The systematic coronary risk evaluation (SCORE) for the prevention of cardiovascular diseases. Does evidence exist for its effectiveness? A systematic review Sun, vitamin D, and cardiovascular disease. Information and Risk Modification Trial (INFORM): design of a randomised controlled trial of communicating different types of information about coronary heart disease risk, alongside lifestyle advice, to achieve change in health-related behaviour Global Risk Assessment to Guide Blood Pressure Management in Cardiovascular Disease Prevention The association of renal impairment with all-cause and cardiovascular disease mortality. National Study of Women’s Awareness, Preventive Action, and Barriers to Cardiovascular Health Is high serum uric acid a risk marker or a target for treatment? Examination of its independent effect in a large cohort with low cardiovascular risk. Cost-effectiveness of interventions to control cardiovascular diseases and type 2 diabetes mellitus in South Asia: protocol for a systematic review The relationship of fibrinogen and factors VII and VIII to incident cardiovascular disease and death in the elderly: results from the cardiovascular health study. Depression and cardiovascular sequelae in postmenopausal women. The Women's Health Initiative (WHI). Impact of socioeconomic deprivation on screening for cardiovascular disease risk in a primary prevention population: a cross-sectional study A prospective study of variability in systolic blood pressure and mortality in a rural Bangladeshi population cohort. Favorable cardiovascular risk profile in young women and long-term risk of cardiovascular and all-cause mortality. Lipoprotein(a) as a cardiovascular risk factor: current status Mortality over four years in SHEP participants with a low ankle-arm index. Evaluation of cardiovascular risk predicted by different SCORE equations: The Netherlands as an example Legacy Effect of Delayed Blood Pressure-Lowering Pharmacotherapy in Middle-Aged Individuals Stratified by Absolute Cardiovascular Disease Risk: Protocol for a Systematic Review Risk factors for cardiovascular and cerebrovascular death among African Americans and Hispanics in Los Angeles, California. Prognostic value of depression, anxiety, and anger in hospitalized cardiovascular disease patients for predicting adverse cardiac outcomes. Improving diabetes care: multi-component cardiovascular disease risk reduction strategies for people with diabetes in South Asia--the CARRS multi-center translation trial. Cardiovascular Risk Factor Screening Satisfaction in the Heart of New Ulm Project Cardiorespiratory Fitness in Childhood and Adolescence Affects Future Cardiovascular Risk Factors: A Systematic Review of Longitudinal Studies
Objectives : The SCORE model predicts the ten-year risk of cardiovascular mortality but it is still unknown whether applying the SCORE in clinical practice subsequently improves cardiovascular disease ( CVD ) outcomes . The objective of this study is to assess the effect of total cardiovascular risk estimation using the SCORE in preventing serious cardiovascular events in European adults without prior CVD . Methods and results : Data sources : eight bibliographical data bases ( 2003 – August 2015 ) , other internet sources and reference lists of articles were checked . This was supplemented by contact with the board members of the European Society of Cardiology ( ESC ) and the authors of the SCORE model . Study eligibility criteria : all prospect i ve studies in any language investigating the effect of using the SCORE on the clinical outcome ( CVD death , major events and adverse outcomes ) in an adult population were examined . Two review ers assessed the studies independently ( titles , abstract s , full texts ) . After removal of duplicates , 5,256 records were screened and 14 full text papers considered . No eligible studies were identified . An extensive literature search revealed no r and omized control trial or other prospect i ve study comparing significant clinical outcomes between groups that used the SCORE and those who did not . Conclusions : The effect of using the SCORE ( with or without subsequent intervention ) on CVD death , all-cause mortality , major CVD events like myocardial infa rct ion and stroke , as well as adverse outcomes , is still unknown . A cluster r and omised controlled trial is warranted to evaluate the use of the SCORE on important outcomes Globally , cardiovascular disease ( CVD ) is the number one cause of death , being responsible for approximately 30 % of deaths worldwide . Urbanization and a westernized lifestyle are thought to play a major role in the development of CVD . There is accumulating evidence that vitamin D is a nonclassical risk factor for CVD . The active vitamin D metabolite , 1,25-dihydroxyvitamin D , which is synthesized from its precursor 25-hydroxyvitamin D ( 25[OH]D ) , down-regulates several negative and up-regulates various protective pathways in the heart and vasculature . First r and omized trials demonstrate that vitamin D supplementation leads to vasodilatation and suppresses cardiovascular risk markers such as triglycerides and the inflammation marker tumor necrosis factor-α . Solar UV-B radiation is the major source of vitamin D for humans . Consequently , the vitamin D status is largely influenced by season , geographic latitude , daily outdoor activities , and the percentage of body surface exposed to solar UV-B. A significant proportion of individuals in Europe and North America have  vitamin D concentrations in the deficiency range ( 25[OH]D<25 