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Background: High dietary salt intake is an avoidable cause of hypertension and associated cardiovascular diseases (CVDs). Thus, salt reduction is recommended as one of the most cost-effective interventions for CVD prevention and for achieving the World Health Organization’s (WHO) 25% reduction in premature non-communicable disease (NCD) mortality by 2025. However, current and comprehensive information about national salt reduction policies and related actions across different regions are difficult to access and impede progress and monitoring. Objectives: As an initial step to developing an online repository of salt reduction policies and related actions, and to track nation-wise progress towards the WHO’s 25 by 25 goal, we aimed to identify and assess salt reduction policies and actions in select countries from two of the top five most populous regions of the world- the South-East Asia and Latin America. Methods: We conducted a literature review to identify national and regional salt reduction policies in the selected South-East Asian and Latin American countries, from January 1990–August 2020, available in English and Spanish. We also contacted selected WHO country offices (South-East Asian region) or relevant national authorities (Latin America) to gain access to unpublished documents. Results: In both regions, we found only a few dedicated stand-alone salt reduction policies: Bhutan, Sri-Lanka and Thailand from South East Asia and Costa Rica from Latin America. Available polices were either embedded in other national health/nutritional policy documents/overall NCD policies or were unpublished and had to be accessed via personal communication. Conclusions: Salt reduction policies are limited and often embedded with other policies which may impede their implementation and utility for tracking national and international progress towards the global salt reduction target associated with the 25 by 25 goal. Developing an online repository could help countries address this gap and assist researchers/policymakers to monitor national progress towards achieving the salt reduction target.

Rising prevalence of cardiovascular disease requires in-depth understanding of predisposing factors. Studies show an association between air pollution and CVD but this association is not well documented in southern Nigeria where the use of biomass fuels (BMF) for domestic purposes is prevalent.This study aimed to explore the association between household BMF use and blood pressure (BP) and carotid intima media thickness (CIMT) among rural-dwelling women.A cross-sectional study of 389 women aged 18 years and older. Questionnaires were used to obtain data on predominant fuel used and a brief medical history. Wood, charcoal and agricultural waste were classified as BMF while kerosene, bottled gas and electricity were classified as non-BMF. Blood pressure and CIMT were measured using standard protocols. Regression analysis was used to assess the relationship between fuel type and BP, CIMT, pre-hypertension and hypertension after adjusting for confounders.There was a significant difference in the mean (standard deviation) systolic BP (135.3, 26.7 mmHg vs 123.8, 22.6 mmHg; p 0.01), diastolic BP (83.7, 18.5 mmHg vs 80.1, 13.8 mmHg; p = 0.043) and CIMT (0.63, 0.16 mm vs 0.56, 0.14 mm; p = 0.004) among BMF users compared to non-BMF users. In regression analysis, the use of BMF was significantly associated with 2.7 mmHg higher systolic BP (p = 0.040), 0.04 mm higher CIMT (p = 0.048) in addition to increased odds of pre-hypertension (OR 1.67 95% CI 1.56, 4.99, P = 0.035) but not hypertension (OR 1.23 95% CI 0.73, 2.07, P = 0.440).In this population, there was a significant association between BMF use and increased SBP, CIMT and pre-hypertension. This requires further exploration with a large-scale longitudinal study design because there are policy implications for countries like Nigeria where a large proportion of the population still rely on BMF for domestic energy.

