Risk of cardiovascular death in patients with hepatocellular carcinoma based on the Fine-Gray model

BACKGROUND Hepatocellular carcinoma(HCC)is one of the most common types of cancers worldwide,ranking fifth among men and seventh among women,resulting in more than 7 million deaths annually.With the development of medical tech-nology,the 5-year survival rate of HCC patients can be increased to 70%.How-ever,HCC patients are often at increased risk of cardiovascular disease(CVD)death due to exposure to potentially cardiotoxic treatments compared with non-HCC patients.Moreover,CVD and cancer have become major disease burdens worldwide.Thus,further research is needed to lessen the risk of CVD death in HCC patient survivors.METHODS This study was conducted on the basis of the Surveillance,Epidemiology,and End Results database and included HCC patients with a diagnosis period from 2010 to 2015.The independent risk factors were identified using the Fine-Gray model.A nomograph was constructed to predict the CVM in HCC patients.The nomograph performance was measured using Harrell’s concordance index(C-index),calibration curve,receiver operating characteristic(ROC)curve,and area under the ROC curve(AUC)value.Moreover,the net benefit was estimated via decision curve analysis(DCA).RESULTS The study included 21545 HCC patients,of whom 619 died of CVD.Age(<60)[1.981(1.573-2.496),P<0.001],marital status(married)[unmarried:1.370(1.076-1.745),P=0.011],alpha fetoprotein(normal)[0.778(0.640-0.946),P=0.012],tumor size(≤2 cm)[(2,5]cm:1.420(1.060-1.903),P=0.019;>5 cm:2.090(1.543-2.830),P<0.001],surgery(no)[0.376(0.297-0.476),P<0.001],and chemotherapy(none/unknown)[0.578(0.472-0.709),P<0.001]were independent risk factors for CVD death in HCC patients.The discrimination and calibration of the nomograph were better.The C-index values for the training and validation sets were 0.736 and 0.665,respectively.The AUC values of the ROC curves at 2,4,and 6 years were 0.702,0.725,0.740 in the training set and 0.697,0.710,0.744 in the validation set,respectively.The calibration curves showed that the predicted probab-ilities of the CVM prediction model in the training set vs the validation set were largely consistent with the actual probabilities.DCA demonstrated that the prediction model has a high net benefit.CONCLUSION Risk factors for CVD death in HCC patients were investigated for the first time.The nomograph served as an important reference tool for relevant clinical management decisions.

The Impact of Finerenone on Changes in Pulse Wave Velocity, Arterial Pressure and Heart Related Deaths in Hemodialysis Patients—Study Perspective

The description in the abstract lacks clear logic and a comprehensive summary of this study, so please revise and improve it according to the design theme and main content of this study, and describe it in the order of (research background), purpose/aim, method, results and conclusions. The introduction of the abstract and preface is rather lengthy, but the summary of the whole study and the presentation of the research background are not perfect (mainly because the logic of the context is not clear and orderly), so it will appear a bit messy. Hope to be able to modify (this has been mentioned in the preliminary opinion). Cardiovascular events (CVE) pose a significant threat to individuals with end-stage renal disease (ESRD), yet these patients are often excluded from cardiovascular clinical trials, leaving prognostic factors associated with CVE in ESRD patients largely unexplored. Recent human studies have demonstrated elevated circulating aldosterone levels in ESRD patients, correlating with left ventricular hypertrophy. Additionally, animal models have shown improvements in uremic cardiomyopathy with spironolactone therapy, prompting interest in assessing the efficacy of spironolactone or eplerenone in reducing mortality and improving cardiovascular function in dialysis patients. Clinicians have historically been cautious about prescribing mineralocorticoid receptor antagonists (MRAs) to congestive heart failure patients with chronic kidney disease (CKD) due to hyperkalemia risk. However, the emergence of finerenone, a novel MR antagonist with a favorable safety profile and lower hyperkalemia risk, has renewed interest in MRA therapy in this population. Heart disease, including coronary artery disease, hypertension, and left ventricular failure, is alarmingly prevalent in dialysis patients, contributing significantly to elevated mortality rates compared to the general population. Arterial stiffness, as indicated by pulse wave velocity (PWV), progressively worsens with advancing CKD stages, peaking in severity among ESRD patients undergoing dialysis. High PWV serves as a crucial risk stratification tool in ESRD. Elevated NT-proBNP and BNP levels in ESRD patients are well-documented, with significant associations observed between baseline peptide concentrations and cardiovascular morbidity and mortality. By incorporating finerenone into our study, we aim to investigate its potential benefits in reducing arterial stiffness, lowering blood pressure, and ultimately mitigating heart-related mortality among hemodialysis patients. This study holds substantial implications for hypertension and cardiovascular risk management in this vulnerable patient population. Eligible participants must have been on chronic hemodialysis for at least three months, with ACE inhibitors or angiotensin receptor blockers included in their therapy at maximum tolerable doses. Serum potassium levels 5.7 mmol/L, left ventricular ejection fraction 50%, and PWV higher than age-estimated values are also prerequisites for study entry. Randomized allocation will be conducted using a permuted block design, stratified by center, with allocation communicated via signed study forms during initial examinations. All steps of this research will be conducted in accordance with the principles of the Helsinki Declaration.

