CVD - Calendar - ProCOR

ProCOR - Home Page: "ProCOR's CVD Calendar compiles events taking place globally that are relevant to the prevention of cardiovascular disease in developing countries.

To submit information about an event to the calendar, email details to info@procor.org."

If you like we, from AMICOR, may intermediate the information to insert your programmed scientific activity into the calendar

How Web 2.0 is changing medicine -- Giustini 333 (7582): 1283 -- BMJ

How Web 2.0 is changing medicine -- Giustini 333 (7582): 1283 -- BMJ: "Few concepts in information technology create more confusion than Web 2.0. The truth is that Web 2.0 is a difficult term to define, even for web experts.1 Nebulous phrases like 'the web as platform' and 'architecture of participation' are often used to describe Web 2.0. Medical librarians suggest that rather than intrinsic benefits of the platform itself, it's the spirit of open sharing and collaboration that is paramount.2 The more we use, share, and exchange information on the web in a continual loop of analysis and refinement, the more open and creative the platform becomes; hence, the more useful it is in our work.

What seems clear is that Web 2.0 brings people together in a more dynamic, interactive space. This new generation of internet services and devices—often referred to as social software—can be leveraged to enrich our web experience, as information is continually requested, consumed, and reinterpreted. The new environment features a highly connected digital network of practitioners (medical or otherwise), where knowledge exchange is not limited or controlled by private interests. For me, the promise of open access in Web 2.0—freed of publishing barriers and multinational interests—is especially compelling.

Web 2.0 is primarily about the benefits of easy to use and free internet software./.../"

Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus. A Scientific Statement From the American Heart Association and the Ame

Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus. A Scientific Statement From the American Heart Association and the American Diabetes Association -- Buse et al., 10.1161/CIRCULATIONAHA.106.179294 -- Circulation: "bstract--The American Heart Association (AHA) and the American Diabetes Association (ADA) have each published guidelines for cardiovascular disease prevention: The ADA has issued separate recommendations for each of the cardiovascular risk factors in patients with diabetes, and the AHA has shaped primary and secondary guidelines that extend to patients with diabetes. This statement will attempt to harmonize the recommendations of both organizations where possible but will recognize areas in which AHA and ADA recommendations differ."

Triglycerides and the Risk of Coronary Heart Disease. 10 158 Incident Cases Among 262 525 Participants in 29 Western Prospective Studies -- Sarwar et

Triglycerides and the Risk of Coronary Heart Disease. 10 158 Incident Cases Among 262 525 Participants in 29 Western Prospective Studies -- Sarwar et al., 10.1161/CIRCULATIONAHA.106.637793 -- Circulation: "

Background--Many epidemiological studies have reported on associations between serum triglyceride concentrations and the risk of coronary heart disease, but this association has not been reliably quantified. In the present study, we report 2 separate nested case-control comparisons in 2 different prospective, population-based cohorts, plus an updated meta-analysis of 27 additional prospective studies in general Western populations.

Methods and Results--Measurements were made in a total of 3582 incident cases of fatal and nonfatal coronary heart disease and 6175 controls selected from among the 44 237 men and women screened in the Reykjavik and the European Prospective Investigation of Cancer (EPIC)-Norfolk studies. Repeat measurements were obtained an average of 4 years apart in 1933 participants in the EPIC-Norfolk Study and an average of 12 years apart in 379 participants in the Reykjavik study. The long-term stability of log-triglyceride values (within-person correlation coefficients of 0.64 [95% CI, 0.60 to 0.68] over 4 years and 0.63 [95% CI, 0.57 to 0.70] over 12 years) was similar to those of blood pressure and total serum cholesterol. After adjustment for baseline values of several established risk factors, the strength of the association was substantially attenuated, and the adjusted odds ratio for coronary heart disease was 1.76 (95% CI, 1.39 to 2.21) in the Reykjavik study and 1.57 (95% CI, 1.10 to 2.24) in the EPIC-Norfolk study in a comparison of individuals in the top third with those in the bottom third of usual log-triglyceride values. Similar overall findings (adjusted odds ratio, 1.72; 95% CI, 1.56 to 1.90) were observed in an updated meta-analysis involving a total of 10 158 incident coronary heart disease cases from 262 525 participants in 29 studies.

Conclusions--Available prospective studies in Western populations consistently indicate moderate and highly significant associations between triglyceride values and coronary heart disease risk. Because these associations depend considerably on levels of established risk factors, however, further studies are needed to help assess the nature of any independent associations.

