Results of the North Karelia Project and national NCD prevention

Size: px
Start display at page:

Download "Results of the North Karelia Project and national NCD prevention"

Transcription

1 Results of the North Karelia Project and national NCD prevention Erkki Vartiainen, MD, Professor, Assistant Director General 28/03/2011 Erkki Vartiainen 1

2 2

3

4 Start of the North Karelia project (1) Seven countries study in North Karelia since 1955 Public attention to the high CVD mortality and to the statistics that the province of North Karelia is in the worse situation Petition by the representatives of people in North Karelia for national assistance to cope with the problem (January 1971) Delegation led by the Governor to Helsinki, the petition was handed to the Prime Minister and other decision makers Involvement of Finnish experts and WHO

5 Two main questions in 1970 s Can risk factors and behaviors be changed on population level? If risk factors will reduce what will happen to the mortality?

6 North Karelia Project Aims of the North Karelia Project MAIN OBJECTIVE: Initially: To reduce the CVD mortality Later: To reduce major chronic disease mortality and promote health INTERMEDIATE OBJECTIVES: To reduce the population levels of main risk factors, emphasizing lifestyle changes and to promote secondary prevention NATIONAL OBJECTIVE: Initially: To be pilot for all Finland Later: To be demonstration and model program

7 North Karelia Project Hierarchy of objectives GENERAL GOAL: Improved health MAIN OBJECTIVES: Prevention of chronic diseases & promotion of health INTERMEDIATE OBJECTIVES: Risk factors, life-styles and treatment PRACTICAL OBJECTIVES: Intervention programme Medical / Epidemiological framework: - earlier research - local prevalence Social / Behavioural framework: - theory - community analysis

8 From Karelia to national action First province of North Karelia as a pilot (5 years), then national action Good scientific evaluation to learn of the experience

9 5 % 70 % 25 % People with low risk factor level People with average risk factor level People with clinically high risk factor level Individual risk of CHD Distribution of people according to risk factor level Theoretical presentation of the difference between individual risk and the proportional attributable risk

10

11 North Karelia Project Theoretical principles of the interventions Medical framework: Primary prevention Main targets: smoking, diet, cholesterol, blood pressure Population approach, general risk factor reduction emphasizing lifestyle changes Social / Behavioural framework Social marketing Behaviour modification Communication Innovation diffusion Community organization

12 North Karelia Project Practical intervention Emphasis on persuasion, practical skills, social & environmental support for change Research team & local project office with comprehensive community involvement Main areas: 1. Media activities (materials, massmedia, campaigns) 2. Preventive services (primary health care etc.) 3. Training of professional and other workers 4. Environmental changes (smokefree areas, supermarkets, food industry etc.) 5. Monitoring and feed-back

13 North Karelia Project Evaluation Evaluation tasks 1. Feasibility, performance 2. Effects: risk factors, lifestyles, disease rates, mortality 3. Change process 4. Costs 5. Other consequencies Evaluation types summative: 5-year periods formative, internal evaluation

14 Smoking control programmes Voluntary restrictions of smoking in public places Mass media Voluntary restrictions in advertising Use of opinion leaders Training of health care personnel Cessation services in health centres

15 Hypertension register Computer based Hypertension clinic Nurses in a key position Invitation letter once a year

16 NSO s role Heart Association Martta (house wife s) association

17 Setting strategy Schools Work site Media Family Health centers/hospitals Villages

18 Use of lay opinion leaders to promote health innovations in community Innovation-diffusion theory Training seminars in municipalities Discuss health issues in normal life 805 persons participated Recruiting by local people and Heart Association Evaluation in 1982: 399 (50%) still active

19 Discussions with target groups Target group Very often (%) Occasionally(%) Family Neighbours Work Relatives Friends NGO meetings Shopkeepers 8 27 Media 0 15

20 A comprehensive television smoking cessation programme in Finland Voluntary smokers in TV studio tried to stop smoking 6 sessions + 2 follow-up sessions Intensified filed activity in North Karelia at least 4 sessions attempt to quit quit remained non-smokers

21 Berry program From dairy industry to berry production Helping in marketing and product development Funding from ministry

22 Smoking control programmes Work side programmes School programmes TV programmes Radio programmes Quit and Win Competition Smoke Free Class Competition Quit and Win-Do Not Start and Win for Young People

23 Village competition to lower cholesterol villages, population villages, population Village committees organized 2 months competition Baseline and follow-up cholesterol measurement Best village win 2000

24 Cholesterol changes in 1991 competition Village Baseline % Change Mean

25 Cholesterol change in 1997 competition Baseline End Change Change% N

26 Change (%) in cholesterol by number of dietary changes 0-2,

27 Change in cholesterol value by village activity

28

29

30 % Percentage of weekly smokers (Baseline smokers excluded) Program effect 1 8th OR = 0.47 ( ) 51% 9th OR = 0.68 ( ) 28% ,4 9 14,3 19,9 Experimental Control 0 8th 9th The OR for weekly smoking for experimental school compared to control school pupils

31 Erkki Vartiainen

32 Serum cholesterol in men aged years mmol/l 7,5 7 6,5 North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province 6 5,

33 Serum cholesterol in women aged years mmol/l 7,5 7 6,5 North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province 6 5,

34 Serum cholesterol distribution in North Karelia in 1972 and 2007

35 Use of butter for cooking % North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province

36 Use of vegetable oil for cooking (men age 30-59) North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province

37 Use of butter on bread (men age 30-59) % North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province

38 1982, 1992, 1997, 2002, 2007 FINMONICA/FINRISK surveys Age and sex-stratified random sample, years, in 3-5 study areas Diet subsample Response rates, 60-70% 3-day food record, 1982, h recall, h recall, 2002 and 2007

39 Fat intake 40 Recommendations 30 Total fat (~ 30 EN%) EN% SAFA (~10 EN%) MUFA (10-15 EN%) Year PUFA (5-10 EN%)

40 mmol/l Estimated effects on serum cholesterol Medication effect Dietary effect Medication+dietary effect Observed S-Chol Year

41 mmol/l Estimated effects on serum cholesterol Pufa Dietary chol Sfa Pufa+D-Chol+Sfa Pufa+D-Chol+Sfa+Trans-FA Observed S-Chol Year

