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The development of the cardiovascular diseases leading to the myocardical infraction

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This article has been cited by other articles in PMC. Abstract Current knowledge and research perspectives on the top ranking causes of mortality worldwide, i.

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In fact, until recently, the evidence describing the incidence of acute myocardial infarction, the underlying risk factors, and the clinical outcomes of those who have this acute ischemic coronary event has largely been based on studies conducted in developed countries, with limited data for women and usually of low-ethnic diversity.

Recent reports by the WHO have provided striking public health information, i. Therefore, multiethnic population-based research including prospective cohorts and, when appropriate, case—control studies, is warranted. These studies should be specifically designed to ascertain key public health measures, such as geographic variations in non-communicable diseases, diagnosis of traditional and potential newly discovered risk factors, causes of death and disability, and gaps for improvement in healthcare prevention both primary and secondary and specific treatments.

As an example, a multinational, multiethnic population-based cohort study is the Prospective Urban and Rural Epidemiology study, which is the largest global initiative of nearly 200,000 adults aged 35—70 years, looking at environmental, societal, and biological influences on obesity and chronic health conditions, such as ischemic heart disease, stroke, and cancer among urban and rural communities in low- middle- and high-income countries, with national, community, household, and individual-level data.

Implementation of population-based strategies is crucial to optimizing limited health system resources while improving care and cardiovascular morbidity and mortality.

Among its well-established modifiable risk factors are hypertension, dyslipidemia, smoking, and diabetes.

Conflict of Interest Statement

However, the evidence describing the incidence of acute myocardial infarction, the underlying risk factors, and the clinical outcomes of those who have this acute ischemic coronary event has largely been based on studies conducted in developed countries, with limited data for women and usually of low-ethnic diversity.

Therefore, generalizability to allow for public health implementation has not been properly feasible or has been made with high level of uncertainty 1. We herein describe recent progress in the research-based knowledge through well-designed community-based cohorts and large case—control studies, widely conducted, i.

This research strategy obviously enhances external validity or broader generalizability of assessment of risk factors for acute myocardial infarction and stroke, thus enabling healthcare providers with reliable foundation to implement cost-effective prevention strategies on both community and population the development of the cardiovascular diseases leading to the myocardical infraction.

In order to address this paucity of precision and external validity, high-quality data from well-conducted studies over the last decade have provided cardiovascular field with clinically relevant information as well as additional insights on the risk factors associated with higher risk for the first myocardial infarction or stroke 23.

Those studies were designed to address the lack of representativeness of low-income countries and societal minorities as well as to evaluate the actual impact of traditional and emerging risk factors on the population attributable risk PARi. Moreover, those factors were easily measured and collected by standardized electronic data capture forms, and were considered potentially modifiable, which included the following by decreasing odds ratio: Furthermore, the associations the development of the cardiovascular diseases leading to the myocardical infraction between these risk factors and acute myocardial infarction were consistent in both genders and across different ethnicities and geographic regions, enhancing the worldwide generalizability of the results.

In addition, the investigators aimed to assess individual contribution of specific risk factors to the stroke burden while exploring differences between risk factors for stroke and those for myocardial infarction.

These risk factors were significant for ischemic stroke, whereas smoking, alcohol intake, diet, hypertension, and waist-to-hip ratio were significantly associated with intracerebral hemorrhagic stroke. This second phase of the case—control study for stroke enrolled more than 27,011 individuals, including 13,604 with stroke and 13,407 age- and gender-matched controls.

The other risk factors that contribute most to the stroke risk include lipid levels, physical inactivity, smoking, and diet. Moreover, recent reports by the World Health Organization have provided striking public health information, i. This imbalance obviously leads to growing inequalities in the occurrence, outcomes, and heath care related costs of CVD across various income levels and populations 5.

Therefore, multiethnic population-based research including prospective cohorts and, when appropriate, case—control and cross-sectional studies, is warranted. Epidemiological and clinical studies should be specifically designed to ascertain key public health measures, such as geographic variations, in the prevalence and incidence of non-communicable diseases, diagnosis of traditional and potential newly discovered risk factors, causes of death and disability, and practice gaps.