Objective To determine if virtual care with remote automated monitoring (RAM) technology versus standard care increases days alive at home among adults discharged after non-elective surgery during the covid-19 pandemic. Design Multicentre randomised controlled trial. Setting 8 acute care hospitals in Canada. Participants 905 adults (≥40 years) who resided in areas with mobile phone coverage and were to be discharged from hospital after non-elective surgery were randomised either to virtual care and RAM (n=451) or to standard care (n=454). 903 participants (99.8%) completed the 31 day follow-up. Intervention Participants in the experimental group received a tablet computer and RAM technology that measured blood pressure, heart rate, respiratory rate, oxygen saturation, temperature, and body weight. For 30 days the participants took daily biophysical measurements and photographs of their wound and interacted with nurses virtually. Participants in the standard care group received post-hospital discharge management according to the centre’s usual care. Patients, healthcare providers, and data collectors were aware of patients’ group allocations. Outcome adjudicators were blinded to group allocation. Main outcome measures The primary outcome was days alive at home during 31 days of follow-up. The 12 secondary outcomes included acute hospital care, detection and correction of drug errors, and pain at 7, 15, and 30 days after randomisation. Results All 905 participants (mean age 63.1 years) were analysed in the groups to which they were randomised. Days alive at home during 31 days of follow-up were 29.7 in the virtual care group and 29.5 in the standard care group: relative risk 1.01 (95% confidence interval 0.99 to 1.02); absolute difference 0.2% (95% confidence interval −0.5% to 0.9%). 99 participants (22.0%) in the virtual care group and 124 (27.3%) in the standard care group required acute hospital care: relative risk 0.80 (0.64 to 1.01); absolute difference 5.3% (−0.3% to 10.9%). More participants in the virtual care group than standard care group had a drug error detected (134 (29.7%) v 25 (5.5%); absolute difference 24.2%, 19.5% to 28.9%) and a drug error corrected (absolute difference 24.4%, 19.9% to 28.9%). Fewer participants in the virtual care group than standard care group reported pain at 7, 15, and 30 days after randomisation: absolute differences 13.9% (7.4% to 20.4%), 11.9% (5.1% to 18.7%), and 9.6% (2.9% to 16.3%), respectively. Beneficial effects proved substantially larger in centres with a higher rate of care escalation. Conclusion Virtual care with RAM shows promise in improving outcomes important to patients and to optimal health system function. Trial registration ClinicalTrials.gov NCT04344665 .

© 2020 Elsevier Ltd Background: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. Methods: HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). Findings: Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4–9) in the accelerated-surgery group and 24 h (10–42) in the standard-care group (p

Background: Widespread access to good quality antihypertensive medicines is a critical component for reducing premature cardiovascular disease (CVD) mortality. Poor-quality medicines pose serious health concerns; however, there remains a knowledge gap about the quality of cardiovascular medicines available in low- and middle-income countries.Objectives: The aim of this study was to determine the quality of generic antihypertensive medicines available in the retail market of a developing country.Methods: Samples of the 2 most commonly prescribed classes of antihypertensive medicines were collected from 3 states in 3 different geopolitical zones in Nigeria following a semirandom sampling framework. Medicine samples were purchased by mystery shoppers from 22 pharmacy outlets from 6 local government areas across the 3 states. Medicine quality was determined by measuring the amount of stated active pharmaceutical ingredient using high-performance liquid chromatography with photodiode array detection and classified according to their compliance to the specified pharmacopeia tolerance limits for each antihypertensive drug.Results: Amlodipine and lisinopril were identified as the most commonly prescribed antihypertensive drugs in Nigeria. In total, 361 samples from 22 pharmacies were collected and tested. In total, 24.6% of amlodipine and 31.9% of lisinopril samples were of substandard quality and significantly more samples purchased in rural (59 of 161, 36.7%) compared with urban (32 of 200, 16%) outlets were found to be of substandard quality (p < 0.001). No falsified samples of either amlodipine or lisinopril were detected. There was large variation in price paid for the antihypertensive medicines (range ₦150 to ₦9,750). Of the 24 pharmacy outlets surveyed, 46% stated that patients did not always require a prescription and 21% had previously reported a medicine as falsified or substandard.Conclusions: More than one-quarter of some commonly prescribed antihypertensive medicines available in Nigeria may be of substandard quality. Enhanced quality assurance processes in low- and middle-income countries, such as Nigeria, are needed to support optimum management.HighlightsManagement of hypertension can largely be achieved through availability of and adherence to qualitative evidence-based medicines. There is very little research examining the quality of antihypertensive medicines available in the retail market of low- and middle-income countries.In total, 361 samples of amlodipine and lisinopril were collected from 22 pharmacies and their stated active pharmaceutical ingredient was measured.More than a quarter of some commonly prescribed antihypertensive medicines available in Nigeria appear to be of substandard quality (samples had more or less stated active pharmaceutical ingredient than stated in the United States Pharmacopeia–specified tolerance limits range).However, the proportion of substandard quality was not statistically different for amlodipine and lisinopril, and significantly more samples purchased in rural compared with urban outlets were of substandard quality.No falsified samples (containing no stated active pharmaceutical ingredient) of either amlodipine or lisinopril were detected.Enhanced quality assurance processes in low- and middle-income countries such as Nigeria are needed to support optimum management.