nmol/l ) . Available data indicate that low solar UV-B exposure and /or low 25(OH)D concentrations are associated with an increased risk of CVD . Large nonr and omized studies indicate that CVD mortality is more than twice as high in older individuals with deficient 25(OH)D concentrations compared with those individuals who have adequate 25(OH)D concentrations ( > 75 nmol/l ) . Together , experimental and epidemiological evidence does support a plausible role for improving vitamin D status in CVD prevention in the population at large . Nevertheless , future r and omised clinical trials are needed to evaluate whether vitamin D is effective with respect to primary , secondary , and /or tertiary prevention of CVD Background Cardiovascular disease ( CVD ) remains the leading cause of death globally . Primary prevention of CVD requires cost-effective strategies to identify individuals at high risk in order to help target preventive interventions . An integral part of this approach is the use of CVD risk scores . Limitations in previous studies have prevented reliable inference about the potential advantages and the potential harms of using CVD risk scores as part of preventive strategies . We aim to evaluate short-term effects of providing different types of information about coronary heart disease ( CHD ) risk , alongside lifestyle advice , on health-related behaviours . Methods / Design In a parallel-group , open r and omised trial , we are allocating 932 male and female blood donors with no previous history of CVD aged 40–84 years in Engl and to either no intervention ( control group ) or to one of three active intervention groups : i ) lifestyle advice only ; ii ) lifestyle advice plus information on estimated 10-year CHD risk based on phenotypic characteristics ; and iii ) lifestyle advice plus information on estimated 10-year CHD risk based on phenotypic and genetic characteristics . The primary outcome is change in objective ly measured physical activity . Secondary outcomes include : objective ly measured dietary behaviours ; cardiovascular risk factors ; current medication and healthcare usage ; perceived risk ; cognitive evaluation of provision of CHD risk scores ; and psychological outcomes . The follow-up assessment takes place 12 weeks after r and omisation . The experiences , attitudes and concerns of a subset of participants will be also studied using individual interviews and focus groups . Discussion The INFORM study has been design ed to provide robust findings about the short-term effects of providing different types of information on estimated 10-year CHD risk and lifestyle advice on health-related behaviours . Trial registration Current Controlled Trials IS RCT N17721237 . Registered 12 January 2015 Elevated blood pressure ( BP ) is a causal risk factor for cardiovascular disease ( CVD ) . Epidemiological analyses have established the grade d and continuous association between higher BP and CVD . Moreover , r and omized clinical trials among individuals with hypertension have demonstrated , in aggregate , a reduction in CVD events by 20 % , coronary heart disease ( CHD ) by 17 % , stroke by 27 % , and heart failure by 28 % for every 10 mm Hg systolic BP ( SBP ) lowering with medical therapy.1 Therefore , prevention , detection , treatment , and control of elevated BP , and its clinical correlate hypertension , is an important public health priority and a primary target for CVD prevention . Although national health surveys have demonstrated improvements in hypertension awareness and treatment , strategic opportunities to improve the efficiency and efficacy of applying BP-lowering therapy in patients most likely to benefit remain.2 Global CVD risk assessment , using multivariable prediction models that estimate absolute CVD risk from routinely measured clinical variables , has been promulgated in several CVD prevention guidelines for cholesterol management to target the most intensive preventive therapies to those at highest absolute CVD risk.3–5 Hypertension guidelines , however , have instead relied solely on isolated BP thresholds and BP goals to guide treatment initiation and intensity . In this review , we provide a rationale for incorporating global CVD risk assessment in BP treatment decision-making and propose a framework to guide its implementation in future CVD prevention guidelines . Epidemiological analyses have firmly established that CVD is a multifactorial condition and that modest increases of several CVD risk factors can often lead to greater overall risk than a severe elevation of a Background . The prognostic value of reduced glomerular filtration rate ( GFR ) was examined in a community-based cohort of British women . Methods . Serum creatinine measurements were available for 90 % ( n = 3851 ) of a representative r and om sample of 4286 women aged 60 - 79 years . GFR was estimated using the Modification of Diet in Renal Disease equation . Hazard ratios ( HR ) were calculated using Cox regression with outcomes of all-cause and cardiovascular disease ( CVD ) mortality . Results . Eight hundred and thirty-two women ( 21.6 % ) had a GFR < 60 ml/min/1.73 m(2 ) . Over a median follow-up of 5.6 years , there were 318 deaths ( 100 CVD deaths ) . Women with GFR < 60 ml/min/1.73 m(2 ) compared to all others showed only a borderline increased risk of all-cause mortality [ HR 1.35 ( 95 % confidence intervals : 0.99 , 1.85 ) ] and CVD mortality [ 1.34 ( 0.97 , 1.85 ) ] . Adjustment for conventional CVD risk factors had little impact . The association with CVD mortality was attenuated