Relationship between pulmonary hypertension and cardiovascular events, all-cause death in maintenance hemodialysis patients

Objective: To determine the impact of pulmonary hypertension (PH) on maintenance hemodialysis (MHD) patients' cardiovascular events and all-cause mortality. Methods: We included 90 MHD patients, divided into group with PH and group without PH. All patients had been followed up for 4 years, and the primary endpoints were all cause mortality and cardiovascular events. We compared the clinical data and the endpoint events between the two groups. Results: We found PH in 37 patients (41.11%). The incidence of previous cardiovascular disease in group with PH was significantly higher than that in group without PH (χ2=2.034, P < 0.05). The left atrial diameter in group with PH was significantly higher than that in group without PH (t = 7.265, P < 0.01). Logistic regression analysis revealed that previous cardiovascular disease and left atrial diameter were the independent determinants of PH. The rate of new cardiovascular events in group with PH(59.5%) was significantly higher than that in group without PH(34%) (χ2=9.203, P < 0.05). The associated variables of cardiovascular events were:systolic pulmonary arterial pressure, age, history cardiovascular disease, hs-CRP, ejection fraction, left ventricular diastolic dysfunction. In a multivariate model, the PH maintained its independent association. The mortality rate in group with PH (48.6%) was significantly higher than that in group without PH (26.4%) (χ2=5.049, P <0.05). In the Cox survival analysis, we found an association between mortality and systolic pulmonary arterial pressure, age, previous cardiovascular disease, Alb, ejection fraction. In a multivariate model the PH remains as independent predictor of mortality. Conclusion:Pulmonary hypertension is common in HD patients and a valuable predictor of mortality and cardiovascular events.

Status of cardiovascular disease in China

Cardiovascular disease(CVD)has become the leading cause of death and disability in the global population and imposes a significant economic burden on global health systems.Prevalent cases of total CVD nearly doubled from 271 million in 1990 to 523 million in 2019,and the number of CVD deaths steadily increased from 12.1 million in 1990,reaching 18.6 million in 2019.The global trends for disabilityadjusted life years and years of life lost also increased significantly,and years lived with disability doubled from 17.7 million to 34.4 million over that period.

COVID-19 and Cardiovascular Disease—Two Pandemics, One Success

Background: COVID-19 has had a major impact on all facets of life in the United States. Its devastating effects have resulted in the mobilization of major resources, both at the national, state, and individual levels. This mobilization has resulted in vaccination, personal preventive measures, and new therapies to combat this illness. As a result, the rates of new infections, hospitalizations, and deaths have greatly diminished, minimizing the associated morbidity and mortality. Purpose: What has not been appreciated is that a more serious epidemic has continued unabated in the United States and the Western world. This article emphasizes the importance of a national effort to eradicate cardiovascular disease. Methods: Cardiovascular disease has caused more deaths than COVID-19 in almost all months since the COVID-19 epidemic was first recognized in December 2020. In fact, cardiovascular disease has caused more deaths than either all cancers combined or infections for the last two decades. The tragedy of this truth is that effective therapy is currently available for preventing and reversing cardiovascular disease at a very low cost. What is required is a concerted effort and commitment by all legislative and medical organizations to allocate the resources to abolish asymptomatic cardiovascular disease. Results: Recognition and mobilization of resources to combat this epidemic are much overdue with the resultant savings of lives and billions of dollars. It is past time for the medical establishment to support the national identification of asymptomatic cardiovascular disease and initiate treatment before patients become symptomatic with this deadly disease. Conclusion: The national experience with COVID-19 has demonstrated what can be accomplished when a national concerted effort is made to address a devastating medical epidemic. This commitment is not only feasible for cardiovascular disease, but is also necessary for the benefit of all people in the world.