This study aimed to determine the prevalence of unrecognized depressive symptoms and its associated risk factors among patients with diabetes and/or hypertension attending medical outpatient clinics of a tertiary health centre in southern Nigeria. A cross-sectional study design was employed to assess 200 randomly selected patients attending the clinics. Questionnaires were administered to obtain sociodemographic and medical history data. The perceived stress scale (PSS) was used to determine the presence of subjective psychological stress and PHQ-9 was used to screen for depression. The prevalence of depressive symptoms was 54.9% with 16.5% categorised as having major depression. After adjusting for confounding variables, age younger than 60 years was associated with less odds of having depressive symptoms (AOR 0.32, 95% CI 0.17, 0.62; p=0.001), while only significant psychological stress increased the odds of having depressive symptoms (AOR 2.78, 95% CI 1.37, 5.64; p=0.005). The prevalence of depression among the study participants is high and has the potential to significantly impact the control of their disease and ultimately contribute to the high cardiovascular risk faced by this population.

Among high-risk individuals, statins are beneficial for primary prevention of cardiovascular disease (CVD). In Nigeria, currently, there are no CVD prevention guidelines, so the use of CVD risk estimation to guide statin therapy is left to the discretion of the physician.The objective of the study was to compare 3 CVD risk estimation tools in the evaluation of patients presenting to a tertiary hospital in Nigeria.Cross-sectional study involving 295 patients with any CVD risk factors but not taking statins. Traditional CVD risk factors were assessed with a standard questionnaire and laboratory evaluation. Ten-year CVD risk was estimated with American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease (ACC/AHA ASCVD) Risk Estimator (2013), Framingham Risk Score (Framingham Risk Score [FRS] 2008), and the World Health Organisation/International Society of Hypertension (WHO/ISH) risk prediction chart for Africa Region D. Kappa statistic was used to determine agreement among the estimators.The mean age was 48.4 ± 10.4 years; 60.7% were females. Risk factors for CVD were hypertension (56.3%), dyslipidemia (41.4%), diabetes (20%), obesity (28.5%), and cigarette smoking (4.4%). In all, 50.2%, 16.9%, and 15.2% were classified as high risk using the ACC/AHA ASCVD Risk Estimator, FRS 2008, and WHO/ISH risk chart, respectively. The agreement was moderate between FRS and WHO/ISH (Kappa 0.414, P .001) and fair between ACC/AHA Estimator and WHO/ISH (Kappa 0.223, P .001) and between ACC/AHA Estimator and FRS (Kappa 0.301, P .001).The considerable variation in prediction of high risk using the 3 tools may lead to underutilization of evidence-based therapy. This underscores the dire need for the development of risk prediction tools derived from our own Nigerian population.

The global COVID-19 pandemic has created in its wake an urgent need for a clear guide for managing cardiovascular diseases and the complications it causes on the cardiovascular system. In this regard, the Executive Council of the Nigerian Cardiac Society constituted a committee to develop guidelines on management of Coronavirus Disease 2019 (COVID 19) and Cardiovascular Diseases. These guidelines have been written to provide a simple approach to managing cardiovascular diseases among COVID 19 patients in Nigeria. It will also provide information about potential cardiac implications of COVID 19 based on evidence and offer early clinical guidance on the management, given the current uncertainty of COVID 19. We have intended that this brief write up and set of recommendations be useful not only for primary care physicians, residents and medical students, but also for all professionals who work as hands-on practitioners.

