CM hospital and the general hospital. In multivadable analyses that adjusted for patient characteristics and hospital type, there was no significant difference in use of 13 -blockers between the CM hospital and the general hospital. In contrast, patients discharged from the CM hospital were less likely to receive ACE inhibitors/ARBs compared with those discharged from the general hospital (odds ratio: 0.3, 95% confidence interval: 0.105-O.854). Conclusion: In this study, the CM hospital provides the same quality of care in CHD for prescribing evidence-based medications at discharge compared with another general hospital except for ACE inhibitors/ARBs use. 展开更多
关键词 coronary disease DRUGS secondary prevention Chinese medicine
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The utilization status of aspirin for the secondary prevention of ischemic stroke 被引量:4
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作者 KE Xian-jun YU Yong-fei GUO Zhen-li XU Kang HAI Hong ZHANG Ai-he JIANG Hong PENG Hong 《Chinese Medical Journal》 SCIE CAS CSCD 2009年第2期165-168,共4页
Background The present study was aimed to investigate the usage of aspirin for the secondary prevention of ischemic stroke, evaluate the correlated factors, and analyze the reasons for not taking and irregularly takin... Background The present study was aimed to investigate the usage of aspirin for the secondary prevention of ischemic stroke, evaluate the correlated factors, and analyze the reasons for not taking and irregularly taking aspirin. Methods The patients in this group were all stroke survivors who have formerly been diagnosed with a cerebral infarction or transient ischemic attack (TIA) in our hospital. We investigated their use of aspirin over a three-year period following their hospitalization. According to the patients' aspirin usage, they were divided into treatment and non-treatment groups. In addition, the reasons for not taking or irregularly taking aspirin were analyzed in the two groups. Results A total of 1240 patients were studied, including 367 (29.60%) in the treatment group and 873 (70.40%) cases in the non-treatment group. In addition, 201 (16.20%) cases in the treatment group had been regularly taking aspirin (50-325 mg of aspirin daily) for 1 to 3 years or longer. The results demonstrated that the main reasons for not taking aspirin in this study were related to patients' concerns regarding the side effects of taking aspirin (46.45%), as well as the doctors' inadequacy in informing their patients to take aspirin (38.71%). The major reasons for patients to irregularly take aspirin were that the doctors did not notify the length of aspirin usage to their patients (41.57%), and that doctors did not prescribe aspirin upon the patients' follow-up visit (26.51%). Conclusion The most effective way to increase patient's compliance for aspirin consumption is to promote the guidelines for stroke treatment and to relay these advances in stroke therapy to the patient. Chin Med J 2009; 122(2): 165-168 展开更多
关键词 ischemic stroke ASPIRIN secondary prevention
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Naoxintong Capsule for Secondary Prevention of Ischemic Stroke:A Multicenter,Randomized,and Placebo-Controlled Trial 被引量:2
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作者 YU Xiao-fei ZHU Xu-ying +20 位作者 YUAN Can-xing WU Dan-hong ZHAO Yu-wu YANG Jia-jun WANG Chang-de WUWei-wen LIU Xue-yuan LIU Zhen-guo NIE Zhi-yu DENG Ben-qiang BAO Huan LI Long-xuan WANG Chun-yan ZHANG Hong-zhi ZHANG Jing-si HUANG Ji-han GONG Fan WANG Ming-zhe GUO Yong-mei SUN Yan CAI Ding-fang 《Chinese Journal of Integrative Medicine》 SCIE CAS CSCD 2022年第12期1063-1071,共9页
Objective:To examine whether the combination of Naoxintong Capsule with standard care could further reduce the recurrence of ischemic stroke without increasing the risk of severe bleeding.Methods:A total of 23 Chinese... Objective:To examine whether the combination of Naoxintong Capsule with standard care could further reduce the recurrence of ischemic stroke without increasing the risk of severe bleeding.Methods:A total of 23 Chinese medical centers participated in this trial.Adult patients with a history of ischemic stroke were randomlyassigned ina 1:1ratiousing a blockdesign toreceive eitherNaoxintong Capsule(1.2gorally,twice a day)or placebo in addition to standard care.The primary endpoint was recurrence of ischemic stroke within 2 years.Secondary outcomes included myocardial infarction,death due to recurrent ischemic stroke,and all-cause mortality.The safety of drugs was monitored.Results were analyzed using the intention-to-treat principle. 展开更多
关键词 ischemic stroke Naoxintong Capsule secondary prevention randomized controlled trial Chinese medicine
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Primary and secondary prevention of colorectal cancer: An evidence- based review 被引量:2