in women with pre-existing CVD [ adjusted HR : 0.51 ( 0.24 , 1.04 ) ] . Only the subset of women without CVD at baseline were at risk for later CVD death [ adjusted HR : 1.80 ( 1.13 , 2.88 ) ] . Conclusions . A substantial proportion of older British women have GFR < 60 ml/min/1.73 m(2 ) without strong evidence for statistical association with all-cause mortality . The effect on CVD mortality is partly explained by existing CVD and its risk factors . GFR measurement appears only to play a useful role in the subset of older women without pre-existing CVD who are at higher risk of premature CVD death Background — There is growing awareness of cardiovascular disease ( CVD ) as the leading cause of death in women , but whether this greater awareness is associated with increased action by women to lower their personal or family ’s risk is unknown . Methods and Results — A nationally representative sample of 1008 women selected through r and om-digit dialing were given a st and ardized question naire about history of CVD/risk factors , awareness of leading cause of death , knowledge of healthy and personal levels of CVD risk factors , self-reported actions taken to reduce risk  , and barriers to heart health . The rate of awareness of CVD as the leading cause of death has nearly doubled since 1997 ( 55 % versus 30 % ) was significantly greater for whites compared with blacks and Hispanics ( 62 % versus 38 % and 34 % , respectively ) and was independently correlated with increased physical activity ( odds ratio , 1.35 ; 95 % CI , 1.00 to 1.83 ) and weight loss ( odds ratio , 1.47 ; 95 % CI , 1.14 to 2.02 ) in the previous year in logistic regression models . Fewer than half of the respondents were aware of healthy levels of risk factors . Awareness that personal level was not healthy was positively associated with action . Most women took steps to lower risk in family members and themselves . The most frequently cited barriers for heart health were confusion in the media ( 49 % ) , the belief that health is determined by a higher power ( 44 % ) , and caretaking responsibilities ( 36 % ) . Conclusions — General awareness of CVD risk among women is associated with preventive action . Educational interventions need to be targeted at racial/ethnic minority women BACKGROUND Cohort studies evaluating increased uric acid level as a cardiovascular disease ( CVD ) risk factor have shown variable results ; studies are particularly lacking in lower risk population s. STUDY DESIGN Prospect i ve cohort study . SETTING & PARTICIPANTS 484,568 adults participating in a medical screening program in Taiwan since 1994 were followed up for a median of 8.5 years . Two subgroups were constructed : the first ( n = 246,697 ; 51 % ) excluded participants with either overt CVD or overt CVD risk factors ( including hypertension , diabetes , obesity , and hypertriglyceridemia ) and the second ( n = 157,238 ; 32 % ) further excluded individuals with early-stage CVD risk factors ( including prehypertension , prediabetes , overweight , and borderline hypertriglyceridemia ) . PREDICTOR Serum uric acid . OUTCOMES & MEASUREMENTS All-cause and CVD mortality risk assessed using Cox proportional hazards models for categorical and continuous serum uric acid levels . As applicable , models adjusted for 14 variables . Population -attributable fraction was applied to compare contributions to mortality between high uric acid level and other CVD risk factors . RESULTS In the total cohort , mean age was 41.4 + /- 14.0 years and 26.2 % had serum uric acid levels > or=7 mg/dL. Through 2007 , there were 16,246 deaths ( 3.4 % of all participants ) , with 35.2 % of deaths occurring in individuals with hyperuricemia . Adjusted HRs associated with serum uric acid levels > or=7 mg/dL for all-cause and CVD mortality were 1.10 ( 95 % CI , 1.04 - 1.17 ) and 1.38 ( 95 % CI , 1.20 - 1.58 ) , respectively . In individuals with hyperuricemia , 64.3 % had overt CVD risk factors and 82.5 % had either overt or early-stage CVD risk factors . Individuals with serum uric acid levels > or=8 mg/dL without overt CVD risk factors constituted 13.5 % of the total study population with hyperuricemia ; in analyses excluding those with overt CVD risk factors , serum uric acid level > or=8 mg/dL was significantly associated with all-cause and CVD mortality , with HRs of 1.37 ( 95 % CI , 1.18 - 1.60 ) and 2.30 ( 95 % CI , 1.51 - 3.49 ) , respectively . In the subgroup of those with serum uric acid levels > or=8 mg/dL but who lacked both overt and early-stage CVD risk factors , the HRs for all-cause and CVD mortality were also significant and were 1.39 ( 95 % CI , 1.08 - 1.78 ) and 2.38 ( 95 % CI , 1.24 - 4.54 ) , respectively . HRs for individuals with the same risk profiles but with serum uric acid of 7.0 - 7.9 mg/dL were not significant . In all groups , inclusion of proteinuria and glomerular filtration rate in models substantially attenuated the association between uric acid level and outcomes . High uric acid levels contributed a relatively insignificant portion to mortality ( 1.2 % ) and CVD deaths ( 4.5 % ) in this population . LIMITATIONS A single measurement of uric acid was used . CONCLUSION Increased serum uric acid level is a minor , but significant , risk factor for all-cause and CVD mortality . However , except for a small proportion ( 13.5 % ) , increased serum uric acid level is more a risk marker than a target for treatment and is not an independent risk . Determining appropriate groups to target in clinical trials for uric acid-lowering therapy is critical Introduction