Influence of rurality, deprivation and distance from clinic on uptake in men invited for abdominal aortic aneurysm screening.

BACKGROUND: Effective abdominal aortic aneurysm (AAA) screening requires high uptake. The aim was to assess the independent association of screening uptake with rurality, social deprivation, clinic type, distance to clinic and season. METHODS: Screening across Grampian was undertaken by trained nurses in six community and three hospital clinics. Men aged 65 years were invited for screening by post (with 2 further reminders for non-responders). AAA screening data are stored on a national call-recall database. The Scottish postcode directory was used to allocate to all invited men a deprivation index (Scottish Index of Multiple Deprivation), a Scottish urban/rural category and distance to clinic. Multivariable analysis was undertaken. RESULTS: The cohort included 5645 men invited for screening over 12 months (October 2012 to October 2013); 42·6 per cent lived in urban areas, 38·9 per cent in rural areas and 18·5 per cent in small towns (uptake 87·0, 89·3 and 90·8 per cent respectively). Overall uptake was 88·6 per cent with 76 new AAAs detected: 15·2 (95 per cent c.i. 11·8 to 18·6) per 1000 men screened. Aberdeen city (large urban area) had the lowest uptake (86·1 per cent). Uptake declined with increasing deprivation, with the steepest decline in urban areas. On multivariable analysis, a 1-point increase in deprivation deciles was associated with a 0·08 (95 per cent c.i. 0·06 to 0·11) reduction in the odds of being screened (P < 0·001). Clinic type (community versus hospital), distance to clinic and season were not associated independently with uptake. CONCLUSION: Both urban residence and social deprivation were associated independently with uptake among men invited for AAA screening.

Physical inactivity and arterial dysfunction in patients with rheumatoid arthritis.

OBJECTIVES: The increased risk of cardiovascular (CV) disease associated with rheumatoid arthritis (RA) is partly attributable to chronic inflammation, but traditional CV risk factors such as physical inactivity are also likely to be important. This study assessed the cross-sectional relationship between physical activity (PA) and arterial dysfunction in patients with RA. METHODS: Participants free of overt arterial disease aged 40-65 years were recruited from a consecutive series of RA patients attending a rheumatology clinic. A research nurse measured the 'augmentation index' (AIX%) on a single occasion (a higher AIX% indicates arterial dysfunction) using SphygmoCor radial pulse wave analysis (PWA) according to current recommendations. Participants provided a fasting blood sample and self-completed a patient questionnaire that included the modified Godin PA score (mGPAS). Analysis was adjusted for age, sex, CV and rheumatological factors using multiple linear regression. RESULTS: Among 114 patients (mean age 54 years, median arthritis duration 10 years, 82% women), mean AIX% was 31.5 (SD 7.7) and median mGPAS 15 (IQR 10-35). AIX% was correlated with mGPAS (rho -0.21, p = 0.02). AIX% decreased with more frequent vigorous PA. On unadjusted analysis, a 10-point higher mGPAS was associated with a -0.9 [95% confidence interval (CI) -1.3 to -0.4, p = 0.0005] lower AIX%. On adjusted analysis, the reduction was attenuated to -0.5 (95% CI -0.8 to -0.1, p = 0.03). CONCLUSIONS: A higher level of self-reported PA in RA patients is associated with a lower level of arterial dysfunction independently of other CV and rheumatological factors. Longitudinal studies are required to demonstrate that increased PA improves arterial dysfunction in RA patients.

Arterial dysfunction in patients with rheumatoid arthritis and the consumption of daily fruits and daily vegetables.