"

JAMA -- Theme Issue on Poverty and Human Development: Call for Papers on Interventions to Improve Health Among the Poor, December 27, 2006, Flanagin a

JAMA -- Theme Issue on Poverty and Human Development: Call for Papers on Interventions to Improve Health Among the Poor, December 27, 2006, Flanagin and Winker 296 (24): 2970: "

Poverty is an inveterate consequence and cause of ill health.¹ Without financial resources, people cannot pay for basic human needs: food, water, sanitation, housing, and health care services. In addition, poor people often live in poor countries that have limited or deteriorating health care systems and not enough physicians, nurses, and other trained health care workers. Others live in countries with governments that ignore or are too ineffectual to address the health care needs of the poor. Individuals who are poor also lack adequate education to make appropriate decisions about health and prevention of disease and often lack equity and empowerment to attain education, employment, and skills needed to escape the cycle of poverty.

The first of the United Nation's 8 Millennium Development Goals, determined by 189 countries in 2000, is to eradicate extreme poverty and hunger.² This specific goal is to halve the proportion of people living on less than $1 a day (the World Bank's definition of extreme poverty) and those who suffer from hunger by the year 2015.^2-3 This goal cannot be achieved without improving the level of human development—the opportunity to escape poverty through "the choices that come with a sufficient income, an education, good health, and living in a country that is not governed by tyranny"—among the poor.⁴ Such development requires careful evaluation and study of interventions aimed to address the needs of poor individuals within their unique local conditions and socioeconomic context, with sufficient follow-up to determine whether effects are sustainable.

In 1990, more than 28% of the developing world's population (1.2 billion people) lived in extreme poverty.^2-3 By 2002, this proportion had decreased to 19% but still represented more than 1 billion people.^2-3 While substantial declines in extreme poverty have been reported for Eastern and Southern Asia between 1990 and 2002 (from a rate of 33% to 14% in Eastern Asia and from 39% to 31% in Southern Asia), progress in other regions has been mixed or marginal at best. Limited reductions in poverty rates have been seen in Latin America and the Caribbean (from 11% to 9%), but this region now still has more than 47 million people living in poverty. Rates of poverty in Western Asia and Northern Africa have remained almost unchanged since 1990 (approximately 2%) and have increased in the transition economies of Southeastern Europe and many of the countries of the former Soviet Union (from 0.4% in both regions to 1.8% and 2.5%, respectively). In sub-Saharan Africa, which has the largest regional proportion of extreme poverty in the world, the poverty rate declined only marginally from 1990 to 2002 (from 44.6% to 44.0%), and the number of people living in extreme poverty has increased to 303 million.^2-3

Among all regions of the world other measures demonstrate some progress toward achieving the Millennium Development Goals, including declines in the proportion of people with insufficient food and sanitation, increased enrollments in education, increased proportion of women employed, decreases in child mortality rates, increases in measles vaccination rates, and increased proportion of births attended by skilled health care workers.² Each of these successes will contribute to reducing poverty and promoting human development, but some of this progress has been only marginal and much additional work, aid, funding, and research are needed.^2-3,5

Despite huge increases in wealth and prosperity throughout the world in the last several decades, the gap between the wealthy and the poor has widened, with more than 1 billion people still living in extreme poverty.^{3, 5} The United Nations Human Development Index is a composite of 3 dimensions of human development: living a long and healthy life (measured by life expectancy), being educated (measured by adult literacy and enrollment in primary, secondary, and tertiary schools), and having a decent standard of living (measured by purchasing power parity and income).⁴ According to the most recent report, Norway has the highest level of human development, and Niger the lowest.⁴ Individuals in Norway are nearly 50 times wealthier and live almost twice as long as those in Niger and have nearly universal enrollment in education, compared with 21% in Niger. People in the 31 countries with the lowest levels of human development, which represent 9% of the world's population, have an average life expectancy of 46 years, 32 years less than in countries with high levels of human development. This discrepancy illustrates the connection between income and poverty and human development: poverty prevents people from attaining education and employment, achieving and maintaining health, managing illness or disability, and thus, escaping poverty.⁴