While a number of strategies are being implemented to control cardiovascular diseases ( CVDs ) and type 2 diabetes mellitus ( T2DM ) , the cost-effectiveness of these in the South Asian context has not been systematic ally evaluated . We aim to systematic ally review the economic ( cost-effectiveness ) evidence available on the individual- , group- and population -level interventions for control of CVD and T2DM in South Asia . Methods and analysis This review will consider all relevant economic evaluations , either conducted alongside r and omised controlled trials or based on decision modelling estimates . These studies must include participants at risk of developing CVD/T2DM or with established disease in one or more of the South Asian countries ( India , Bangladesh , Pakistan , Sri Lanka , Nepal , Maldives , Bhutan and Afghanistan ) . We will identify relevant papers by systematic ally search ing all major data bases and registries . Selected articles will be screened by two independent research ers . Method ological quality of the studies will be assessed using a modified Drummond and a Phillips checklist . Cochrane guidelines will be followed for bias assessment in the effectiveness studies . Results Results will be presented in line with the PRISMA ( Preferred Reporting Items for Systematic review and Meta- analysis ) checklist , and overall quality of evidence will be presented as per the GRADE ( Grade s of Recommendation , Assessment , Development and Evaluation ) approach . Ethics and dissemination The study has received ethics approval from the All India Institute of Medical Sciences , New Delhi , India . The results of this review will provide policy-relevant recommendations for the uptake of cost-effectiveness evidence in prioritising decisions on essential chronic disease care packages for South Asia . Study registration number PROSPERO CRD42013006479 Little is known about the prospect i ve associations of fibrinogen , factor VII , or factor VIII with  cardiovascular disease ( CVD ) and mortality in the elderly . At baseline in the Cardiovascular Health Study ( 5888 white and African American men and women ; aged > /=65 years ) , we measured  fibrinogen , factor VIII , and factor VII .  We used sex-stratified stepwise Cox survival analysis to determine relative risks ( RRs ) for CVD events and all-cause mortality ( up to 5 years of follow-up ) , both unadjusted and adjusted for CVD risk factors and sub clinical CVD . After adjustment , comparing the fifth quintile to the first , fibrinogen was significantly associated in men with coronary heart disease events ( RR=2.1 ) and stroke or transient ischemic attack ( RR=1.3 ) , and also with mortality within 2.5 years of follow-up ( RR=5.8 ) and later ( RR=1.7 ) . Factor VIII was significantly associated in men with coronary heart disease events ( RR=1.5 ) and mortality ( RR=1.8 ) , and in women with stroke/transient ischemic attack ( RR=1.4 ) . For both factors , values were higher in those who died , whether causes were CVD-related or non-CVD-related , but highest in CVD death . Factor VII exhibited associations with incident angina ( RR=1.44 ) in men and with death in women ( RR , middle quintile compared with first=0.66 ) . However , in general , factor VII was not consistently associated with CVD events in this population . We conclude that , if confirmed in other studies , the measurement of fibrinogen and /or factor VIII may help identify older individuals at higher risk for CVD events and mortality BACKGROUND Sub clinical depression , often clinical ly unrecognized , may pose increased risk of cardiovascular disease . Few studies have prospect ively investigated cardiovascular events related to depression in older women . We describe prevalence , cardiovascular correlates , and relationship to subsequent cardiovascular events of depressive symptoms among generally healthy postmenopausal women . METHODS The Women 's Health Initiative Observational Study followed up 93 676 women for an average of 4.1 years .  Depression was measured at baseline with a short form of the Center for Epidemiological Studies Depression Scale .  Risks of cardiovascular disease ( CVD ) events were estimated from Cox proportional hazards models adjusting for multiple demographic , clinical , and risk factor covariates . RESULTS Current depressive symptoms above the screening cutoff point were reported by 15.8 % of women . Depression was significantly related to CVD risk and comorbidity ( odds ratios ranging from 1.12 for hypertension to 1.60 for history of stroke or angina ) . Among women with no history of CVD , depression was an independent predictor of CVD death ( relative risk , 1.50 ) and all-cause mortality ( relative risk , 1.32 ) after adjustment for age , race , education , income , diabetes , hypertension , smoking , high cholesterol level requiring medication , body mass index , and physical activity . Taking antidepressant medications did not alter the depression-associated risks associated . CONCLUSIONS A large proportion of older women report levels of depressive symptoms that are significantly related to increased risk of CVD death and all-cause mortality , even after controlling for established CVD risk factors . Whether early recognition and treatment of sub clinical depression will lower CVD risk remains to be determined in clinical trials Objectives Investigate the association between socioeconomic deprivation and completeness of cardiovascular disease ( CVD ) risk factor recording in primary care , uptake of screening in people with incomplete