Cardiovascular disease in Europe: epidemiological update 2016

Townsend, Nick; Wilson, Lisa; Bhatnagar, Prachi; Wickramasinghe, Kremlin; Rayner, Mike; Nichols, Melanie

doi:10.1093/eurheartj/ehw334

Cited by 1,389 publications

(1,011 citation statements)

References 8 publications

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“…Cardiovascular disease (CVD) remains the most common cause of death in Europe, accounting for 45% of all deaths 1. Patients who have survived a myocardial infarction (MI) are at increased risk for recurrent ischemic events2 and heart failure,3 which stresses the importance of developing effective and safe primary and secondary prevention strategies.…”

Section: Introductionmentioning

confidence: 99%

Effects of Leisure‐Time and Transport‐Related Physical Activities on the Risk of Incident and Recurrent Myocardial Infarction and Interaction With Traffic‐Related Air Pollution: A Cohort Study

Kubesch

Jørgensen

Hoffmann

et al. 2018

JAHA

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BackgroundPhysical activity enhances the uptake of air pollutants, possibly reducing its beneficial effects. We examined the effects of leisure‐time and transport‐related physical activities on the risk of myocardial infarction (MI), and whether potential benefits on MI are reduced by exposure to traffic‐related air pollution.Methods and ResultsA group of 57 053 participants (50–65 years of age) from the Danish Diet, Cancer, and Health cohort reported physical activity at baseline (1993–1997) and were linked to registry data on hospital contacts and out‐of‐hospital deaths caused by MI, until December 2015. Nitrogen dioxide levels were estimated at participants’ baseline residences. We used Cox regressions to associate participation in sports, cycling, walking, and gardening with incident and recurrent MI, and tested for interaction by nitrogen dioxide. Of 50 635 participants without MI at baseline, 2936 developed incident MI, and of 1233 participants with MI before baseline, 324 had recurring MI during follow‐up. Mean nitrogen dioxide concentration was 18.7 μg/m3 at baseline (1993–1997). We found inverse statistically significant associations between participation in sports (hazard ratio; 95% confidence interval: 0.85; 0.79–0.92), cycling (0.91; 0.84–0.98), gardening (0.87; 0.80–0.95), and incident MI, while the association with walking was statistically nonsignificant (0.95; 0.83–1.08). Recurrent MI was statistically nonsignificantly inversely associated with cycling (0.80; 0.63–1.02), walking (0.82, 0.57–1.16), and gardening (0.91; 0.71–1.18), and positively with sports (1.06; 0.83–1.35). There was no effect modification of the associations between physical activity and MI by nitrogen dioxide.ConclusionsBenefits of physical activity on both the incidence and the recurrence of MI are not reduced by exposure to high levels of air pollution.

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Section: Introductionmentioning

confidence: 99%

Effects of Leisure‐Time and Transport‐Related Physical Activities on the Risk of Incident and Recurrent Myocardial Infarction and Interaction With Traffic‐Related Air Pollution: A Cohort Study

Kubesch

Jørgensen

Hoffmann

et al. 2018

JAHA

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“…1 Despite downward secular trends, CVD remains the largest single cause of mortality in England, accounting for around 34% of deaths annually. 2 Cardiovascular disease also contributes significantly to health inequalities, with prevalence of risk factors, established disease, adverse health outcomes and premature death being disproportionately high in people in lower socio-economic classes and ethnic minority groups. 2 Many countries have begun prioritising cardiovascular risk assessment programmes with CVD prevention strategies, for instance the Million Hearts initiative in the United States and More Heart and Diabetes Checks in New Zealand.…”