42 Estimated effect of statins on population cholesterol % Estimate

43 Serum cholesterol level by myocardial infarction and statins 7 6,78 6,75 6,5 6 5,5 5 6,3 6,2 5,96 5,91 5,82 5,7 5,66 5,66 5,6 5,52 5,54 5,37 5,07 4,92 5,37 4,99 MI patients NO MI MI and statins MI no statins 4,5 4,58 4,

44 Systolic blood pressure in men aged mmhg North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province

45 Systolic blood pressure in women aged years mmhg North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province

46 Diastolic blood pressure in men aged years mmhg North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province

47 Diastolic blood pressure in women aged years mmhg North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province

48 Salt intake in Finland g/day Calculated, men Calculated, women 24 hour urine, men hour urine, women Linear (24 hour urine, men) Linear (24 hour urine, women) Linear (Calculated, men) Linear (Calculated, women)

49 Body mass index in men aged Kg/m North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province

50 Body mass index in women aged years Kg/m North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province

51 BMI by education, women years kg/m Highest Medium Lowest

52 Cumulative incidence of T2D, % DPS-F study Diabetes by treatment group during the total follow-up period Log-rank test: p= Hazard ratio=0.57 (95% CI ) Control Intervention 0 Intervention ceased Follow-up time, years Lindström et. al. Lancet 2006:368;

53 Diabetes incidence per 100 person years Finnish DPS-F study Diabetes incidence rate by success score (number of intervention goals achieved) Test of trend: p< Number of goals achieved at year 3 0 Lindström et. al. Lancet 2006

54 Background Disturbances in glucose metabolism in Finns aged y. FIN-D2D survey 2004 (n=2896) Men Women Diagnosed type 2 diabetes 7.4% 4.3% } 15.7% Screen-detected type 2 diabetes 8.3% 6.9% Impaired glucose tolerance 14.7% 15.9% Impaired fasting glucose 9.3% 4.8% } 11.2% Total*: 41.8% 33.2% * Age-adjusted Suom Lääkäril 2006;61:

55 FIN-D2D high-risk subjects 10,200 high risk persons included in interventions in primary and occupational health care during Additional 10,000 persons with risk score 7-14 have received written information. A total of >20,000 have contacted primary or occupational health care system due to programme.

56 Why did diet change? North Karelia Project (community based CVD prevention program) Consensus in the medical community Political consensus Recommendations Cholesterol screening Fat debates Educational programs Business got interested

57 Smoking in men aged years % North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province

58 Smoking in women aged years % North Karelia Kuopio province Southwest Finland Helsinki area Oulu province Lapland province

59

60 Figure 2. Male and female ever-regular smoking by birth cohort Figure 1. Daily smoking prevalence % 60 WW I generation/ Early independence generation % 100 Depression generation Post WW II Baby-boomer generation Early 1960 s generation entering into typical smoking initiation age when TCA 1976 was enforced Men Men Women Women Year Separate dots = observed prevalence for age groups by gender Solid lines = log-linear model estimates for prevalence by gender Dotted lines = extrapolation assuming the effect of the 1976 Tobacco Control Act to be zero for genders

61 Age-adjusted mortality rates of coronary heart disease in North Karelia and the whole of Finland among males aged years from 1969 to start of the North Karelia Project extension of the Project nationally North Karelia Mortality per population Age-standadized to European population All Finland Year

62

63

64 North Karelia Project Prevention of CVD Do the risk factor changes explain the CVD mortality changes?

65 Observed and predicted decline in CHD mortality in men % Year Observed All risk factors Cholesterol Diastolic BP Smoking

66 CHD mortality fall in Finland fewer deaths Risk Factors -71% Cholesterol - 53% Smoking - 11% Blood pressure - 7% Treatments -24% AMI treatments - 4% Secondary prevention - 8% Heart failure - 2% Angina: CABG & PTCA - 8% Angina: Aspirin etc - 2% Other Factors -5% T Laatikainen et al Am J Epid 2005

67 Thank you!

68 % 35 Projected impact of risk factor changes in Australia All Chol 10% HR chol 4.5 Combination BP 5% HR 140 Combination No smoking 5 0 Vartainen et al MJA 2011;194:

69 Subjective health: percent stating their health as good or very good (men) % North Karelia Kuopio province Southwest Finland Helsinki area Year

70 North Karelia Project From pilot/demonstration program to national action National health program Medical knowledge NATIONAL DEMONSTRATION PROGRAM Public need for change Visible experiences, results National policy NATIONAL ACTION Diffusion

71 North Karelia Project MEDICAL KNOWLEDGE SOSIAL & BEHAVIORAL THEORY COMMUNITY PROGRAM HARD PRACTICAL WORK

72 Chow et Int J Epidemiol 2009;38:1580

73 Constraints Suspicions from the cardiological scientific community Medical knowledge on prevention questionable, community prevention new concept North Karelia socially deprived area, poor and with many social problems (unemployment, migration, shortage of doctors etc) War and post war years: Great poverty, after that increase in consumption Dairy farming main agriculture: Butter and animal fat highly valued culturally Strong commercial pressures ( FAT WAR ), supported by political pressures Raising the funding (intervention and evaluation research) To maintain interest and funding over decades

74 Advantages Magnitude of problem, concern of people Relatively homogenous population, traditions of community action Trust in experts and in public action Good information system Good collaboration with people

75 Why success in North Karelia Appropriate epidemiological and behavioural framework Restricted, well defined targets Good monitoring of immediate targets (Behaviours, process) Flexible intervention Emphasis in changing environment and social norms Working closely with the community Positive feedback, work with media International collaboration, support from WHO Close interaction with national health policy, integration with National Public Health Institute Long term, dedicated leadership

76 Major elements of successful National Preventive Program 1 Research Health services (especially primary health care) Health education programmes (coalitions, NGO s, collaboration with media etc.) Schools, educational institutions Industry, business

77 Major elements of successful National Preventive Program 2 National demonstration programme(s), focal point(s) Policy decisions, intersectoral collaboration, legislation Monitoring system International collaboration

78 North Karelia has shown Prevention of major chronic diseases is possible and pays off Population based prevention is a cost effective and sustainable public health approach to chronic disease control Prevention calls for simple changes in some lifestyles (individual, family, community, national and global level action) Many results of prevention occur surprisingly quickly (CVD, diabetes) and also at relatively late age At the same time increases in subjective health and physical capacity

