Displaying publications 1 - 20 of 562 in total

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  1. Taher M, Mohamed Amiroudine MZ, Tengku Zakaria TM, Susanti D, Ichwan SJ, Kaderi MA, et al.
    PMID: 25873982 DOI: 10.1155/2015/740238
    Obesity has been often associated with the occurrence of cardiovascular diseases, type 2 diabetes, and cancer. The development of obesity is also accompanied by significant differentiation of preadipocytes into adipocytes. In this study, we investigated the activity of α-mangostin, a major xanthone component isolated from the stem bark of G. malaccensis, on glucose uptake and adipocyte differentiation of 3T3-L1 cells focusing on PPARγ, GLUT4, and leptin expressions. α-Mangostin was found to inhibit cytoplasmic lipid accumulation and adipogenic differentiation. Cells treated with 50 μM of α-mangostin reduced intracellular fat accumulation dose-dependently up to 44.4% relative to MDI-treated cells. Analyses of 2-deoxy-D-[(3)H] glucose uptake activity showed that α-mangostin significantly improved the glucose uptake (P < 0.05) with highest activity found at 25 μM. In addition, α-mangostin increased the amount of free fatty acids (FFA) released. The highest glycerol release level was observed at 50 μM of α-mangostin. qRT-PCR analysis showed reduced lipid accumulation via inhibition of PPARγ gene expression. Induction of glucose uptake and free fatty acid release by α-mangostin were accompanied by increasing mRNA expression of GLUT4 and leptin. These evidences propose that α-mangostin might be possible candidate for the effective management of obesity in future.
    Matched MeSH terms: Cardiovascular Diseases
  2. Mohd Bukhari DA, Siddiqui MJ, Shamsudin SH, Rahman MM, So'ad SZM
    J Pharm Bioallied Sci, 2017 Jul-Sep;9(3):164-170.
    PMID: 28979070 DOI: 10.4103/jpbs.JPBS_35_17
    Diabetes is a common metabolic disease indicated by unusually high plasma glucose level that can lead to major complications such as diabetic neuropathy, retinopathy, and cardiovascular diseases. One of the effective therapeutic managements of the disease is to reduce postprandial hyperglycemia through inhibition of α-glucosidase, a carbohydrate-hydrolyzing enzyme to retard overall glucose absorption. In recent years, a plenty of research works have been conducted looking for novel and effective α-glucosidase inhibitors (AGIs) from natural sources as alternatives for the synthetic AGI due to their unpleasant side effects. Plants and herbs are rich with secondary metabolites that have massive pharmaceutical potential. Besides, studies showed that phytochemicals such as flavonoids, alkaloids, terpenoids, anthocyanins, glycosides, and phenolic compounds possess significant inhibitory activity against α-glucosidase enzyme. Malaysia is a tropical country that is rich with medicinal herbs. In this review, we focus on eight Malaysian plants with the potential as AGI to develop a potential functional food or lead compounds against diabetes.
    Matched MeSH terms: Cardiovascular Diseases
  3. Sin Teh S, Ong ASH, Choo YM, Mah SH
    J Oleo Sci, 2018;67(6):697-706.
    PMID: 29863090 DOI: 10.5650/jos.ess18009
    Saturated fats are commonly claimed to raise human blood cholesterols and contribute to cardiovascular disease. Previous literature data were highlighted that although palm oil is 50% saturated, it does not behave like a saturated fat. Human trials were conducted to compare the effects on serum cholesterol levels given by palm olein and monounsaturated oils. It was postulated that saturation/unsaturation of the fatty acids situated at sn-2 positions of triglycerides in the fat molecules determine the induced blood lipid levels but not the overall saturation of oils. The results showed that the lipid parameters (LDL and HDL) effects induced by these oils are similar with no significant differences. This study provides concrete evidence that the unsaturation levels of these oils at sn-2 position of TG are similar (90-100%) which are claimed to be responsible for the lipid parameters. In conclusion, the public negative perception on believing that the overall saturation of oils is detrimental to health should be corrected because in fact the unsaturation at sn-2 positions of the saturated vegetable fat such as palm olein and cocoa butter make them behave like mono-unsaturated oils, unlike saturated animal fats that possess a high content of saturated fatty acids at sn-2 position.
    Matched MeSH terms: Cardiovascular Diseases/etiology
  4. Ishak A, Mohd Yusoff SS, Wan Abdullah W
    Malays Fam Physician, 2018;13(3):44-46.
    PMID: 30800235 MyJurnal
    A 26-year-old woman with an unknown medical illness presented with yellowish skin lesions around both eyes, visible for the past 4 years. The lesions were neither itchy nor tender and had increased gradually in size. She had neither constitutional nor hyperthyroidism symptoms. She is the youngest out of four siblings, and none of her family members have cardiovascular disease or similar problems. Upon examination, there were bilateral yellowish plaques over the periorbital region. Her body mass index (BMI) was 23.8 kg/m2. Her vital signs were all normal at every visit.
    Matched MeSH terms: Cardiovascular Diseases
  5. Teng S, Khong KW, Pahlevan Sharif S, Ahmed A
    JMIR Public Health Surveill, 2020 10 01;6(4):e19618.
    PMID: 33001036 DOI: 10.2196/19618
    BACKGROUND: Poor nutrition and food selection lead to health issues such as obesity, cardiovascular disease, diabetes, and cancer. This study of YouTube comments aims to uncover patterns of food choices and the factors driving them, in addition to exploring the sentiments of healthy eating in networked communities.