Sudden death in the southern region of Saudi Arabia:A retrospective study

BACKGROUND Sudden death is unanticipated,non-violent death taking place within the first 24 h after the onset of symptoms.It is a major public health problem worldwide.Moreover,the effects of living at moderate altitude on mortality are poorly understood.AIM To retrospectively report the frequency and the main causes of sudden deaths in relation to total deaths at Asir Central Hospital,2255 m above sea level,in the southern region of Saudi Arabia over a period of 4 years from 2013 to 2016.METHODS The medical records of 1821 deaths were examined and showed 353 cases(19.4%)of sudden death.RESULTS The highest incidence of sudden death was among the elderly(51%),whereas,the lowest was among children and adolescents(6.5%).With regard to gender,the incidence of sudden death was higher in males(54.4%)compared to 45.6% in females.In this study,we found that the most common direct causes of sudden death were cardiovascular diseases(29.2%),respiratory disease(22.7%),infectious disease(12.2%),cancer(9.4%)and hematological diseases(6.2%).With respect to seasonal variation,the highest incidence was during winter(31.32%)followed by summer(25.8%).CONCLUSION The results of this study will help emergency physicians and health care providers to exercise due care to reduce the incidence of sudden death and raise public awareness about the impact of sudden death.

铁稳态、铁死亡与心血管疾病

心血管疾病是是当今人类病死的主要原因,哺乳动物心脏和血管细胞维持心血管系统的结构和稳态,因此细胞死亡对于心脏和血管稳态的发展至关重要。铁死亡是一种基于铁驱动的脂质过氧化机制的调节性细胞死亡,广泛参与了应激诱导的心脏和血管细胞的细胞死亡。在铁的催化下,细胞内脂质氢过氧化物代谢的紊乱导致谷胱甘肽过氧化物酶4失活,从而破坏氧化还原动态平衡,最终触发细胞死亡。氨基酸、铁、脂及其相关途径的代谢被认为是铁死亡的特异性生物标志物。铁死亡在动脉粥样硬化、主动脉夹层、动脉瘤、缺血再灌注、脑梗死、心力衰竭、心肌缺血再灌注损伤、心肌病、肺动脉高压、钙化性血管和瓣膜疾病等心血管疾病的病理、生理过程中起重要作用。

血液透析患者血清β_(2)微球蛋白水平与死亡率的相关分析

目的探讨维持性血液透析(MHD)患者血清β_(2)微球蛋白(β_(2)-MG)与全因死亡及心脑血管死亡的相关性。方法纳入120例进行MHD的患者,收集患者透析前临床资料和生化检验结果,根据血清β_(2)-MG水平三分位数将患者分为低β_(2)-MG水平组(血清β_(2)-MG<30.0 mg/L,n=40),中等β_(2)-MG水平组(30.0 mg/L<β_(2)-MG<38.8 mg/L,n=40),高β_(2)-MG水平组(血清β_(2)-MG≥38.8 mg/L,n=40)。比较3组患者的基线资料,采用Kaplan-Meier法进行生存分析,Cox风险回归模型用于分析死亡率的影响因素。结果3组间体重、BMI、糖尿病史、残余尿量、透析龄、血磷、eGFR比较,差异均有统计学意义(P<0.05)。多元逐步线性回归分析显示,MHD患者血清多因素β_(2)-MG与残余尿量呈独立负相关(r=-3.475,P<0.05)。Cox回归分析结果显示,在校正年龄、性别、血清白蛋白、肌酐、eGFR、体重和超滤量等因素后,高水平β_(2)-MG是MHD患者发生死亡(HR=1.039,95%CI:1.003~1.076,P<0.05)与心脑血管疾病死亡的独立危险因素(HR=1.058,95%CI:1.015~1.102,P<0.05)。Kaplan-Meier生存分析显示,与β_(2)-MG中水平组比较,β_(2)-MG高水平组患者生存率明显降低(HR=0.330,95%CI:0.126~0.861,P<0.05)。结论血清β_(2)-MG是MHD患者死亡的独立预测因素,提示控制血清β_(2)-MG水平可能改善MHD患者的预后。

