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Although prediabetes is associated with increased cardiovascular disease (CVD) risk, it is not often targeted in CVD prevention programs. We sought to evaluate the impact of a tailored prediabetes program to reverse prediabetes and lower CVD risk. Consecutive subjects of the Integrative Cardiac

Tracking medication use and lifestyle counseling to prevent CVD among patients with diabetes mellitus (DM) may identify opportunities to improve care delivery and patient outcomes. Trends in the proportion of visits of patients age ≥ 40 with preventive medication (antiplatelet therapy [aspirin or

Background New cardiovascular disease (CVD) risk factors are being recognized and suggested to be included in CVD risk stratification. High-sensitivity C-reactive protein (hs-CRP) and the metabolic syndrome (MetS) are among these risk factors. However, CVD risk classification may be divergent when using different approaches. Objectives To compare differences in CVD risk estimation using the Framingham risk score (FRS), hs-CRP and the presence of the MetS in a group of 109 postmenopausal women in primary CVD prevention. Methods The FRS and presence of the MetS were determined. CVD risk was evaluated with a cardiovascular point scoring system based on Framingham covariables and hs-CRP values (Women's Health Study [WHS] model). The estimated CVD risks based on hs-CRP levels and the WHS model were compared with the FRS. Results Using the FRS, 99% of women (n=108) were determined to have a low CVD risk. The MetS was identified in 39.4% (n=43) of the women. When hs-CRP was used alone to estimate CVD risk, 37.6% (n=41) of women were classified as being at low, 33.9% (n=37) at moderate and 28.4% (n=31) at high CVD risk. With the WHS model, 83.5% (n=91), 14.7% (n=16) and 1.8% (n=2) of women were classified as being at low, moderate and high CVD risk, respectively. Conclusions A substantial number of postmenopausal women showing evidence of the MetS were not identified by the FRS, even though women with the MetS are at higher risk of CVD. Estimation of risk by hs-CRP is significantly divergent when using conventional hs-CRP cutoff values compared with an integrated use in the WHS model.

The prevalence of chronic disease has increased as individuals with spinal cord injuries (SCIs) experience longer survival. Cardiovascular disease (CVD) is a leading cause of their morbidity and mortality. A necessary component of any CVD prevention is a healthy diet. This can be especially challenging for persons experiencing body composition changes, low resting metabolic rates, functional impairments, and barriers to healthy living; together these comprise an obesogenic environment. This monograph will discuss critical features of a healthy diet and dietary interventions providing risk reduction after SCI. If well designed and appropriately supported, diet can make a significant contribution to CVD prevention.

This article, the second of two on cardiovascular risk estimation, discusses factors that health professionals should consider when communicating the results of a cardiovascular risk assessment to the individual. Risk communication is a two-way process requiring competence and caring in the health professional so that individuals understand and trust the information they receive. The various influences that can affect an individual’s perception of cardiovascular risk are described. The evidence for different approaches to presenting the level of risk is reviewed. People who attend for cardiovascular risk estimation need health professionals to effectively communicate the results so that the most benefit can be achieved through self care by making lifestyle changes, under taking CVD prevention therapies or monitoring.

Cardiovascular disease (CVD) is a leading cause of mortality and is responsible for one-third of all global deaths. Regrettably, surveys of physician’s clinical practice patterns indicate that the recommendations made in the guidelines are sometimes not implemented and the predefined goals of therapy for patients with cardiovascular diseases are not achieved. CVD prevention and management can only be improved through an integrated approach that addresses overall cardiovascular risk and that involve general practitioners as well as specialists.

In Brief People with diabetes are at much higher risk for cardiovascular disease(CVD) than the average population. Evidence-based, prioritized, and strategic management of CVD risk factors among people with diabetes is necessary for the improvement of its burden on disability, morbidity, mortality, and high health care costs. Risk factors for diabetes and CVD are similar, and most can be effectively decreased by lifestyle modification. Medical nutrition therapy and other lifestyle recommendations for CVD prevention and treatment are discussed.