Background: Long-term exposure to indoor air pollution from biomass fuel combustion is a risk factor for respiratory disease, which is an increasingly prevalent contributor to morbidity and mortality in low- and middle-income countries. This study evaluated the association between household fuel use and the peak expiratory flow rate (PEFR) of rural-dwelling women in selected communities of the Niger Delta. Methods: This was a cross-sectional study including 321 non-smoking women aged 18 years and older. Questionnaires were used to obtain data on predominant fuel used and a brief medical history. Women with current respiratory symptoms were excluded. Fuel use was classified into three categories: biomass fuels (BMF), such as wood, animal dung and coal, kerosene and liquefied petroleum gas (LPG). The PEFR was measured with an Omron peak flow meter using standard protocols and was abnormal if it was less than 80% of predicted value based on age and height. Results: The mean age of the 321 women was 38.5±14.2 years. The biomass fuel users had significantly lower PEFR (353.9±104.4) compared to kerosene users (376.2±70.1) and LPG users (393.6± 93.3) (p=0.030). The overall prevalence of abnormal PEFR was 22.4%. The PEFR was abnormal in more BMF users (28%) than kerosene users (13.4%) and LPG users (9.4%) (p=0.005). The PEFR of women who used LPG was 20.8 l/min higher than BMF users (p=0.012). The users of BMF were 5.8 times more likely to have abnormal PEFR than LPG users (OR 5.8, 95% CI 1.62, 20.52, p=0.007). Conclusion: In this population, the use of biomass fuel was significantly associated with abnormal PEFR. This needs to be further explored in this population with a larger study using more objective measures, such as spirometry testing, to guide policies for the implementation of preventive strategies to protect vulnerable women from chronic obstructive airway disease.

Background Prevention and optimal management of hypertension in the general population is paramount to the achievement of the World Heart Federation (WHF) goal of reducing premature cardiovascular disease (CVD) mortality by 25% by the year 2025 and widespread access to good quality antihypertensive medicines is a critical component for achieving the goal. Despite research and evidence relating to other medicines such as antimalarials and antibiotics, there is very little known about the quality of generic antihypertensive medicines in low-income and middle-income countries. The aim of this study was to determine the physicochemical equivalence (percentage of active pharmaceutical ingredient, API) of generic antihypertensive medicines available in the retail market of a developing country. Methods An observational design will be adopted, which includes literature search, landscape assessment, collection and analysis of medicine samples. To determine physicochemical equivalence, a multistage sampling process will be used, including (1) identification of the 2 most commonly prescribed classes of antihypertensive medicines prescribed in Nigeria; (2) identification of a random sample of 10 generics from within each of the 2 most commonly prescribed classes; (3) a geographical representative sampling process to identify a random sample of 24 retail outlets in Nigeria; (4) representative sample purchasing, processing to assess the quality of medicines, storage and transport; and (5) assessment of the physical and chemical equivalence of the collected samples compared to the API in the relevant class. In total, 20 samples from each of 24 pharmacies will be tested (total of 480 samples). Discussion Availability of and access to quality antihypertensive medicines globally is therefore a vital strategy needed to achieve the WHF 25×25 targets. However, there is currently a scarcity of knowledge about the quality of antihypertensive medicines available in developing countries. Such information is important for enforcing and for ensuring the quality of antihypertensive medicines.

Cardiovascular disease (CVD) remains a leading cause of mortality and morbidity worldwide. Although mortality rates for CVD have fallen by up to three-quarters in the UK, it still accounts for 26% of all deaths there. It costs the UK economy over £15 billion each year.1 Declining CVD mortality rates increases the number of individuals surviving into old age with CVD, leaving them at increased risk for a subsequent event. For individuals who have not suffered an event, the presence of certain genetic, behavioural and biological factors increases their risk of CVD. At least 80% of CVDs are potentially preventable by the elimination of health risk behaviours through a combination of changes to lifestyle—diet, physical activity, smoking cessation and reduction in the harmful use of alcohol.2 These behaviours are modifiable when evidence-based behavioural models of change are employed.3 Across Europe and other western countries, there are vast improvements in the management of risk conditions like hypertension, diabetes, dyslipidaemia and acute CVD events through medical interventions, devices and pharmacological treatments, but addressing the underlying causes of the disease to prevent further morbidity and mortality is more important. The 2016 European Guidelines on CVD prevention in clinical practice define priorities for CVD prevention in clinical practice, risk assessment and treatment goals.4 Yet gaps still exist in the delivery of such knowledge into daily clinical practice as shown in the most recent European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE IV) survey where there was suboptimal control of risk …