Substantial efforts have been directed at reducing poverty, addressing health needs, and ultimately improving human development during the last few decades.^3-5 However, much of the early work begun in the 1960s and 1970s lost support in the mid-1980s following severe economic downturns in many poor countries, the demise of previously state-run approaches to development and the provision of health care, and overall pessimism about the ability to actually reduce poverty and provide health care for all.⁶ In addition, acts of violence, conflicts, and mass disasters have led to social upheaval and long-term displacement, rendering the most basic health care impossible to deliver. Signs of renewed concern and attention began in the late 1990s with recognition by agencies such as the World Bank of the connection between health, poverty reduction, equity, and economic success as well as increased governmental and private aid and funding of research into poverty and health.⁶ However, most aid still falls far short of promises and what is needed.⁵

A vast literature discusses poverty and its associations and effects. A recent search of MEDLINE using the key term "poverty" resulted in more than 22 000 citations, while results in Google Scholar included about 1.3 million articles. However, the MEDLINE citations represent less than 0.002% of the database's 14 million total citations.⁷ Furthermore, despite the large number of articles, the effectiveness of many interventions to improve health in poor countries remains untested and unproven.⁸ In fact, compared with costly interventions and therapies that are mostly available to those who can pay for them, relatively few health interventions targeted to serve the poor are evidence-based.⁸ A systematic review of 286 randomized controlled trials (RCTs) on topics relevant to 35 leading causes of global burden of disease published in 6 leading general medical journals in 1999 found that 124 (43%) of these trials addressed 1 of the 35 leading causes of global burden of disease. Of these, ischemic heart disease, HIV/AIDS, and cerebrovascular disease were the most commonly studied.⁹ One third of these trials studied 1 of 10 top causes of global burden of disease, but 7 (20%) of the leading causes of global burden of disease were not addressed by any trial.

However, progress is being made in efforts to conduct reliable research on the health needs of the poor and to provide evidence-based solutions. Since 1971, 404 reports of RCTs on interventions related to poverty have been included in MEDLINE, with 57% of these published in the last 6 years. Recent studies have examined a range of interventions, some successful and some not, including strategies to reduce inequalities in access to care; microcredit programs; sustainable health care financing alternatives for the poor; strategies to provide access to essential drugs, vaccines, and therapies; strategies to reduce infant and maternal mortality rates; nutritional interventions; behavioral interventions to improve health and adherence with therapeutic regimens and to prevent disease; educational programs; family planning services; interventions to increase access to clean water and sanitation; and primary care treatments for preventable diseases, chronic diseases, and mental health disorders. The success of microcredit was recognized with this year's award of the Nobel Peace Prize to Muhammad Yunus and Grameen Bank for their "efforts to create economic and social development from below."¹⁰

To help disseminate research into interventions that specifically address the needs of the poor, JAMA will publish a theme issue on poverty and human development in October 2007. JAMA is 1 of more than 140 scientific journals participating in plans to simultaneously publish papers on this topic under the coordination of the Council of Science Editors.¹¹ For this theme issue, JAMA will consider manuscripts that report original research of interventions targeted to address poverty, hunger, access to care, and prevention of disease that are based on careful consideration and analysis of local context, evidence, and environments and that are directly targeted to serve the poor. We are also interested in assessments of interventions that are both scalable and sustainable. We are primarily interested in receiving reports of randomized or cluster controlled trials, but we will also consider cohort studies, case-control studies, and other observational studies as well as systematic reviews, meta-analyses, and commentaries. Manuscripts received by May 1, 2007, will have the best chance of consideration for the issue. Please see JAMA's Instructions for Authors for information on preparing and submitting manuscripts.¹²

Trends in Incidence, Lifetime Risk, Severity, and 30-Day Mortality of Stroke Over the Past 50 Years, December 27, 2006, Carandang et

JAMA -- Abstract: Trends in Incidence, Lifetime Risk, Severity, and 30-Day Mortality of Stroke Over the Past 50 Years, December 27, 2006, Carandang et al. 296 (24): 2939:
" Context Prior estimates of long-term trends in the incidence and severity of stroke have varied; trends in lifetime risk have not been reported.

Objective To determine long-term trends in the incidence, lifetime risk, severity, and 30-day mortality of clinical stroke.

Design, Setting, and Participants Prospective evaluation of the community-based Framingham Study original and offspring cohorts. Participants were 9152 men and women free of prevalent stroke and undergoing follow-up for up to 50 years over 3 consecutive periods (1950-1977, 1978-1989, and 1990-2004), with biennial ascertainment of stroke risk factor data and active surveillance for incident clinical stroke and cause-specific mortality.