OBJECTIVE Bipolar disorder (BD) is associated with increased rates of cardiovascular disease (CVD). Brain-derived neurotrophic factor (BDNF) and inflammatory markers are leading biomarkers in BD. We examined whether these biomarkers underlie the link between BD and CVD proxies among adolescents with bipolar spectrum disorders. METHODS Subjects were 60 adolescents, 13-19 years old (40 with BD and 20 healthy controls [HCs]). Semistructured interviews determined diagnoses based on DSM-IV. Serum was assayed for BDNF, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). Carotid intima media thickness (cIMT) and flow-mediated dilation were assessed using ultrasound. Procedures were conducted at a subspecialty clinic (January 2011-May 2014). RESULTS Adolescents with BD had significantly greater waist circumference (BD: 81.72 cm [11.67 cm], HC: 75.64 cm [8.63 cm]; U = 547.5, P = .021), body mass index (BMI) (BD: 25.50 kg/m²undefined[5.29 kg/m²], HC: 21.76 kg/m² [3.43 kg/m²]; U = 608.5, P < .0001), pulse pressure (BD: 42.31 mm Hg [10.57 mm Hg], HC: 33.84 mm Hg [6.69 mm Hg]; U = 561.5, P < .001), and IL-6 (BD: 8.93 pg/mL [7.71 pg/mL], HC: 4.96 pg/mL [6.38 pg/mL]; U = 516.0, P < .0001) than HC adolescents. Subjects with BD-I (n = 14) and BD-II (n = 16) had greater IL-6 versus HCs (F₃,₅₁ = 5.29, P = .003). Controlling for BMI and age did not alter these findings. IL-6 was higher in symptomatic (n = 19) and asymptomatic BD (n = 21) versus that found in HCs (F₂,₅₂ = 7.96, P = .001). In symptomatic BD, lower BDNF was associated with greater mean cIMT (ρ = -0.507, P = .037). CONCLUSIONS This study found evidence of increased inflammation among adolescents with BD. While present findings suggest a potential interplay between symptomatic status, biomarkers, and atherosclerosis proxies, there were no significant differences in cIMT or flow-mediated dilation in adolescents with BD compared to HCs. This may indicate that there is potential opportunity for CVD prevention strategies in adolescents with BD.

People with depression history develop cardiovascular diseases at a higher rate than people without depression, suggesting that current CVD prevention guidelines are less effective for this patient group. There are several reasons for this, including that screening for behavioural and biological CVD risk factors is less likely to occur among those with depression; that screening, when it does occur, comes years after depression onset allowing decades for CVD-potentiating lifestyles to become habitual; and that depression-CVD biological mediators (e.g. HPA axis dysregulation) are not a specific focus of attention in either primary care or specialist mental health services. Ways to improve CVD prevention approaches among those with depression are discussed. These include commencing screening earlier in the life (and depressive disorder) course, using integrative and collaborative care approaches developed for SMI to simultaneously address physical and mental health needs in depressed patients and making greater use of psychological treatments that incorporate stress reduction components.

Aims: To determine nurses’ perception of the knowledge and skills needed to deliver cardiovascular disease (CVD) prevention programmes and to describe their continuing professional development (CPD) needs. Design: Two cross-sectional descriptive surveys using two postal questionnaires were conducted with first, past students (n=83) of the ‘Managing Cardiovascular Risk Factors’ course and second, practice nurses (PN) (n=690), taken from a purposeful sample of Scottish health boards. Results: Past students rated knowledge and skills possibly needed to deliver CVD care. Those categorized as ‘advanced clinical’ were rated significantly higher than ‘management’ or ‘nurse development’ (P Conclusions: Nurses perceiving they had a high input into CVD care or who had completed courses on CVD were more likely to seek further higher-level education. This has implications for CVD CPD delivery.