血清铁蛋白和转铁蛋白饱和度与非贫血人群死亡风险的相关性分析

目的探讨非贫血人群血清铁蛋白(serum ferritin,SF)和转铁蛋白饱和度(transferrin saturation,TSAT)与全因死亡和心血管死亡的相关性。方法选取1999—2000年和2001—2002年国家健康和营养检查调查研究(national health and nutrition examination survey,NHANES)的非贫血人群7167例,于2006年12月31日前对死亡终点进行随访,采用阈值效应分析和多因素cox回归模型分析SF和TAST与全因死亡和心血管死亡风险的相关性。结果7167例患者中男3533例、女3634例,年龄18~85岁,平均(46.1±20.0)岁,BMI平均(27.9±6.2)kg/m2。平均随访(5.1±1.2)年,共随访11623人/年,其中全因死亡452例、心血管死亡117例。SF与全因死亡和心血管死亡呈非线性相关,SF的截断值为200 ng/ml;当SF<200 ng/ml时,SF每增加100 ng/ml,全因死亡风险增加25%(HR=1.252,95%CI:1.068~1.486,P=0.008),心血管死亡风险增加37%(HR=1.370,95%CI:1.076~1.900,P=0.036)。TSAT与全因死亡率呈L型非线性相关,截断值为30%,当TSAT<30%时,TSAT每增加10%,全因死亡风险降低21%(HR=0.791,95%CI:0.681~0.914,P=0.001);TSAT与心血管死亡风险呈线性负相关(HR=0.803,95%CI:0.660~0.963,P=0.014)。结论非贫血人群的SF与全因死亡和心血管死亡呈非线性相关、截断值为200 ng/ml,TSAT与全因死亡呈L型相关、截断值为30%,且TSAT与心血管死亡呈负相关。建议将非贫血人群的SF与TSAT控制在合适范围,以降低死亡风险,并改善预后。

靶向铁死亡治疗心血管疾病的研究进展

随着我国经济社会的发展、国人饮食结构发生变化以及老龄化程度不断加深,我国心血管疾病的发病率和病死率仍在升高,给国民的生命健康造成巨大威胁,同时也给社会造成较大的经济负担。因此,近年来针对心血管疾病发病机制的研究亦是日新月异。铁死亡是近年来新定义的一种程序性细胞死亡方式,本团队前期研究发现铁死亡是调控主动脉夹层发生发展的病理新机制,且靶向铁死亡能显著抑制小鼠主动脉夹层的进展及夹层破裂死亡。此外,铁死亡也被证实参与心肌缺血再灌注损伤、动脉粥样硬化、药物诱发的心力衰竭、败血症诱发的心肌病和糖尿病心肌病等多种心血管疾病的病理进程,提示靶向铁死亡有望成为治疗心血管疾病的新方法。因此,本文将对铁死亡在心血管疾病中的研究进展进行概述,并讨论其潜在的临床转化价值。

不同心力衰竭亚型老年患者血清尿酸与预后的关系

背景血清尿酸(serum uric acid,sUA)与炎症和微血管功能障碍有关,对不同的心力衰竭分型可能有不同的影响。目的研究sUA水平与不同左心室射血分数心力衰竭亚型老年患者预后的关系。方法纳入2014年9月—2017年7月解放军总医院第一医学中心和苏州大学附属第一医院心血管内科住院的老年慢性心力衰竭患者,所有患者入院24 h内接受血清尿酸的检测。随访至2017年9月,以心血管死亡事件为终点事件,以多因素Cox回归模型评估sUA水平对预后的影响。结果1355例患者中位随访时间18个月,总体上心血管死亡事件发生率为6.8%(92例),射血分数减低的心力衰竭(heart failure with reduced ejection fraction,HFrEF)、射血分数中间值的心力衰竭(heart failure with mid-range ejection fraction,HFmrEF)和射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFpEF)三组心血管死亡事件发生率分别为13.9%(47例)、6.1%(24例)和3.4%(21例)。与低sUA组相比,高sUA组患者心血管死亡事件的发生风险更高(HR=2.141,95%CI:1.199~3.824,P=0.01)。亚组分析中,在HFrEF患者中,与低sUA组相比,高sUA组不良事件发生风险也升高(HR=4.151,95%CI:1.866~9.234,P<0.001);在HFmrEF患者中,高sUA组心血管死亡事件发生风险相较低sUA组同样升高(HR=4.724,95%CI:1.664~13.414,P=0.004)。结论sUA水平的升高与老年HFrEF和HFmrEF患者心血管不良预后相关。