Main Outcome Measures Incidence (age-adjusted, sex-specific), severity, 30-day mortality, and mortality-adjusted 10-year and lifetime risk of stroke in each of the specified periods.

Results There were 1030 incident clinical strokes (450 [44%] in men, 629 atherothrombotic brain infarctions [61%]) in 9152 persons 55 years or older over 174 917 person-years of follow-up. The age-adjusted incidence of first stroke per 1000 person-years in each of the 3 periods was 7.6, 6.2, and 5.3, respectively, in men (P = .02 for trend) and 6.2, 5.8, and 5.1 in women (P = .01 for trend). The lifetime risk at age 65 years decreased from 19.5% to 14.5% in men (P = .11) and from 18.0% to 16.1% in women (P = .61). Age-adjusted stroke severity did not vary across periods; however, 30-day mortality decreased significantly in men (from 23% to 14%; P = .01) but not significantly in women (from 21% to 20%; P = .32).

Conclusions In this cohort of men and women free of prevalent clinical stroke at initial examination, incidence of stroke has decreased over the past 50 years but the lifetime risk has not declined to the same degree, perhaps due to improved life expectancy. The results of this study suggest that improved control of risk factors has lowered stroke incidence but emphasize the need for continued primary prevention efforts. "

CVD Surveillance System toward prevention

A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Stroke, and Cardiovascular Nursing and the Interdisciplinary Working Groups on Quality of Care and Outcomes Research and Atherosclerotic Peripheral Vascular Disease

David C. Goff, Jr, MD, PhD; Lawrence Brass, MD†; Lynne T. Braun, PhD, RN, CNP; Janet B. Croft, PhD; Judd D. Flesch; Francis G.R. Fowkes, MD, PhD; Yuling Hong, MD, PhD; Virginia Howard, MSPH; Sara Huston, PhD; Stephen F. Jencks, MD, MPH; Russell Luepker, MD, MS; Teri Manolio, MD, PhD; Christopher O’Donnell, MD, MPH; Rose Marie Robertson, MD; Wayne Rosamond, PhD; John Rumsfeld, MD, PhD; Stephen Sidney, MD, MPH; Zhi Jie Zheng, MD, PhD
A strategic goal of the American Heart Association (AHA) is to reduce heart disease, stroke, and risk for both by 25%,1 and Healthy People 2010 (HP2010) established 4 national goals for heart disease and stroke prevention and management.2 However, the current health tracking systems (surveillance) in the United States cannot track progress toward these goals in a comprehensive
and systematic manner. This article provides a brief overview of these goals, prevention and management strategies, and the role of surveillance in monitoring the impact of prevention and treatment efforts. It also provides a review of the existing surveillance system for monitoring progress toward preventing heart disease and stroke in the United States and recommendations
for filling important gaps in that system. This information will serve as an important basis for advocacy to guide the development of a comprehensive surveillance system to support the current HP2010 and AHA goals and the likely future goal of eliminating the epidemic burden of heart disease and stroke.
Recommendations are categorized as overarching (fundamental recommendations that cut across goal areas) or as goal-specific.
They are further classified according to priority (P) (I for high priority and II for intermediate priority. No low-priority recommendations were made), staging (S) (I for early staging [1–2
years], II for intermediate staging [2–4 years], and III for later staging), and cost (C) ($ for items estimated to cost less than $10 million per year, $$ for estimates of $10 to $100 million, and $$$ for estimates exceeding $100 million). In addition, potential barriers to action are addressed.
Overarching Recommendations
1. A National Heart Disease and Stroke Surveillance unit should be established to produce annual reports on key indicators of progress in the prevention and management of heart disease and stroke. P I, S I, C $.
2. Cardiovascular disease (CVD), including cardiac arrests, acute coronary syndromes (heart attack and unstable angina), stroke, chronic heart failure (CHF), and related interventional procedures, should be classified as reportable conditions. P I, S III (although developmental
work should begin earlier), C $$$.
3. Data collection about patients’ encounters with the healthcare system should be revised to include collection of data on lipoprotein cholesterol concentrations, blood sugar, and glycohemoglobin values. P I, S I, C $.
4. Data elements should be standardized across surveys, and unnecessary duplication in data sources should be avoided. P I, S I, C $ (potentially cost saving).
5. The design and conduct of nationally representative surveillance programs should be revised to facilitate oversampling by states, territories, and tribal organizations and to provide meaningful estimates on ethnic subgroups in the populations. Sampling within states, territories, and tribal organizations should be designed to facilitate oversampling by counties. P I, S
II, C $$ to $$$ (depending on extent of oversampling achieved).
6. Mechanisms should be developed to enable linkage between healthcare data systems, including the national surveillance programs (eg, National Ambulatory Medical Care Survey [NAMCS], National Hospital Discharge Survey [NHDS], and National Death Index), and
electronic health records. P I, S II, C $$$ (startup) and $$ (maintenance).
7. Studies are needed to establish the validity of multiple measures collected by self-report and provider report in national databases. P II, S II, C $$.