Background: The aim of the study was to identify the spectrum of cardiothoracic and vascular surgical cases in the University of Port Harcourt Teaching Hospital (UPTH) and identify the limitations to service delivery and recommend solutions to improve service delivery to patients. Methods: A cross-sectional study of all the cases seen over a 5-year period at UPTH was analyzed. The data were retrieved from theatre records of both elective and emergency cases. All patients were included except those with closed tube thoracostomy drainage inserted in the accident and emergency theaters and patients who were referred out before they could have surgery. The results were tabulated and described using frequencies and percentages. Results: A total of 93 patients had surgeries in the 5-year period with a mean age of 38.5 years and a range of 3–82 years. Fifty-seven (61.3%) were males, with a male-to-female ratio of 3:2. Fourteen (15.1%) patients were children aged 3–16 years, 67 (72.0%) were adults (17–64 years), and 12 (12.9%) were the elderly (65 years and above). Twenty (21.5%) had surgeries on cardiac structures, 46 (49.5%) had surgeries on thoracic structures, and 27 (29.0%) had different vascular surgeries. For the cardiac structures, 8 (40%) had pericardiectomy and tube pericardiostomy while 12 (60%) had pacemaker insertion. Thoracic surgical procedures included 3 (6.5%) diaphragmatic repairs, 7 (15.2%) esophageal surgeries, 22 (47.8%) pleuropulmonary surgeries, 6 (13.0%) chest wall reconstructions, 5 (10.9%) mediastinal tumor excisions, and 3 (6.5%) other surgeries. The vascular surgeries included 26 (96.3%) peripheral vascular repairs and 1 (3.7%) abdominal aortic aneurysm repairs. Conclusion: There are shortcomings with the practice of cardiothoracic surgeries at the hospital as major procedures like open-heart surgeries are not done despite availability of human expertise. Thus, there is an urgent need for measures to ensure that open-heart surgery commences, in addition to the provision of some surgical equipment and improvement on some surgical techniques. Furthermore, more collaboration with the other team members in the hospital needs to be actively encouraged.

Diabetes mellitus (DM) is a chronic, progressive metabolic disorder with several complications that affect virtually all the systems in the human body. Type 2 DM (T2DM) is a major risk factor for cardiovascular disease (CVD). The management of T2DM is multifactorial, taking into account other major modifiable risk factors, like obesity, physical inactivity, smoking, blood pressure, and dyslipidemia. A multidisciplinary team is essential to maximize the care of individuals with DM. DM self-management education and patient-centered care are the cornerstones of management in addition to effective lifestyle strategies and pharmacotherapy with individualization of glycemic goals. Robust evidence supports the effectiveness of this approach when implemented. Individuals with DM and their family members usually share a common lifestyle that, not only predisposes the non-DM members to developing DM but also, increases their collective risk for CVD. In treating DM, involvement of the entire family, not only improves the care of the DM individual but also, helps to prevent the risk of developing DM in the family members.

Background: Hypertension is associated with left ventricular hypertrophy (LVH). Serum uric acid is often elevated in hypertension. Objective: To assess the relationship between serum uric acid and left ventricular mass and geometry in untreated patients with essential hypertension. Materials and Methods: A cross-sectional study was carried out in 130 newly diagnosed untreated patients with essential hypertension. Sixty-five healthy age- and sex-matched non-hypertensive individuals served as controls for comparison. Left ventricular mass and geometry were evaluated by transthoracic echocardiography. Blood samples were collected for assessing uric acid levels. Results: Hyperuricemia was present in 46.9% and 16.9% of cases and controls, respectively (P Conclusion: These results indicate that serum uric acid is associated with LVH in patients with hypertension especially women even at the time of diagnosis, thus may be a reliable marker of greater cardiovascular risk.