Mainstream preventive interventions often fail to reach poor populations with a high risk of cardiovascular diseases (CVDs) in Pakistan. A community-based CVD primary prevention project aimed at developing approaches to reduce risk factors in such populations was established by Heartfile in collaboration with the National Rural Support Program in the district of Lodhran. The project implemented a range of activities integrated with existing social and health service mechanisms during a three year intervention period 2000/01-03/04. These were targeted in 4 key settings: community health education, mass media interventions, training of health professionals and health education through Lady Health Workers. The project received support from the Department for International Development, UK. At the community level, a pre-test-post-test quasi-experimental design was used for examining project outcomes related to the community component of the intervention. Pre and post-intervention (training) evaluations were conducted involving all health care providers in randomly selected workshops in order to determine baseline levels of knowledge and the impact of training on knowledge level. In order to assess practices of physician and non-physician health care providers patient interviews, with control comparisons were conducted at each health care facility. Significant positive changes were observed in knowledge levels at a community level in the district of intervention compared with baseline knowledge levels particularly in relation to a heart healthy diet, beneficial level of physical activity, the causes of high blood pressure and heart attack and the effects of high blood pressure and active and passive smoking on health. Significant changes in behaviors at a practice level were not shown in the district of intervention. However the project played a critical role in spurring national action for the prevention and control of non-communicable diseases and introducing sustainable public health interventions for poor communities in Pakistan.

Over the past three decades, statins have become first-line treatment for reducing LDL cholesterol (LDL-C) and cardiovascular disease (CVD). They have provided a clear, robust, and reproducible relationship between the absolute LDL-C reduction and the decrease in CVD; every 1 mmol/L (~40 mg/dL) in LDL-C reduction results in a 22 % decrease in CVD events. This relationship has recently been extended to reduction in LDL-C with a non-statin, ezetimibe, on top of statin therapy, further consolidating LDL-C as the cornerstone in CVD risk reduction. Despite these two effective and safe LDL-C-lowering drugs, there remains a need for additional drugs to reduce LDL-C, the focus of this review which covers agents which produce sufficient LDL-C reduction to potentially help address this unmet need and are either recently approved or currently in clinical trials.

Cardiovascular diseases (CVD) are the leading cause of mortality worldwide. It is widely accepted that oxidative stress plays a key role in their development and progression; hence oxidative damage might be abrogated by antioxidants. Polyphenols are phytochemicals showing extensively studied antioxidant properties in-vivo. Most representative sources of these compounds include fruits, greens, nuts, herbs, cocoa, tea and coffee. Epidemiological evidence suggests an association between the consumption of polyphenol-rich vegetables and the reduction of cardiovascular disease prevalence. This fact could be related to the anti-inflammatory, antithrombotic and vasodilatory effects of polyphenols. Even though these biological effects could be mainly attributed to the antioxidant activity of polyphenols, other pharmacological mechanisms should also be considered. The latter could comprise direct anti-inflammatory effects, modulation of intracellular signaling and gene expression, improvement of nitric oxide homeostasis, as well as platelet antiaggregation. However, it is noticeable that protocols of interventions to evaluate the properties of polyphenols have failed to show the same positive results reported from observational studies. At present, a controversy exists regarding the actual effectiveness of polyphenols in preventing cardiovascular diseases. Therefore, an improvement of the available knowledge about polyphenol pharmacokinetics, together with a better understanding of the mechanisms of action of these compounds, could be of great benefit. Thus, a rational support for the development of interventional designs could provide reliable evidence on the actual role of polyphenols in CVD prevention.