The pooled data will provide the rationale for proposals and implementation of feasible strategies, with primary goals of improvement in cardiovascular disease prevention, both primary — starting early in life or even during fetal development — and secondary, with sustained long-term accessibility, affordability, and patient adherence to available effective medications, and adoption of quality of care improvement programs. Finally, current epidemiological research recognizes the continuous need for global, accurate, and reliable description of morbidity and mortality due to cardiovascular causes, which would enable comparisons while assessing the progress of delivery of benefit-proven cardiovascular care 67.

As a good example of research with warranted broader geographic and ethnic representativeness, the multinational, population-based cohort Prospective Urban and Rural Epidemiology PURE study is the largest global initiative assessing societal, biological, and environmental influences on relevant chronic public health conditions, such as ischemic heart disease and stroke 8. The PURE study currently comprises nearly 200,000 adults aged 35—70 years who were initially enrolled between 2003 and 2009, from either urban or rural communities in low- middle- and high-income countries.

Prespecified statistical assumptions were taken into consideration to collect huge amount of relevant data at national, community, household, and individual levels, since the baseline and throughout the long-term follow-up.

  1. A number of different medications can also be used to treat a heart attack. In many persons with rheumatic valvular disease, more than one valve is involved.
  2. For patients who did not attain goal BP with the starting drug, the study investigator could add the step 2 agents atenolol, clonidine, or reserpine.
  3. Later infections may bring about recurrences of rheumatic fever that damage the heart.
  4. Indeed, it is important to discuss how to apply newly developed evidence into daily practice, which certainly requires huge collaboration on global, political, governmental, societal, professional, and local levels to foster rapid, full, and measurable implementation of simple, widely available, cost-effective, and safe strategies of prevention and treatment targeting significant reductions in cardiovascular mortality. Sudden death usually occurs outside the hospital, of course, and thus presents a more difficult problem.
  5. The JNC 7 classifications reflect recent data showing that hypertension plays a central role in the progression of CVD.

Some of its recent contributions include the following: Overall, those findings emphasize the substantial gap that requires improvement efforts by public health polices in terms of adequate hypertension diagnosis, broad accessibility to inexpensive treatments, and eventually targeted blood pressure control and lower morbidity and mortality. In terms of non-pharmacological prevention strategies, among a sample of patients with prior coronary heart disease or cerebrovascular disease event from countries with various income levels, the proportion of individuals adopting all three healthy lifestyle behaviors, i.

Lastly, because sustained use of secondary prevention medications is not ideally offered worldwide — especially low in poorer countries and in rural-resident individuals — systematic, regionally customized feasible approaches are needed to improve the long-term use of simple, affordable and effective treatments, i. After taking this knowledge into consideration, what would be the next steps for prevention of myocardial infarction, stroke, heart failure, and related deaths?

In order to achieve that goal of prevention while targeting significant reductions in morbidity and mortality, continuously growing body of evidence through population-based research and, consequently, worldwide implementation of simple and efficient large-scale primary and secondary prevention strategies are highly demanded and, therefore, should be a global priority on a multilevel organized task force.

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Indeed, it is important to discuss how to apply newly developed evidence into daily practice, which certainly requires huge collaboration on global, political, governmental, societal, professional, and local levels to foster rapid, full, and measurable implementation of simple, widely available, cost-effective, and safe strategies of prevention and treatment targeting significant reductions in cardiovascular mortality.

Furthermore, some recommendations have been recently released to provide guidance to improving cardiovascular health at the community level, which include some interventions for public health programs: It is relevant to mention some of the main principles of this global prevention plan: Conflict of Interest Statement The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Global burden of cardiovascular diseases, part I: Lancet 2010 376 9735: World Health Organization; 2011. European guidelines on cardiovascular disease prevention in clinical practice version 2012.

Acute Myocardial Infarction

Eur Heart J 2012 33: Am Heart J 2009 158: Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high, middle, and low-income countries. JAMA 2013 310 9: Prevalence of a healthy lifestyle among individuals with cardiovascular disease in high- middle- and low-income countries. JAMA 2013 309 15: Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries the PURE Study: Lancet 2011 378 9798: A scientific statement for public health practitioners, healthcare providers, and health policy makers.