Palm oil consumption and its effects on serum lipid levels and cardiovascular disease in humans is still a subject of debate. Advocacy groups with varying agenda fuel the controversy. This update intends to identify evidence-based evaluations of the influence of palm oil on serum lipid profile and cardiovascular disease. Furthermore, it suggests a direction for future research. The sources of information were based on a PubMed, Google Scholar, African Journal online and Medline search using key words including: palm oil, palmitic acid, saturated fatty acids and heart disease. Published animal and human experiments on the association of palm oil and its constituents on the serum lipid profile and cardiovascular disease were also explored for relevant information. These papers are reviewed and the available evidence is discussed. Most of the information in mainstream literature is targeted at consumers and food companies with a view to discourage the consumption of palm oil. The main argument against the use of palm oil as an edible oil is the fact that it contains palmitic acid, which is a saturated fatty acid and by extrapolation should give rise to elevated total cholesterol and low-density lipoprotein cholesterol levels. However, there are many scientific studies, both in animals and humans that clearly show that palm oil consumption does not give rise to elevated serum cholesterol levels and that palm oil is not atherogenic. Apart from palmitic acid, palm oil consists of oleic and linoleic acids which are monounsaturated and polyunsaturated respectively. Palm oil also consists of vitamins A and E, which are powerful antioxidants. Palm oil has been scientifically shown to protect the heart and blood vessels from plaques and ischemic injuries. Palm oil consumed as a dietary fat as a part of a healthy balanced diet does not have incremental risk for cardiovascular disease. Little or no additional benefit will be obtained by replacing it with other oils rich in mono or polyunsaturated fatty acids.

Sandra N Ofori, Osaretin J OdiaDepartment of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, NigeriaBackground: Hypertension is a major risk factor for cardiovascular mortality, as it acts through its effects on target organs, such as the heart and kidneys. Hyperuricemia increases cardiovascular risk in patients with hypertension.Objective: To assess the relationship between serum uric acid and target organ damage (left ventricular hypertrophy and microalbuminuria) in untreated patients with essential hypertension.Patients and methods: A cross-sectional study was carried out in 130 (85 females, 45 males) newly diagnosed, untreated patients with essential hypertension. Sixty-five healthy age- and sex-matched non-hypertensive individuals served as controls for comparison. Left ventricular hypertrophy was evaluated by cardiac ultrasound scan, and microalbuminuria was assessed in an early morning midstream urine sample by immunoturbidimetry. Blood samples were collected for assessing uric acid levels.Results: Mean serum uric acid was significantly higher among the patients with hypertension (379.7±109.2 µmol/L) than in the controls (296.9±89.8 µmol/L; P

Introduction Cardiovascular disease (CVD) prevalence is increasing in low- and middle-income countries. Total risk assessment is key to prevention. Methods Studies and guidelines published between 1990 and 2013 were sought using Medline database, PubMed, and World Health Organization report sheets. Search terms included ‘risk assessment’ and ‘cardiovascular disease prevention’. Observational studies and randomized controlled trials were reviewed. Results The ideal risk prediction tool is one that is derived from the population in which it is to be applied. Without national population-based cohort studies in sub-Saharan African countries like Nigeria, there is no tool that is used consistently. Regardless of which one is adopted by national guidelines, routine consistent use is advocated by various CVD prevention guidelines. Conclusions In low-resource settings, the consistent use of simple tools like the WHO charts is recommended, as the benefit of a standard approach to screening outweighs the risk of missing an opportunity to prevent CVD.

Background The objective was to compare the improvements in lifestyle and risk factor profiles in patients with and without diabetes mellitus (DM) in the intervention arm of EUROACTION study. Methods This was a retrospective analysis of the intervention arm of EUROACTION trial. Primary outcome was proportions meeting the European targets for not smoking, diet, physical activity (PA), body mass index (BMI), waist circumference (WC), blood pressure (BP), total and low-density lipoprotein (LDL) cholesterol and cardio-protective drug use at one year. Results 179 and 777 coronary patients with and without DM, and 340 and 917 high-risk individuals (HRI) with and without DM, respectively were identified. The proportions of coronary patients achieving the lifestyle targets improved from the initial assessment (IA) except non-smoking, which reduced. At one year, significantly fewer patients with DM attained the targets for BMI (13.2% vs 31.3%, p = 0.002) and BP