European Journal of Preventive Cardiology

Penaloza-Ramos, Maria Cristina; Jowett, Sue; Mant, Jonathan; Schwartz, Claire; Bray, Emma P; Sayeed Haque, M; Richard Hobbs, FD; Little, Paul; Bryan, Stirling; Williams, Bryan; McManus, Richard J

doi: 10.1177/2047487315618784pmid: 26603745

BackgroundA previous economic analysis of self-management, that is, self-monitoring with self-titration of antihypertensive medication evaluated cost-effectiveness among patients with uncomplicated hypertension. This study considered cost-effectiveness of self-management in those with raised blood pressure plus diabetes, chronic kidney disease and/or previous cardiovascular disease.Design and methodsA Markov model-based economic evaluation was undertaken to estimate the long-term cost-effectiveness of self-management of blood pressure in a cohort of 70-year-old ‘high risk’ patients, compared with usual care. The model used the results of the TASMIN-SR trial. A cost–utility analysis was undertaken from a UK health and social care perspective, taking into account lifetime costs of treatment, cardiovascular events and quality adjusted life years. A subgroup analysis ran the model separately for men and women. Deterministic sensitivity analyses examined the effect of different time horizons and reduced effectiveness of self-management.ResultsBase-case results indicated that self-management was cost-effective compared with usual care, resulting in more quality adjusted life years (0.21) and cost savings (–£830) per patient. There was a 99% chance of the intervention being cost-effective at a willingness to pay threshold of £20,000 per quality adjusted life year gained. Similar results were found for separate cohorts of men and women. The results were robust to sensitivity analyses, provided that the blood pressure lowering effect of self-management was maintained for more than a year.ConclusionSelf-management of blood pressure in high-risk people with poorly controlled hypertension not only reduces blood pressure, compared with usual care, but also represents a cost-effective use of healthcare resources.

Ogawa, Hisao; Soejima, Hirofumi; Matsui, Kunihiko; Kim-Mitsuyama, Shokei; Yasuda, Osamu; Node, Koichi; Yamamuro, Megumi; Yamamoto, Eiichiro; Kataoka, Keiichiro; Jinnouchi, Hideaki; Sekigami, Taiji; ,

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Mostofsky, Elizabeth; Johansen, Martin Berg; Lundbye-Christensen, Søren; Tjønneland, Anne; Mittleman, Murray A; Overvad, Kim

doi: 10.1177/2047487315624524pmid: 26701875

BackgroundThere have been discrepant findings on whether coffee consumption is associated with the rate of developing atrial fibrillation (AF).Methods and resultsWe used data on 57,053 participants (27,178 men and 29,875 women) aged 50–64 years in the Danish Diet, Cancer and Health study. All participants provided information on coffee intake via food-frequency questionnaires at baseline. Incident AF was identified using nationwide registries. During a median follow-up of 13.5 years, 3415 AF events occurred. Compared with no intake, coffee consumption was inversely associated with AF incidence, with multivariable-adjusted hazard ratios of 0.93 (95% confidence interval [CI] 0.74–1.15) for more than none to <1 cup/day, 0.88 (95% CI 0.71–1.10) for 1 cup/day, 0.86 (95% CI 0.71–1.04) for 2–3 cups/day, 0.84 (95% CI 0.69–1.02) for 4–5 cups/day, 0.79 (95% CI 0.64–0.98) for 6–7 cups/day and 0.79 (95% CI 0.63–1.00) for >7 cups/day (p-linear trend = 0.02).ConclusionsIn this large population-based cohort study, higher levels of coffee consumption were associated with a lower rate of incident AF.

Barbieri, Lucia; Verdoia, Monica; Marino, Paolo; Suryapranata, Harry; De Luca, Giuseppe; ,

doi: 10.1177/2047487315614493pmid: 26525064

BackgroundContrast-induced nephropathy is a common complication of procedures that are likely to use contrast media. The identification of high-risk patients and preventive optimal hydration are key measures to reduce the incidence of contrast-induced nephropathy. The aim of this study was to evaluate the role of the contrast volume to creatinine clearance ratio (V/CrCl) in the prediction of contrast-induced nephropathy after coronary angiography or percutaneous coronary intervention.MethodsOur population consisted of 2308 consecutive patients undergoing coronary angiography and/or percutaneous coronary intervention. The risk of contrast-induced nephropathy was evaluated across quartiles of the V/CrCl. Receiver operating characteristic curves were used to identify the best predictive value. Contrast-induced nephropathy was defined as an absolute increase of 0.5 mg/dL or a relative increase of >25% in creatinine levels 24–48 hours after the procedure.ResultsThe total incidence of contrast-induced nephropathy was 12.2% and was significantly higher in the fourth quartile (first quartile 8.8%, second quartile 8.9%, third quartile 11.6% and fourth quartile 19.4%; P < 0.001). Using receiver operating characteristic curves we identified V/CrCl ≥ 6.15 as the best discriminant value for the prediction of contrast-induced nephropathy, which occurred in 25.1% of patients with V/CrCl ≥ 6.15 versus 9.7% in patients with V/CrCl < 6.15. These results were also confirmed at multivariate analysis after correction for all baseline confounders (adjusted odds ratio (AOR) (95% confidence interval (CI)) 1.81 (1.19–2.76); P = 0.005). The association between V/CrCl > 6.15 and an increased risk of contrast-induced nephropathy was confirmed among diabetic (11% vs. 27.7%; p P < 0.001) and non-diabetic patients (8.9% vs. 23%; Pp < 0.001), also after correction for all baseline confounders.ConclusionsThis is one of the largest studies evaluating the association between the V/CrCl ratio and the risk of contrast-induced nephropathy in patients undergoing coronary angiography or percutaneous coronary intervention. We found that a V/CrCl ratio >6.15 was independently associated with an increased risk of contrast-induced nephropathy.