79 North Karelia Project Conclusions A comprehensive, determined and theory-based community program can have a meaningful positive effect on risk factors and life styles Such changes are associated with respective favourable changes in chronic disease rates and health of the population A major national demonstration program can be a strong tool for favourable national development in chronic disease prevention and health promotion

80 PROMOTING CARDIOVASCULAR HEALTH AND PREVENTING CARDIOVASCULAR DISEASES Health Promotion FINNISH HEART PLAN How to reduce the number of cardiovascular Health in all decision making in the society Differences in health between population groups Resources on national and regional level local units/networks in health promotion Prevention Population strategy Cardiovascular diseases and life style Physical activity Nutrition Heart Symbol Canteen catering Weight control Non-Smoking disease morbidity and mortality by half Risk group strategy - Prevention programme of type 2 diabetes - Current Care Guidelines for Hypertension - Current Care Guidelines for Smoking, Nicotine Dependency and Interventions for Cessation - Guidelines of European Society of Cardiology on cardiovascular disease prevention in clinical practice STRAGEGIES OF EARLY DIAGNOSTICS AND TREATMENT - Developing cooperation between special health care and primary health care - Local treatment plans - Diminishing differences in treatment between social groups - Increasing the number of coronary angiographies - Increasing the number of coronary angioplasties - On call cardiology service - Increasing the number of cardiologists - Adequate medical treatment - Woman s heart REHABILITATION AND SECUNDARY PREVENTION - Developing cooperation between special health care and primary health care - Rehabilitation resources - Out patient rehabilitation model in health centres for heart patients - Heart patient working and returning to work

International model for prevention of chronic disease: Finland experience

International model for prevention of chronic disease: Finland experience International model for prevention of chronic disease: Finland experience Erkki Vartiainen, MD, Professor, Assistant Director General 06/12/2011 Erkki Vartiainen 1 2 Start of the North Karelia project

More information

Introduction to Finnish NCD Prevention. PREVENTION OF NONCOMMUNICABLE DISEASES SEMINAR, Helsinki

Introduction to Finnish NCD Prevention. PREVENTION OF NONCOMMUNICABLE DISEASES SEMINAR, Helsinki Introduction to Finnish NCD Prevention PREVENTION OF NONCOMMUNICABLE DISEASES SEMINAR, Helsinki 14.3.2011 28/03/2011 Pekka Puska, Director General 2 Global Health Burden Estimated global deaths by cause,

More information

The North Karelia Project: Cardiovascular disease prevention in Finland

The North Karelia Project: Cardiovascular disease prevention in Finland O P E N A C C E S S National Institute for Health and Welfare (THL), Mannerheimintie 166, 00270 Helsinki, Finland *Email: erkki.vartiainen@thl.fi Review article The North Karelia Project: Cardiovascular

More information

ACHIEVEMENTS AND CHALLENGES IN NCD PREVENTION IN FINLAND

ACHIEVEMENTS AND CHALLENGES IN NCD PREVENTION IN FINLAND Pekka Puska Professor, Member of Parliament Past Director General, National Institute for Health and Welfare (THL), Finland Past President, International Association of National Public Health Institutes

More information

Nutrition policy in Finland

Nutrition policy in Finland Nutrition policy in Finland Suvi M. Virtanen, Professor 13.3.2012 20/03/2012 Nutrition policy in Finland / SM Virtanen 1 The top of Europe Four seasons Population 5,4 million Life expectancy at birth:

More information

NCD MONITORING AND NPHI S

NCD MONITORING AND NPHI S Pekka Puska, Professor, MD, PhD, MPolSc Director General, National Institute for Health and Welfare (THL), Finland Vice President, International Association of National Public Health Institutes (IANPHI)

More information

Political incentives for more effective prevention including health care settings

Political incentives for more effective prevention including health care settings Pekka Puska, MD, PhD, MpolSc Ex director General, National Institute for Health and Welfare (THL), Finland President, Int. Association of National Public Health Institutes (IANMPHI) Political incentives

More information

Cardiovascular risk factor changes in Finland,

Cardiovascular risk factor changes in Finland, International Epidemiological Association 2000 Printed in Great Britain International Journal of Epidemiology 2000;29:49 56 Cardiovascular risk factor changes in Finland, 1972 1997 Erkki Vartiainen, Pekka

More information

Implementing Type 2 Diabetes Prevention Programmes

Implementing Type 2 Diabetes Prevention Programmes Implementing Type 2 Diabetes Prevention Programmes Jaakko Tuomilehto Department of Public Health University of Helsinki Helsinki, Finland FIN-D2D Survey 2004 Prevalence of previously diagnosed and screen-detected

More information

Population models of health impact of combination polypharmacy

Population models of health impact of combination polypharmacy Population models of health impact of combination polypharmacy Global Summit on Combination Polypharmacy for CVD, 25 th September 2012 Dr Mark Huffman Northwestern University, Chicago Charity No: 1110067

More information

Preventive Cardiology Scientific evidence

Preventive Cardiology Scientific evidence Preventive Cardiology Scientific evidence Professor David A Wood Garfield Weston Professor of Cardiovascular Medicine International Centre for Circulatory Health Imperial College London Primary prevention

More information

The DIABETES CHALLENGE IN PAKISTAN FIFTH NATIONAL ACTION PLAN

The DIABETES CHALLENGE IN PAKISTAN FIFTH NATIONAL ACTION PLAN 1. INTRODUCTION The DIABETES CHALLENGE IN PAKISTAN FIFTH NATIONAL ACTION PLAN 2014 2018 UNITE AGAINST DIABETES STOP RISING TREND Diabetes is a significant and growing challenge globally that affects individuals,

More information

Glycemic index, glycemic load, and the risk of acute myocardial infarction in middle-aged Finnish men:

Glycemic index, glycemic load, and the risk of acute myocardial infarction in middle-aged Finnish men: Glycemic index, glycemic load, and the risk of acute myocardial infarction in middle-aged Finnish men: The Kuopio Ischaemic Heart Disease Risk Factor Study Jaakko Mursu, Jyrki K. Virtanen, Tiina H. Rissanen,

More information

Repeat ischaemic heart disease audit of primary care patients ( ): Comparisons by age, sex and ethnic group

Repeat ischaemic heart disease audit of primary care patients ( ): Comparisons by age, sex and ethnic group Repeat ischaemic heart disease audit of primary care patients (2002-2003): Comparisons by age, sex and ethnic group Baseline-repeat ischaemic heart disease audit of primary care patients: a comparison