BACKGROUND/OBJECTIVES: Rheumatoid arthritis (RA) is associated with increased arterial dysfunction and increased risk of cardiovascular disease. Regular fruit and vegetable consumption prevents cardiovascular disease, but their influence on arterial dysfunction in RA has not been investigated. We assessed the relationship between daily fruit-vegetable consumption and arterial dysfunction in this high-risk group. SUBJECTS/METHODS: Participants were recruited from a consecutive series of RA patients aged 40-65 years without overt cardiovascular disease attending rheumatology clinics. Standardised research nurse assessment included SphygmoCor pulse wave analysis using radial applanation tonometry (a higher augmentation index (AIX%) indicates arterial dysfunction), fasting blood sample, patient questionnaire and medical record review. Multivariable analysis was used to adjust for age, sex, cholesterol, mean arterial blood pressure, smoking habit, alcohol consumption, physical activity, cumulative inflammatory burden, rheumatoid nodules, disability and education. RESULTS: We recruited 114 RA patients: 81% female, mean age 54 years, median arthritis duration 10 years and mean AIX% 31.5 (s.d. 7.7). Fruit and vegetable consumption were significantly correlated (Spearman's rho 0.54, P≪0.0001) and on unadjusted analysis daily fruit and vegetable consumption was associated with a lower AIX% (-3.2; 95% CI -6.4 to -0.1, P=0.05). On adjusted analysis AIX% was lower with daily vegetable (-4.2; 95% CI -7.9 to -0.5; P=0.003), but not with daily fruit (-0.02; 95% CI -3.9 to 3.8; P=0.99) consumption. CONCLUSIONS: Daily vegetable consumption, but not daily fruit consumption, was independently associated with more favourable arterial function in patients with RA. These findings are consistent with the enterosalivary circulation of nitrate having an influence on arterial function.

Constitutional symptoms at the onset of rheumatoid arthritis and subsequent arterial stiffness.

The onset of rheumatoid arthritis (RA) can be associated with constitutional symptoms. Systemic inflammation may be a common factor behind such symptoms and the subsequent development of arterial disease. The aim of this study was to determine if a relationship exists between constitutional symptoms and arterial stiffness. We recruited 103 ambulatory RA patients (85 female) without overt arterial disease aged between 40 and 65 years attending hospital clinics. A research nurse measured arterial stiffness (heart rate standardised augmentation index, AIX) using the 'SphygmoCor' device, fasting lipids and erythrocyte sedimentation rate (ESR). Assessment included patient recall of constitutional symptoms at arthritis onset (aching muscles, tiredness, generalised weakness, low mood/depression, fever, loss of weight, loss of appetite) and a detailed medical record review. Regression analysis was used to adjust mean differences in AIX in the presence/absence of constitutional symptoms for current age, sex, arthritis duration, age arthritis onset, study ESR, ever smoked, mean arterial blood pressure (BP), treated hypertension and cholesterol. Mean age was 54 years (age arthritis onset 42 years), brachial BP 125/82 mmHg, cholesterol 5.4 mmol/L, ever smoked 59%, median RA duration 9 years, median ESR 16 mm/h and mean AIX 31.7 (SD 7.8). Unadjusted mean difference in AIX was -0.7 (95%CI -4.5 to 3.1; p = 0.72) in the presence of constitutional symptoms and the adjusted mean difference was -0.1 (-3.2 to 2.9; p = 0.93). No individual symptoms were significantly associated with increased arterial stiffness. In conclusion, we found no convincing association between constitutional symptoms at the onset of arthritis and subsequent arterial stiffness.

Gender inequalities in the management of angina pectoris: cross-sectional survey in primary care.

BACKGROUND AND AIMS: To determine the extent of gender differences in the routine clinical care of patients with angina pectoris in primary care. METHODS: A cross-sectional survey of general practitioner (GP) medical records undertaken by trained data managers in 6 GP practices. 925 adults (489 men) with a clinical diagnosis of angina (prevalence = 2.4%, 95%CI 2.3-2.6). Data extracted included: level of care; risk factor recording; prescribed medication; exercise ECG and coronary revascularisation. Adjusted male-to-female odds ratios (AOR) adjusted for age, angina duration, and previous myocardial infarction, (MI). RESULTS: Women with angina were older than men (71 v 65 years) with a lower prevalence of MI (30% v 45%), but a longer duration of angina (5 v 4 years). Men were more likely to receive once daily aspirin (AOR = 2.07, 95%CI 1.56-2.74) and be prescribed triple anti-anginal therapy (1.58, 95%CI 1.03-2.42). Men were also significantly more likely to undergo exercise ECG (1.56, 95%CI 1.14-2.15) and surgical revascularisation (1.71, 95%CI 1.03-2.85). Women tended to receive GP care alone (AOR =0.64, 95%CI 0.46-0.89), whilst men received specialist cardiac care (1.47, 95%CI 1.09-2.00). Beta-blocker use following MI was similar (0.99, 95%CI 0.59-1.69). CONCLUSION: Differences in the management of men and women are unaccountedfor by differences in age, previous MI or duration of angina. Gender differences in management of CHD reported from secondary care may also exist in primary care.