Background/Aims: The prevalence of cardiovascular diseases (CVD) is rising and it is the prime cause of death in all developed countries. Bioactive compounds (BACs) can play a role in CVD prevention and treatment. To examine the scientific evidence supporting BACs groups' efficacy in CVD prevention and treatment, we conducted a systematized review. Methods: All available information on Medline, LILACS and EMBASE; all randomized controlled trials (RCTs) with prospective, parallel or crossover designs in humans in which the BACs effect was compared with that of placebo/control. Vascular homeostasis, blood pressure, endothelial function, oxidative stress and inflammatory biomarkers were considered primary outcomes. Results: We selected 26 articles, verifying their quality based on the Scottish Intercollegiate Guidelines Network, establishing diverse quality levels of scientific evidence according to the design and bias risk of a study. Grades of recommendation were included, depending on the evidence strength of antecedents. Conclusions: Evidence shows that certain BACs' derivative from active lipids and nitrogen compounds, mainly from horse chestnut seed extract, sterol plants, allium derivatives, and certain doses of beta-glucans, can be helpful in decreasing the prevalence of CVD risk factors. However, further rigorous evidence is necessary to support and prove BACs' effect on CVD prevention and treatment.

Women age 65 and older without known cardiovascular disease (CVD), women of any age with established CVD, and women of any age with an estimated 10-year risk of CVD ≥10%, are likely to experience a net benefit from preventive low-dose aspirin therapy and should be considered for such therapy unless contraindicated.

Statin treatment is a cornerstone in the prevention of cardiovascular disease, but questions remain regarding its effects in patients with ankylosing spondylitis. Is there enough evidence supporting the use of statins in these patients?

Menopausal hormone therapy has no evidence-based role for the primary or secondary prevention of coronary heart disease. Coronary prevention should involve lifestyle and pharmacologic interventions documented as beneficial in randomized clinical trials and promulgated in national guidelines.

Currently, the nursing profession lacks specialized training, to be a part of preventive cardiovascular healthcare team. The article aims to describe the obstacles Indian nurses face in becoming active and valued members of the cardiovascular healthcare team and to propose solutions. Cardiovascular disease (CVD) imposes substantial and increasing physical, psychological, societal, and financial burdens. More emphasis needs to be placed on preventive measures, which should be made available and affordable in rural as well as urban areas. Nurses are well positioned to be leaders in these initiatives. However, nurses in India face numerous obstacles in providing optimal care, including a significant shortage of trained personnel. Nursing education at advanced levels needs to be standardized and should reflect core competencies. Appropriate use of nursing resources in CVD prevention can allow physicians to treat the sickest patients, reduce cost of care, and help relieve the human burden of morbidity and mortality due to CVD.

Objective CVD are the leading causes of death and disability in the world. Since there are no published data about the knowledge of CVD risk factors among Croatian older adults, this was the primary aim of this study. Another aim was to determine relationship between actual CVD risk (total cholesterol – TC and triglyceride levels – TG, blood pressure – BP, body mass index – BMI, smoking) and self-assessed CVD risk among older adults. Methods We used a cross-sectional epidemiological study in which participants (969 subjects aged >70 years) answered a written questionnaire. Participants’ BMI, BP, TC and triglycerides were measured. Results The actual presence of CVD risk factors in participants did not appear to alter their perceptions of risk compared to participants without CVD risk factors (the percentage of participants who think that they have moderate/high CVD risk is almost the same: 75.5% among participants with actual CVD risk factors; 75.7% among those without CVD risk factors). Accordingly, 24.5% of participants with actual CVD risk factors failed to recognize that risk. Only 23.4% of participants correctly recognized BP target values, while 49.8% participants successfully recognized TC target levels. The knowledge of target BP and/or TC levels did not influence participants’ ability to assess their own CVD risk. Surprisingly, 41.8% of participants reported that they have not discussed CVD risk factors with their physicians. Conclusion The results suggest insufficient awareness of CVD risk factors among Croatian older adults and a need for improved promotion of CVD prevention in this population segment.

