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Circulation Sep 2019
Review
2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
Topics: Advisory Committees; American Heart Association; Cardiology; Cardiovascular Diseases; Humans; Practice Guidelines as Topic; Primary Prevention; Research Report; United States
PubMed: 30879355
DOI: 10.1161/CIR.0000000000000678 -
Clinical Medicine & Research Aug 2020Aspirin has demonstrated a clear benefit in secondary prevention of coronary syndrome, while aspirin's effect in primary prevention is unclear. This report will explore... (Review)
Review
Aspirin has demonstrated a clear benefit in secondary prevention of coronary syndrome, while aspirin's effect in primary prevention is unclear. This report will explore the role of aspirin as primary prevention for various vascular events. It strives to provide a clear guide for clinicians on whether or not to prescribe aspirin for their patients for primary prevention. Current guidelines and recent trials failed to show clear benefit against primary prevention, with risks outweighing benefits in moderate to high risk patients. A thoughtful discussion between patients and their doctors should be conducted before beginning aspirin use. More studies are needed to gain a better understanding of aspirin use in primary prevention.
Topics: Aspirin; Cardiovascular Diseases; Humans; Primary Prevention; Risk Factors
PubMed: 32580960
DOI: 10.3121/cmr.2020.1548 -
Frontiers in Endocrinology 2020Type 1 Diabetes (T1D) is one of the most common chronic autoimmune diseases in children. The disease is characterized by the destruction of beta cells, leading to... (Review)
Review
Type 1 Diabetes (T1D) is one of the most common chronic autoimmune diseases in children. The disease is characterized by the destruction of beta cells, leading to hyperglycemia, and to a lifelong insulin-dependent state. Although several studies in the last decades have added relevant insights, the complex pathogenesis of the disease is not yet completely understood. Recent studies have been focused on several factors, including family history and genetic predisposition (HLA and non-HLA genes) as well as environmental and metabolic biomarkers, with the aim of predicting the development and progression of T1D. Once a child becomes symptomatic, beta cell mass has already reached a critical threshold (usually a residual of 20-30% of normal amounts), thus representing only the very late phase of the disease. In particular, this final stage follows two preceding asymptomatic stages, which have been precisely identified. In view of the long natural history and complex pathogenesis of the disease, many strategies may be proposed for primary, secondary, and tertiary prevention. Strategies of primary prevention aim to prevent the onset of autoimmunity against beta cells in asymptomatic individuals at high risk for T1D. In addition, the availability of novel humoral and metabolic biomarkers that are able to characterize subjects at high risk of progression, have stimulated several studies on secondary and tertiary prevention, aimed to preserve residual beta cell destruction and/or to prolong the remission phase after the onset of T1D. This review focuses on the major current knowledge on prediction and prevention of T1D in children.
Topics: Diabetes Mellitus, Type 1; Disease Progression; Genetic Predisposition to Disease; Humans; Primary Prevention
PubMed: 32670194
DOI: 10.3389/fendo.2020.00248 -
Circulation Sep 20191. The most important way to prevent atherosclerotic vascular disease, heart failure, and atrial fibrillation is to promote a healthy lifestyle throughout life. 2. A... (Review)
Review
2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
1. The most important way to prevent atherosclerotic vascular disease, heart failure, and atrial fibrillation is to promote a healthy lifestyle throughout life. 2. A team-based care approach is an effective strategy for the prevention of cardiovascular disease. Clinicians should evaluate the social determinants of health that affect individuals to inform treatment decisions. 3. Adults who are 40 to 75 years of age and are being evaluated for cardiovascular disease prevention should undergo 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation and have a clinician–patient risk discussion before starting on pharmacological therapy, such as antihypertensive therapy, a statin, or aspirin. The presence or absence of additional risk-enhancing factors can help guide decisions about preventive interventions in select individuals, as can coronary artery calcium scanning. 4. All adults should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish and minimizes the intake of fats, processed meats, refined carbohydrates, and sweetened beverages. For adults with overweight and obesity, counseling and caloric restriction are recommended for achieving and maintaining weight loss. 5. Adults should engage in at least 150 minutes per week of accumulated moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity. 6. For adults with type 2 diabetes mellitus, lifestyle changes, such as improving dietary habits and achieving exercise recommendations are crucial. If medication is indicated, metformin is first-line therapy, followed by consideration of a sodium-glucose cotransporter 2 inhibitor or a glucagon-like peptide-1 receptor agonist. 7. All adults should be assessed at every healthcare visit for tobacco use, and those who use tobacco should be assisted and strongly advised to quit. 8. Aspirin should be used infrequently in the routine primary prevention of ASCVD because of lack of net benefit. 9. Statin therapy is first-line treatment for primary prevention of ASCVD in patients with elevated low-density lipoprotein cholesterol levels (≥190 mg/dL), those with diabetes mellitus, who are 40 to 75 years of age, and those determined to be at sufficient ASCVD risk after a clinician–patient risk discussion. 10. Nonpharmacological interventions are recommended for all adults with elevated blood pressure or hypertension. For those requiring pharmacological therapy, the target blood pressure should generally be <130/80 mm Hg.
