Does present use of cardiovascular medication reflect elevated cardiovascular risk scores estimated ten years ago? A population based longitudinal observational study

Background It is desirable that those at highest risk of cardiovascular disease should have priority for preventive measures, eg. treatment with prescription drugs to modify their risk. We wanted to investigate to what extent present use of cardiovascular medication (CVM) correlates with cardiovascular risk estimated by three different risk scores (Framingham, SCORE and NORRISK) ten years ago. Methods Prospective logitudinal observational study of 20 252 participants in The Hordaland Health Study born 1950-57, not using CVM in 1997-99. Prescription data obtained from The Norwegian Prescription Database in 2008. Results 26% of men and 22% of women aged 51-58 years had started to use some CVM during the previous decade. As a group, persons using CVM scored significantly higher on the risk algorithms Framingham, SCORE and NORRISK compared to those not treated. 16-20% of men and 20-22% of women with risk scores below the high-risk thresholds for the three risk scores were treated with CVM, while 60-65% of men and 25-45% of women with scores above the high-risk thresholds received no treatment. Among women using CVM, only 2.2% (NORRISK), 4.4% (SCORE) and 14.5% (Framingham) had risk scores above the high-risk values. Low education, poor self-reported general health, muscular pains, mental distress (in females only) and a family history of premature cardiovascular disease correlated with use of CVM. Elevated blood pressure was the single factor most strongly predictive of CVM treatment. Conclusion Prescription of CVM to middle-aged individuals by large seems to occur independently of estimated total cardiovascular risk, and this applies especially to females

Construction of an odds model of coronary heart disease using published information: the Cardiovascular Health Improvement Model (CHIME)

Background: There is a need for a new cardiovascular disease model that includes a wider range of relevant risk factors, in particular lifestyle factors, to aid targeting of interventions and improve population models of the impact of cardiovascular disease and preventive strategies. The model needs to be applicable to a wider population including different ethnic groups, different countries and to those with and without cardiovascular disease. This paper describes the construction of the Cardiovascular Health Improvement Model that aims to meet these requirements. Method: An odds model is used. Information was taken from 2003 mortality statistics for England and Wales, the Health Survey for England 2003 and published data on relative risk in those with and without CVD and mean blood pressure values in hypertensives. The odds ratios used were taken from the INTERHEART study. Results: A worked example is given calculating the 10-year coronary heart disease risk for a 57 year-old non-diabetic male with no personal or family history of cardiovascular disease, who smokes 30 cigarettes a day and has a systolic blood pressure of 137 mmHg, a total cholesterol (TC) of 6.2 mmol/l, a high density lipoprotein (HDL) of 1.3 mol/l, and a body mass index of 21. He neither drinks regularly nor exercises. He can give no reliable information about his mental health or fruit and vegetable intake. His 10-year risk of CHD death is 2.47%. Conclusion: This paper demonstrates a method for developing a CHD risk model. Further improvements could be made to the model with additional information. The method is applicable to other causes of death

Current European guidelines for management of arterial hypertension: Are they adequate for use in primary care? Modelling study based on the Norwegian HUNT 2 population

<p>Abstract</p> <p>Background</p> <p>Previous studies indicate that clinical guidelines using combined risk evaluation for cardiovascular diseases (CVD) may overestimate risk. The aim of this study was to model and discuss implementation of the current (2007) hypertension guidelines in a general Norwegian population.</p> <p>Methods</p> <p>Implementation of the current <it>European Guidelines for the Management of Arterial Hypertension </it>was modelled on data from a cross-sectional, representative Norwegian population study (The Nord-Trøndelag Health Study 1995-97), comprising 65,028 adults, aged 20-89, of whom 51,066 (79%) were eligible for modelling.</p> <p>Results</p> <p>Among individuals with blood pressure ≥120/80 mmHg, 93% (74% of the total, adult population) would need regular clinical attention and/or drug treatment, based on their total CVD risk profile. This translates into 296,624 follow-up visits/100,000 adults/year. In the Norwegian healthcare environment, 99 general practitioner (GP) positions would be required in the study region for this task alone. The number of GPs currently serving the adult population in the study area is 87 per 100,000 adults.</p> <p>Conclusion</p> <p>The potential workload associated with the European hypertension guidelines could destabilise the healthcare system in Norway, one of the world's most long- and healthy-living nations, by international comparison. Large-scale, preventive medical enterprises can hardly be regarded as scientifically sound and ethically justifiable, unless issues of practical feasibility, sustainability and social determinants of health are considered.</p

Palynological analysis of a late Holocene core from Santo Antônio da Patrulha, Rio Grande do Sul, Southern Brazil

A sedimentar core collected at Santo Antônio da Patrulha, Rio Grande do Sul State, southmost Brazil, was submitted to pollen analysis to provide the vegetational history of this region, and the paleoecological and paleoclimatic changes. A total of 98 taxa of palynomorphs was identified from 35 subsamples. Three radiocarbonic datings were obtained along a section of 115 cm depth, including the basal age of 4730 ± 50 yr BP. Pollen diagrams and cluster analysis were performed based on palynomorphs frequencies, demonstrating five distinct phases (SAP-I to SAP-V), which reflected different paleoecological conditions. The predominance of plants associated with grasslands in the phase SAP-I suggests warm and dry climate conditions. A gradual increasing of humidity conditions was observed mainly from the beginning of the phase SAP-III, when the vegetation set a mosaic of grasslands and Atlantic rainforest. Furthermore, the presence of some forest taxa ( Acacia-type, Daphnopsis racemosa, Erythrina-type and Parapiptadenia rigida-type), from the phase SAP-IV, is interpreted as an influence of the seasonal semideciduous forest in the study region. From the phase SAP-V (ca. 4000 yrs BP), the vegetation became similar to the modern one (extant Atlantic rainforest Biome), especially after 2000 yrs BP (calibrated age).Um testemunho de sondagem coletado em Santo Antônio da Patrulha, Rio Grande do Sul, Brasil, foi submetido para análise polínica a fim de revelar a história vegetacional e mudanças paleoecológicas e paleoclimáticas. Um total de 98 táxons foi identificado a partir de 35 subamostras. Três datações radiocarbônicas foram obtidas ao longo de uma seção de 115 cm de profundidade, incluindo a idade basal de 4730 ± 50 anos AP. Diagramas polínicos e análises de agrupamentos foramrealizadas com base nas freqüências dos palinomorfos, demonstrando cinco fases distintas (SAP-I a SAP-V), as quais refletiram diferentes condições paleoecológicas. A predominância de plantas relacionadas à vegetação campestre na fase SAP-I sugere condições climáticas quentes e secas. Um gradual aumento nas condições de umidade foi observado principalmente no início da fase SAP-III, quando a vegetação conformou um mosaico de Campos e Floresta Atlântica. Além disso, a presença de certos táxons florestais (tipo- Acacia, Daphnopsis racemosa, tipo Erythrina e tipo Parapiptadenia rigida), a partir da fase SAP-IV, é interpretada como influência da Floresta Estacional Semidecidual na região de estudo. A partir da fase SAP-V (ca. 4000 anos AP) a vegetação tornou-se similar à moderna (atual Bioma da Floresta Atlântica), especialmente após 2000 anos AP (idade calibrada)

The Rotterdam Study: 2012 objectives and design update

The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, oncological, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over a 1,000 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods

Lawson criterion for ignition exceeded in an inertial fusion experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion