Academic literature on the topic 'Ethnic minority; Cardiovascular disease; Smoking'

Depression is frequently associated with other psychiatric disorders, chronic health problems, and distressed close relationships. This comorbidity between depression and other disorders and problems is important. Furthermore, there has been a large increase in research on depressive comorbidity. Therefore, a book of 37 state-of-the-art reviews by experts will be helpful to teachers, researchers, practitioners, developers of relevant policies, and students in these areas. The comorbidity of depression with other psychiatric disorders is addressed in chapters focusing on panic disorder, post-tr

The American Heart Association and American Stroke Association have published special guidelines for the prevention of cardiovascular disease in women. The European Union project ‘A Road Map for Gender Medicine in Europe’ pointed out the lack of female aspects in the guidelines from the European Society of Cardiology. So far, about 200 risk factors or non-healthy lifestyle factors have been identified in women The INTERHEART study highlighted nine risk factors that are responsible for 90% of cardiovascular disease in both genders. The nine risk factors are important for both men and women but differ in impact. For women, diabetes and hypertension appear to be the strongest. The Framingham Risk Score has been criticized because it underestimates the risk in asymptomatic postmenopausal women. The SCORE system ranges between 45 and 65 years only, it estimates fatal but not total risk, it is limited to the major determinants of risk, and not adapted to different ethnic or sex difference. Because the same risk factors for both sexes have been used in risk calculations for the last 40 years, the Reynolds score system for women was introduced, adding age, systolic blood pressure, haemoglobin A1c, current smoking, total high-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and family history. Only a further 5% risk is added in the medium-risk group and taken away from the low-risk group. Traditional risk factors include the major ones of diabetes, hypertension, dyslipidaemia, smoking, and family history of premature heart disease, as well as the non-independent risk variables of physical inactivity and body weight and composition.

The American Heart Association and American Stroke Association have published special guidelines for the prevention of cardiovascular disease in women. The European Union project ‘A Road Map for Gender Medicine in Europe’ pointed out the lack of female aspects in the guidelines from the European Society of Cardiology. So far, about 200 risk factors or non-healthy lifestyle factors have been identified in women The INTERHEART study highlighted nine risk factors that are responsible for 90% of cardiovascular disease in both sexes. The nine risk factors are important for both men and women but differ in impact. For women, diabetes and hypertension appear to be the strongest. The Framingham Risk Score has been criticized because it underestimates the risk in asymptomatic postmenopausal women. The SCORE system ranges between 45 and 65 years only, it estimates fatal but not total risk, it is limited to the major determinants of risk, and not adapted to different ethnic or sex difference. Because the same risk factors for both sexes have been used in risk calculations for the last 40 years, the Reynolds score system for women was introduced, adding age, systolic blood pressure, haemoglobin A1c, current smoking, total high-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and family history. Only a further 5% risk is added in the medium-risk group and taken away from the low-risk group. Traditional risk factors include the major ones of diabetes, hypertension, dyslipidaemia, smoking, and family history of premature heart disease, as well as the non-independent risk variables of physical inactivity and body weight and composition. New guidelines have appeared since this chapter was originally published with no major differences between the treatment recommendations between men and women.

Significant variation is evident among different ethnicities regarding the prevalence, awareness, severity, treatment, and complications of major cardiovascular disease (CVD) risk factors. Relative to white Europeans, stroke mortality is almost doubled in South Asians and Afro-Caribbeans; however, when coronary artery disease mortality is considered, it is high in South Asians and low in Afro-Caribbeans. Hypertension is more common, severe, and is associated with higher rates of morbidity and mortality in black people than white people. Diabetes is more prevalent and less controlled in South Asians which leads to a nearly fourfold higher cardiovascular mortality in South Asians than other ethnic groups. Furthermore, South Asians suffer from a highly atherogenic lipid profile. In contrast, black people are generally known for their higher high-density lipoprotein and lower triglyceride levels than white people which seem to play a major role in protecting them from coronary artery disease. For a given waist circumference, Asian, black, and Caucasian people show different levels of intra-abdominal adiposity and CVD risk. Hence, the joint definition from five major organizations in 2009 of the metabolic syndrome set ethnic-specific values of waist circumference to define central obesity. Black Caribbean men have the highest rates of current smoking among all ethnic groups in the United Kingdom while nearly all South Asian and black African women are never-smokers. Varied genetic and lifestyle-related risk factors and their interactions seem to be responsible for the ethnic differences in CVD risk factors. There is a clear need for ethnic-specific guidelines for diagnosis and treatment of major CVD risk factors to maximize the outcomes of preventive strategies.

Significant variation is evident among different ethnicities regarding the prevalence, awareness, severity, treatment, and complications of major cardiovascular disease (CVD) risk factors. Relative to white Europeans, stroke mortality is almost doubled in South Asians and Afro-Caribbeans; however, when coronary artery disease mortality is considered, it is high in South Asians and low in Afro-Caribbeans. Hypertension is more common, severe, and is associated with higher rates of morbidity and mortality in black people than white people. Diabetes is more prevalent and less controlled in South Asians which leads to a nearly fourfold higher cardiovascular mortality in South Asians than other ethnic groups. Furthermore, South Asians suffer from a highly atherogenic lipid profile. In contrast, black people are generally known for their higher high-density lipoprotein and lower triglyceride levels than white people which seem to play a major role in protecting them from coronary artery disease. For a given waist circumference, Asian, black, and Caucasian people show different levels of intra-abdominal adiposity and CVD risk. Hence, the joint definition from five major organizations in 2009 of the metabolic syndrome set ethnic-specific values of waist circumference to define central obesity. Black Caribbean men have the highest rates of current smoking among all ethnic groups in the United Kingdom while nearly all South Asian and black African women are never-smokers. Varied genetic and lifestyle-related risk factors and their interactions seem to be responsible for the ethnic differences in CVD risk factors. There is a clear need for ethnic-specific guidelines for diagnosis and treatment of major CVD risk factors to maximize the outcomes of preventive strategies.

Atherosclerotic renovascular disease (ARVD) refers to atheromatous narrowing of one or both renal arteries and frequently coexists with atherosclerotic disease in other vascular beds. Patients with this condition are at high risk of adverse cardiovascular events, with mortality around 8% per year. Many patients with ARVD have chronic kidney disease, but only a minority progress to endstage kidney disease, suggesting that pre-existing hypertensive and/or ischaemic renal parenchymal injury is the usual cause of renal dysfunction. Many patients with ARVD are asymptomatic, but there can be important complications such as uncontrolled hypertension, rapid decline in kidney function, and recurrent acute heart failure (flash pulmonary oedema). Management—patients with ARVD should receive medical vascular protective therapy just like other patients with atheromatous disease. This involves antiplatelet agents such as aspirin, statins, antihypertensive agents (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are the drugs of choice), optimization of glycaemic control in diabetic patients, and advice/help to stop smoking. On the basis of randomized controlled trial data, they should not be offered revascularization by angioplasty/stenting for the purpose of improving blood pressure control or stabilizing/improving renal function. However, there is evidence that a subgroup of patients with specific complications of ARVD (as previously mentioned) may benefit from revascularization.