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  • Ovid Technologies (Wolters Kluwer Health)  (22)
  • 1
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    Structured Lifestyle Modification Interventions Involving Frontline Health Workers for Population‐Level Blood Pressure Reduction: Results of a Cluster Randomized Controlled Trial in India (DISHA Study)
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of the American Heart Association Vol. 11, No. 6 ( 2022-03-15)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 11, No. 6 ( 2022-03-15)
    Abstract: Population‐wide reduction in mean blood pressure is proposed as a key strategy for primary prevention of cardiovascular disease. We evaluated the effectiveness of a task‐sharing strategy involving frontline health workers in the primary prevention of elevated blood pressure. Methods and Results We conducted DISHA (Diet and lifestyle Interventions for Hypertension Risk reduction through Anganwadi Workers and Accredited Social Health Activists) study, a cluster randomized controlled trial involving 12 villages each from 4 states in India. Frontline health workers delivered a custom‐made and structured lifestyle modification intervention in the selected villages. A baseline survey was conducted in 23 and 24 clusters in the control (n=6663) and intervention (n=7150) groups, respectively. The baseline characteristics were similar between control and intervention clusters. In total 5616 participants from 23 clusters in the control area and 5699 participants from 24 clusters in the intervention area participated in a repeat cross‐sectional survey conducted immediately after the intervention phase of 18‐months. The mean (SD) systolic blood pressure increased from 125.7 (18.1) mm Hg to 126.1 (16.8) mm Hg in the control clusters, and it increased from 124.4 (17.8) mm Hg to 126.7 (17.5) mm Hg in the intervention clusters. The population average adjusted mean difference in difference in systolic blood pressure was 1.75 mm Hg (95% CI, −0.21 to 3.70). Conclusions Task‐sharing interventions involving minimally trained nonphysician health workers are not effective in reducing population average blood pressure in India. Expanding the scope of task sharing and intensive training of health workers such as nurses, nutritionists, or health counselors in management of cardiovascular risk at the population level may be more effective in primary prevention of cardiovascular disease. Registration URL: https://www.ctri.nic.in ; Unique identifier: CTRI/2013/10/004049.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.121.023526
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 2
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    Abstract MP51: Global, Regional, And National Intakes Of Sugar-sweetened Beverages, Milk, And Fruit Juice: A Systematic Analysis Including 193 Country-specific Nutrition Surveys Worldwide.
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation Vol. 129, No. suppl_1 ( 2014-03-25)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 129, No. suppl_1 ( 2014-03-25)
    Abstract: Background: Sugar-sweetened beverages (SSBs), fruit juice, and milk each significantly contribute to health and disease. To-date, assessment of their global distributions and health impacts have been limited by insufficient comparable and reliable data by country, age, and sex. Objective: To quantify global, regional, and national levels of SSB, fruit juice, and milk intake by age and sex in adults over age 20 in 2010. Methods: We identified, obtained, and assessed data on intakes of these beverages in adults, by age and sex, from 193 nationally representative diet surveys worldwide, representing 62% of the world’s population. We developed a multi-level hierarchical Bayesian model to account for differences in national and regional missingness, measurement incomparability, study representativeness, and sampling and modeling uncertainty. Results: In 2010, global average intakes were 0.58 (95%UI: 0.37, 0.89) 8 oz servings/day for SSBs, 0.16 (0.10, 0.26) for fruit juice, and 0.57 (0.39, 0.83) for milk. There was significant heterogeneity in consumption of each beverage by region and age (Figure). SSB intakes were highest in the Caribbean (1.9 servings/day; 1.2, 3.0) fruit juice intakes were highest in Australia and New Zealand (0.66; 0.35, 1.13), and milk intakes were highest in Central Latin America and parts of Europe (1.06; 0.68, 1.59). Consumption levels of all three beverages were lowest in East Asia and Oceania. Globally and within regions, SSB consumption was highest in younger adults; fruit juice consumption showed little relation with age; and milk intakes were highest in older adults. Conclusions: This quantitative assessment of current beverage intakes at global, regional, and national levels, as well as by age and sex, is imperative for informing public health and policy priorities for intervention strategies, as well as for quantifying the impacts of these beverages on health worldwide.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.129.suppl_1.mp51
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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  • 3
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    Response to Letter Regarding Article, “Estimated Global, Regional, and National Disease Burdens Related to Sugar-Sweetened Beverage Consumption in 2010”