More information

Trends In CVD, Related Risk Factors, Prevention and Control In China

Trends In CVD, Related Risk Factors, Prevention and Control In China Trends In CVD, Related Risk Factors, Prevention and Control In China Youfa Wang, MD, MS, PhD Associate Professor Center for Human Nutrition Department of International Health Department of Epidemiology

More information

EuroPrevent 2010 Fatal versus total events in risk assessment models

EuroPrevent 2010 Fatal versus total events in risk assessment models EuroPrevent 2010 Fatal versus total events in risk assessment models Pekka Jousilahti, MD, PhD,Research Professor National Institute for Health and Welfare, Finland Risk assessment models Estimates the

More information

Some good practices in an interagency approach to the prevention of NCDs in Russia

Some good practices in an interagency approach to the prevention of NCDs in Russia National Research Center for Preventive Medicine of the Russian Federation WHO Collaborating Center on Development and Implementation of Non-communicable Disease Prevention Policy and Programs Collaborating

More information

ÝÐ Ë ÌÝÍÄÈÉÍ ßÀÌ THE SECOND NATIONAL PROGRAM ON PREVENTION AND CONTROL OF DISEASES CAUSED BY UNHEALTHY LIFESTYLES

ÝÐ Ë ÌÝÍÄÈÉÍ ßÀÌ THE SECOND NATIONAL PROGRAM ON PREVENTION AND CONTROL OF DISEASES CAUSED BY UNHEALTHY LIFESTYLES ÝÐ Ë ÌÝÍÄÈÉÍ ßÀÌ THE SECOND NATIONAL PROGRAM ON PREVENTION AND CONTROL OF DISEASES CAUSED BY UNHEALTHY LIFESTYLES Ulaanbaatar, 2014 THE SECOND NATIONAL PROGRAM ON PREVENTION AND CONTROL OF DISEASES CAUSED

More information

Five chapters 1. What is CVD prevention 2. Why is CVD prevention needed 3. Who needs CVD prevention 4. How is CVD prevention applied 5. Where should CVD prevention be offered Shorter, more adapted to clinical

More information

Meeting the 2025 salt and raised blood pressure reduction targets

Meeting the 2025 salt and raised blood pressure reduction targets Meeting the 2025 salt and raised blood pressure reduction targets Dr Timothy Armstrong Coordinator Department of Prevention of Noncommunicable Diseases Leading risk factors for global mortality Source:

More information

John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam

John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam Latest Insights from the JUPITER Study John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam Inflammation, hscrp, and Vascular Prevention

More information

Professor Norman Sharpe. Heart Foundation West Coast

Professor Norman Sharpe. Heart Foundation West Coast Professor Norman Sharpe Heart Foundation West Coast Primary Care the Keystone to Heart Health Improvement Norman Sharpe June 2013 The heart health continuum and the keystone position The culprit disease

More information

Finland s experiences in salt reduction Pirjo Pietinen, Professor Brussels, /10/09 Presentation name / Author 1

Finland s experiences in salt reduction Pirjo Pietinen, Professor Brussels, /10/09 Presentation name / Author 1 Finland s experiences in salt reduction Pirjo Pietinen, Professor Brussels, 21.10.2009 20/10/09 Presentation name / Author 1 30 years of systematic work concerning salt Recommendation to reduce salt intake

More information

Finnish experiece in the reduction of diet-related NCD s. Geneva 27 June, 2013 Sirpa Sarlio-Lähteenkorva

Finnish experiece in the reduction of diet-related NCD s. Geneva 27 June, 2013 Sirpa Sarlio-Lähteenkorva Finnish experiece in the reduction of diet-related NCD s Geneva 27 June, 2013 Sirpa Sarlio-Lähteenkorva Background, history and achivements Main approaches in health promotion Dietary targets: aturated

More information

WHO global response to salt reduction strategies

WHO global response to salt reduction strategies WHO global response to salt reduction strategies Dr Godfrey C Xuereb Team Leader Population-based Prevention Team SPP Unit Prevention of Noncommunicable Diseases Department The World Health Organization

More information

Guidelines on cardiovascular risk assessment and management

Guidelines on cardiovascular risk assessment and management European Heart Journal Supplements (2005) 7 (Supplement L), L5 L10 doi:10.1093/eurheartj/sui079 Guidelines on cardiovascular risk assessment and management David A. Wood 1,2 * 1 Cardiovascular Medicine

More information

Depok-Indonesia STEPS Survey 2003

Depok-Indonesia STEPS Survey 2003 The STEPS survey of chronic disease risk factors in Indonesia/Depok was carried out from February 2003 to March 2003. Indonesia/Depok carried out Step 1, Step 2 and Step 3. Socio demographic and behavioural

More information

Cardiovascular Risk Assessment and Management Making a Difference

Cardiovascular Risk Assessment and Management Making a Difference Cardiovascular Risk Assessment and Management Making a Difference Norman Sharpe March 2014 Numbers and age-standardised mortality rates from all causes, by sex, 1950 2010 Death rates halved Life expectancy

More information

Pattern of lipid biomarkers and risk of cardiovascular disease

Pattern of lipid biomarkers and risk of cardiovascular disease Pattern of lipid biomarkers and risk of cardiovascular disease Robert Clarke Clinical Trial Service Unit University of Oxford 9 January 2017 Biomarkers for dietary fats Blood lipids (LDL, HDL, triglycerides,

More information

Socioeconomic status and the 25x25 risk factors as determinants of premature mortality: a multicohort study of 1.7 million men and women

Socioeconomic status and the 25x25 risk factors as determinants of premature mortality: a multicohort study of 1.7 million men and women Socioeconomic status and the 25x25 risk factors as determinants of premature mortality: a multicohort study of 1.7 million men and women (Lancet. 2017 Mar 25;389(10075):1229-1237) 1 Silvia STRINGHINI Senior

More information

Diabetes Mellitus: A Cardiovascular Disease

Diabetes Mellitus: A Cardiovascular Disease Diabetes Mellitus: A Cardiovascular Disease Nestoras Mathioudakis, M.D. Assistant Professor of Medicine Division of Endocrinology, Diabetes, & Metabolism September 30, 2013 1 The ABCs of cardiovascular