Cardiovascular disease (CVD) is the leading cause of death and disability in most Western industrialized countries including the U.S., cutting across all ethnic, racial, and gender groups. Despite the tremendous body of research to support the efficacy and cost-effectiveness of CVD prevention

Objectives: To investigate the association between low birthweight (LBW

In 2011, the Nebraska DHHS implemented a near-real—time inpatient (IP) surveillance system, to enhance the surveillance of Cardiovascular Disease (CVD). An IP database was created in ESSENCE and algorithms were defined for myocardial infarction (MI) and for the detection of 5 risk factors for CVD. The number of monthly MIs was tracked and the frequency of each risk factor analyzed. Results of this study demonstrate the applicability of ESSENCE for near-real-time monitoring of risk factors and CVD events. Such timely detection holds potential to enhance prospective monitoring of CVD trends in populations and impact efforts towards CVD prevention.

is probably the most prevalent risk factor in cardiac ICU patients [11]. This led to more intensive treatment regimens aiming to approach nearnormal glycemia. As mentioned above, these studies failed to demonstrate CVD prevention, and in one case even found a harmful effect [2–4]. Interestingly, similar findings were found in nondiabetic hyperglycemic patients in the setting of ICUs. Hyperglycemia in this situation is also related to worse outcomes [12]. Studies conducted to correct the hyper glycemia in the ICU showed improved outcome [13,14]. When the glucose target was lowered to a ‘normal’ level, however, increased mortality was recently reported [15].

Health literacy has been called the first public health movement of the 21st century. Practical health literacy for chronic disease prevention and management currently involves a variety of domains centered on communication and empowerment. Understanding who may be at risk and identifying a variety of strategies for outreach programs focused on CVD prevention and self-management can help at-risk clients obtain full program benefits. A discussion of CVD health literacy resources is included.

Cardiovascular diseases (CVD) shorten average human life for 10 years. In total mortality rate they occupy the top of the list. According to the researches during the last decade, number of patients with CVD will continue to increase mainly due to obesity raise and increase in number of patients suffering from diabetes mellitus. At the same time in CVD prevention presence of all risk factors is taken into consideration since they potentiate one another and significantly increase risk for CV event. Population and high-risk preventive strategies should be complementary; an approach limited to high-risk persons will be less effective; population education programs are still needed. In both strategies, the goal is reduction of risk for occurrence of fatal CVD event. If the goal cannot be reached by reduction of one risk factor, risk for fatal CVD can be reduced by acting upon other risk factors more intensively. We should always consider modification of lifestyle since there is no adequate CVD prevention without it regardless application of various medicines.

Cardiovascular disease (CVD) is the leading cause of mortality in men and women. An estimated 83.6 million American adults (>1 in 3) have one or more types of cardiovascular diseases. In 2010, an estimated 7.6 million inpatient cardiovascular operations and procedures were performed in the United States; 4.4 million were performed on men, and 3.2 million were performed on women [1]. In clinical trials on cardiovascular diseases, women are generally under-represented, raising potential concerns for bias. In clinical trials used to support 2007 American Heart Association (AHA) guidelines for CVD prevention in women, women represented only one third of patients despite similar prevalence of disease in men and women. Only 31 % of primary trial publications specifically reported results in women. Representation of women was lowest among trials for heart failure (29 %) and CAD (25 %) [2].