基于Relief-F算法的心血管介入患者术后死亡风险预测

针对心血管介入患者全周期病理数据普遍存在缺失、不连续、非结构化等问题,建立了心血管介入专病数据库,并采用基于Relief-F算法的预测方法,对心血管介入患者术后死亡风险进行预测。首先参照HL7、CDISC等国际心血管疾病统一标准对各数据源进行标准化处理,建立研究数据集,并对数据进行清洗和预处理;其次采用Relief-F算法对特征进行选择,最终保留30个特征变量;再次选择逻辑回归、支持向量机、随机森林等3种机器学习方法进行建模分析,并采用10折交叉验证方法对分类器进行训练;最后引入准确率等模型评价指标来评估各算法在数据集上的分类预测效果。实验结果表明:随机森林的分类效果在该研究数据集上的表现最佳,准确率达到81.97%,精确率为86.90%,召回率为82.14%,F1值为0.8441。该研究提出的方法能够客观反映患者术后死亡风险,为心血管介入患者术后死亡风险预测提供了一种有效的解决方案。

临床衰弱指数对急性心肌梗死患者在院心脏康复后远期预后的预测价值

目的·探讨临床衰弱指数(Clinical Frailty Scale,CFS)对急性心肌梗死(acute myocardial infarction,AMI)患者在院心脏康复(cardiac rehabilitation,CR)后远期预后的预测价值。方法·序贯纳入2020年5月至2022年5月在上海交通大学医学院附属第六人民医院心脏中心接受诊治的501例AMI患者。采集患者基本临床信息,制定分级在院CR方案。根据患者出院前的CFS等级将患者分为3组,即正常(norm)组、脆弱(vulnerable)组和衰弱(frail)组,比较3组患者1年主要心血管事件率,包括全因死亡率及心力衰竭(心衰)再住院率。采用Logistic回归分析研究影响主要心血管事件率的危险因素,通过受试者操作特征(receiver operator characteristic,ROC)曲线分析各危险因素对主要心血管事件率的预测价值,建立最佳风险预测模型。结果·AMI患者在院CR后衰弱程度与高龄、B型利钠肽前体峰值(peak pro-B-type natriuretic peptide,peak proBNP)呈正比,与性别差异呈反比(P<0.05)。随患者衰弱程度增加,两种事件率均增高;其中全因死亡率(分别为2.6%、5.6%、15.2%)的组间差异有统计学意义(P=0.002),心衰再住院率(分别为19.6%、22.2%、24.2%)的组间差异无统计学意义。两两比较,frail组全因死亡率显著高于norm组(P=0.004),但vulnerable组与norm组的差异无统计学意义。CFS分级能够敏感预测AMI患者1年后的全因死亡风险(β=1.89,OR=6.61,P=0.001),且叠加CFS分级的风险模型预测效应最佳(AUC=0.845,P=0.000)。结论·接受在院CR的AMI患者出院前进行CFS分级,有助于识别1年内全因死亡风险较高的人群。

M^(6)A modification in cardiovascular disease:With a focus on programmed cell death

N^(6)-methyladenosine(m^(6)A)methylation is one of the most predominant internal RNA modifications in eukaryotes and has become a hot spot in the field of epigenetics in recent years.Cardiovascular diseases(CVDs)are a leading cause of death globally.Emerging evidence demonstrates that RNA modifications,such as the m^(6)A modification,are associated with the development and progression of many diseases,including CVDs.An increasing body of studies has indicated that programmed cell death(PCD)plays a vital role in CVDs.However,the molecular mechanisms underlying m^(6)A modification and PCD in CVDs remain poorly understood.Herein,elaborating on the highly complex connections between the m^(6)A mechanisms and different PCD signaling pathways and clarifying the exact molecular mechanism of m^(6)A modification mediating PCD have significant meaning in developing new strategies for the prevention and therapy of CVDs.There is great potential for clinical application.

Implications of Necroptosis for Cardiovascular Diseases

Necroptosis is a non-apoptotic programmed cell death pathway,which causes necrosislike morphologic changes and triggers inflammation in the surrounding tissues.Accumulating evidence has demonstrated that necroptosis is involved in a number of pathological processes that lead to cardiovascular diseases.However,the exact molecular pathways linking them remain unknown.Herein,this review summarizes the necroptosis-related pathways involved in the development of various cardiovascular diseases,including atherosclerosis,cardiac ischemia-reperfusion injury,cardiac hypertrophy,dilated cardiomyopathy and myocardial infarction,and may shed light on the diagnosis and treatment of these diseases.