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作者 Sandra J.Gonzalez Maria C.Mejia de Grubb Robert S.Levine 《Family Medicine and Community Health》 2017年第1期78-84,共7页
Colorectal cancer (CRC) is a common cancer that affects one in three men and one in four women worldwide. Late-stage detection is associated with significantly lower 5-year survival rates. Although it is well establis... Colorectal cancer (CRC) is a common cancer that affects one in three men and one in four women worldwide. Late-stage detection is associated with significantly lower 5-year survival rates. Although it is well established that CRC mortality rates have decreased in the past several decades, adoption of routine screening continues to lag behind screening for other common cancers such as cervical and breast cancer. The decrease in overall rates has been attributed, in part, to improved primary and secondary prevention efforts, including smoking prevention and cessation programs, nutritional counseling, and the use of evidence-based screening protocols, as well as access to better treatment. Despite the increased screening rates, it is estimated that at least one-third of eligible people do not receive appropriate screening. The objective of this review is to describe the current epidemiology of CRC and to demonstrate effective primary and secondary prevention strategies for the primary care provider. 展开更多
关键词 Colorectal cancer ADENOCARCINOMA modifiable risk factors primary prevention secondary prevention primary care
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Vorapaxar in patients with diabetes mellitus and previous myocardial infarction: Findings from the thrombin receptor antagonist in secondary prevention of atherothrombotic ischemic events-TIMI 50 trial 被引量:3
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《South China Journal of Cardiology》 CAS 2015年第1期63-63,共1页
Background Vorapaxar reduces cardiovascular death, myocardial infarction (MI), or stroke in patients with previous MI while increasing bleeding. Patients with diabetes mellitus (DM) are at high risk of recurrent t... Background Vorapaxar reduces cardiovascular death, myocardial infarction (MI), or stroke in patients with previous MI while increasing bleeding. Patients with diabetes mellitus (DM) are at high risk of recurrent thrombotic events despite standard therapy and may derive particular benefit from antithrombotic therapies. The Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events-TIMI 50 trial was a randomized, double-blind, placebo-controlled trial of vorapaxar in patients with stable atherosclerosis. 展开更多
关键词 TIMI DM Findings from the thrombin receptor antagonist in secondary prevention of atherothrombotic ischemic events-TIMI 50 trial Vorapaxar in patients with diabetes mellitus and previous myocardial infarction
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Management of cerebral amyloid angiopathy and atrial fibrillation:We are still far from precision medicine
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作者 Liuba Fusco Zefferino Palamà +5 位作者 Antonio Scarà Alessio Borrelli Antonio Gianluca Robles Gabriele De Masi DeLuca Silvio Romano Luigi Sciarra 《World Journal of Cardiology》 2024年第5期231-239,共9页
The use of anticoagulation therapy could prove to be controversial when trying to balance ischemic stroke and intracranial bleeding risks in patients with concurrent cerebral amyloid angiopathy(CAA)and atrial fibrilla... The use of anticoagulation therapy could prove to be controversial when trying to balance ischemic stroke and intracranial bleeding risks in patients with concurrent cerebral amyloid angiopathy(CAA)and atrial fibrillation(AF).In fact,CAA is an age-related cerebral vasculopathy that predisposes patients to intracerebral hemorrhage.Nevertheless,many AF patients require oral systemic dose-adjusted warfarin,direct oral anticoagulants(such as factor Xa inhibitors)or direct thrombin inhibitors to control often associated with cardioembolic stroke risk.The prevalence of both CAA and AF is expected to rise,due to the aging of the population.This clinical dilemma is becoming increasingly common.In patients with coexisting AF and CAA,the risks/benefits profile of anticoagulant therapy must be assessed for each patient individually due to the lack of a clear-cut consensus with regard to its risks in scientific literature.This review aims to provide an overview of the management of patients with concomitant AF and CAA and proposes the implementation of a risk-based decision-making algorithm. 展开更多
关键词 ANTICOAGULATION Atrial fibrillation Cerebral amyloid angiopathy Intracerebral hemorrhage STROKE Watchman secondary prevention Left atrial appendage closure
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Assessment of post-myocardial infarction lipid levels and management:Results from a tertiary care hospital of Pakistan