Background: Non-communicable Disease (NCD) is increasingly burdening developing countries including Indonesia. However only a few intervention studies on NCD control in developing countries are reported. This study aims to report experiences from the development of a community-based pilot intervention to prevent cardiovascular disease (CVD), as initial part of a future extended PRORIVA program (Program to Reduce Cardiovascular Disease Risk Factors in Yogyakarta, Indonesia) in an urban area within Jogjakarta, Indonesia. Methods: The study is quasi-experimental and based on a mixed design involving both quantitative and qualitative methods. Four communities were selected as intervention areas and one community was selected as a referent area. A community-empowerment approach was utilized to motivate community to develop health promotion activities. Data on knowledge and attitudes with regard to CVD risk factors, smoking, physical inactivity, and fruit and vegetable were collected using the WHO STEPwise questionnaire. 980 people in the intervention areas and 151 people in the referent area participated in the pre-test. In the post-test 883 respondents were re-measured from the intervention areas and 144 respondents from the referent area. The qualitative data were collected using written meeting records (80), facilitator reports (5), free-listing (112) and in-depth interviews (4). Those data were analysed to contribute a deeper understanding of how the population perceived the intervention. Results: Frequency and participation rates of activities were higher in the low socioeconomic status (SES) communities than in the high SES communities (40 and 13 activities respectively). The proportion of having high knowledge increased significantly from 56% to 70% among men in the intervention communities. The qualitative study shows that respondents thought PRORIVA improved their awareness of CVD and encouraged them to experiment healthier behaviours. PRORIVA was perceived as a useful program and was expected for the continuation. Citizens of low SES communities thought PRORIVA was a “cheerful” program. Conclusion: A community-empowerment approach can encourage community participation which in turn may improve the citizen’s knowledge of the danger impact of CVD. Thus, a bottom-up approach may improve citizens’ acceptance of a program, and be a feasible way to prevent and control CVD in urban communities within a low income country. Previously included in thesis in manuscript form.

Background Ethnic minority groups have higher prevalence of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). We assessed general practitioners’ (GPs’) performance with respect to the pharmacological prevention of CVD in patients with T2DM from different ethnic backgrounds in Oslo. Methods Of 1653 T2DM patients cared for by 49 GPs in 2005, 380 had a diagnosis of CVD. Ethnicity was categorized as Norwegian, South Asian and other. Risk factor levels, medication use, achievement of treatment targets (HbA1c ≤ 7.5%, systolic blood pressure (SBP) ≤ 140 mmHg, total cholesterol/HDL-cholesterol < 4) and therapeutic intensity (number of drugs targeting each risk factor) were recorded. Chi-square, Wald tests and multiple linear regression analyses were used. Results Of the 1273 patients receiving primary prevention, 1.5% had their Hb1Ac, 4.8% SBP and 12.7% lipids levels above treatment thresholds without relevant prescriptions. Among patients on pharmacological therapy, 66% reached the HbA1c, 62% SBP and 62% lipid target. Proportions not achieving the HbA1c target were 26% in Norwegians, 38% in South Asians and 29% in others (p = 0.008). Proportions not achieving the SBP target were 42% in Norwegians, 22% in South Asians and 25% in others (p ≤ 0.001). Of those not achieving the HbA1c and SBP targets, 43% and 35% respectively, used only one agent. In secondary prevention, 0.8% of the patients had their HbA1c, 0.5% SBP and 7.4% lipid levels above treatment thresholds without relevant prescriptions. Among patients on pharmacological therapy, 65% reached the HbA1c, 64% SBP and 66% lipid target. Proportions not achieving the HbA1c target were 26% in Norwegians, 47% in South Asians and 40% in others (p = 0.03). Proportions not achieving the SBP target were 36% in Norwegians, 22% in South Asians and 56% in others (p = 0.050). Of those not achieving HbA1c and SBP targets, 49% and 21% respectively, were on mono-therapy. Conclusions Norwegian GPs comply reasonably well with guidelines for pharmacological prevention of CVD in T2DM patients across ethnic groups. However, lipid-lowering therapy was generally underused, and the achievement of treatment targets for HbA1c in ethnic minorities and for BP in Norwegians could be improved.