Hall, Andrew J; Stubbs, Brendon; Mamas, Mamas A; Myint, Phyo K; Smith, Toby O

doi: 10.1177/2047487315610663pmid: 26464295

BackgroundTo examine for a possible relationship between osteoarthritis and cardiovascular disease.DesignA systematic review and meta-analysis.MethodsPublished and unpublished literature from: MEDLINE, EMBASE, CINAHL, the Cochrane Library, OpenGrey and clinical trial registers. Search to 22 November 2014. Cohort, case-control, randomised and non-randomised controlled trial papers reporting the prevalence of cardiovascular disease in osteoarthritis were included.ResultsFifteen studies with 32,278,744 individuals were eligible. Pooled prevalence for overall cardiovascular disease pathology in people with osteoarthritis was 38.4% (95% confidence interval (CI): 37.2% to 39.6%). Individuals with osteoarthritis were almost three times as likely to have heart failure (relative risk (RR): 2.80; 95% CI: 2.25 to 3.49) or ischaemic heart disease (RR: 1.78; 95% CI: 1.18 to 2.69) compared with matched non-osteoarthritis cohorts. No significant difference was detected between the two groups for the risk of experiencing myocardial infarction or stroke. There was a three-fold decrease in the risk of experiencing a transient ischaemic attack in the osteoarthritis cohort compared with the non-osteoarthritis group.ConclusionsPrevalence of cardiovascular disease in patients with osteoarthritis is significant. There was an observed increased risk of incident heart failure and ischaemic heart disease in people with osteoarthritis compared with matched controls. However, the relationship between osteoarthritis and cardiovascular disease is not straightforward and there is a need to better understand the potential common pathways linking pathophysiological mechanisms.

Avanzini, Fausto; Marzona, Irene; Baviera, Marta; Barlera, Simona; Milani, Valentina; Caimi, Vittorio; Longoni, Paolo; Tombesi, Massimo; Silletta, Maria G; Tognoni, Gianni; Roncaglioni, Maria Carla; ,

Ekblom-Bak, Elin; Ekblom, Örjan; Bergström, Göran; Börjesson, Mats

doi: 10.1177/2047487315619734pmid: 26635358

BackgroundTime spent being sedentary, regardless of time in exercise, has been associated with metabolic risk using regression modelling. By using isotemporal substitution modelling, the effect of replacing sedentary time with an equal amount of time in physical activity (PA) of different intensities can be considered. The present study aims to investigate the effect of replacing sedentary time with time in light, moderate and vigorous PA to the prevalence of the metabolic syndrome (MetS). Also, replacement of sedentary time by PA of different bout lengths was studied.MethodsIn total, 836 participants (52% women), aged 50–64 years, from the SCAPIS pilot study were included. Daily time spent sedentary and in PA of different intensities was assessed using hip-worn accelerometers.ResultsIn this cross-sectional study, replacing 10 minutes of sedentary time with the same amount of light PA was associated with significant lower MetS prevalence, odds ratio (OR) 0.96 (95% confidence interval 0.93–0.98). Replacement with moderate PA resulted in even lower OR, 0.89 (0.82–0.97), with the lowest OR for vigorous PA, 0.41 (0.26–0.66). Participants with high energy intake and high daily sedentary time benefitted more from the replacement of sedentary time with light PA. Significant associations were seen for all bout lengths of light, moderate and vigorous PA in a stepwise-like fashion from one minute to up to 120 minute bouts.ConclusionTheoretical substitutions of sedentary time with PA of any intensity and of as little as one minute were associated with significantly lower ORs for MetS. This may be an easily communicable message in clinical practice and for public health purposes.