Topics: Advisory Committees; American Heart Association; Cardiology; Cardiovascular Diseases; Humans; Practice Guidelines as Topic; Primary Prevention; Research Report; Risk Reduction Behavior; United States
PubMed: 30879339
DOI: 10.1161/CIR.0000000000000677 -
Journal of the American College of... Nov 2018Continued improvement in medical and device therapy for heart failure (HF) has led to better survival with this disease. Longer survival and increasing numbers of... (Review)
Review
Continued improvement in medical and device therapy for heart failure (HF) has led to better survival with this disease. Longer survival and increasing numbers of unhealthy lifestyle factors and behaviors leading to occurrence of HF at younger ages are both contributors to an increase in the overall prevalence of HF. Clinicians treating this complex disease tend to focus on pharmacological and device therapies, but often fail to capitalize on the significant opportunities to prevent or treat HF through lifestyle modification. Herein, the authors review the evidence behind weight management, exercise, nutrition, dietary composition, supplements, and mindfulness and their potential to influence the epidemiology, pathophysiology, etiology, and management of stage A HF.
Topics: Behavior Therapy; Diet, Healthy; Dietary Supplements; Exercise; Heart Failure; Humans; Obesity; Primary Prevention; Risk Reduction Behavior; Treatment Outcome
PubMed: 30384895
DOI: 10.1016/j.jacc.2018.08.2160 -
Acta Pharmaceutica (Zagreb, Croatia) Dec 2019Taking responsibility for your life, among other factors, means also considering what to eat and which nutrition pattern to follow. Everyone needs to think about what... (Review)
Review
Taking responsibility for your life, among other factors, means also considering what to eat and which nutrition pattern to follow. Everyone needs to think about what they put on the plate and which ingredients should be avoided. Food, as such, will never be a drug or medication, like a painkilling tablet relieving pain in a short amount of time, for example. However, proper nutrition is our ally in the prevention of diseases, maintaining balance in our body and our mind. By following the main principles of a healthy diet, the physiological homeostasis can be managed, as well as faster recovery from disease achieved. This review is aimed at summarizing basic principles of nutrition recommendations and at empowering stakeholders (pharmacists, medical biochemists, physicians) to be able to communicate to their patients and customers healthy and sustainable nutrition choices through the personalized advice.
Topics: Diet, Healthy; Food; Humans; Nutrients; Nutrition Policy; Primary Prevention
PubMed: 31639089
DOI: 10.2478/acph-2019-0051 -
Journal of the American College of... Jun 2019The efficacy and safety of aspirin for primary prevention of cardiovascular disease (CVD) remain debatable. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The efficacy and safety of aspirin for primary prevention of cardiovascular disease (CVD) remain debatable.
OBJECTIVES
The purpose of this study was to examine the clinical outcomes with aspirin for primary prevention of CVD after the recent publication of large trials adding >45,000 individuals to the published data.
METHODS
Randomized controlled trials comparing clinical outcomes with aspirin versus control for primary prevention with follow-up duration of ≥1 year were included. Efficacy outcomes included all-cause death, cardiovascular (CV) death, myocardial infarction (MI), stroke, transient ischemic attack (TIA), and major adverse cardiovascular events. Safety outcomes included major bleeding, intracranial bleeding, fatal bleeding, and major gastrointestinal (GI) bleeding. Random effects DerSimonian-Laird risk ratios (RRs) for outcomes were calculated.
RESULTS
A total of 15 randomized controlled trials including 165,502 participants (aspirin n = 83,529, control n = 81,973) were available for analysis. Compared with control, aspirin was associated with similar all-cause death (RR: 0.97; 95% confidence interval [CI]: 0.93 to 1.01), CV death (RR: 0.93; 95% CI: 0.86 to 1.00), and non-CV death (RR: 0.98; 95% CI: 0.92 to 1.05), but a lower risk of nonfatal MI (RR: 0.82; 95% CI: 0.72 to 0.94), TIA (RR: 0.79; 95% CI: 0.71 to 0.89), and ischemic stroke (RR: 0.87; 95% CI: 0.79 to 0.95). Aspirin was associated with a higher risk of major bleeding (RR: 1.5; 95% CI: 1.33 to 1.69), intracranial bleeding (RR: 1.32; 95% CI: 1.12 to 1.55), and major GI bleeding (RR: 1.52; 95% CI: 1.34 to 1.73), with similar rates of fatal bleeding (RR: 1.09; 95% CI: 0.78 to 1.55) compared with the control subjects. Total cancer and cancer-related deaths were similar in both groups within the follow-up period of the study.