    OBJECTIVE: The objectives of the study are to explore the determinants, motives, and barriers to healthy eating behaviors in online communities and provide insight into YouTube video commenters' perceptions and sentiments of healthy eating through text mining techniques.

    METHODS: This paper applied text mining techniques to identify and categorize meaningful healthy eating determinants. These determinants were then incorporated into hypothetically defined constructs that reflect their thematic and sentimental nature in order to test our proposed model using a variance-based structural equation modeling procedure.

    RESULTS: With a dataset of 4654 comments extracted from YouTube videos in the context of Malaysia, we apply a text mining method to analyze the perceptions and behavior of healthy eating. There were 10 clusters identified with regard to food ingredients, food price, food choice, food portion, well-being, cooking, and culture in the concept of healthy eating. The structural equation modeling results show that clusters are positively associated with healthy eating with all P values less than .001, indicating a statistical significance of the study results. People hold complex and multifaceted beliefs about healthy eating in the context of YouTube videos. Fruits and vegetables are the epitome of healthy foods. Despite having a favorable perception of healthy eating, people may not purchase commonly recognized healthy food if it has a premium price. People associate healthy eating with weight concerns. Food taste, variety, and availability are identified as reasons why Malaysians cannot act on eating healthily.

    CONCLUSIONS: This study offers significant value to the existing literature of health-related studies by investigating the rich and diverse social media data gleaned from YouTube. This research integrated text mining analytics with predictive modeling techniques to identify thematic constructs and analyze the sentiments of healthy eating.