risk factor recording and with actual CVD risk within the screened subgroup . Design Cross-sectional study . Setting Nine UK general practice s. Participants 7987 people aged 50–74 years with no CVD diagnosis . Methods CVD risk was estimated using the Framingham equation from data extracted from primary care electronic health records . Where there was insufficient information to calculate risk , patients were invited to attend a screening assessment . Analysis Proportion of patients for whom clinical data were sufficiently complete to enable CVD risk to be calculated ; proportion of patients invited to screening who attended ; proportion of patients who attended screening whose 10-year risk of a cardiovascular event was high ( > 20 % ) . For each outcome , a set of logistic regression models were run . Crude and adjusted ORs were estimated for person-level deprivation , age , gender and smoking status . We included practice -level deprivation as a continuous variable and practice as a r and om effect to account for clustering . Results People who had lower  Indices of Multiple Deprivation ( IMD ) scores ( less deprived ) had significantly worse routine CVD risk factor recording ( adjusted OR 0.97 ( 0.95 to 1.00 ) per IMD decile ; p=0.042 ) . Screening attendance was poorer in those with more deprivation ( adjusted OR 0.89 ( 0.86 to 0.91 ) per IMD decile ; p<0.001 ) . Among those who attended screening , the most deprived were more likely to have CVD risk > 20 % ( OR 1.09 ( 1.03 to 1.15 ) per IMD decile ; p=0.004 ) . Conclusions Our data suggest that those who had the most to gain from screening were least likely to attend , potentially exacerbating existing health inequalities . Future research should focus on tailoring the delivery of CVD screening to ensure engagement of socioeconomically deprived groups OBJECTIVE Limited studies suggest that blood pressure variability over time is a risk factor of long-term cardiovascular outcomes . However , most of these were in population s with pre-existing cardiovascular diseases ( CVD ) and studies in general population are lacking . METHODS The study included 11,153 participants in a population -based , prospect i ve cohort study in Araihazar , Bangladesh .  Resting blood pressure was measured at baseline and every two years thereafter . Participants were followed up for an average of 6.5 years ( 2002 - 2009 ) . RESULTS Male gender , older age , baseline systolic blood pressure ( SBP ) , and absence of betel leaf use were independently positively associated with greater SBP variability over time . There was a significant association between SBP variability and the risk of death from overall CVD , especially from major CVD events . The positive association with the risk of death from any cause and stroke in age- and sex-adjusted models was attenuated in fully-adjusted models . In addition , the hazard ratio ( HR ) of stroke mortality was greater for individuals with both high baseline and high SBP variability . Similar patterns of HRs were observed for all-cause and CVD mortalities . CONCLUSION In this rural Bangladeshi population , variability in SBP contributes to the risk of death from CVD and may further potentiate the increased mortality risk associated with high SBP CONTEXT For women , impact of cardiovascular risk factors measured in young adulthood , particularly favorable ( low-risk ) profile , on mortality has been difficult to assess due to low short-term death rates . OBJECTIVE To assess the relationship of baseline coronary risk factor status to mortality from coronary heart disease ( CHD ) , cardiovascular diseases ( CVDs ) , and all causes in young women . DESIGN Prospect i ve cohort study . SETTING AND PARTICIPANTS A total of 7302 women aged 18 to 39 years without prior CHD or major electrocardiographic abnormalities screened between 1967 and 1973 for the Chicago Heart Association Detection Project in Industry . Risk groups were defined using national guidelines for values of systolic and diastolic blood pressure , serum cholesterol level , body mass index , presence of diabetes , and smoking status . Participants were divided into 4 groups : low risk , 0 risk factors high but 1 or more unfavorable , 1 only risk factor high , and 2 or more risk factors high . MAIN OUTCOME MEASURES All-cause mortality , CHD mortality , and CVD mortality ; hazard ratio of outcome measures comparing low-risk group with other groups . RESULTS Only 20 % met low-risk criteria ; 59 % had high levels of 1 or more risk factors . During an average follow-up of 31 years , there were 47 CHD deaths , 94 CVD deaths , and 469 deaths from all causes . The age-adjusted CVD death rate per 10,000 person-years was lowest for low-risk women and increased with the number of risk factors , ie , 1.5 , 1.7 , 5.0 , and 9.1 for low-risk ; 0 , 1 , and 2 or more risk factors high , respectively . Multivariate-adjusted CVD mortality hazard ratio for low-risk women was 0.19 ( 95 % confidence interval , 0.08 - 0.45 ) compared with women with 2 or more risk factors high . Similar patterns were observed for CHD and all-cause mortality and for both blacks and whites . CONCLUSION For women with favorable levels for all 5 major risk factors at younger ages , CHD and CVD are rare ; long-term and all-cause mortality are much lower compared with others Aims The aims of the study were , first , to critically evaluate lipoprotein(a ) [ Lp(a ) ] as a cardiovascular risk factor and , second , to advise on screening for elevated plasma Lp(a ) , on desirable levels , and on therapeutic strategies . Methods