More information

Secondary Prevention of Coronary Heart Disease in Primary Health Care

Secondary Prevention of Coronary Heart Disease in Primary Health Care & Secondary Prevention of Coronary Heart Disease in Primary Health Care Olivera Batić-Mujanović¹*, Muharem Zildžić², Azijada Beganlić¹ 1. House of Health Tuzla, Family Medicine Teaching Center, Albina

More information

Dietary Reference Values: a Tool for Public Health

Dietary Reference Values: a Tool for Public Health HOGE GEZONDHEISRAAD Dietary Reference Values: a Tool for Public Health CONSEIL SUPERIEUR DE LA SANTE Belgian Dietary Reference Values for Energy and Macronutrients: FATS G. De Backer Brussels, February

More information

Secondary prevention and systems approaches: Lessons from EUROASPIRE and EUROACTION

Secondary prevention and systems approaches: Lessons from EUROASPIRE and EUROACTION Secondary prevention and systems approaches: Lessons from EUROASPIRE and EUROACTION Dr Kornelia Kotseva National Heart & Lung Insitute Imperial College London, UK on behalf of all investigators participating

More information

Branko N Huisa M.D. Assistant Professor of Neurology UNM Stroke Center

Branko N Huisa M.D. Assistant Professor of Neurology UNM Stroke Center Branko N Huisa M.D. Assistant Professor of Neurology UNM Stroke Center THE END! CHANGABLE Blood pressure Diabetes Mellitus Hyperlipidemia Atrial fibrillation Nicotine Drug abuse Life style NOT CHANGABLE

More information

Caribbean Expert Consultation on Scaling Up Population-Based Screening and Management of CVD and Diabetes: Context and Objectives

Caribbean Expert Consultation on Scaling Up Population-Based Screening and Management of CVD and Diabetes: Context and Objectives Caribbean Expert Consultation on Scaling Up Population-Based Screening and Management of CVD and Diabetes: Context and Objectives T. Alafia Samuels MBBS, MPH, PhD: PAHO/WHO (Montego Bay, Jamaica, 4 March

More information

FINDIET 2007 Survey: energy and nutrient intakes

FINDIET 2007 Survey: energy and nutrient intakes Public Health Nutrition: 13(6A), 920 924 doi:10.1017/s1368980010001102 FINDIET 2007 Survey: energy and nutrient intakes Pirjo Pietinen*, Merja Paturi, Heli Reinivuo, Heli Tapanainen and Liisa M Valsta

More information

Obesity in Finland activity to prevent adverse trends

Obesity in Finland activity to prevent adverse trends Obesity in Finland activity to prevent adverse trends Marjaana Lahti-Koski development manager, health promotion Adjunct prof, PhD, MSc (nutrition), Finnish Heart Association marjaana.lahti-koski@sydanliitto.fi

More information

Getting serious about preventing cardiovascular disease

Getting serious about preventing cardiovascular disease Getting serious about preventing cardiovascular disease Southwark s Experience Professor Kevin Fenton Director of Health and Wellbeing, London Borough of Southwark February 2018 Twitter: @ProfKevinFenton

More information

A logical approach to planning health care services in relation to need Dr Christopher A Birt University of Liverpool

A logical approach to planning health care services in relation to need Dr Christopher A Birt University of Liverpool EUREGIO III A logical approach to planning health care services in relation to need Dr Christopher A Birt University of Liverpool PURPOSE OF A HEALTH SERVICE To utilise resources allocated to the health

More information

Models of preventive care in clinical practice to achieve 25 by 25

Models of preventive care in clinical practice to achieve 25 by 25 Models of preventive care in clinical practice to achieve 25 by 25 Professor David A Wood Garfield Weston Professor of Cardiovascular Medicine International Centre for Circulatory Health Imperial College

More information

SUPPLEMENTAL MATERIAL

SUPPLEMENTAL MATERIAL SUPPLEMENTAL MATERIAL Supplemental Table 1. Distribution of Participants Characteristics by Treatment Group at Baseline - The Vitamin D and calcium (CaD) Trial of the Women s Health Initiative (WHI) Study,

More information

Quality Payment Program: Cardiology Specialty Measure Set

Quality Payment Program: Cardiology Specialty Measure Set Measure Title * Reportable via PINNACLE α Reportable via Diabetes Collaborative CQMC v1.0 Measure High Priority Measure Cross Cutting Measure Heart Failure (HF): Angiotensin- Converting Enzyme (ACE) Inhibitor

More information

PREVENTION AND CONTROL OF CARDIOVASCULAR DISEASES. Report by the Regional Director

PREVENTION AND CONTROL OF CARDIOVASCULAR DISEASES. Report by the Regional Director WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU 1\~GIONAL DU PACIFIQUE OCCIDENTAL REGIONAL COlvlMITTEE Thirty-sixth session Manila 16-20 September

More information

The Evidence for Populationwide Reduction in Sodium Intake: Why All the Fuss?

The Evidence for Populationwide Reduction in Sodium Intake: Why All the Fuss? The Evidence for Populationwide Reduction in Sodium Intake: Why All the Fuss? CIA-Harvard Menus of Change National Leadership Summit June 10, 2014 Cambridge, MA General Session IV Lawrence J Appel, MD,

More information

Quality Payment Program: Cardiology Specialty Measure Set

Quality Payment Program: Cardiology Specialty Measure Set Quality Payment Program: Cardiology Specialty Set Title Number CMS Reporting Method(s) Heart Failure (HF): Angiotensin- Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for

More information

Prevenzione cardiovascolare e cambiamento degli stili di vita. Gian Franco Gensini

Prevenzione cardiovascolare e cambiamento degli stili di vita. Gian Franco Gensini Prevenzione cardiovascolare e cambiamento degli stili di vita Gian Franco Gensini Main causes of death worldwide at all ages (year:: 2005) 17.5 milion Preventing Chronic Diseases A vital investiment. WHO

More information

The local healthcare system: Focusing on health

The local healthcare system: Focusing on health The local healthcare system: Focusing on health Sian Griffiths Professor of Public Health Director of the School of Public Health Chairman, Department of Community and Family Medicine The Chinese University

More information

National Strategy. for Control and Prevention of Non - communicable Diseases in Kingdom of Bahrain

National Strategy. for Control and Prevention of Non - communicable Diseases in Kingdom of Bahrain Kingdom of Bahrain Ministry of Health National Strategy for Control and Prevention of Non - communicable Diseases in Kingdom of Bahrain 2014 2025 Behavioural Risk Factors Tobacco Use Unhealthy Diets Physical