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Circulation Vol. 133, No. 15 ( 2016-04-12)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 133, No. 15 ( 2016-04-12)
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.116.020667
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 4
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    Abstract P279: Major Dietary Risk Factors for Cardiometabolic Disease: Current Evidence for Causal Effects and Effect Sizes From the Global Burden of Diseases (GBD) 2015 Study
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Circulation Vol. 133, No. suppl_1 ( 2016-03)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 133, No. suppl_1 ( 2016-03)
    Abstract: Background: Dietary habits are major contributors to cardiometabolic diseases. Estimating the impact of diet on these conditions requires identification and quantification of evidence for causal effects. Objectives: To comprehensively evaluate the current evidence and quantify the effects of major dietary factors on CHD, stroke, and diabetes as part of the Global Burden of Diseases (GBD) 2015 study. Methods: We assessed probable or convincing evidence for causal effects based on Bradford-Hill, World Health Organization, and WCRF/AICR criteria. We searched PubMed through April 2015 to identify systematic reviews and meta-analyses of well-designed observational studies and clinical trials. Meta-analyses were evaluated and selected based on design, number of studies and events, definition of dietary exposure and disease outcomes, length of follow-up, statistical methods, evidence of bias, and control for confounders. Effect sizes and uncertainty were quantified per standardized units. We focused on dose-response meta-analyses. When necessary, original data were extracted from individual studies within each meta-analysis to perform de novo dose-response meta-analyses using generalized least squares for trend estimation. Results: We identified 11 dietary factors with probable or convincing evidence for causal effects on CHD, 4 on stroke, and 7 on diabetes. ( Table ). Examples of other factors not yet meeting probable or convincing evidence for causal effects included coffee and tea (consistent dose-response, yet plausible biology not well-established), eggs, and dietary cholesterol. Conclusion: This evaluation provides the best current evidence-based quantitative estimates of effects of major dietary factors on CHD, stroke, and diabetes. These findings enable quantitative estimation of disease burdens of suboptimal diet in the US and globally, and also inform policy planning and priorities.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.133.suppl_1.p279
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 5
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    Abstract P265: Macrosocial Disparity, Diet, and Cardiovascular Mortality in Global Populations Undergoing Transition
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Circulation Vol. 133, No. suppl_1 ( 2016-03)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 133, No. suppl_1 ( 2016-03)
    Abstract: Background: Economic and social disparities are linked to poor health outcomes in diverse countries worldwide. Differences in diet may mediate many of these effects, yet to-date, the impact of social, economic, and demographic inequality on the quality and diversity of diet has not been examined in a comparable manner globally. Objective: To comparably quantify the relationships of macroeconomic indicators of disparity with diet quality in 84 countries worldwide, and to assess their associations with CVD mortality. Methods: Data on country-specific per-capita GDP, urbanization, income inequality (income Gini coefficient and share of income held by top 1%), education, and educational inequality (educational Gini); on dietary quality and diversity; and on CVD mortality rates were obtained from our Global Dietary Database and other sources (Figure). Relationships between income inequality, diet quality, and CVD mortality were examined through multivariate regression controlling for country-level per-capita GDP, including country-level fixed effects, as well as through non-parametric Loess regression. Analyses were performed separately for 1990, 2010, and for the percent change between 1990 and 2010 for each variable. Results: From 1990-2010 income inequality increased by 〉 5% in 51 of 84 countries and decreased by 〉 5% in 15/84 countries. Of countries with increasing income inequality, 61% had worsening scores for unhealthy diet; of those with decreasing income inequality, only 27% had worsening unhealthy diet scores. CVD mortality increased in 43% of countries with increasing income inequality, primarily in Eastern Europe/Asia; while it declined in ½ of countries with declining income inequality (Figure). Results for educational inequality and urbanization are in progress. Conclusions: This first cross-country analysis of macrosocial disparities, diet quality and CVD mortality highlights regional heterogeneity and time variance the impacts of these inequities on diet and subsequent risk of CVD.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.133.suppl_1.p265
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 6