and results The robust and specific association between elevated Lp(a ) levels and increased cardiovascular disease (CVD)/coronary heart disease ( CHD ) risk , together with recent genetic findings , indicates that elevated Lp(a ) , like elevated LDL-cholesterol , is causally related to premature CVD/CHD . The association is continuous without a threshold or dependence on LDL- or non-HDL-cholesterol levels . Mechanistically , elevated Lp(a ) levels may either induce a prothrombotic/anti-fibrinolytic effect as apolipoprotein(a ) resembles both plasminogen and plasmin but has no fibrinolytic activity , or may accelerate atherosclerosis because , like LDL , the Lp(a ) particle is cholesterol-rich , or both . We advise that Lp(a ) be measured once , using an isoform-insensitive assay , in subjects at intermediate or high CVD/CHD risk with premature CVD , familial hypercholesterolaemia , a family history of premature CVD and /or elevated Lp(a ) , recurrent CVD despite statin treatment , ≥3 % 10-year risk of fatal CVD according to European guidelines , and /or ≥10 % 10-year risk of fatal + non-fatal CHD according to US guidelines . As a secondary priority after LDL-cholesterol reduction , we recommend a desirable level for Lp(a ) < 80th percentile ( less than ∼50 mg/dL ) . Treatment should primarily be niacin 1–3 g/day , as a meta- analysis of r and omized , controlled intervention trials demonstrates reduced CVD  by niacin treatment . In extreme cases , LDL-apheresis is efficacious in removing Lp(a ) . Conclusion We recommend screening for elevated Lp(a ) in those at intermediate or high CVD/CHD risk , a desirable level < 50 mg/dL as a function of global cardiovascular risk , and use of niacin for Lp(a ) and CVD/CHD risk reduction OBJECTIVES To assess the risk of total and cardiovascular mortality in older adults with systolic hypertension and with a low ankle-arm index ( AAI ) as a marker of sub clinical peripheral arterial disease ( PAD ) . DESIGN Prospect i ve observational study PARTICIPANTS A subgroup of 1537 participants in the Systolic Hypertension in the Elderly Program ( SHEP ) were screened for lower extremity arterial disease using the AAI . Participants were evaluated at 4 years to determine vital status and cause of death . Total and cardiovascular disease ( CVD ) mortality rates were assessed in relationship to clinical CVD at baseline , cardiovascular risk factors and the presence of a low AAI ( sub clinical PAD ) . RESULTS Total mortality rates increased as the AAI decreased in those with and without clinical CVD at baseline . In those without clinical CVD at baseline , the presence of an AAI < or = .9 was associated with an age-adjusted relative risk ( RR ) of 3.00 for total mortality in men and 2.67 in women . Results were similar for CVD mortality and persisted after adjustment for cardiovascular risk factors including the presence of an abnormal electrocardiogram . CONCLUSIONS A low ankle arm-index predicted a two to three-fold increase in total and cardiovascular mortality in older adults with systolic hypertension of risk for incident cardiovascular disease . In this study of older adults with systolic hypertension , 19.7 % of the participants had sub clinical PAD . Risk factor modification could be targeted to older adults based on markers of asymptomatic atherosclerosis Background In Europe , for primary prevention of cardiovascular diseases ( CVD ) , the Systematic COronary Risk Evaluation ( SCORE ) risk charts for high-risk and low-risk regions ( SCORE-high and SCORE-low , respectively ) are used . For the Dutch ‘ Clinical Practice Guideline for Cardiovascular Risk Management ’ an adapted SCORE risk chart ( SCORE-NL ) was developed in collaboration with the SCORE group . We evaluated these three SCORE equations using Dutch risk factor and mortality data . Design Prospect i ve cohort study with 10-year follow-up . Methods Baseline data were collected between 1987 and 1997 in 32 885 persons aged 37.5–62.5 years .  Vital status was checked and causes of death were obtained from Statistics Netherl and s. On the basis of the level of risk factors , the expected number of CVD deaths was calculated by applying the three SCORE equations and compared with the observed number . Results The observed CVD mortality was three-fold higher in men ( n = 242 ; 1.6 % ) than in women ( n = 83 ; 0.5 % ) . On the basis of SCORE-NL , 8.5 % of the men and 0.8 % of the women had a CVD mortality risk of 5 % or more . The ratio of the observed-to-expected number of CVD deaths was 0.75 for men and 0.55 for women using SCORE-NL , 0.54 and 0.56 using SCORE-high , and 1.11 and 0.95 using SCORE-low . Conclusion At the population level , SCORE-low predicts the number of CVD deaths well , whereas both SCORE-NL and SCORE-high overestimate the number of CVD deaths by a factor 1.5–2 Background Many national and international guidelines recommend that the initiation of blood pressure (BP)-lowering drug treatment for the primary prevention of cardiovascular disease ( CVD ) should no longer be based on BP level alone , but on absolute cardiovascular risk . While BP-lowering drug treatment is beneficial in high-risk individuals at any level of elevated BP , clinicians are concerned about legacy effects on patients with low-to-moderate risk and mildly elevated BP who remain “ untreated ” . Objective We aim to investigate the legacy effect of delayed BP-lowering pharmacotherapy in middle-aged individuals ( 45 - 65 years ) with mildly elevated BP ( systolic BP 140 - 159 mmHg and /or diastolic BP 90 - 99 mmHg ) stratified by