Introduction Many studies report that women suffering from preeclampsia have an increased risk of developing hypertension and cardiovascular disease (CVD) later in life. However, due to incomplete understanding of the preeclampsia CVD association, no single CVD prevention strategy is recommended for previously preeclamptic women. Should all women be informed and thereby be classified as at risk? Or should the recommendations be more selective or await more evidence? How are the existing evidence interpreted internationally and which clinical recommendations do different national guidelines offer previously preeclamptic women today? Objectives This study aims to compare the clinical recommendations of different national guidelines on prevention of later in life hypertension and CVD in previously preeclamptic women. Methods Guidelines developed by the National Associations of Gynecologists and Obstetricians in eight different countries were compared. Results The definition of preeclampsia and especially severe preeclampsia differ between the countries. Two of the guidelines only recommend informing the woman and their general practitioner about the risk of hypertension later in life. On the contrary, the remaining six guidelines recommend informing about the increased CVD risk later in life. At the same time, these six guidelines also recommend encouraging previously preeclamptic women to pursue a healthy lifestyle. The recommendations vary substantially from no follow-up to follow-up at the postpartum period or at the age of 50. Additionally, recommendations regarding the content and frequency of follow-up also show great variations. Conclusion The definition of preeclampsia differs between countries making CVD prevention strategies difficult to compare. Furthermore, clinical recommendations of the eight examined national guidelines show substantial variation and these will be presented at the conference. This variation clearly reflects lack of evidence, but also stress the need of international debate on post-preeclampsia CVD prevention strategy.

Summary Objective Type-2 diabetes is mainly the metabolic defect involving multiple organs. To conclude their intricate relationships, the term ‘ominous octet’ had been proposed to denote this phenomenon. In this study, we enrolled older men without any medications for MetS components to further elucidate the relationships between normoglycaemic state and MetS. Methods We enrolled male subjects with FPG less than 100 mg/dl and aged 65 and older undergoing routine health check-ups in Taiwan. After excluding subjects taking medications that might affect the components of MetS, a total of 6679 men were eligible for the analysis. Study subjects were further grouped into FPG tertiles ( 95 mg/dl for tertil 1, tertil 2 and tertil 3, respectively). Results There was a significant trend between the FPG and percentages of subjects having MetS (p = 0.009). The relationships between the MetS components were higher in FPG 2 and FPG 3 than FPG 1. In simple correlation, all of the MetS and LDL-C were positively correlated with FPG level and multiple regression further confirmed the same result except for HDL-C that became non-significant. Subjects in FPG3 had significantly higher ORs (ORs = 1.19) for having MetS than those in FPG1. Conclusions In conclusion, higher FPG still had higher risk of having MetS in normoglycaemic range in elderly male. More strict FPG level control may be valuable in CVD prevention and warrants further investigations.

Do guidelines on the prevention of cardiovascular disease (CVD) improve the efficacy of preventive strategies in clinical practice? This question is relevant because, despite many efforts to improve the quality of preventive cardiology, results from surveys in different countries continue to show that many subjects receive no or inappropriate preventive care. Different approaches have been proposed and used in the past decades to improve preventive cardiology in clinical practice, such as

Cardiovascular disease (CVD) is a commonly recognized umbrella term encompassing conditions, disease or disorders of the heart and/or blood vessels that may result in impairment of optimal cardiovascular functioning. CVD is the leading cause of morbidity and mortality in the United States, as well as in both developed and developing nations. Although the risk for CVD in the United States may vary according to and fluctuate within certain demographic, educational, behavioral and socio-economic characteristics, disparities in CVD prevention and treatment continue to ensue, particularly within minority populations. This gap in CVD disparity is further increased in regard to African American women living in rural southern communities. Demographic, socioeconomic and neighborhood characteristics are suggested to converge within rural African American communities to additively influence CVD risk.

The majority of Western countries have reported large falls in cardiovascular diseases (CVD) mortality rates since the 1970s. Yet since the 1980s, they have also experienced two-fold or three-fold increases in the prevalence of obesity and type 2 diabetes - both considered substantial risk factors for CVD. So why have these increasing risks apparently not impacted on CVD mortality falls? This viewpoint outlines the main factors involved; examines recent trends and apparent contradictions; offers some explanations for the trends; discusses how more usefully complex epidemiological models might lead to clearer evidence; offers some explanations for the trends; and explores the implications for CVD prevention.