    Matched MeSH terms: Cardiovascular Diseases
  6. Rajadurai J, Lopez EA, Rahajoe AU, Goh PP, Uboldejpracharak Y, Zambahari R
    Nat Rev Cardiol, 2012 Aug;9(8):464-77.
    PMID: 22525668 DOI: 10.1038/nrcardio.2012.59
    Cardiovascular disease (CVD) is an under-recognized major health problem among women in South-East Asia. The prevalence of cardiovascular risk factors such as hypertension, diabetes mellitus, dyslipidemia, physical inactivity, and being overweight or obese has shown a significantly increasing trend among women in the region, with the exception of Singapore. The problem is compounded by low awareness that CVD is a health problem for women as well as for men, by misconceptions about the disease, and by the lack of suitable, locally available health literature. Efforts have been made by the national heart associations and other organizations to increase heart health awareness and promote healthy lifestyles. Singapore initiated these prevention programs in the early 1990s and has been successful in reducing the prevalence of cardiovascular risk factors. The governments of the region, in accordance with the Noncommunicable Disease Alliance, have begun implementing appropriate preventive strategies and improving health-delivery systems. However, psychological, social, and cultural barriers to cardiovascular health awareness in women need to be addressed before these programs can be fully and successfully implemented.
    Matched MeSH terms: Cardiovascular Diseases/epidemiology*; Cardiovascular Diseases/psychology
  7. Jan Mohamed HJ, Mitra AK, Zainuddin LR, Leng SK, Wan Muda WM
    Women Health, 2013;53(4):335-48.
    PMID: 23751089 DOI: 10.1080/03630242.2013.788120
    Metabolic syndrome has been associated with an increased risk of cardiovascular disease and diabetes mellitus. The objective of this study was to determine gender differences in the prevalence and factors associated with metabolic syndrome in a rural Malay population. This cross-sectional study, conducted in Bachok, Kelantan, involved 306 respondents aged 18 to 70 years. The survey used a structured questionnaire to collect information on demographics, lifestyle, and medical history. Anthropometric measurements, such as weight, height, body mass index, waist and hip circumference, and blood pressure were measured. Venous blood samples were taken by a doctor or nurses and analyzed for lipid profile and fasting glucose. The overall prevalence of metabolic syndrome was 37.5% and was higher among females (42.9%). Being unemployed or a housewife and being of older age were independently associated with metabolic syndrome in a multivariate analysis. Weight management and preventive community-based programs involving housewives, the unemployed, and adults of poor education must be reinforced to prevent and manage metabolic syndrome effectively in adults.
    Matched MeSH terms: Cardiovascular Diseases/complications; Cardiovascular Diseases/etiology; Cardiovascular Diseases/epidemiology
  8. Zaini A
    Diabetes Res Clin Pract, 2000 Oct;50 Suppl 2:S23-8.
    PMID: 11024580 DOI: 10.1016/S0168-8227(00)00175-3
    Population studies all over the world have clearly showed that the prevalence of Type 2 diabetes mellitus (DM) is escalating at phenomenal scale and very likely we are heading towards epidemic proportions. In 1985, the estimated population of diabetic individuals in the world was 30 million but by 1995 this figure soared to 135 million. Based on current trends, epidemiologists predict that the population of diabetic individuals will swell up to a staggering 300 million by the year 2025. Almost half of that will be in the Asia Oceania region alone. Dr Hilary King of WHO pointed out that there will be a projected rise of about 42% in developed countries whereas the developing countries will see an escalation to the magnitude of 170% (H. King, R.E. Aubert, W.H. Herman, Global burden of diabetes, 1995-2025: prevalence, numerical estimates and projections, Diabetes Care 21 (1998) 1414-1431; WHO Health Report 1997, WHO Switzerland). There will be a 3-fold rise of the disease in Asia and much of these will be seen in China (40 million) and India (55 million) by virtue of the massive population of these countries. Nevertheless, the other rapidly developing Asian nations like Singapore, Malaysia, Thailand and those making up Indochina will experience the surge. At the same time the prevalence and incidence of diabetes complications will also increase. Based on recent WHO prediction (WHO Newsletter, The global burden of diabetes 1995-2025. World Diabetes 3 (1997) 5-6), it is estimated that by the year 2000 the following figures will be seen:Diabetes complications are major causes of premature death all over the world and most of these are avoidable. DCCT and UKPDS are landmark studies showing strong evidence that major complications can be drastically reduced by maintaining to near normoglycaemic control.
    Matched MeSH terms: Cardiovascular Diseases/epidemiology
  9. Ong HT
    J Fam Pract, 2007 Sep;56(9):727-34.
    PMID: 17764644
    Matched MeSH terms: Cardiovascular Diseases/prevention & control*
  10. Cheong AT, Khoo EM, Liew SM, Chinna K
    PLoS One, 2018;13(8):e0201931.
    PMID: 30092064 DOI: 10.1371/journal.pone.0201931
    BACKGROUND: There is a need to improve public's participation in health checks for early identification of individuals at high risk of CVD for prevention. The objective of this study is to identify significant determinants associated with individuals' intention to undergo CVD health checks. These determinants could be used to develop effective strategies to improve CVD health check participation.

    METHODS: This was a cross sectional survey using mall intercept interviews. It was carried out in a hypermarket surrounded by housing estates with a population of varying socioeconomic backgrounds. Inclusion criteria were Malaysian nationality and age 30 years and older. The validated CVD health check questionnaire was used to assess participants' intention and the determinants that influenced their intention to undergo CVD health checks.

    RESULTS: A total of 413 participants were recruited. The median age of the participants was 45 years (IQR 17 years) and 60% of them were female. Participants indicated they were likely (45.0%) or very likely (38.7%) to undergo CVD health checks while 16.2% were not sure, unlikely or very unlikely to undergo health checks. Using ordinal regression analysis, perception of benefits, drawbacks of CVD health checks, perception of external barriers and readiness to handle outcomes following CVD health checks were the significant determinants of individuals' intention to undergo CVD health checks.

    CONCLUSIONS: To improve individuals' participation in CVD health checks, we need to develop strategies to address their perception of benefits and drawbacks of CVD health checks, the perceived external barriers and their readiness to handle outcomes following CVD health checks.