Hamood, Hatem; Hamood, Rola; Green, Manfred S; Almog, Ronit

doi: 10.1177/2047487315597209pmid: 26198723

BackgroundThe extent to which drug adherence may be affected by patient characteristics remains unclear. This study investigated potential determinants of adherence to evidence-based cardioprotective medications in patients with acute myocardial infarction.DesignPatient-based retrospective cohort study of 4655 elderly one-year survivors of acute myocardial infarction, members of a health organization in Israel, between 2005 and 2010.MethodsAll patients filled at least one prescription for any key medication. Adherence was measured using the proportion-of-days-covered (PDC) metric and defined as PDC ≥ 80%.ResultsNonadherence to aspirin, β-blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers or statins approximated 50%, and 80% for combined therapy of all medications. In multivariable analyses, compared with nonadherents to all medications, adherers to at least one medication were more likely to be of Jewish origin (adjusted odds ratio (AOR), 2.11; 95% confidence interval (CI), 1.60–2.78), inhabitants of the central or northern districts, and attending a cardiologist at least once during the first year of follow-up (AOR, 1.26; 95% CI, 1.05–1.51). Increasing number of outpatient visits was associated with improved adherence and followed a significant dose–response gradient. Factors significantly associated with reduced adherence were presence of comorbid conditions, particularly chronic ischemic heart disease (AOR 0.69; 95% CI, 0.57–0.83) and readmissions (AOR, 0.65; 95% CI, 0.55–0.78). Results were consistent when evaluating adherence to each medication separately.ConclusionsOutpatient adherence to recommended therapy in patients with acute myocardial infarction is suboptimal and is related to health services utilization. Further research is needed to investigate patient subjective behavioral-related drivers for medication therapy discontinuation after myocardial infarction in the absence of a clinical reason.

Lachman, Sangeeta; Peters, Ron JG; Lentjes, Marleen AH; Mulligan, Angela A; Luben, Robert N; Wareham, Nicholas J; Khaw, Kay-Tee; Boekholdt, S Matthijs

doi: 10.1177/2047487315602015pmid: 26336197

BackgroundThe American Heart Association has prioritised seven cardiovascular health metrics to reduce the cardiovascular burden, including: body mass index, healthy diet, physical activity, smoking status, blood pressure, glycated haemoglobin A1c and total cholesterol. The aim of the current study was to assess the association between the American Heart Association-defined health metrics and the risk of cardiovascular events in the EPIC-Norfolk prospective study.DesignProspective cohort study.MethodsAn overall cardiovascular health score was calculated based on the number of health metrics including ideal, intermediate or poor. Cox proportional hazards models were used to describe the association of the seven metrics separately and the overall health score with risk of coronary heart disease, stroke and cardiovascular disease. A total of 10,043 participants was included in the analysis (follow-up 1993–2008). For all individual health metrics a more ideal status was associated with a lower risk of cardiovascular events.Results and conclusionAs for the overall cardiovascular health score, those in the highest (i.e. healthiest) category (score 12–14) had an adjusted hazard ratio for coronary heart disease of 0.07 (95% confidence interval (CI) 0.02–0.29, P < 0.001), for stroke of 0.16 (95% CI 0.02–1.37, P = 0.09) and for cardiovascular disease of 0.07 (95% CI 0.02–0.23, P < 0.001), compared to people in the lowest (i.e. unhealthiest) category (score 0–2). The overall cardiovascular health score was strongly and inversely associated with risk of coronary heart disease, stroke and cardiovascular disease. Our data suggest that even small improvements in modifiable risk factors may lead to substantial reductions in the risks of cardiovascular events.

Floud, Sarah; Balkwill, Angela; Canoy, Dexter; Reeves, Gillian K; Green, Jane; Beral, Valerie; Cairns, Benjamin J; ,

doi: 10.1177/2047487315607056pmid: 26416995

BackgroundParticipation in social activities is thought to prevent heart disease, but evidence is inconclusive.DesignWe assessed whether participating in social activities reduces the risk of coronary heart disease (CHD) in a large prospective study of 735,159 middle-aged UK women.MethodsWomen reported their participation in eight social activities (religious group, voluntary work, adult education, art/craft/music, dancing, sports club, yoga, bingo) and were followed for first CHD event (hospital admission or death) over the next 8.6 years. Cox regression models were used to estimate relative risks for CHD incidence by participation in each and in any of the social activities.ResultsAfter adjustment for age and region only, every activity except bingo was associated with a reduced risk of CHD (n = 30,756 cases in total). However, after additional adjustment for 11 factors (deprivation, education, smoking, physical activity, body mass index, alcohol, marital status, self-rated health, happiness, hypertension, diabetes), every relative risk estimate moved close to 1.0. For example, for participation in any of the activities compared with none, the relative risk adjusted for age and region only was 0.83 (99% confidence interval 0.81–0.86), but changed to 1.06 (99% confidence interval 1.02–1.09) after additional adjustment. Adjustment for education, self-rated health, smoking and physical activity attenuated the associations most strongly. Residual confounding and other unmeasured factors may well account for any small remaining associations.ConclusionsAssociations between participation in various social activities and CHD risk appear to be largely or wholly due to confounding by personal characteristics of the participants.