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作者 Rubina Rauf Muhammad Ismail Soomro +3 位作者 Muhamman Nauman Khan Mukesh Kumar Najia Aslam Soomro Khawar Abbas Kazmi 《World Journal of Cardiology》 2024年第5期282-292,共11页
BACKGROUND Lipid treatment practices and levels in post-acute myocardial infarction(AMI)patients,which are crucial for secondary prevention.AIM To evaluate the lipid treatment practices and lipid levels in post-myocar... BACKGROUND Lipid treatment practices and levels in post-acute myocardial infarction(AMI)patients,which are crucial for secondary prevention.AIM To evaluate the lipid treatment practices and lipid levels in post-myocardial infarction(MI)patients at a tertiary care hospital in Pakistan.METHODS In this cross-sectional study,we analyzed patients who had experienced their first AMI event in the past 3 years.We assessed fasting and non-fasting lipid profiles,reviewed statin therapy prescriptions,and examined patient compliance.The recommended dose was defined as rosuvastatin≥20 mg or atorvastatin≥40 mg,with target total cholesterol levels set at<160 mg/dL and target low-density lipoprotein cholesterol(LDL-C)at<55 mg/dL.RESULTS Among 195 patients,71.3%were male,and the mean age was 57.1±10.2 years.The median duration since AMI was 36(interquartile range:10-48)months and 60% were diagnosed with ST-segment elevation MI.Only 13.8% of patients were advised to undergo lipid profile testing after AMI,88.7% of patients were on the recommended statin therapy,and 91.8% of patients were compliant with statin therapy.Only 11.5% had LDL-C within the target range and 71.7% had total cholesterol within the target range.Hospital admission in the past 12 months was reported by 14.4%,and the readmission rate was significantly higher among non-compliant patients(37.5%vs 5.6%).Subsequent AMI event rate was also significantly higher among non-compliant patients(43.8%vs 11.7%).CONCLUSION Our study highlights that while most post-AMI patients received the recommended minimum statin therapy dose,the inadequate practice of lipid assessment may compromise therapy optimization and raise the risk of subsequent events. 展开更多
关键词 Lipid profile DYSLIPIDEMIA Acute myocardial infarction secondary prevention Lipid lowering therapy
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Future clinical prospects of C-peptide testing in the early diagnosis of gestational diabetes
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作者 Charalampos Milionis Ioannis Ilias +2 位作者 Anastasia Lekkou Evangelia Venaki Eftychia Koukkou 《World Journal of Experimental Medicine》 2024年第1期13-21,共9页
Gestational diabetes is typically diagnosed in the late second or third trimester of pregnancy.It is one of the most common metabolic disorders among expectant mothers,with potential serious short-and long-term compli... Gestational diabetes is typically diagnosed in the late second or third trimester of pregnancy.It is one of the most common metabolic disorders among expectant mothers,with potential serious short-and long-term complications for both maternal and offspring health.C-peptide is secreted from pancreatic beta-cells into circulation in equimolar amounts with insulin.It is a useful biomarker to estimate the beta-cell function because it undergoes negligible hepatic clearance and consequently it has a longer half-life compared to insulin.Pregnancy induces increased insulin resistance due to physiological changes in hormonal and metabolic homeostasis.Inadequate compensation by islet beta-cells results in hyperglycemia.The standard oral glucose tolerance test at 24-28 wk of gestation sets the diagnosis.Accumulated evidence from prospective studies indicates a link between early pregnancy C-peptide levels and the risk of subsequent gestational diabetes.Elevated C-peptide levels and surrogate glycemic indices at the beginning of pregnancy could prompt appropriate strategies for secondary prevention. 展开更多
关键词 C-PEPTIDE Gestational diabetes secondary prevention PREGNANCY Clinical laboratory techniques
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Molecular therapy and prevention of hepatocellular carcinoma 被引量:5
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作者 HubertE.Blum 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2003年第1期11-22,共12页