    Matched MeSH terms: Cardiovascular Diseases/diagnosis*
  11. Ahmad Zamri L, Appannah G, Zahari Sham SY, Mansor F, Ambak R, Mohd Nor NS, et al.
    J Obes, 2020;2020:3198326.
    PMID: 32399286 DOI: 10.1155/2020/3198326
    Objectives: To examine the association of weight loss magnitude with changes in cardiometabolic risk markers in overweight and obese women from low socioeconomic areas engaged in a lifestyle intervention.

    Methods: Analyses were performed on 243 women (mean body mass index 31.27 ± 4.14 kg/m2) who completed a 12-month lifestyle intervention in low socioeconomic communities in Klang Valley, Malaysia. Analysis of covariance (ANCOVA) was used to compare changes of cardiometabolic risk factors across weight change categories (2% gain, ±2% maintain, >2 to <5% loss, and 5 to 20% loss) within intervention and control group.

    Results: A graded association for changes in waist circumference, fasting insulin, and total cholesterol (p=0.002, for all variables) across the weight change categories were observed within the intervention group at six months postintervention. Participants who lost 5 to 20% of weight had the greatest improvements in those risk markers (-5.67 cm CI: -7.98 to -3.36, -4.27 μU/mL CI: -7.35, -1.19, and -0.59 mmol/L CI: -.99, -0.19, respectively) compared to those who did not. Those who lost >2% to <5% weight reduced more waist circumference (-4.24 cm CI: -5.44 to -3.04) and fasting insulin (-0.36 μU/mL CI: -1.95 to 1.24) than those who maintained or gained weight. No significant association was detected in changes of risk markers across the weight change categories within the control group except for waist circumference and adiponectin.

    Conclusion: Weight loss of >2 to <5% obtained through lifestyle intervention may represent a reasonable initial weight loss target for women in the low socioeconomic community as it led to improvements in selected risk markers, particularly of diabetes risk.

    Matched MeSH terms: Cardiovascular Diseases/etiology; Cardiovascular Diseases/prevention & control*
  12. Saffian SM, Duffull SB, Wright D
    Clin. Pharmacol. Ther., 2017 Aug;102(2):297-304.
    PMID: 28160278 DOI: 10.1002/cpt.649
    There is preliminary evidence to suggest that some published warfarin dosing algorithms produce biased maintenance dose predictions in patients who require higher than average doses. We conducted a meta-analysis of warfarin dosing algorithms to determine if there exists a systematic under- or overprediction of dose requirements for patients requiring ≥7 mg/day across published algorithms. Medline and Embase databases were searched up to September 2015. We quantified the proportion of over- and underpredicted doses in patients whose observed maintenance dose was ≥7 mg/day. The meta-analysis included 47 evaluations of 22 different warfarin dosing algorithms from 16 studies. The meta-analysis included data from 1,492 patients who required warfarin doses of ≥7 mg/day. All 22 algorithms were found to underpredict warfarin dosing requirements in patients who required ≥7 mg/day by an average of 2.3 mg/day with a pooled estimate of underpredicted doses of 92.3% (95% confidence interval 90.3-94.1, I(2) = 24%).
    Matched MeSH terms: Cardiovascular Diseases/diagnosis; Cardiovascular Diseases/drug therapy*
  13. Yang L, Guo Z, Qi S, Fang T, Zhu H, Santos HO, et al.
    Complement Ther Med, 2020 Aug;52:102505.
    PMID: 32951753 DOI: 10.1016/j.ctim.2020.102505
    BACKGROUND & OBJECTIVE: Walnut intake is considered a healthy dietary approach worldwide, particularly as a nutritional tool for the management of obesity and cardiometabolic disorders. Among these lines, leptin and adiponectin, as well as glycemic biomarkers, deserve further attention. We aimed to examine the impact of walnut intake on circulation levels of leptin and adiponectin through a systematic review and meta-analysis of randomized clinical trials (RCTs); secondarily, assessing the glycemic profile as well.

    METHODS: The literature search was implemented in four following databases: Web of Science, Scopus, PubMed/Medline, and Google Scholar, thus, determining studies that measured the effects of walnut consumption on adiponectin, leptin, and glycemic biomarkers levels from 2004 up to December 2019.