I appreciate the comments by Dr. Babu and colleagues regarding my paper [(1)][1] with respect to the importance of lifestyle factors in general and specifically the role of physical activity in the prevention of atherosclerotic cardiovascular disease (CVD). In CVD prevention, there are several

Objective To examine US physicians' self-reported knowledge about the Polypill, factors considered in deciding whether to prescribe it, and acceptance of prescribing it for cardiovascular disease (CVD) prevention. Methods Numerical scales of 0 (lowest) to 5 (highest) were used to assess self-reported knowledge and importance of factors relevant to making a decision to prescribe a Polypill. Characteristics of physicians indicating they would prescribe a Polypill were compared. Results Among 952 physicians surveyed February through March 2010, mean self-rated knowledge about the Polypill was 2.0 ± 1.5. Importance of degree of CVD event reduction, cost, and side effects were rated with means of 4.4, 4.3, and 4.3, respectively. 83% of respondents indicated they would “definitely” or “probably” prescribe it for high-risk patients; 62% would do so for moderate risk patients. Physicians with self-rated knowledge at ≥ 75th percentile were more likely to indicate they would prescribe a Polypill for moderate risk (adjusted OR 2.16; 95% CI 1.60–2.93) and high-risk (adjusted OR 1.57; 95% CI 1.07–2.32) patients. Conclusion Among this sample of physicians, there is relatively high acceptance of prescribing a Polypill for CVD prevention despite relatively modest knowledge about it.

Healthcare systems throughout the world are under increasing pressure to control and minimise costs. The substitution of initially-prescribed drugs with cheaper equivalents is an obvious option which presents a rapid and visible means to reduce these costs. Whether the substitution improves patient and/or population outcomes must be appraised and this paper highlights the conditions under which therapeutic substitution may require additional thought and consideration.In this paper, some of the medical evidence and the regulatory environment for and against the three types of therapeutic substitution - generic, within-class and between-class - are discussed. This article is not an exhaustive review of the literature, but captures some of the key clinical, pharmacological, economic, policy and ethical issues regarding generic and therapeutic substitution. Search criteria of the most commonly used terms, i.e. therapeutic substitution, switching, interchange, and bioequivalence, were applied to Embase, PubMed and Google Scholar to identify relevant publications.Although population studies support therapeutic substitution in principle, there is evidence that substitution may not always result in therapeutic equivalence in individual patients, with the consequent potential for greater risks of decreased efficacy and/or increased safety concerns. Factors such as patient choice and therapeutic equivalence also play an important role in the effectiveness of the treatment and overall management of the patient. The pan-European regulatory environment provides another contradiction, encouraging widespread cost containment through reduction in drug acquisition costs, while simultaneously promoting an increased role for patients in defining and managing their own treatment.There is a strong rationale for careful management in some patients with cardiovascular disease. Treatment decisions should be transparent and based on strong clinical evidence. If not, drug substitution on economic grounds alone cannot be considered to be in the individual patient's interest and is therefore unethical.

Objective Since there are almost no data about the perceptions and attitudes of the general public concerning risk factors for cardiovascular diseases (CVD) this survey was performed. Method Face-to-face interviews were conducted based upon a questionnaire with 883 members of the general population from different parts of Croatia in October–November 2008. Results 36.1% of them correctly identified CVD as the leading cause of death but the most feared disease was cancer (40.0%). CVD was on the second place with only 21.6%. 30.9% was aware that elevated LDL-cholesterol increases CVD risk but 49.0% knew that high HDL-cholesterol is beneficial. 43.3% knew their total cholesterol (TC) value and 74.4% knew their blood pressure (BP). 30.9% knew what their target TC should be and 33.9% knew what their target BP should be. The knowledge about TC and BP target values was positively associated with higher educational level. 53.2% of the general public reported that they have never discussed any CVD risk factor with their physician. Conclusion These data suggest insufficient awareness of CVD risk factors in general population and a need for improved promotion of CVD prevention. To achieve this people and physicians should be motivated by the health authorities and/or insurance companies.

The implementation of the guidelines is crucial so thta they could really be transformed into the everyday clinical practice.