More mystery deaths than thought

BBC NEWS | Health | More mystery deaths than thought: "he rate of sudden unexplained deaths in England is around eight times higher than previously thought, warn experts.

Around 500 people may die every year from sudden arrhythmic death syndrome, a study published in Heart shows.

SADS is linked to a genetic heart defect and family members should be screened to prevent more deaths, the researchers said.

The study also found that only one-third of cases had been correctly identified by post-mortem.

The researchers identified 56 cases of SADS from 115 coroners' reports of unascertained causes of death."

'Fat scan' shows up health risk

BBC NEWS Health 'Fat scan' shows up health risk: "Hammersmith Hospital, in west London, is currently the only hospital in Europe using the MRI scan.
Its scientists say 40% of the population have 'bad' fat around the heart, liver or pancreas, even though many appear thin.
They warn it is possible to be slim and yet still be at risk of conditions like diabetes because of 'hidden' fat.
Evidence suggests the precise location of fat has more of a bearing on health than simply being overweight. "

Ischemic Heart Disease Events Triggered by Short-Term Exposure to Fine Particulate Air Pollution -- Pope et al. 114 (23): 2443 -- Circulation

Ischemic Heart Disease Events Triggered by Short-Term Exposure to Fine Particulate Air Pollution -- Pope et al. 114 (23): 2443 -- Circulation: "Background— Recent evidence suggests that long-term exposure to particulate air pollution contributes to pulmonary and systemic oxidative stress, inflammation, progression of atherosclerosis, and risk of ischemic heart disease and death. Short-term exposure may contribute to complications of atherosclerosis, such as plaque vulnerability, thrombosis, and acute ischemic events. These findings are inconclusive and controversial and require further study. This study evaluates the role of short-term particulate exposure in triggering acute ischemic heart disease events.

Methods and Results— A case-crossover study design was used to analyze ischemic events in 12 865 patients who lived on the Wasatch Front in Utah. Patients were drawn from the cardiac catheterization registry of the Intermountain Heart Collaborative Study, a large, ongoing registry of patients who underwent coronary arteriography and were followed up longitudinally. Ambient fine particulate pollution (particles with an aerodynamic diameter ≤2.5 µm; PM2.5) elevated by 10 µg/m3 was associated with increased risk of acute ischemic coronary events (unstable angina and myocardial infarction) equal to 4.5% (95% confidence interval, 1.1 to 8.0). Effects were larger for those with angiographically demonstrated/.../"

Pfizer Ends Studies on Drug for Heart Disease - New York Times

Pfizer Ends Studies on Drug for Heart Disease - New York Times:
By ALEX BERENSON
Published: December 3, 2006
"Pfizer announced last night that it had discontinued research on its most important experimental drug, a treatment for heart disease. The decision is a stunning development that is likely to seriously damage the company’s prospects through the next decades.
Preliminary research found that the drug, torcetrapib, appeared to be linked with deaths and heart problems in the patients who were taking it.
For people with heart disease, Pfizer’s decision to stop the trial represents the failure of a drug that many cardiologists had viewed as a potentially major advance in efforts to reduce heart attacks and strokes.
Torcetrapib is designed to raise levels of so-called good cholesterol. It was to be used in combination with older drugs called statins, like Lipitor and Zocor, which reduce so-called bad cholesterol.
As recently as Thursday, Pfizer executives had hailed the drug at a meeting with investors and analysts at the company’s research center in Groton, Conn.
“This will be one of the most important compounds of our generation,” said Jeffrey B. Kindler, Pfizer’s chief executive.
Pfizer is the world’s biggest drug company, with 106,000 employees and $51 billion in sales in 2005."