    RESULTS: Fourteen trials were include in the meta-analysis, with an intervention period ranging from 5 weeks to 12 months.Walnut intake increased leptin (weighted mean difference (WMD): 2.502 ng/mL; 95 % CI: 2.147-2.856, p 

    Matched MeSH terms: Cardiovascular Diseases
  14. Aye M, Sazali M
    Singapore Med J, 2012 Aug;53(8):545-50.
    PMID: 22941134
    INTRODUCTION: Metabolic syndrome (MS) is a cluster of risk factors that increases the risk of cardiovascular disease and type 2 diabetes mellitus (DM). Waist circumference (WC), a surrogate indicator of abdominal fat mass, is used to measure central obesity associated with increased risk of hypertension, insulin resistance and type 2 DM, whereas body mass index (BMI) is traditionally used to measure somatic obesity. This study aimed to identify the WC and BMI cut-off points to predict the metabolic risk factors for MS and to determine which is a better predictor.
    METHODS: This was a cross-sectional study conducted over a period of six months. The study involved 355 subjects aged 13-91 years. Youden's index was used to identify the optimal cut-off points.
    RESULTS: The optimal cut-off point of WC to predict individual metabolic risk in females was 84.5-91.0 cm. The BMI cut-off point to predict hypertension and raised fasting blood sugar was 23.7 kg/m², and that for low level high-density lipoprotein cholesterol was 22.9 kg/m². For males, the corresponding cut-off points were 86.5-91.0 cm for WC and 20.75-25.5 kg/m² for BMI, with corresponding sensitivities and specificities. Area under the curve and the odds of developing individual and ≥ 2 metabolic risk factors for MS were higher for WC than for BMI.
    CONCLUSION: WC is a better predictor of metabolic risk factors for developing MS than BMI. Therefore, we propose that metabolic risk factors be screened when WC ≥ 80 cm is found in both genders regardless of BMI.
    Matched MeSH terms: Cardiovascular Diseases/etiology*
  15. Jankovic N, Geelen A, Streppel MT, de Groot LC, Kiefte-de Jong JC, Orfanos P, et al.
    Am J Clin Nutr, 2015 Oct;102(4):745-56.
    PMID: 26354545 DOI: 10.3945/ajcn.114.095117
    BACKGROUND: Cardiovascular disease (CVD) represents a leading cause of mortality worldwide, especially in the elderly. Lowering the number of CVD deaths requires preventive strategies targeted on the elderly.

    OBJECTIVE: The objective was to generate evidence on the association between WHO dietary recommendations and mortality from CVD, coronary artery disease (CAD), and stroke in the elderly aged ≥60 y.

    DESIGN: We analyzed data from 10 prospective cohort studies from Europe and the United States comprising a total sample of 281,874 men and women free from chronic diseases at baseline. Components of the Healthy Diet Indicator (HDI) included saturated fatty acids, polyunsaturated fatty acids, mono- and disaccharides, protein, cholesterol, dietary fiber, and fruit and vegetables. Cohort-specific HRs adjusted for sex, education, smoking, physical activity, and energy and alcohol intakes were pooled by using a random-effects model.

    RESULTS: During 3,322,768 person-years of follow-up, 12,492 people died of CVD. An increase of 10 HDI points (complete adherence to an additional WHO guideline) was, on average, not associated with CVD mortality (HR: 0.94; 95% CI: 0.86, 1.03), CAD mortality (HR: 0.99; 95% CI: 0.85, 1.14), or stroke mortality (HR: 0.95; 95% CI: 0.88, 1.03). However, after stratification of the data by geographic region, adherence to the HDI was associated with reduced CVD mortality in the southern European cohorts (HR: 0.87; 95% CI: 0.79, 0.96; I(2) = 0%) and in the US cohort (HR: 0.85; 95% CI: 0.83, 0.87; I(2) = not applicable).

    CONCLUSION: Overall, greater adherence to the WHO dietary guidelines was not significantly associated with CVD mortality, but the results varied across regions. Clear inverse associations were observed in elderly populations in southern Europe and the United States.