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    Spatiotemporal and Demographic Trends and Disparities in Cardiovascular Disease Among Older Adults in the United States Based on 181 Million Hospitalization Records
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Journal of the American Heart Association Vol. 8, No. 21 ( 2019-11-05)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 8, No. 21 ( 2019-11-05)
    Abstract: The US population is aging, with concurrent increases in cardiovascular disease (CVD) burdens; however, spatiotemporal and demographic trends in CVD incidence in the US elderly have not been investigated in detail. This study aims to characterize trends from 1991 to 2014 in CVD hospitalizations among US Medicare beneficiaries, aged 65+ years, by single year of age/sex/race/state using records from the US Centers for Medicare & Medicaid, covering 98% of older Americans. Methods and Results We abstracted 181 202 758 US Centers for Medicare & Medicaid hospitalization records indicating CVD in any of 10 diagnosis codes; tabulated total cases of CVD by sex, age, race, state, and calendar year (1991–2014); and normalized hospitalization counts to standardize over data batches. Stratum‐specific hospitalization rates were calculated using US Centers for Medicare & Medicaid records and US Census population counts; a cubic polynomial function was fit to year‐specific distributions of rates by single year of age. Nationwide, CVD‐related hospitalization rates increased from 1991 to 2014. Differences between hospitalization rates at age 65 and 66 years, representing magnitude of healthcare deferral until Medicare onset, increased by 7.49 per 100 people 1991 to 2006 overall, and were largest among blacks and Native Americans. Rates of CVD hospitalizations were consistently highest in the Midwest/Deep South. Evidence of misclassification of race/ethnicity in US Centers for Medicare & Medicaid hospitalization records in the 1990s was noted. Conclusions Trends in CVD‐related hospitalization rates among older Americans highlight the essential need for targeted policies to reduce CVD burdens, to improve reporting of race/ethnicity in large administrative databases, and to enhance access to affordable healthcare.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.119.012727
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 7
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    Abstract P357: The Impact of Dietary and Metabolic Risk Factors on Cardiovascular and Diabetes Mortality in South Asia: An Analysis from the 2010 Global Burden of Disease (GBD) Study
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Circulation Vol. 125, No. suppl_10 ( 2012-03-13)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 125, No. suppl_10 ( 2012-03-13)
    Abstract: BACKGROUND: Cardiometabolic diseases are rising in South Asia. The impact of modifiable diet and metabolic risk factors on mortality due to these diseases has not been quantified for this region using consistent methodology. OBJECTIVE: To estimate disease-specific mortality effects of major diet and metabolic risk factors by age and sex in South Asia. METHODS: We used a comparative risk assessment analysis (CRA) framework, developed as part of the 2010 GBD study, for six countries of the region (India, Pakistan, Bangladesh, Afghanistan, Nepal, Bhutan). The current national risk factor exposure distribution for these countries was obtained from systematic literature searches of nationally representative surveys and direct author contact. We identified 8 surveys for diet and 50 for metabolic risks. The likely causal effect sizes of risk factor-disease relationships (RRs) were derived from meta-analyses of trials or epidemiological studies. Plausible optimal alternative exposure distributions were identified from other global studies or regions, and total disease-specific deaths were obtained from 2008 WHO data. Missing exposure data were imputed using multi-level hierarchical Bayesian models with time varying covariates. Inputs were combined to compute population attributable fractions and mortality preventable from these risks. We performed sensitivity analyses by varying choice of exposure metrics, causal effect sizes, and alternative distributions. Updated GBD estimates for smoking and physical activity are in progress. RESULTS: Among metabolic risks, high systolic blood pressure and high BMI produced the highest number of preventable cardiometabolic deaths in South Asia in 2008 in both men and women ( Figure ). Other risks, including fruits also contributed to a substantial number of deaths. CONCLUSIONS: Use of CRA methods allows quantification of the impact of specific modifiable risk factors on disease, informing health policy and priority setting to improve diet and lifestyle in people of South Asia.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.125.suppl_10.AP357
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
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  • 8
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    Response to Letter Regarding Article, “The Global Cardiovascular Risk Transition: Associations of Four Metabolic Risk Factors With Macroeconomic Variables in 1980 and 2008”
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Circulation Vol. 128, No. 18 ( 2013-10-29)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 128, No. 18 ( 2013-10-29)