absolute risk for primary prevention of CVD , but particularly in the low-risk ( < 10 % five-year absolute risk ) group . Methods R and omized trials of BP-lowering therapy versus placebo or pretreated subjects in active comparator studies with posttrial follow-up will be identified using a 2-step process . First , r and omized trials of BP-lowering therapy will be identified by ( 1 ) retrieving the references of trials included in published systematic review s of BP-lowering therapy , ( 2 ) retrieving studies published by the Blood Pressure Lowering Treatment Trialists ’ Collaboration ( BPLTTC ) , and ( 3 ) checking studies referenced in the 1993 World Health Organization/International Society of Hypertension meeting memor and um on BP management . Posttrial follow-up studies will then be identified by forward citation search ing the r and omized trials identified in step 1 through Web of Science . The search will include r and omized controlled trials with at least 1-year in-trial period and a posttrial follow-up phase . Age is the major determinant of absolute cardiovascular risk , so the participants in our review will be restricted to middle-aged adults who are more likely to have a lower cardiovascular risk profile . The primary outcome will be all-cause mortality . Secondary outcomes will include cardiovascular mortality , fatal stroke , fatal myocardial infa rct ion , and death due to heart failure . Results The search es for existing systematic review s and BPLTTC studies were piloted and modified . The study is expected to be completed before June 2018 . Conclusions The findings of this study will contribute to the body of knowledge concerning the beneficial , neutral , or harmful effects of delayed BP-lowering drug treatment on the primary prevention of CVD in patients with mildly elevated BP and low-to-moderate CVD risk . Trial Registration PROSPERO International Prospect i ve Register of Systematic Review s : CRD42017058414 ; https://www.crd.york.ac.uk/ PROSPERO /display_record.asp?ID = CRD42017058414 ( Archived by WebCite ® at http://www.webcitation.org/6t6sa8O2Q OBJECTIVE To describe the risk factors associated with cardiovascular mortality in the African American ( AA ) and Hispanic population s in Los Angeles County in an effort to define causes for the excess mortality seen in AAs . METHODS This was a longitudinal analysis of all-cause , cardiovascular , and cerebrovascular mortality in a large , prospect i ve multiethnic cohort of individuals aged 45 - 74 years . Death rates between AA and Hispanic men and women during the six-year period from 1993 to 1998 due to hypertension , cardiomyopathy , acute myocardial infa rct ion ( AMI ) , ischemic heart disease , and stroke were compared . RESULTS There were 1,157 deaths due to cardiovascular disease ( CVD ) or cerebrovascular disease among the 71,798 eligible members of the cohort included in these analyses .  Age-adjusted mortality rates were two to five times higher in AAs as compared with Hispanics ( e.g. , 373.15 in AAs for hypertensive disease vs 50.37 in Hispanics ) . A history of hypertension was the most common significant risk factor for CVD ; other risk factors significantly associated with CVD mortality included cigarette smoking and a past history of diabetes and stroke . Adjusting for these factors did not remove the significance of AA ethnicity as a risk factor for CVD mortality in either subjects reporting or subjects not reporting hypertension at baseline . CONCLUSIONS The evidence for both higher relative severity and higher incidence of hypertensive disease among AAs , and the consistency of the effect across gender , suggests that a major determinant of risk may be a gene environment interaction Although attention has recently been focused on the role of psychosocial factors in patients with cardiovascular disease ( CVD ) , the factors that have the greatest influence on prognosis have not yet been eluci date d. The aim of this study was to evaluate the effects of depression , anxiety , and anger on the prognosis of patients with CVD . Four hundred fourteen consecutive patients hospitalized with CVD were prospect ively enrolled .  Depression was evaluated using the Patient Health Question naire , anxiety using the Generalized Anxiety Disorder Question naire , and anger using the Spielberger Trait Anger Scale .  Cox proportional-hazards regression was used to examine the individual effects of depression , anxiety , and anger on a combined primary end point of cardiac death or cardiac hospitalization and on a combined secondary end point of all-cause death or hospitalization during follow-up ( median 14.2 months ) . Multivariate analysis showed that depression was a significant risk factor for cardiovascular hospitalization or death after adjusting for cardiac risk factors and other psychosocial factors ( hazard ratio 2.62 , p = 0.02 ) , whereas anxiety was not significantly associated with cardiovascular hospitalization or death after adjustment ( hazard ratio 2.35 , p = 0.10 ) . Anger was associated with a low rate of cardiovascular hospitalization or death ( hazard ratio 0.34 , p < 0.01 ) . In conclusion , depression in hospitalized patients with CVD is a stronger independent risk factor for adverse cardiac events than either anxiety or anger . Anger may help prevent adverse outcomes . Routine screening for depression should therefore be performed in patients with CVD , and the potential effects of anger in clinical practice should be reconsidered AIMS Cardiovascular disease ( CVD ) is the leading cause of morbidity and