More information

The impact of dairy products on cardiovascular health

The impact of dairy products on cardiovascular health The impact of dairy products on cardiovascular health D Vasilopoulou 2014 1 Overview CVD mortality in UK Does dairy consumption increase the risk of CVD? Dairy intake as part of healthy lifestyle RESET

More information

PREVENTION OF TYPE 2 DIABETES AT NATIONAL LEVEL

PREVENTION OF TYPE 2 DIABETES AT NATIONAL LEVEL PREVENTION OF TYPE 2 DIABETES AT NATIONAL LEVEL Jaana Lindström PhD, Adjunct professor, Head of Unit Diabetes Prevention Unit Department of Chronic Diseases Prevention National Institute for Health and

More information

The Mediterranean Diet: The Optimal Diet for Cardiovascular Health

The Mediterranean Diet: The Optimal Diet for Cardiovascular Health The Mediterranean Diet: The Optimal Diet for Cardiovascular Health Vasanti Malik, ScD Research Scientist Department of Nutrition Harvard School of Public Health Cardiovascular Disease Prevention International

More information

The importance of follow-up after a cardiac event: CARDIAC REHABILITATION. Dr. Guy Letcher

The importance of follow-up after a cardiac event: CARDIAC REHABILITATION. Dr. Guy Letcher The importance of follow-up after a cardiac event: CARDIAC REHABILITATION Dr. Guy Letcher The National Medicare Experience Mortality After Angioplasty 225,915 patients Mortality After Bypass Surgery 357,885

More information

Overview. The Mediterranean Diet: The Optimal Diet for Cardiovascular Health. No conflicts of interest or disclosures

Overview. The Mediterranean Diet: The Optimal Diet for Cardiovascular Health. No conflicts of interest or disclosures The Mediterranean Diet: The Optimal Diet for Cardiovascular Health No conflicts of interest or disclosures Vasanti Malik, ScD Research Scientist Department of Nutrition Harvard School of Public Health

More information

Overall Assessment: Good level of support for target although there were some concerns on achievability.

Overall Assessment: Good level of support for target although there were some concerns on achievability. (Version dated 22 March 2012) SUMMARY OF FEEDBACK FROM MEMBER STATES ON THE FIRST DISCUSSION PAPER ON THE PROPOSED GLOBAL MONITORING FRAMEWORK AND INDICATORS AND TARGETS FOR THE PREVENTION AND CONTROL

More information

Different worlds, different tasks for health promotion: comparisons of health risk profiles in Chinese and Finnish rural people

Different worlds, different tasks for health promotion: comparisons of health risk profiles in Chinese and Finnish rural people HEALTH PROMOTION INTERNATIONAL Vol. 16, No. 4 Oxford University Press 2001. All rights reserved Printed in Great Britain Different worlds, different tasks for health promotion: comparisons of health risk

More information

Labelling the salt content in foods: a useful tool in reducing sodium intake in Finland

Labelling the salt content in foods: a useful tool in reducing sodium intake in Finland Public Health Nutrition: 11(4), 335 340 DOI: 10.1017/S1368980007000249 Labelling the salt content in foods: a useful tool in reducing sodium intake in Finland Pirjo Pietinen*, Liisa M Valsta, Tero Hirvonen

More information

Guidelines: Saturated fatty acid and trans-fatty acid intake for adults and children

Guidelines: Saturated fatty acid and trans-fatty acid intake for adults and children Guidelines: Saturated fatty acid and trans-fatty acid intake for adults and children Contents Acknowledgements... 2 Abbreviations and acronyms... 2 Executive summary... 3 Introduction... 15 Scope and purpose...

More information

Page down (pdf converstion error)

Page down (pdf converstion error) 1 of 6 2/10/2005 7:57 PM Weekly August6, 1999 / 48(30);649-656 2 of 6 2/10/2005 7:57 PM Achievements in Public Health, 1900-1999: Decline in Deaths from Heart Disease and Stroke -- United States, 1900-1999

More information

REPORT FROM THE CANADIAN CHRONIC DISEASE SURVEILLANCE SYSTEM:

REPORT FROM THE CANADIAN CHRONIC DISEASE SURVEILLANCE SYSTEM: REPORT FROM THE CANADIAN CHRONIC DISEASE SURVEILLANCE SYSTEM: PROTECTING AND EMPOWERING CANADIANS TO IMPROVE THEIR HEALTH TO PROMOTE AND PROTECT THE HEALTH OF CANADIANS THROUGH LEADERSHIP, PARTNERSHIP,

More information

Community intervention programs to prevent cardiovascular disease

Community intervention programs to prevent cardiovascular disease 1 (7) Community intervention programs to prevent cardiovascular disease SBU Summary and Conclusions Introduction The prevention of disease is a mission of major importance to society and the individual.

More information

Identification of subjects at high risk for cardiovascular disease

Identification of subjects at high risk for cardiovascular disease Master Class in Preventive Cardiology Focus on Diabetes and Cardiovascular Disease Geneva April 14 2011 Identification of subjects at high risk for cardiovascular disease Lars Rydén Karolinska Institutet

More information

Metabolic Syndrome. Shon Meek MD, PhD Mayo Clinic Florida Endocrinology

Metabolic Syndrome. Shon Meek MD, PhD Mayo Clinic Florida Endocrinology Metabolic Syndrome Shon Meek MD, PhD Mayo Clinic Florida Endocrinology Disclosure No conflict of interest No financial disclosure Does This Patient Have Metabolic Syndrome? 1. Yes 2. No Does This Patient

More information

Obesity Prevention and Control: Provider Education with Patient Intervention

Obesity Prevention and Control: Provider Education with Patient Intervention Obesity Prevention and : Provider Education with Patient Summary Evidence Table and Population Cohen et al. (1991) 1987-1988 : RCT Location: Pittsburgh, PA Physician training session by a behavioral psychologist

More information

40% minimum reduction from

40% minimum reduction from 160 Circulatory Disease Mortality Target: Death rates in England 1993-2006 Persons under 75 Death / 100,000 population A fall of 44% over 10 years 140 120 100 80 60 40 20 141.0 84.2 Immortality guaranteed

More information

... Introduction. Methods. Eeva Ketola 1, Tiina Laatikainen 2, Erkki Vartiainen 2