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.113.005449
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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  • 9
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    Abstract P294: Estimated Benefits and Risks of Lowering Sodium Intake With Potassium-based Salt Substitutes in China: a Modelling Study
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Circulation Vol. 139, No. Suppl_1 ( 2019-03-05)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 139, No. Suppl_1 ( 2019-03-05)
    Abstract: Introduction: Replacement of regular salt (NaCl) with potassium-based salt substitutes is a promising strategy to reduce blood pressure (BP) and prevent cardiovascular disease (CVD), especially in countries like China with high discretionary salt intake and low potassium intake. However, benefits of this strategy remain uncertain, and the risks of hyperkalemia and increased CVD mortality in persons with chronic kidney disease (CKD) are a concern. Hypothesis: In China, the estimated benefits of nationwide potassium-based salt substitution on CVD mortality will exceed potential risks. Methods: We used a comparative risk assessment framework to estimate potential benefits and risks of nationwide replacement of discretionary salt with potassium-based salt substitute (30±10% KCl) on CVD mortality in China. We incorporated existing data and corresponding uncertainties from randomized trials, the China National Survey of CKD, the Global Burden of Disease, and the CKD Prognosis Consortium ( Table ). We estimated averted CVD deaths from reduced BP subsequent to salt substitution in the adult population (benefits), and CVD deaths attributed to hyperkalemia from salt substitution in CKD patients (risks). Results: A nationwide implementation of potassium-based salt substitution in China, could prevent ~400,000 CVD deaths/year through BP lowering in the adult population, and increase ~10,000 CVD deaths/year through hyperkalemia among CKD patients (Table). For each additional death in CKD patients, around 40 CVD deaths could be averted in the adult population. Overall, the intervention could result in 369,258 (95% uncertainty interval: 160,702-576,680) net fewer deaths each year, corresponding to 9.4% (4.1-14.7) of annual CVD deaths in China. Conclusions: A nationwide potassium-based salt substitution in China could result in significant net benefits, preventing about 1 in 10 CVD deaths. Strategies to avoid potential hyperkalemic deaths among CKD patients could further improve the benefit:risk ratio.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.139.suppl_1.P294
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 10
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    Estimated Global, Regional, and National Disease Burdens Related to Sugar-Sweetened Beverage Consumption in 2010
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 132, No. 8 ( 2015-08-25), p. 639-666
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 132, No. 8 ( 2015-08-25), p. 639-666
    Abstract: Sugar-sweetened beverages (SSBs) are consumed globally and contribute to adiposity. However, the worldwide impact of SSBs on burdens of adiposity-related cardiovascular diseases (CVDs), cancers, and diabetes mellitus has not been assessed by nation, age, and sex. Methods and Results— We modeled global, regional, and national burdens of disease associated with SSB consumption by age/sex in 2010. Data on SSB consumption levels were pooled from national dietary surveys worldwide. The effects of SSB intake on body mass index and diabetes mellitus, and of elevated body mass index on CVD, diabetes mellitus, and cancers were derived from large prospective cohort pooling studies. Disease-specific mortality/morbidity data were obtained from Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We computed cause-specific population-attributable fractions for SSB consumption, which were multiplied by cause-specific mortality/morbidity to compute estimates of SSB-attributable death/disability. Analyses were done by country/age/sex; uncertainties of all input data were propagated into final estimates. Worldwide, the model estimated 184 000 (95% uncertainty interval, 161 000–208 000) deaths/y attributable to SSB consumption: 133 000 (126 000–139 000) from diabetes mellitus, 45 000 (26 000–61 000) from CVD, and 6450 (4300–8600) from cancers. Five percent of SSB-related deaths occurred in low-income, 70.9% in middle-income, and 24.1% in high-income countries. Proportional mortality attributable to SSBs ranged from 〈 1% in Japanese 〉 65 years if age to 30% in Mexicans 〈 45 years of age. Among the 20 most populous countries, Mexico had largest absolute (405 deaths/million adults) and proportional (12.1%) deaths from SSBs. A total of 8.5 (2.8, 19.2) million disability-adjusted life years were related to SSB intake (4.5% of diabetes mellitus–related disability-adjusted life years). Conclusions— SSBs are a single, modifiable component of diet that can impact preventable death/disability in adults in high-, middle-, and low-income countries, indicating an urgent need for strong global prevention programs.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.114.010636
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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