Section: Introductionmentioning

confidence: 99%

“…2 Cardiovascular disease also contributes significantly to health inequalities, with prevalence of risk factors, established disease, adverse health outcomes and premature death being disproportionately high in people in lower socio-economic classes and ethnic minority groups. 2 Many countries have begun prioritising cardiovascular risk assessment programmes with CVD prevention strategies, for instance the Million Hearts initiative in the United States and More Heart and Diabetes Checks in New Zealand. 3 4 Recently the World Health Organisation published a global action plan for 2013-2020, 5 with targets to achieve 25% relative reduction in premature mortality from non-communicable diseases including CVD and diabetes; and at least 50% of eligible people Evaluation of the NHS Health Check programme is facilitated by the very high use of electronic health records in English primary care, though current evidence mostly comes from local studies with short follow up of patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Coverage of a national cardiovascular risk assessment and management programme (NHS Health Check): Retrospective database study

Chang¹,

Soljak²,

Lee³

et al. 2015

Preventive Medicine

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ObjectiveTo determine coverage of NHS Health Check, a national cardiovascular risk assessment programme in England, in the first four years after implementation, and to examine prevalence of high cardiovascular disease (CVD) risk and uptake of statins in high risk patients. Method ResultsProgramme coverage was 21.4% over four years, with large variations between practices (0%-72.7%) and regions (9.4%-30.7%). Coverage was higher in older patients (adjusted odds ratio 2.88, 95% confidence interval 2.49-3.31 for patients 70-74 years) and in patients with a family history of premature coronary heart disease (2.37, 2.22-2.53), but lower in Black Africans (0.75, 0.61-0.92) and Chinese (0.68, 0.47-0.96) compared with White British. Coverage was similar in patients living in deprived and affluent areas. Prevalence of high CVD risk (QRISK2≥20%) among attendees was 4.6% One third (33.6%) of attendees at high risk were prescribed a statin after Health Checks. ConclusionsCoverage of the programme and statin prescribing in high risk individuals was low. Coverage was similar in deprived and affluent groups but lower in some ethnic minority groups, possibly widening inequalities. These findings raise a question about whether recommendations by WHO to develop CVD risk assessment programmes internationally will deliver anticipated health benefits. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT3 HIGHLIGHTS  Coverage of the programme examined nationally was low in the first four years. Wide variation in coverage was observed between practices and English regions. Increases in statin prescribing were found in both high and lower risk patients. Only 1/3 of attendees at high risk were prescribed a statin after Health Check. Almost five times more patients at lower risk than high risk were offered a statin.

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“…It accounted for 31.5% of all deaths and 45% of all non-communicable disease deaths, more than twice that caused by cancer, as well as more than all communicable, maternal, neonatal, and nutritional disorders combined (Townsend et al, 2016). 1 For these reasons, we believe that hypercholesterolaemia is a particularly interesting condition to analyse.…”

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confidence: 99%

Drug therapy adherence and health outcomes in the presence of physician and patient unobserved heterogeneity

2017

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Understanding the role that drug adherence has on health outcomes in everyday clinical practice is central for the policy maker. This is particularly true when patients suffer from asymptomatic chronic conditions (e.g., hypertension, hypercholesterolaemia, and diabetes). By exploiting a unique longitudinal dataset at patient and physician level in Italy, we show that patients and physicians unobserved characteristics play an important role in determining health status, at least as important as drug adherence. Most importantly, we find that both adherence and prescribed treatment regimen effects are highly heterogeneous across physicians, highlighting their crucial role in shaping patients' health status.

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Cardiovascular disease in Europe: epidemiological update 2016

Cited by 1,389 publications

References 8 publications

Effects of Leisure‐Time and Transport‐Related Physical Activities on the Risk of Incident and Recurrent Myocardial Infarction and Interaction With Traffic‐Related Air Pollution: A Cohort Study

Effects of Leisure‐Time and Transport‐Related Physical Activities on the Risk of Incident and Recurrent Myocardial Infarction and Interaction With Traffic‐Related Air Pollution: A Cohort Study

Coverage of a national cardiovascular risk assessment and management programme (NHS Health Check): Retrospective database study

Drug therapy adherence and health outcomes in the presence of physician and patient unobserved heterogeneity

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