    Matched MeSH terms: Cardiovascular Diseases/mortality*; Cardiovascular Diseases/prevention & control
  16. Yusoff K
    Asia Pac J Clin Nutr, 2002;11 Suppl 7:S443-7.
    PMID: 12492632
    Cardiovascular disease, in particular coronary artery disease (CAD), remains the most important cause of morbidity and mortality in developed countries and, in the near future, more so in the developing world. Atherosclerotic plaque formation is the underlying basis for CAD. Growth of the plaque leads to coronary stenosis, causing a progressive decrease in blood flow that results in angina pectoris. Acute myocardial infarction and unstable angina were recently recognised as related to plaque rupture, not progressive coronary stenosis. Acute thrombus formation causes an abrupt coronary occlusion. The characteristics of the fibrin cap, contents of the plaque, rheological factors and active inflammation within the plaque contribute to plaque rupture. Oxidative processes are important in plaque formation. Oxidized low density lipoproteins (LDL) but not unoxidized LDL is engulfed by resident intimal macrophages, transforming them into foam cells which develop into fatty streaks, the precursors of the atherosclerotic plaque. Inflammation is important both in plaque formation and rupture. Animal studies have shown that antioxidants reduce plaque formation and lead to plaque stabilisation. In humans, high intakes of antioxidants are associated with lower incidence of CAD, despite high serum cholesterol levels. This observation suggests a role for inflammation in CAD and that reducing inflammation using antioxidants may ameliorate these processes. Men and women with high intakes of vitamin E were found to have less CAD. Vitamin E supplementation was associated with a significant reduction in myocardial infarction and cardiovascular events in the incidence of recurrent myocardial infarction. In the hierarchy of evidence in evidence-based medicine, data from large placebo-controlled clinical trials is considered necessary. Results from various mega-trials have not shown benefits (nor adverse effects) conferred by vitamin E supplementation, suggesting that vitamin E has no role in the treatment of CAD. These results do not seem to confirm, at the clinical level, the effect of antioxidants against active inflammation during plaque rupture. However, a closer examination of these studies showed a number of limitations, rendering them inconclusive in addressing the role of vitamin E in CAD prevention and treatment. Further studies that specifically address the issue of vitamin E in the pathogenesis of atherosclerosis and in the treatment of CAD need be performed. These studies should use the more potent antioxidant property of alpha-tocotrienol vitamin E.
    Matched MeSH terms: Cardiovascular Diseases/etiology; Cardiovascular Diseases/metabolism; Cardiovascular Diseases/prevention & control
  17. Phua, P. S. P, Ng, T. K. W., Teh, L. K., Voon, P. T.
    MyJurnal
    Introduction: Inflammation is one of the major cause of cardiovascular disease, obesity, cancer and stroke. Many dietary compounds containing kernel oil or coconut oil with anti-inflammatory effect can delay the onset of these chronic diseases however the underlying mechanism is unclear. Methods: This study compares the effects of 5% virgin palm kernel oil (VPKO), virgin coconut oil (VCO) and refined, bleached, deodorized olive oil (RBDOO) on selected immune markers in healthy sprague dawley (SD) rats (n=16 per treatment) across 8 weeks. Sera were obtained for four major immunological analyses including cluster of differentiation 4 (CD 4), cluster of differentiation 8 (CD 8), interleukin 6 (IL 6), and c reactive protein (CRP). Results were expressed in mean ± standard error of the mean (mean±SE). Results: Eight weeks fat feeding had no significant difference in weight gain across treatments. Interestingly, we observe significant different on the concentration of CD 4 (p=0.001) with the lowest CD 4 level in rats fed with VPKO 3.87±0.65 ng/ml. The concentration of CD 8 in rats fed with VPKO 8.19±0.25 (p=0.001) ng/ml was comparable to VCO fed rats but was found lower than the control group, RBDOO fed rats. Lower T cell count (CD 4 or CD 8) indicates suppression in inflammation. IL-6 and CRP concentration in rat fed with VPKO 10.89±0.22 pg/ml and 118.39±7.13 ng/ml were slightly higher than that of VCO fed rats but were lower than RBDOO fed rats. Conclusion: We postulate that VPKO could be a potential supplement as an alternative to VCO for relieving inflammation and enhancing body immune system.
    Matched MeSH terms: Cardiovascular Diseases
  18. Dagenais GR, Leong DP, Rangarajan S, Lanas F, Lopez-Jaramillo P, Gupta R, et al.
    Lancet, 2020 03 07;395(10226):785-794.
    PMID: 31492501 DOI: 10.1016/S0140-6736(19)32007-0
    BACKGROUND: To our knowledge, no previous study has prospectively documented the incidence of common diseases and related mortality in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) with standardised approaches. Such information is key to developing global and context-specific health strategies. In our analysis of the Prospective Urban Rural Epidemiology (PURE) study, we aimed to evaluate differences in the incidence of common diseases, related hospital admissions, and related mortality in a large contemporary cohort of adults from 21 HICs, MICs, and LICs across five continents by use of standardised approaches.