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in some areas of the world with an extremely poor prognosis. The major etiologic risk factors for HCC development include hepatitis B virus (HB... Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in some areas of the world with an extremely poor prognosis. The major etiologic risk factors for HCC development include hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, toxins (alcohol, aflatoxin BI) and various inherited metabolic liver diseases, such as hemochromatosis and alpha-1-antitrypsin deficiency. Central to the molecular pathogenesis of HCC are mutations of various genes and genetic/chromosomal instability that result from chronic liver disease and the associated enhanced liver cell regeneration and mitotic activity. Alterations in the structure or expression of several tumor suppressor genes and oncogenes have been described. In addition, mechanisms leading to genetic instability due to mismatch repair deficiency or chromosomal instability and aneuploidy due to defective chromosomal segregation appear to be involved. The prognosis of HCC patients is generally very poor. Most studies have shown a five-year survival rate of less than 5% in symptomatic patients. HCC has been found to be quite resistant to radio- or chemotherapy. Investigations of the natural history and clinical course of HCC revealed a long-term survival of patients only with small asymptomatic HCC that could be treated surgically or nonsurgically. For patients with advanced symptomatic HCC, novel therapeutic strategies such as gene therapy are urgently needed. Apart from exploring and refining new HCC treatment strategies, the implementation of the existing measures or the development of novel measures to prevent HCC is most important. Primary HCC prevention could have a major impact on the incidence of HCC. Further, secondary prevention of a local recurrence or of new HCC lesions in patients after successful surgical or nonsurgical HCC treatment is of paramount importance and is expected to significantly improve disease-free and overall survival rates of patients. Based on rapid scientific advances, molecular diagnosis, gene therapy and molecular prevention are becoming increasingly part of our patient management and will eventually complement or in part replace the existing diagnostic, therapeutic and preventive strategies. Overall, this should result in a reduced HCC incidence and an improved clinical outcome for patients with HCC, one of the most devastating malignancies worldwide. 展开更多
关键词 chronic liver diseases EPIDEMIOLOGY gene therapy HEPATOCARCINOGENESIS immune therapy natural course oncolytic viruses primary prevention secondary prevention
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Setting Research Priorities for Cervical Cancer Prevalence, Prevention and Treatment in WHO Africa Region
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作者 Leopold Ouedraogo Triphonie Nkurunziza +13 位作者 Assumpta Muriithi Chilanga Asmani Hayfa Elamin Souleymane Zan Bigirimana Françoise Mihretu Belete Gbenou Dina Dadji Kwami Kim Caron Rahn Ali Moazzam Tolu Lemi Blami Dao Issiaka Sombie Okech Mollent 《Advances in Reproductive Sciences》 2021年第1期41-49,共9页
<strong>Background:</strong> Cervical cancer has been ranked among the leading causes of deaths among women in Africa. Despite this, priority setting mechanisms used in planning for programmes and interven... <strong>Background:</strong> Cervical cancer has been ranked among the leading causes of deaths among women in Africa. Despite this, priority setting mechanisms used in planning for programmes and interventions that respond to sexual and reproductive health and rights services particularly in cervical cancer prevalence, prevention and treatment have not adequately taken into account research based evidence to respond appropriately. <strong>Methods:</strong> We adapted the Child Health and Nutrition Research Initiative method. A wide range of stakeholders identified potential research areas in an online survey. A technical working group comprising of 67 participants reviewed the questions for modification and removal of out scope questions. Finally, scoring and ranking was done to provide the top ten priorities questions. <strong>Results:</strong> “Cost-benefit analysis of systematic human papillomavirus vaccination compared to the current cost of cervical cancer in public health care systems” scored 27. This was followed by two research questions ranked at 24 points: “assessment of women’s and girls’ knowledge on the importance of early cervical cancer screening,” and “human papilloma virus vaccination and contributions of new technologies to the supply and storage of vaccines, including human papillomavirus vaccine”. <strong>Conclusion:</strong> The study identified 10 priority research questions that can guide the agenda for cervical cancer prevalence, prevention and treatment in the WHO Africa region. The identified priorities will be of use to policy makers, researchers and programmers and other stakeholders who can invest in areas that greatly affect cervical cancer prevalence, prevention and treatment. 展开更多
关键词 Cervical Cancer SCREENING secondary prevention HPV Vaccination Sexual and Reproductive Health
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Promoting Health Behavior Change in Canada: A Quality Improvement Project Integrating Prevention and Wellness in Frontline Care
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作者 Kiran Rabheru David Conn +5 位作者 Daria Parsons Ariane S. Massie Julie Mitchell Michael Vallis Claire Checkland Keri-Leigh Cassidy 《Open Journal of Psychiatry》 2021年第3期125-137,共13页