... Introduction. Methods. Eeva Ketola 1, Tiina Laatikainen 2, Erkki Vartiainen 2 European Journal of Public Health, Vol. 20, No. 1, 107 112 ß The Author 2009. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. doi:10.1093/eurpub/ckp070

More information

Nutrition & Diet for Healthy Lifestyles in Europe

Nutrition & Diet for Healthy Lifestyles in Europe Nutrition & Diet for Healthy Lifestyles in Europe Supported by the European Commission, Directorate General for Health & Consumer Protection & The Ministry of Health, Greece. Organized by University of

More information

ACTION PLAN. Intergovernmental Coordinating Body, Ministry of Finance. Intergovernmental Coordinating Body, Ministry of Finance

ACTION PLAN. Intergovernmental Coordinating Body, Ministry of Finance. Intergovernmental Coordinating Body, Ministry of Finance ACTION PLAN Strategic goal 1: Reduction of tobacco demand which should reduce the prevalence of smoking in the population Objectives Activity/Action Responsible Party/Implementing Body Deadline Source

More information

Bridging health promotion intervention policy with behavioral risk factor surveillance in Thailand

Bridging health promotion intervention policy with behavioral risk factor surveillance in Thailand Bridging health promotion intervention policy with behavioral risk factor surveillance in Thailand The 7 th World Alliance for Risk Factor Surveillance (WARFS) Global Conference Toronto, Ontario, Canada,

More information

Reducing risk in heart disease

Reducing risk in heart disease Reducing risk in heart disease An expert guide to clinical practice for secondary prevention of coronary heart disease Prof Patricia Davidson (chair) Prof Nigel Stocks Dr Anu Aggarwal Ms Jill Waddell Ms

More information

Heart Disease Genesis

Heart Disease Genesis Heart Disease Genesis The Ultimate Lecture on CAD origins Petr Polasek MD FRCPC FACC Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored,

More information

EUROPEAN JOURNAL OF PUBLIC HEALTH 2003; 13: Health behaviour in Estonia, Finland and Lithuania Standardized comparison

EUROPEAN JOURNAL OF PUBLIC HEALTH 2003; 13: Health behaviour in Estonia, Finland and Lithuania Standardized comparison EUROPEAN JOURNAL OF PUBLIC HEALTH 2003; 13: 11 17 Health behaviour in Estonia, Finland and Lithuania 1994 1998 Standardized comparison PEKKA PUSKA, VILLE HELASOJA, RITVA PRÄTTÄLÄ, ANU KASMEL, JURATE KLUMBIENE

More information

Health Improvement Initiative

Health Improvement Initiative The City of Dalton Health Improvement Initiative Case Study: City of Dalton Chronic Disease Risk Reduction Program Improved Health and Lowered Costs EXPERIENCE TRUE HEALTH 5 Batterson Park Rd, Suite 1

More information

Reduction in salt consumption in Europe: a preventive and economic imperative Francesco P Cappuccio MD MSc DSc FRCP FFPH FBHS FAHA

Reduction in salt consumption in Europe: a preventive and economic imperative Francesco P Cappuccio MD MSc DSc FRCP FFPH FBHS FAHA Reduction in salt consumption in Europe: a preventive and economic imperative Francesco P Cappuccio MD MSc DSc FRCP FFPH FBHS FAHA Professor of Cardiovascular Medicine & Epidemiology Head, WHO Collaborating

More information

Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden

Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden Cardiovascular Disease Prevention (CVD) Three Strategies for CVD

More information

Biases in clinical research. Seungho Ryu, MD, PhD Kanguk Samsung Hospital, Sungkyunkwan University

Biases in clinical research. Seungho Ryu, MD, PhD Kanguk Samsung Hospital, Sungkyunkwan University Biases in clinical research Seungho Ryu, MD, PhD Kanguk Samsung Hospital, Sungkyunkwan University Learning objectives Describe the threats to causal inferences in clinical studies Understand the role of

More information

Prof. Arnon Baruch Afek Director General of the Ministry of Health of the State of Israel

Prof. Arnon Baruch Afek Director General of the Ministry of Health of the State of Israel Prof. Arnon Baruch Afek Director General of the Ministry of Health of the State of Israel WHO and FAO 19-21 November Thank you, Mr. / Ms. Chair. I am grateful and honored to have the opportunity to address

More information

Addressing human resource challenges for delivery of NCD services in Bhutan

Addressing human resource challenges for delivery of NCD services in Bhutan Addressing human resource challenges for delivery of NCD services in Bhutan Tandin Dorji Chief, NCD Division Department of Public Health Ministry of Health Royal Govt. of Bhutan Country Profile Area: 38,394

More information

Disclosures. Diabetes and Cardiovascular Risk Management. Learning Objectives. Atherosclerotic Cardiovascular Disease

Disclosures. Diabetes and Cardiovascular Risk Management. Learning Objectives. Atherosclerotic Cardiovascular Disease Disclosures Diabetes and Cardiovascular Risk Management Tony Hampton, MD, MBA Medical Director Advocate Aurora Operating System Advocate Aurora Healthcare Downers Grove, IL No conflicts or disclosures

More information

Hypertension JNC 8 (2014)

Hypertension JNC 8 (2014) Hypertension JNC 8 (2014) Renewed: February 2018 Updated: February 2015 Comparison of Seventh Joint National Committee (JNC 7) vs. Eighth Joint National Committee (JNC 8) Hypertension Guidelines Methodology

More information

Blood Pressure LIMBO How Low To Go?

Blood Pressure LIMBO How Low To Go? Blood Pressure LIMBO How Low To Go? Joseph L. Kummer, MD, FACC Bryan Heart Spring Conference April 21 st, 2018 Hypertension Epidemiology Over a billion people have hypertension Major cause of morbidity

More information

Health Indicators and Status in the European Union

Health Indicators and Status in the European Union Elmadfa I,Weichselbaum E (eds): European Nutrition and Health Report 4. Forum Nutr. Basel, Karger, 5, vol 58, pp 47 61 Health Indicators and Status in the European Prevalence of Overweight and Obesity

More information

Supplemental table 1. Dietary sources of protein among 2441 men from the Kuopio Ischaemic Heart Disease Risk Factor Study MEAT DAIRY OTHER ANIMAL

Supplemental table 1. Dietary sources of protein among 2441 men from the Kuopio Ischaemic Heart Disease Risk Factor Study MEAT DAIRY OTHER ANIMAL ONLINE DATA SUPPLEMENT 1 SUPPLEMENTAL MATERIAL Pork Bacon Turkey Kidney Cream Cottage cheese Mutton and lamb Game (elk, reindeer) Supplemental table 1. Dietary sources of protein among 2441 men from the