Natural History of Atherosclerosis: A Critical Evaluation of the Current Understanding of the Natural History of Human Atherosclerosis

Natural History of Atherosclerosis: A Critical Evaluation of the Current Understanding of the Natural History of Human Atherosclerosis
At a 2004 meeting in Paris, Renu Virmani, MD, FACC, medical director and founder of CVPath Institute, Gaithersburg, Maryland, warned that drug-eluting stents (DESs) could increase the risk of late thrombosis leading to MIs months or even years after the stents were implanted. Despite pathology slides vividly showing the victims’ stents totally occluded by clots, few of her colleagues showed much interest in her warning. Yet subsequent analyses of clinical trial and registry data suggest that late thrombosis is seen more often with DES placement than with older bare-metal stents (BMSs). The data – summarized in an AHA ’06 report featuring Robert S. Schwartz, MD, FACC (click here) – have renewed interest in the natural history of human atherosclerosis and what can be done clinically to reduce the risk of late thrombosis.

Acute rheumatic fever is still a clinical challenge -- 333 (7579): 0 -- BMJ

Acute rheumatic fever is still a clinical challenge -- 333 (7579): 0 -- BMJ: "BMJ 2006;333 (2 December), doi:10.1136/bmj.333.7579.0-b
Related Article
This week in the BMJ
Acute rheumatic fever is still a clinical challenge
Acute rheumatic fever, now rare in high income populations, remains highly prevalent in developing countries where access to health care is poor, says Cilliers (doi: 10.1136/bmj.39031.420637.BE) in her clinical review. Although it is known to be caused by humoral and cell mediated immune responses to group A beta haemolytic streptococcus antigens, the syndrome of carditis, polyarthritis, and skin or neurological changes is still not completely understood. Only 0.3-3% of patients with acute streptococcal pharyngitis develop rheumatic fever and a genetic predisposition is certain.

Related Article
Rheumatic fever and its management
Antoinette M CilliersBMJ 2006 333: 1153-1156. [Extract] [Full Text]

Childhood Poverty Grows into Adult Heart Disease

Childhood Poverty Grows into Adult Heart Disease - CME Teaching Brief® - MedPage Today: ", Nov. 27 -- A poor childhood more than doubles the risk of early heart disease among white male physicians who achieve a high socioeconomic status, found researchers here. Action Points

Explain to patients who ask that this study suggests that relative poverty in childhood has a persistent effect and increases the risk of heart disease as adults among white male physicians who achieve high socioeconomic status.


Point out that this increased risk is not mediated by established coronary heart disease risk factors.
The finding, based on a long-running prospective study of the precursors of heart disease, underlines the persistent effect of relative poverty on children's future health, according to Michelle Kittleson, M.D., Ph.D., of Johns Hopkins.
Interestingly, the effect appears to moderate over time, as other risk factors for coronary heart disease begin to predominate with increasing age, Dr. Kittleson (now at the UCLA) and colleagues reported in the Nov. 27 issue of Archives of Internal Medicine.
Dr. Kittleson and colleagues analyzed data from the John Hopkins Precursors Study, which enrolled graduates of the university's medical school between 1948 and 1964. Median follow-up has reached 40 years.
The cohort was valuable to examine the effects of childhood socioeconomic status, Dr. Kittleson and colleagues said, because it eliminated a key adult confounding effect. All of the participants went on to enjoy the income and professional status of physicians.
For this analysis, the researchers excluded female graduates, those of non-European background, those who did not provide information about parental occupation, and those who were unavailable for follow-up, leaving 1,131 volunteers."

The polypill: at what price would it become cost effective? -- Franco et al. 60 (3): 213 -- Journal of Epidemiology and Community Health

The polypill: at what price would it become cost effective? -- Franco et al. 60 (3): 213 -- Journal of Epidemiology and Community Health: "Introduction: A promising concept in cardiovascular disease prevention (the polypill) was introduced in 2003. Although the polypill may seem as an effective intervention, data on its costs and cost effectiveness remain unknown. The aim of this study was to determine the maximum price of the polypill for it to be a cost effective alternative in the primary prevention of cardiovascular disease.
Methods: Data on the hypothetical effects of the polypill were taken from the literature. Using data from the Framingham heart study and the Framingham offspring study, life tables were built to model the assumed benefits of the polypill. Using a third party payer perspective and a 10 years time horizon, the authors calculated what should be the maximum drug cost of the polypill for it to be cost effective (using a 20 000/year of life saved threshold) in the primary prevention of cardiovascular disease among populations at different levels of absolute risk of coronary heart disease and age.
Results: To be cost effective among populations at levels of 10 year coronary heart disease risk over 20% (high risk), the annual cost of medication for the polypill therapy should be no more than 302 or 410 for men at age 50 and 60 years respectively. For cost effective prevention in populations at levels of coronary heart disease risk between 10% and 20% the costs should be two to three times lower.
Conclusion: Although the polypill could theoretically be a highly effective intervention, the costs of the medication could be its caveat for implementation in the primary prevention of cardiovascular disease. "

Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational obs

Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE) -- Fox et al. 333 (7578): 1091 -- BMJ: "Objective To develop a clinical risk prediction tool for estimating the cumulative six month risk of death and death or myocardial infarction to facilitate triage and management of patients with acute coronary syndrome. Design Prospective multinational observational study in which we used multivariable regression to develop a final predictive model, with prospective and external validation. Setting Ninety four hospitals in 14 countries in Europe, North and South America, Australia, and New Zealand. Population 43 810 patients (21 688 in derivation set; 22 122 in validation set) presenting with acute coronary syndrome with or without ST segment elevation enrolled in the global registry of acute coronary events (GRACE) study between April 1999 and September 2005. Main outcome measures Death and myocardial infarction. Results 1989 patients died in hospital, 1466 died between discharge and six month follow-up, and 2793 sustained a new non-fatal myocardial infarction. Nine factors independently predicted death and the combined end point of death or myocardial infarction in the period from admission to six months after discharge: age, development (or history) of heart failure, peripheral vascular disease, systolic blood pressure, Killip class, initial serum creatinine concentration, elevated initial cardiac markers, cardiac arrest on admission, and ST segment deviation. The simplified model was robust, with prospectively validated C-statistics of 0.81 for predicting death and 0.73 for death or myocardial infarction from admission to six months after discharge. The external applicability of the model was validated in the dataset from GUSTO IIb (global use of strategies to open occluded coronary arteries). Conclusions This risk prediction tool uses readily identifiable variables to provide robust prediction of the cumulative six month risk of death or myocardial infarction. It is a rapid and widely applicable method for assessing cardiovascular risk to complement clinical assessment and can guide patient triage and management across the spectrum of patients with acute coronary syndrome. "

Time course of depression and outcome of myocardial infarction.

De: Marcelo Gustavo Colominas [mailto:mgcolominas@hotmail.com]
Enviada em: quinta-feira, 23 de novembro de 2006 00:50
Arch Intern Med. 2006 Oct 9;166(18):2035-43.
Time course of depression and outcome of myocardial infarction.
Parashar S, Rumsfeld JS, Spertus JA, Reid KJ, Wenger NK, Krumholz HM, Amin A, Weintraub WS, Lichtman J, Dawood N, Vaccarino V.
Divisions of General Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA. smallik@emory.edu
BACKGROUND: Depression predicts worse outcomes after myocardial infarction (MI), but whether its time course in the month following MI has prognostic importance is unknown. Our objective was to evaluate the prognostic importance of transient, new, or persistent depression on outcomes at 6 months after MI. METHODS: In a prospective registry of acute MI (Prospective Registry Evaluating outcomes after Myocardial Infarction: Events and Recovery [PREMIER]), depressive symptoms were measured in 1873 patients with the Patient Health Questionnaire (PHQ) during hospitalization and 1 month after discharge and were classified as transient (only at baseline), new (only at 1 month), or persistent (at both times). Outcomes at 6 months included (1) all-cause rehospitalization or mortality and (2) health status (angina, physical limitation, and quality of life using the Seattle Angina Questionnaire). RESULTS: Compared with nondepressed patients, all categories of depression were associated with higher rehospitalization or mortality rates, more frequent angina, more physical limitations, and worse quality of life. The adjusted hazard ratios for rehospitalization or mortality were 1.34, 1.71, and 1.42 for transient, new, and persistent depression, respectively (all P<.05). Corresponding odds ratios were 1.62, 2.73, and
2.64 (all P<.01) for angina and 1.69, 2.25, and 3.27 (all P<.05) for physical limitation. Depressive symptoms showed a stronger association with health status compared with traditional measures of disease severity.
CONCLUSION: Depressive symptoms after MI, irrespective of whether they persist, subside, or newly develop in the first month after hospitalization, are associated with worse outcomes after MI.
Publication Types:
Multicenter Study
PMID: 17030839 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=17030839&dopt=Abstract
_________________
Marcelo G. Colominas
EyP-FAC
SCChaco