    METHODS: The PURE study is a prospective, population-based cohort study of individuals aged 35-70 years who have been enrolled from 21 countries across five continents. The key outcomes were the incidence of fatal and non-fatal cardiovascular diseases, cancers, injuries, respiratory diseases, and hospital admissions, and we calculated the age-standardised and sex-standardised incidence of these events per 1000 person-years.

    FINDINGS: This analysis assesses the incidence of events in 162 534 participants who were enrolled in the first two phases of the PURE core study, between Jan 6, 2005, and Dec 4, 2016, and who were assessed for a median of 9·5 years (IQR 8·5-10·9). During follow-up, 11 307 (7·0%) participants died, 9329 (5·7%) participants had cardiovascular disease, 5151 (3·2%) participants had a cancer, 4386 (2·7%) participants had injuries requiring hospital admission, 2911 (1·8%) participants had pneumonia, and 1830 (1·1%) participants had chronic obstructive pulmonary disease (COPD). Cardiovascular disease occurred more often in LICs (7·1 cases per 1000 person-years) and in MICs (6·8 cases per 1000 person-years) than in HICs (4·3 cases per 1000 person-years). However, incident cancers, injuries, COPD, and pneumonia were most common in HICs and least common in LICs. Overall mortality rates in LICs (13·3 deaths per 1000 person-years) were double those in MICs (6·9 deaths per 1000 person-years) and four times higher than in HICs (3·4 deaths per 1000 person-years). This pattern of the highest mortality in LICs and the lowest in HICs was observed for all causes of death except cancer, where mortality was similar across country income levels. Cardiovascular disease was the most common cause of deaths overall (40%) but accounted for only 23% of deaths in HICs (vs 41% in MICs and 43% in LICs), despite more cardiovascular disease risk factors (as judged by INTERHEART risk scores) in HICs and the fewest such risk factors in LICs. The ratio of deaths from cardiovascular disease to those from cancer was 0·4 in HICs, 1·3 in MICs, and 3·0 in LICs, and four upper-MICs (Argentina, Chile, Turkey, and Poland) showed ratios similar to the HICs. Rates of first hospital admission and cardiovascular disease medication use were lowest in LICs and highest in HICs.

    INTERPRETATION: Among adults aged 35-70 years, cardiovascular disease is the major cause of mortality globally. However, in HICs and some upper-MICs, deaths from cancer are now more common than those from cardiovascular disease, indicating a transition in the predominant causes of deaths in middle-age. As cardiovascular disease decreases in many countries, mortality from cancer will probably become the leading cause of death. The high mortality in poorer countries is not related to risk factors, but it might be related to poorer access to health care.

    FUNDING: Full funding sources are listed at the end of the paper (see Acknowledgments).

    Matched MeSH terms: Cardiovascular Diseases/mortality*
  19. Walli-Attaei M, Joseph P, Rosengren A, Chow CK, Rangarajan S, Lear SA, et al.
    Lancet, 2020 07 11;396(10244):97-109.
    PMID: 32445693 DOI: 10.1016/S0140-6736(20)30543-2
    BACKGROUND: Some studies, mainly from high-income countries (HICs), report that women receive less care (investigations and treatments) for cardiovascular disease than do men and might have a higher risk of death. However, very few studies systematically report risk factors, use of primary or secondary prevention medications, incidence of cardiovascular disease, or death in populations drawn from the community. Given that most cardiovascular disease occurs in low-income and middle-income countries (LMICs), there is a need for comprehensive information comparing treatments and outcomes between women and men in HICs, middle-income countries, and low-income countries from community-based population studies.

    METHODS: In the Prospective Urban Rural Epidemiological study (PURE), individuals aged 35-70 years from urban and rural communities in 27 countries were considered for inclusion. We recorded information on participants' sociodemographic characteristics, risk factors, medication use, cardiac investigations, and interventions. 168 490 participants who enrolled in the first two of the three phases of PURE were followed up prospectively for incident cardiovascular disease and death.

