Contrasting cardiovascular mortality trends in Eastern Mediterranean populations: Contributions from risk factor changes and treatments

Publication date: 1 April 2016Source:International Journal of Cardiology, Volume 208 Author(s): Julia Critchley, Simon Capewell, Martin O’Flaherty, Niveen Abu-Rmeileh, Samer Rastam, Olfa Saidi, Kaan Sözmen, Azza Shoaibi, Abdullatif Husseini, Fouad Fouad, Nadia Ben Mansour, Wafa Aissi, Habiba Ben Romdhane, Belgin Unal, Piotr Bandosz, Kathleen Bennett, Mukesh Dherani, Radwan Al Ali, Wasim Maziak, Hale Arık, Gül Gerçeklioğlu, Deniz Utku Altun, Hatice Şimşek, Sinem Doganay, Yücel Demiral, Özgür Aslan, Nigel Unwin, Peter Phillimore, Nourredine Achour, Waffa Aissi, Riadh Allani, Chokra Arfa, Heidar Abu-Kteish, Niveen Abu-Rmeileh, Radwan Al Ali, Deniz Altun, Balsam Ahmad, Hale Arık, Özgür Aslan, Latifa Beltaifa, Nadia Ben Mansour, Kathleen Bennett, Habiba Ben Romdhane, Nabil Ben Salah, Marissa Collins, Julia Critchley, Simon Capewell, Mukesh Dherani, Yücel Demiral, Sinem Doganay, Madonna Elias, Gül Ergör, Ibtihal Fadhil, Fouad Fouad, Gül Gerçeklioğlu, Rula Ghandour, Sibel Göğen, Abdullatif Husseini, Samer Jaber, Sibel Kalaca, Rana Khatib, Rasha Khatib, Saer Koudsie, Bülent Kilic, Olfa Lassoued, Helen Mason, Wasim Maziak, Maher Abou Mayaleh, Nahed Mikki, Ghmaez Moukeh, Martin O. Flaherty, Peter Phillimore, Samer Rastam, Gojka Roglic, Olfa Saidi, Gül Saatli, Ilhan Satman, Azza Shoaibi, Hatice Şimşek, Nesrien Soulaiman, Kaan Sözmen, Faten Tlili, Belgin Unal, Nigel Unwin, Nazan Yardim, Shahaduz ZamanBackgroundMiddle income countries are facing an epidemic of non-communicable diseases, especially coronary heart disease (CHD). We used a validated CHD mortality model (IMPACT) to explain recent trends in Tunisia, Syria, the occupied Palestinian territory (oPt) and Turkey.MethodsData on populations, mortality, patient numbers, treatments and risk factor trends from national and local surveys in each country were collated over two time points (1995–97; 2006–09); integrated and analysed using the IMPACT model.ResultsRisk factor trends: Smoking prevalence was high in men, persisting in Syria but decreasing in Tunisia, oPt and Turkey. BMI rose by 1–2kg/m2 and diabetes prevalence increased by 40%–50%. Mean systolic blood pressure and cholesterol levels increased in Tunisia and Syria.Mortality trends: Age-standardised CHD mortality rates rose by 20% in Tunisia and 62% in Syria. Much of this increase (79% and 72% respectively) was attributed to adverse trends in major risk factors, occurring despite some improvements in treatment uptake.CHD mortality rates fell by 17% in oPt and by 25% in Turkey, with risk factor changes accounting for around 46% and 30% of this reduction respectively. Increased uptake of community treatments (drug treatments for chronic angina, heart failure, hypertension and secondary prevention after a cardiac event) accounted for most of the remainder.DiscussionCHD death rates are rising in Tunisia and Syria, whilst oPt and Turkey demonstrate clear falls, reflecting improvements in major risk factors with contributions from medical treatments. However, smoking prevalence remains very high in men; obesity and diabetes levels are rising dramatically.

Contrasting cardiovascular mortality trends in Eastern Mediterranean populations: Contributions from risk factor changes and treatments