<strong>Background:</strong> The critical need for Health Behaviour Change (HBC) for preventative care has been highlighted by the COVID-19 pandemic. This quality improvement project assessed the effective... <strong>Background:</strong> The critical need for Health Behaviour Change (HBC) for preventative care has been highlighted by the COVID-19 pandemic. This quality improvement project assessed the effectiveness and acceptability of Fountain of Health HBC tools as a minimal intervention for primary and secondary prevention among Canadian clinicians and their patients. <strong>Methods:</strong> Clinicians received HBC education and tools (paper tools and app-based) to assist their patients in setting a S.M.A.R.T (Specific, Measurable, Action-oriented, Realistic, Time-limited) goal at baseline and assessed four weeks later. Primary outcome measures were: 1) patient self-report of success at goal attainment;2) patient self-reported evaluation of change in well-being and health attitudes;and 3) clinician experience and engagement. <strong>Results:</strong> A total of 2184 clinicians received HBC education. Of these, 759 clinicians registered to participate in the project. 961 patients set S.M.A.R.T. HBC goals using either the paper tools (PT) or the app format. Patient data revealed nearly all patients (89% of PT users and 90% of app users) at least partially succeeded in attaining their goal at a four-week follow-up. Most patients (85% of PT and 80% of app users) also reported improvement in their well-being. A significant difference in health beliefs and attitudes was found in both PT (p < 0.001) and app users (p = 0.003). <strong>Conclusions:</strong> HBC is challenging. Educating and providing clinicians with HBC tools as a minimal intervention was found to be a successful health prevention strategy to improve patient well-being and health attitudes, and achieve S.M.A.R.T. goals. Results show HBC tools, education, and support for clinicians are both acceptable and effective for HBC in frontline care. These findings are relevant and timely given greater reliance on virtual care in the wake of the COVID-19 pandemic. Further research with rigorous methodology is needed to implement programs to achieve sustainable HBC to promote health on a large scale. 展开更多
关键词 Behaviour Sciences Mental Health Medical Education Primary and secondary prevention Health Behavior Change Risk Reduction Tools for Health and Wellness Positive Psychiatry
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New Screening Approach for Ocular Diseases
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作者 Rogil José De Almeida Torres Andréa Luchini +2 位作者 Rogério João De Almeida Torres Mebaliah Luchini De Almeida Torres Lucas Antônio De Almeida Torres 《Health》 2023年第10期1059-1069,共11页
Objective: Present a new screening approach for ocular diseases. Method: Transversal, retrospective, single center study that analyzed medical records of patients from a social project on the prevention of blindness a... Objective: Present a new screening approach for ocular diseases. Method: Transversal, retrospective, single center study that analyzed medical records of patients from a social project on the prevention of blindness and amblyopia, which aimed at: 1) Detect the main ocular disorders such as amblyopia, primary angle-closure suspect (PACS);glaucoma suspect (GS);predisposing retinal detachment lesions (PRDL);age-related macular degeneration (AMD), and diabetic retinopathy (DR);2) Perform cataract diagnosis;3) Provide guidance and treatment for allergic conjunctivitis. 4) Prescribe glasses for children until 14 years of age. Participants were examined by a single specialist, holder of a post-doctoral degree in ophthalmology, with 36 years of experience and a sub-specialization in retina and vitreous. All data were analyzed in 2022. Results: The examiner diagnosed 42 cases of PACS, 21 of GS, 8 of PRDL, 14 of AMD, 3 of DR, 40 of cataract and 31 cases of allergic conjunctivitis. Thirty-three participants younger than 14 were prescribed glasses. Other pathologies included retinal detachment, papilledema, corneal ulcer, suspected conjunctival squamous cell carcinoma, retinal vasculitis, strabismus, uveitis, bilateral papilla paleness and lacrimal duct obstruction. Out of the 297 cases examined, 168 participants presented some type of alteration that could compromise their vision. Conclusion: The examiner’s experience and knowledge were decisive factors for the quick diagnosis, advice, screening and/or treatment of several ocular diseases. The social project results reveal that the primary care and/or the screening performed by a specialist are likely to reduce blindness cases. 展开更多
关键词 SCREENING Ocular Diseases Primary prevention secondary prevention Health Care Quality ACCESS EVALUATION AMAUROSIS
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