The Use of Lipoprotein-Associated Phospholipase A2 in a Chinese Population to Predict Cardiovascular Events

Objective To explore associations between lipoprotein-associated phospholipase A2(Lp-PLA2)and the risk of cardiovascular events in a Chinese population,with a long-term follow-up.Methods A random sample of 2,031 participants(73.6%males,mean age=60.4 years)was derived from the Asymptomatic Polyvascular Abnormalities Community study(APAC)from 2010 to 2011.Serum Lp-PLA2 levels were determined by enzyme-linked immunosorbent assay(ELISA).The composite endpoint was a combination of first-ever stroke,myocardial infarction(MI)or all-cause death.Lp-PLA2 associations with outcomes were assessed using Cox models.Results The median Lp-PLA2 level was 141.0 ng/m L.Over a median follow-up of 9.1 years,we identified 389 events(19.2%),including 137 stroke incidents,43 MIs,and 244 all-cause deaths.Using multivariate Cox regression,when compared with the lowest Lp-PLA2 quartile,the hazard ratios with95%confidence intervals for developing composite endpoints,stroke,major adverse cardiovascular events,and all-cause death were 1.77(1.24–2.54),1.92(1.03–3.60),1.69(1.003–2.84),and 1.94(1.18–3.18)in the highest quartile,respectively.Composite endpoints in 145(28.6%)patients occurred in the highest quartile where Lp-PLA2(159.0 ng/m L)was much lower than the American Association of Clinical Endocrinologists recommended cut-off point,200 ng/m L.Conclusion Higher Lp-PLA2 levels were associated with an increased risk of cardiovascular event/death in a middle-aged Chinese population.The Lp-PLA2 cut-off point may be lower in the Chinese population when predicting cardiovascular events.

Sudden cardiac death in patients with rheumatoid arthritis

An increased cardiovascular morbidity and mortality, including the risk of sudden cardiac death(SCD), has been shown in patients with rheumatoid arthritis(RA). Abnormalities in autonomic markers such as heart rate variability and ventricular repolarization parameters, such as QTc interval and QT dispersion, have been associated with sudden death in patients with RA. The interplay between these parameters and inflammation that is known to exist with RA is of growing interest. In this article, we review the prevalence and predictors of SCD in patients with RA and describe the potential underlying mechanisms, which may contribute to this. We also review the impact of biologic agents on arrhythmic risk as well as cardiovascular morbidity and mortality.

An overview of end-of-life issues in a cardiology department. Is the mode of death worse in the cardiac intensive care unit?

Introduction Cardiovascular (CV) diseases are the most common causes of death and causes frequent hospital admissions.[1] The increase in life expectancy and the appearance of new treatments,[2] is changing in the clinical profile of CV disease, with a rise in chronic processes and concomitant comorbidities.[ 3] These changes are probably reflected in the current profile of patients admitted to cardiology departments, and in their causes of mortality.

Dynamic Analysis of Morbidity and Mortality of Cardiovascular Diseass in Countryside

This paper reports the surveillance results of the morbidity ofacute accident due to coronacy heart disease and struke, and the control effect of them in a natural population of 378,538 peasants in Haimen county from 1983 to 1989,according to the WHO monica project. The results show that annual average morbidity of acute myocardial infarction, sndden death due to coronary heart disease and stroke in Haimen serveilance population is 2.51/100000,6.14/100000 and 74.47/100000 respectively. The morbidity of cardiovascular diseases in male was higher than that in female, and the mcrbidity in the middle-aged and eldwes was higher than that in younger people.The morbidity level in male and feniale was lower, compared with the population in Zhendin county,Hobei province in north China. These findings nught be attributable to the lower risk factors of cardiovascular disease in Haimen county. The authors suggest that the key of cardiovascular disease control in Haimen is to prevent stroke.

Changing trends of cardiovascular risk factors among Indians:a review of emerging risks

The global burden of disease due to cardiovascular diseases(CVDs) is escalating,and the changing trends of CVD risk factors are identified among Indians experiencing rapid health transition.Contributory causes include:growing population with demographic shifts and altered age profile,socio-economic factors,lifestyle changes due to urbanization.Indians are also having genetic predisposition to cardiovascular diseases and adult are susceptible to vascular disease linking possible gene-environment interactions influencing ethnic diversity.Altered diets with more of junk foods along with diminished physical activity are additive factors contributing to the acceleration of CVD epidemics,along with all form of tobacco use.The pace of health transition,however,varies across geographical regions from urban to rural population with consequent variations in the relative burdens of the dominant CVDs.A comprehensive public health response must be looked to plan over all strategies to integrate policies and programs that effectively impact on the multiple determinants of CVDs to provide protection over the life span through primordial,primary and secondary prevention.Populations as well as individuals at risk must be protected through initiatives,enable nutritionbased preventive strategies to protect and promote cardiovascular health.