    FINDINGS: From Jan 6, 2005 to May 6, 2019, 202 072 individuals were recruited to the study. The mean age of women included in the study was 50·8 (SD 9·9) years compared with 51·7 (10) years for men. Participants were followed up for a median of 9·5 (IQR 8·5-10·9) years. Women had a lower cardiovascular disease risk factor burden using two different risk scores (INTERHEART and Framingham). Primary prevention strategies, such as adoption of several healthy lifestyle behaviours and use of proven medicines, were more frequent in women than men. Incidence of cardiovascular disease (4·1 [95% CI 4·0-4·2] for women vs 6·4 [6·2-6·6] for men per 1000 person-years; adjusted hazard ratio [aHR] 0·75 [95% CI 0·72-0·79]) and all-cause death (4·5 [95% CI 4·4-4·7] for women vs 7·4 [7·2-7·7] for men per 1000 person-years; aHR 0·62 [95% CI 0·60-0·65]) were also lower in women. By contrast, secondary prevention treatments, cardiac investigations, and coronary revascularisation were less frequent in women than men with coronary artery disease in all groups of countries. Despite this, women had lower risk of recurrent cardiovascular disease events (20·0 [95% CI 18·2-21·7] versus 27·7 [95% CI 25·6-29·8] per 1000 person-years in men, adjusted hazard ratio 0·73 [95% CI 0·64-0·83]) and women had lower 30-day mortality after a new cardiovascular disease event compared with men (22% in women versus 28% in men; p<0·0001). Differences between women and men in treatments and outcomes were more marked in LMICs with little differences in HICs in those with or without previous cardiovascular disease.

    INTERPRETATION: Treatments for cardiovascular disease are more common in women than men in primary prevention, but the reverse is seen in secondary prevention. However, consistently better outcomes are observed in women than in men, both in those with and without previous cardiovascular disease. Improving cardiovascular disease prevention and treatment, especially in LMICs, should be vigorously pursued in both women and men.

    FUNDING: Full funding sources are listed at the end of the paper (see Acknowledgments).

    Matched MeSH terms: Cardiovascular Diseases/drug therapy; Cardiovascular Diseases/mortality*; Cardiovascular Diseases/epidemiology; Cardiovascular Diseases/prevention & control*
  20. Chia YC, Lim HM, Ching SM
    BMC Cardiovasc Disord, 2014 Nov 20;14:163.
    PMID: 25410585 DOI: 10.1186/1471-2261-14-163
    BACKGROUND: The Pooled Cohort Risk Equation was introduced by the American College of Cardiology (ACC) and American Heart Association (AHA) 2013 in their Blood Cholesterol Guideline to estimate the 10-year atherosclerotic cardiovascular disease (ASCVD) risk. However, absence of Asian ethnicity in the contemporary cohorts and limited studies to examine the use of the risk score limit the applicability of the equation in an Asian population. This study examines the validity of the pooled cohort risk score in a primary care setting and compares the cardiovascular risk using both the pooled cohort risk score and the Framingham General Cardiovascular Disease (CVD) risk score.
    METHODS: This is a 10-year retrospective cohort study of randomly selected patients aged 40-79 years. Baseline demographic data, co-morbidities and cardiovascular (CV) risk parameters were captured from patient records in 1998. Pooled cohort risk score and Framingham General CVD risk score for each patient were computed. All ASCVD events (nonfatal myocardial infarction, coronary heart disease (CHD) death, fatal and nonfatal stroke) occurring from 1998-2007 were recorded.
    RESULTS: A total of 922 patients were studied. In 1998, mean age was 57.5 ± 8.8 years with 66.7% female. There were 47% diabetic patients and 59.9% patients receiving anti-hypertensive treatment. More than 98% of patients with pooled cohort risk score ≥7.5% had FRS >10%. A total of 45 CVD events occurred, 22 (7.2%) in males and 23 (3.7%) in females. The median pooled cohort risk score for the population was 10.1 (IQR 4.7-20.6) while the actual ASCVD events that occurred was 4.9% (45/922). Our study showed moderate discrimination with AUC of 0.63. There was good calibration with Hosmer-Lemeshow test χ2 = 12.6, P = 0.12.
    CONCLUSIONS: The pooled cohort risk score appears to overestimate CV risk but this apparent over-prediction could be a result of treatment. In the absence of a validated score in an untreated population, the pooled cohort risk score appears to be appropriate for use in a primary care setting.
    Matched MeSH terms: Cardiovascular Diseases/diagnosis; Cardiovascular Diseases/ethnology*; Cardiovascular Diseases/mortality; Cardiovascular Diseases/therapy
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