Publication date: Available online 7 January 2016Source:International Journal of Cardiology Author(s): Julia Critchley, Simon Capewell, Martin O. Flaherty, Niveen Abu-Rmeileh, Samer Rastam, Olfa Saidi, Kaan Sözmen, Azza Shoaibi, Abdullatif Husseini, Fouad Fouad, Nadia Ben Mansour, Wafa Aissi, Habiba Ben Romdhane, Belgin Unal, Piotr Bandosz, Kathleen Bennett, Mukesh Dherani, Radwan Al Ali, Wasim Maziak, Hale Arık, Gül Gerçeklioğlu, Deniz Utku Altun, Hatice Şimşek, Sinem Doganay, Yücel Demiral, Özgür Aslan, Nigel Unwin, Peter Phillimore, Nourredine Achour, Waffa Aissi, Riadh Allani, Chokra Arfa, Heidar Abu-Kteish, Niveen Abu-Rmeileh, Radwan Al Ali, Deniz Altun, Balsam Ahmad, Hale Arık, Özgür Aslan, Latifa Beltaifa, Nadia Ben Mansour, Kathleen Bennett, Habiba Ben Romdhane, Nabil Ben Salah, Marissa Collins, Julia Critchley, Simon Capewell, Mukesh Dherani, Yücel Demiral, Sinem Doganay, Madonna Elias, Gül Ergör, Ibtihal Fadhil, Fouad Fouad, Gül Gerçeklioğlu, Rula Ghandour, Sibel Göğen, Abdullatif Husseini, Samer Jaber, Sibel Kalaca, Rana Khatib, Rasha Khatib, Saer Koudsie, Bülent Kilic, Olfa Lassoued, Helen Mason, Wasim Maziak, Maher Abou Mayaleh, Nahed Mikki, Ghmaez Moukeh, Martin O. Flaherty, Peter Phillimore, Samer Rastam, Gojka Roglic, Olfa Saidi, Gül Saatli, Ilhan Satman, Azza Shoaibi, Hatice Şimşek, Nesrien Soulaiman, Kaan Sözmen, Faten Tlili, Belgin Unal, Nigel Unwin, Nazan Yardim, Shahaduz ZamanBackgroundMiddle income countries are facing an epidemic of non-communicable diseases, especially coronary heart disease (CHD). We used a validated CHD mortality model (IMPACT) to explain recent trends in Tunisia, Syria, the occupied Palestinian territory (oPt) and Turkey.MethodsData on populations, mortality, patient numbers, treatments and risk factor trends from national and local surveys in each country were collated over two time points (1995–97; 2006–09); integrated and analysed using the IMPACT model.ResultsRisk factor trends: Smoking prevalence was high in men, persisting in Syria but decreasing in Tunisia, oPt and Turkey. BMI rose by 1–2kg/m2 and diabetes prevalence increased by 40%–50%. Mean systolic blood pressure and cholesterol levels increased in Tunisia and Syria.Mortality trends: Age-standardised CHD mortality rates rose by 20% in Tunisia and 62% in Syria. Much of this increase (79% and 72% respectively) was attributed to adverse trends in major risk factors, occurring despite some improvements in treatment uptake.CHD mortality rates fell by 17% in oPt and by 25% in Turkey, with risk factor changes accounting for around 46% and 30% of this reduction respectively. Increased uptake of community treatments (drug treatments for chronic angina, heart failure, hypertension and secondary prevention after a cardiac event) accounted for most of the remainder.DiscussionCHD death rates are rising in Tunisia and Syria, whilst oPt and Turkey demonstrate clear falls, reflecting improvements in major risk factors with contributions from medical treatments. However, smoking prevalence remains very high in men; obesity and diabetes levels are rising dramatically.

Risk Factors and Coping Style Affect Health Outcomes in Adults With Type 2 Diabetes

Objective:Most psychosocial interventions among individuals with Type 2 diabetes mellitus (T2DM) target depressive symptoms (DSs) rather than causal antecedents that lead to DSs or affect health-related quality of life (HrQoL). This research investigated a conceptual model of the effects of risk factors and coping styles on HrQoL and DSs in patients with T2DM.
Method:A descriptive, correlational design was used with a convenience sample of 241 adults with T2DM aged ≥ 20 years recruited from a hospital metabolic outpatient department. Data were collected using a demographic questionnaire, the modified Ways of Coping Checklist, the Center for Epidemiological Studies Depression Scale, the Short Form 36 Health Survey, and physiological examination. HbA1C was collected from participants’ medical records. Structural equation modeling techniques were used to analyze relationships among risk factors, mediators, and HrQoL.
Results:Younger age, more education, and longer duration of diabetes predicted better physical quality of life. Duration of diabetes and three coping styles predicted DSs. Longer duration of diabetes and lower fasting glucose predicted better mental quality of life. Three coping styles acted as mediators between risk factors and health, that is, active and minimizing styles promoted positive outcomes, while avoidance promoted negative outcomes.
Conclusions:This integrated model provides a holistic picture of how risk factors and coping style influence HrQoL and DSs in individuals with T2DM. Nurses could use active coping strategies in cognitive behavioral therapy to enhance glycemic control in patients with T2DM.