mortality in people with diabetes in South Asia . The CARRS Translation Trial tests the effectiveness , cost-effectiveness , and sustainability of a clinic-based multi-component CVD risk reduction intervention among people with diabetes in India and Pakistan . METHODS We r and omly assigned 1146 adults with diabetes recruited from 10 urban clinic sites , to receive usual care by physicians or to receive an integrated multi-component CVD risk reduction intervention . The intervention involves electronic health record management , decision-support prompts to the healthcare team , and the support of a care coordinator to actively facilitate patient and provider adherence to evidence -based guidelines . The primary outcome is a composite of multiple CVD risk factor control ( blood glucose and either blood pressure or cholesterol , or all three ) . Other outcomes include control of the individual CVD risk factors , process and patient-centered measures , cost-effectiveness , and acceptability/feasibility . CONCLUSION The CARRS Translation Trial tests a low-cost diabetes care delivery model in urban South Asia to achieve comprehensive cardio-metabolic disease case-management of high-risk patients ( clinical trials.gov number : NCT01212328 ) Objective Community-based cardiovascular disease ( CVD ) risk factor screening programs have been used successfully in rural health improvement initiatives . However , little is known about what consumers like or dislike about them , which is a barrier to the design of future process improvements . The objective of this study was to examine the degree to which health risks and participant characteristics predicted screening satisfaction . Design This study utilized a cross-sectional survey design . Setting Data was collected as part of the broader Heart of New Ulm Project , which is a community-based CVD prevention demonstration project based in rural Minnesota . Participants There were 126 r and omly invited individuals from the CVD risk factor screenings , with 118 individuals who agreed to participate and had complete data available for analyses . Methods A multivariate logistic regression analysis was used to examine the association between demographics , lifestyle , and biometric risk factors and screening satisfaction . Results Twenty percent of respondents indicated some level of dissatisfaction with the screening process . Satisfied participants were more likely to be female ( OR=4.15 ) , not have an optimal lifestyle ( OR=3.47 ) , and have an intention to improve their lifestyle habits ( OR=3.26 ) . Age , education , and CVD risk level were not significant predictors in the final model . Conclusion Satisfaction was high in this screening program , with healthy males being least satisfied with their experience . This has implication s for the design of future intervention efforts , as they may require specific programmatic features and more specialized , targeted marketing strategies to attract a broad spectrum of participants likely to benefit Background Although cardiorespiratory fitness ( CRF ) in childhood and adolescence may be linked to future cardiovascular health , there is currently limited evidence for a longitudinal association . Objectives To provide a systematic review on the prospect i ve association between CRF in childhood and adolescence and cardiovascular disease ( CVD ) risk factors at least 2 years later . Methods Using a systematic search of Medline , Embase , and SPORTD iscus , relevant articles were identified by the following criteria : generally healthy children and adolescents between 3 and 18 years of age with CRF assessed at baseline , and a follow-up period of ≥ 2 years . The outcome measures were CVD risk factors . We appraised quality of the included articles with STROBE and QUIPS checklists . Results After screening 7524 titles and abstract s , we included 38 articles , assessing 44,169 children and adolescents followed up for a median of 6 years . Eleven articles were of high quality . There was considerable heterogeneity in methodology , measurement of CRF , and outcomes , which hampered meta- analysis . In approximately half of the included articles higher CRF in childhood and adolescence was associated with lower body mass index ( BMI ) , waist circumference , body fatness and lower prevalence of metabolic syndrome in later life . No associations between CRF in childhood and adolescence and future waist-to-hip ratio , blood pressure , lipid profile , and glucose homeostasis were observed . Conclusion Although about half of the included articles reported inverse associations between CRF in childhood and adolescence and future BMI , body fatness , and metabolic syndrome , evidence for other CVD risk factors was unconvincing . Many articles did not account for important confounding factors such as adiposity . Recommendations for future research include st and ardizing the measurement of CRF , i.e. by reporting VO2max , using st and ardized outcome assessment s , and performing individual patient data meta-analyses
Conclusions Interventions using physician reminders , using dedicated personnel to deliver screening , and provision of financial incentives were found to be effective in increasing CVD risk factors screening uptake
Background Cardiovascular disease ( CVD ) is the leading cause of death globally .
However , many individuals are unaware of their CVD risk factors .
The objective of this systematic review is to determine the effectiveness of existing intervention strategies to increase uptake of  CVD risk factors screening .