More information

Message From the Minister

Message From the Minister May 2002 Message From the Minister A basic principle of the health and social services system is that people have a responsibility to maintain their own health. The Department of Health and Social Services

More information

Update on CVD and Microvascular Complications in T2D

Update on CVD and Microvascular Complications in T2D Update on CVD and Microvascular Complications in T2D Jay S. Skyler, MD, MACP Division of Endocrinology, Diabetes, and Metabolism and Diabetes Research Institute University of Miami Miller School of Medicine

More information

Placebo-Controlled Statin Trials MANAGEMENT OF HIGH BLOOD CHOLESTEROL MANAGEMENT OF HIGH BLOOD CHOLESTEROL: IMPLICATIONS OF THE NEW GUIDELINES

Placebo-Controlled Statin Trials MANAGEMENT OF HIGH BLOOD CHOLESTEROL MANAGEMENT OF HIGH BLOOD CHOLESTEROL: IMPLICATIONS OF THE NEW GUIDELINES MANAGEMENT OF HIGH BLOOD CHOLESTEROL: IMPLICATIONS OF THE NEW GUIDELINES Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest

More information

Food Choice at Work From Evaluation to Practical Application in Everyday Workplace Settings

Food Choice at Work From Evaluation to Practical Application in Everyday Workplace Settings Food Choice at Work From Evaluation to Practical Application in Everyday Workplace Settings Clare Kelly Food Choice at Work Ltd Department of Epidemiology and Public Health University College Cork, Ireland

More information

Guidelines for Integrated Management of. Cardiovascular Diseases and Diabetes. in Clinics and Ri-hospitals

Guidelines for Integrated Management of. Cardiovascular Diseases and Diabetes. in Clinics and Ri-hospitals Guidelines for Integrated Management of Cardiovascular Diseases and Diabetes in Clinics and Ri-hospitals Ministry of Public Health DPR Korea January 2013 Rationale ncommunicable diseases such as cardiovascular

More information

Vascular Diseases. Overview: Selected Slides

Vascular Diseases. Overview: Selected Slides Vascular Diseases Overview: Selected Slides Total deaths and change in vascular death rates

More information

Module 2. Global Cardiovascular Risk Assessment and Reduction in Women with Hypertension

Module 2. Global Cardiovascular Risk Assessment and Reduction in Women with Hypertension Module 2 Global Cardiovascular Risk Assessment and Reduction in Women with Hypertension 1 Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored,

More information

July 13, Dear Ms. Davis:

July 13, Dear Ms. Davis: July 13, 2010 Carole Davis Co-Executive Secretary and Designated Federal Officer of the Dietary Guidelines Advisory Committee Center for Nutrition Policy and Promotion U.S. Department of Agriculture 3101

More information

The Need for Balance in Evaluating the Evidence on Na and CVD

The Need for Balance in Evaluating the Evidence on Na and CVD The Need for Balance in Evaluating the Evidence on Na and CVD Salim Yusuf Professor of Medicine, McMaster University Executive Director, Population Health Research Institute Vice-President Research, Hamilton

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Åsvold BO, Vatten LJ, Bjøro T, et al; Thyroid Studies Collaboration. Thyroid function within the normal range and risk of coronary heart disease: an individual participant

More information

National Multi-sectoral Action Plan for Prevention & Control of NCDs in India

National Multi-sectoral Action Plan for Prevention & Control of NCDs in India National Multi-sectoral Action Plan for Prevention & Control of NCDs in India Webinar on Double-Duty Policies for Improved Nutrition 7 th June 2017 Prof. Damodar Bachani, MD, MPHM Deputy Commissioner (NCD)

More information

Going Coconut over Saturated Fat? Why So Much Confusion? Part 1 Interpreting Conflicting Research

Going Coconut over Saturated Fat? Why So Much Confusion? Part 1 Interpreting Conflicting Research Going Coconut over Saturated Fat? Why So Much Confusion? Part 1 Interpreting Conflicting Research Disclosures Alice H Lichtenstein Board Member/Advisory Panel Food and Nutrition Board, National Academies

More information

Andrew Cohen, MD and Neil S. Skolnik, MD INTRODUCTION

Andrew Cohen, MD and Neil S. Skolnik, MD INTRODUCTION 2 Hyperlipidemia Andrew Cohen, MD and Neil S. Skolnik, MD CONTENTS INTRODUCTION RISK CATEGORIES AND TARGET LDL-CHOLESTEROL TREATMENT OF LDL-CHOLESTEROL SPECIAL CONSIDERATIONS OLDER AND YOUNGER ADULTS ADDITIONAL

More information

Primary and Secondary Prevention of Cardiovascular Disease. Frank J. Green, M.D., F.A.C.C. St. Vincent Medical Group

Primary and Secondary Prevention of Cardiovascular Disease. Frank J. Green, M.D., F.A.C.C. St. Vincent Medical Group Primary and Secondary Prevention of Cardiovascular Disease Frank J. Green, M.D., F.A.C.C. St. Vincent Medical Group AHA Diet and Lifestyle Recommendations Balance calorie intake and physical activity to

More information

Nutritional Risk Factors for Peripheral Vascular Disease: Does Diet Play a Role?

Nutritional Risk Factors for Peripheral Vascular Disease: Does Diet Play a Role? Nutritional Risk Factors for Peripheral Vascular Disease: Does Diet Play a Role? John S. Lane MD, Cheryl P. Magno MPH, Karen T. Lane MD, Tyler Chan BS, Sheldon Greenfield MD University of California, Irvine

More information

Cardiovascular Complications of Diabetes

Cardiovascular Complications of Diabetes VBWG Cardiovascular Complications of Diabetes Nicola Abate, M.D., F.N.L.A. Professor and Chief Division of Endocrinology and Metabolism The University of Texas Medical Branch Galveston, Texas Coronary

More information

Cardiac Rehabilitation after Primary Coronary Intervention CONTRA

Cardiac Rehabilitation after Primary Coronary Intervention CONTRA DEBATE SESSION Is there a role for cardiac rehabilitation in the modern era of Percutaneous coronary intervention and coronary artery bypass grafting? Cardiac Rehabilitation after Primary Coronary Intervention

More information