CONCLUSIONS
Aspirin for primary prevention reduces nonfatal ischemic events but significantly increases nonfatal bleeding events.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Cardiovascular Diseases; Gastrointestinal Hemorrhage; Humans; Primary Prevention; Randomized Controlled Trials as Topic
PubMed: 31196447
DOI: 10.1016/j.jacc.2019.03.501 -
Atencion Primaria 2019To assess the effectiveness of the interventions to prevent a pregnancy in adolescence.
OBJECTIVE
To assess the effectiveness of the interventions to prevent a pregnancy in adolescence.
DESIGN
Systematic review.
DATA SOURCES
The following databases were consulted: PubMed, CINAHL, Scopus, Cuiden Plus, LILACS, and IME, in order to identify interventions aimed at preventing a pregnancy in adolescence.
STUDY SELECTION
A total of 24 primary investigations, in which an educational program to prevent a pregnancy in the adolescence was evaluated, were selected. The quality of the selected studies was assessed according to the CASPe scale.
RESULTS
Educational programs for the modification of the teenage pregnancy rate show inconclusive results, as there are 2 studies that find a reduction, and 2 that find that there are no significant changes. For secondary outcomes, it was found that educational programs are effective for increasing the knowledge level about sexuality and contraceptive methods and changing attitudes about the risk of a teenage pregnancy or the use of contraceptive methods. There are no statistically significant differences between the studies with a positive and negative outcome (P>.05) for any of the results analysed in this review.
CONCLUSION
There is no a single intervention modality that is the most effective for prevention of a teenage pregnancy. More research is needed with a longitudinal approach that assess not only intermediate results, but also a modification in the pregnancy rate.
Topics: Adolescent; Female; Health Education; Health Knowledge, Attitudes, Practice; Humans; Pregnancy; Pregnancy in Adolescence; Primary Prevention; Program Evaluation
PubMed: 29903543
DOI: 10.1016/j.aprim.2018.04.003 -
Annals of Allergy, Asthma & Immunology... Jul 2020
Topics: Allergy and Immunology; Humans; Primary Prevention; Vaccines
PubMed: 32564925
DOI: 10.1016/j.anai.2020.03.031 -
JAMA Internal Medicine Nov 2015Breast cancer is the leading cause of female cancer burden, and its incidence has increased by more than 20% worldwide since 2008. Some observational studies have... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Breast cancer is the leading cause of female cancer burden, and its incidence has increased by more than 20% worldwide since 2008. Some observational studies have suggested that the Mediterranean diet may reduce the risk of breast cancer.
OBJECTIVE
To evaluate the effect of 2 interventions with Mediterranean diet vs the advice to follow a low-fat diet (control) on breast cancer incidence.
DESIGN, SETTING, AND PARTICIPANTS
The PREDIMED study is a 1:1:1 randomized, single-blind, controlled field trial conducted at primary health care centers in Spain. From 2003 to 2009, 4282 women aged 60 to 80 years and at high cardiovascular disease risk were recruited after invitation by their primary care physicians.
INTERVENTIONS
Participants were randomly allocated to a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat).
MAIN OUTCOMES AND MEASURES
Breast cancer incidence was a prespecified secondary outcome of the trial for women without a prior history of breast cancer (n = 4152).
RESULTS
After a median follow-up of 4.8 years, we identified 35 confirmed incident cases of breast cancer. Observed rates (per 1000 person-years) were 1.1 for the Mediterranean diet with extra-virgin olive oil group, 1.8 for the Mediterranean diet with nuts group, and 2.9 for the control group. The multivariable-adjusted hazard ratios vs the control group were 0.32 (95% CI, 0.13-0.79) for the Mediterranean diet with extra-virgin olive oil group and 0.59 (95% CI, 0.26-1.35) for the Mediterranean diet with nuts group. In analyses with yearly cumulative updated dietary exposures, the hazard ratio for each additional 5% of calories from extra-virgin olive oil was 0.72 (95% CI, 0.57-0.90).
CONCLUSIONS AND RELEVANCE
This is the first randomized trial finding an effect of a long-term dietary intervention on breast cancer incidence. Our results suggest a beneficial effect of a Mediterranean diet supplemented with extra-virgin olive oil in the primary prevention of breast cancer. These results come from a secondary analysis of a previous trial and are based on few incident cases and, therefore, need to be confirmed in longer-term and larger studies.
TRIAL REGISTRATION
ISRCTN.org Identifier: ISRCTN35739639.
Topics: Aged; Breast Neoplasms; Cardiovascular Diseases; Diet, Mediterranean; Dietary Fats; Female; Follow-Up Studies; Humans; Incidence; Middle Aged; Nuts; Olive Oil; Primary Prevention; Risk Reduction Behavior; Time; Treatment Outcome
PubMed: 26365989
DOI: 10.1001/jamainternmed.2015.4838