Sex differences in Cardiovascular risk factors and management in a preventive Cardiology clinic at a tertiary referral center

Background@#Cardiovascular disease is the leading cause of death in both genders worldwide. Gender differences in clinical presentation and treatment have been reported.@*Objective@#This study aims to describe and compare the cardiovascular risk factors and management strategies for primary prevention among Filipinos.@*Methods@#An analytical cross-sectional study was done on 2,082 patients at the Preventive Cardiology Clinic of a tertiary referral center in Quezon City, Philippines from January 1, 2002 to December 31, 2017.@*Results@# Seventy-two percent of the patients were females with a higher mean age compared to males (57.67 + 10.50 vs 55.66 + 11.82, p 0.002). There were more women who were unemployed (75.2 vs 45.9, p<0.001). There was no significant difference in the prevalence of hypertension (68.6% vs 67.9%, p=0.542) and type 2 diabetes mellitus (19.8% vs 21.5%, p=0.437) in both genders. Beta blockers (24.1%), calcium channel blockers (22.9%) and angiotensin receptor blockers (22.1%) were the most commonly prescribed anti-hypertensive drugs. Biguanides were the most commonly prescribed glucose-lowering drug (11.3%). Compared to men, more women had dyslipidemia (51.8% vs 38.6%, p<0.001). Statins were more commonly prescribed in women (22.4 vs 18.1%, p=0.033).@*Conclusion@#There were significantly more women seen in our Preventive Cardiology clinic. Smoking and alcoholic drinking were higher in males. BMI, total cholesterol and HDL were significantly higher in females than in males.

Prevalence and Factors Associated with Obesity at a Primary Preventive Cardiology Clinic: The Philippine Heart Center Experience

@#INTRODUCTION: Obesity has been linked to the development of type 2 diabetes mellitus (T2DM) and cardiovascular diseases. This study primarily aims to determine the prevalence of obesity among the Filipino patients in our institution since there have been no previous studies on this subset of patients. METHODS: A cross-sectional analytical study of 2,078 patients at the Primary Preventive Cardiology Out-Patient Clinic of the Philippine Heart Center (PHC) was done from January 1, 2002 to December 31, 2017. The prevalence of obesity was determined using the World Health Organization (WHO) and Asian classification. Factors associated with obesity were determined using binary logistic regression analysis. RESULTS: A majority of the patients were females (1499, 71.14%) with a higher mean age compared to the male patients (57.67±10.5 vs 55.66±11.8, p<0.001). Hypertension (68.5%), coronary artery disease (37.1%) and T2DM (20.3%) were the most common co-morbid illnesses in both genders. The mean body mass index (BMI) was 25.8±4.3 kg/m2 for the female patients while it was 25.2±4.1 kg/m2 for the male patients (p<0.001). The prevalence of obesity using the WHO and Asian classifications was 15% (n=312). Compared to the Asian criteria, there were significantly more patients classified as having normal weight (44.09% vs 24.95%, p<0.001) and overweight (37.98% vs 19.13%, p<0.001) using the WHO classification. Pre-obesity, an additional criterion of the Asian classification which was not adopted by WHO was seen in 37.98% of the patients. On multivariate analysis, female gender (OR 1.31, 95% CI [1.08-1.59)] p=0.006) and T2DM (OR 1.25, 95% CI [1.01-1.56], p=0.42) were significant factors associated with obesity while age (OR 0.98, 95% CI [0.98-0.99], p<0.001) was protective of obesity. CONCLUSION: The prevalence of obesity in our cohort was consistent with the worldwide prevalence reported by the WHO which underscores the need for effective weight management programs and primary preventive strategies 7to lower the prevalence and obviate the development of complications related to obesity. Female gender and T2DM were significant factors associated with obesity, while age was a significant protective factor of obesity.

The Effect of Health Education on Blood Pressure in an Urban Poor Community

@#The objective of the study was to evaluate the effect of cardiovascular health education on change in blood pressure at 3, 6, 12, and 18 months follow-up. This was a prospective cohort study. Participants were from an urban poor community in Metro Manila. Included were the 98 adults at least 40 years of age with hypertension, without cardiovascular disease. Among those previously diagnosed with hypertension, 20.3% had controlled blood pressures at the time of screening. There were 29.6% newly diagnosed cases of hypertension in the study. During the 18-month intervention phase, cardiovascular disease health education and counseling on risk factor control were given along with medical check-ups. Systolic and diastolic blood pressures were measured at 3, 6, 12, and 18 months. The decreases in mean systolic blood pressures from the baseline at 3, 6, 12 and 18 months were 11.9, 15.2, 9.1, and 14.1-mm Hg, respectively. The diastolic blood pressures decreased by 6.9, 9.3,.4.6, and 4.4 mm Hg. These differences were statistically significant. For the urban poor, health education on risk factor modification and cardiovascular diseases can be an important tool in improving blood pressure.

Comparison of the prevalence of Hypertension using three proposed classifications in a single center primary prevention setting

Introduction@#The American College of Cardiology/American Heart Association (ACC/AHA) revised the thresholds for the definition and treatment of hypertension that was recommended by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) while the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) Guidelines for the Prevention, Detection, Evaluation, and Management of High Blood Pressure retained their previous classification but revised the recommendations for diagnosis and treatment. The impact of these changes in our setting is uncertain. This study aims to compare the prevalence of hypertension using the three proposed criteria in a primary preventive setting.@*Methods@#This is a cross-sectional analytical study using data at the Primary Preventive Cardiology Clinic of the Philippine Heart Center from January 1, 2002 to December 31, 2017.@*Results@#There were 2,082 patients in this study. The mean age is 57.1±10.9 years with a female predominance (72.5%). Most of the patients were married (67.3%, 1,401) and unemployed (67.1%, 1,398). Comorbid illnesses include dyslipidemia (48.2%) and type 2 diabetes mellitus (20.3%). The prevalence of hypertension using the JNC 7 and the 2018 ESC/ESH blood pressure (BP) classification was 56% (n=1,167). When the 2017 ACC/AHA BP classification was applied, there was a significant increase in the prevalence of hypertension to 80.3% (n=1671) (p<0.001) demonstrating an absolute increase of +24.2%.@*Conclusion@#The study shows a high prevalence of hypertension which further increased when the 2017 ACC/AHA BP classification was applied This can impose a significant public health burden that needs to be addressed to prevent or decrease hypertension-related complications. Use of the new guidelines may affect diagnosis and treatment of hypertension with potential cost implications.