Researchers isolate a master heart cell

Researchers isolate a master heart cell - The Boston Globe: "A team of Harvard scientists announced yesterday that it has discovered a single kind of cell that builds the three main types of heart tissue, an advance that boosts the prospects of using cells to treat heart disease, the nation's top killer.
The team identified the heart cell in mice, and proved that it develops into the muscle cells that power the heart, the cells that make up blood vessels, and the smooth muscle cells that allow the vessels to expand and contract.
If the human equivalent of the new cells is found, it could be given to patients to rebuild heart tissue that cannot be repaired today. The work could also give biologists new tools to look for heart drugs.
There has been a rush of work in recent years to develop therapies that inject cells capable of repairing patients' damaged heart muscle. But the field has been hampered because biologists have not known what type of cell to use. Researchers around the world have launched clinical trials, but the trials have used blood cells, not heart cells, and the results have been modest, at best.
The research identifies, for the first time, a kind of master heart cell, similar to a stem cell, with a proven ability to build a wide range of heart tissues. The scientists cautioned that important obstacles remain before cell therapies based on the research can be tested in humans."

Extending the Horizon in Chronic Heart Failure. Effects of Multidisciplinary, Home-Based Intervention Relative to Usual Care -- Inglis et al., 10.1161

Background--The long-term impact of chronic heart failure management programs over the typical life span of affected individuals is unknown.
Methods and Results--The effects of a nurse-led, multidisciplinary, home-based intervention (HBI) in a typically elderly cohort of patients with chronic heart failure initially randomized to either HBI (n=149) or usual postdischarge care (UC) (n=148) after a short-term hospitalization were studied for up to 10 years of follow-up (minimum 7.5 years of follow-up). Study end points were all-cause mortality, event-free survival (event was defined as death or unplanned hospitalization), recurrent hospital stay, and cost per life-year gained. Median survival in the HBI cohort was almost twice that of UC (40 versus 22 months; P<0.001), with fewer deaths overall (HBI, 77% versus 89%; adjusted relative risk, 0.74; 95% CI, 0.53 to 0.80; P<0.001). HBI was associated with prolonged event-free survival (median, 7 versus 4 months; P<0.01). HBI patients had more unplanned readmissions (560 versus 550) but took 7 years to overtake UC; the rates of readmission (2.04±3.23 versus 3.66±7.62 admissions; P<0.05) and related hospital stay (14.8±23.0 versus 28.4±53.4 days per patient per year; P<0.05) were significantly lower in the HBI group. HBI was associated with 120 more life-years per 100 patients treated compared with UC (405 versus 285 years) at a cost of $1729 per additional life-year gained when we accounted for healthcare costs including the HBI.
Conclusions--In altering the natural history of chronic heart failure relative to UC (via prolonged survival and reduced frequency of recurrent hospitalization), HBI is a remarkably cost- and time-effective strategy over the longer term.

Risk Factors Socioeconomic status

Impact of Traditional and Novel Risk Factors on the Relationship Between Socioeconomic Status and Incident Cardiovascular Events -- Albert et al., 10.1161/CIRCULATIONAHA.106.660043 -- Circulation: "Background--Persons of lower socioeconomic status have greater cardiovascular risk than those of higher socioeconomic status. However, the mechanism through which socioeconomic status affects cardiovascular disease (CVD) is uncertain. Virtually no data are available that examine the prospective association between novel inflammatory and hemostatic CVD risk indicators, socioeconomic status, and incident CVD events. Methods and Results--We assessed the relationship between 2 indicators of socioeconomic status (education and income), traditional and novel CVD risk factors (high sensitivity C-reactive protein, soluble intercellular adhesion molecule-1, fibrinogen, and homocysteine), and incident CVD events among 22 688 apparently healthy female health professionals participating in the Women’s Health Study. These women were followed up for 10 years for the development of myocardial infarction, ischemic stroke, coronary revascularization, and cardiovascular death. More educated women were less likely to be smokers; had a lower prevalence of hypertension, diabetes, and obesity; and were more likely to participate in vigorous physical activity than less educated women. At baseline, median total cholesterol, low-density lipoprotein, triglyceride, C-reactive protein, intercellular adhesion molecule-1, fibrinogen, and homocysteine levels for women in 5 categories of education (<2 trend="0.006),">Conclusions--In this prospective analysis, we observed a decrease in incident CVD events with increasing levels of education and income. In contrast to the relationship between income and CVD events, the relationship of CVD events with education was explained only partially by traditional and novel risk factors for CVD."