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Heart --- Cardiovascular Agents --- Cardiovascular Agents --- Cardiovascular agents
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The Committee for Cardiovascular Pathology of the Department of Medical Sciences of the Academy of Sciences and Arts of Bosnia and Herzegovina over the past years organized following symposiums which resulted with publications of the Academy of Sciences and Arts of Bosnia and Herzegovina (ANUBiH): 1. Symposium: “I work with heart”, ANUBiH, 2010; 2. International Symposium “Pulmonary Artery Hypertension”, ANUBiH, 2011, Book no: CXXXIX/39; 3. Symposium: “The Risk Factors for Development of Cardiovascular Diseases”, ANUBiH, 2011, Book no: CXLI/40; 4. Symposium: “Congenital Heart Defects”, ANUBiH, 2012, Book no: CL/42; 5. International Symposium: “Perspectives in Paediatric Cardiology” (Dubrovnik), ANUBiH, 2012, Book no: CLI/43; 6. Symposium: “Rhythm disturbances in children and adults”, ANUBiH, 2013; 7. International Symposium: “Acquired Heart Disease”, ANUBiH, 2014, Book no: CLVIII/45; 8. International Scientific Symposium: “Fetal medicine: from Leonardo da Vinci up Today”, ANUBiH, 2015, Book no: CLIX/46; 9. International Symposium: “Mitral Valve Diseases in Children and Adults”, ANUBiH, 2017, Book no: CLXVIII/49...
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The aim of this thesis was to investigate socio-economic status in relation to morbidity and mortality, in particular cardiovascular disease among women using data from two population based studies from Sweden. The secondary aim was to explore mechanisms potentially linking socio-economic status to health, assessing for example dental, dietary, and lifestyle factors. Samples: The Population Study of Women in Gothenburg Sweden was begun in 1968-69. A representative random sample of 1,622 women was selected according to date of birth and within the strata 38, 46, 50, 54, and 60 years of age; the participation rate was 90 percent. The Gerontological and Geriatric Population Studies in Gothenburg (H-70) are based on representative samples of 70-year olds from Göteborg, Sweden who participated in a series of cross sectional and longitudinal studies between1971 and 2000. Participation rates ranged from 86 percent for men and 83 percent for women in the 1901/2 birth cohort to 65 percent for men and 69 percent for women in the 1930 birth cohort. Main results: High socio-economic status was associated with a decreased risk for cardiovascular disease [RR 0.49; CI 0.24 - 0.99] in middle aged women independently of risk factors such as smoking and obesity;moreover opposing monotonic trends were seen for mortality from cancer and cardiovascular disease in relation to socio-economic status. Tooth loss, a proxy for cumulative lifetime oral infection was also associated with an increased risk for cardiovascular disease in women independently of socio-economic factors such as the husband's occupational category, income, and educational level. Among 70-year old cohorts, later-born women were heavier and had higher body mass index than earlier-born women within the high education group only. However, secular increases in waist-hip ratio were seen in both educational groups. Compared to earlier-born cohorts of 70-year old men, later-born cohorts had higher body mass index and cholesterol levels across social strata, and heart disease and diabetes mellitus became more prevalent. Among the elderly, secular trends indicated greater improvements in cardiovascular risk factors among women than men, with exception to smoking and alcohol consumption. Diet quality and food selection were assessed in relation to socio-economic status in the youngest cohort of 70-year olds born in 1930. Socio-economic disparities in diet quality were detected in men but not in women. Conclusions: From a public health perspective, it is suggested that risk factor patterns should be investigated in association with socio-economic status in order to expose health inequalities, and to develop more equitable interventions for cardiovascular disease prevention.
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1. Many interventions to quit smoking, increase physical activity, reduce weight and improve diet can reduce risk factors for cardiovascular disease. The interventions seem to produce only small effects, if any, and there is a lack of evidence regarding effects on morbidity and mortality. A small or moderate effect may be important, though, both for the individual but particularly at population level. 2. Several interventions support smoking cessation: mass media campaigns targeted at young people and adults, advice from health professionals both in primary care and hospitals, self help programs, group therapy, telephone advice, interventions in the workplace, nicotine replacement, bupropion and varenicline. 3. Mass media campaigns aimed at adult established smokers seemed to have similar effects regardless of age, gender, ethnicity or education. 4. Biomedical risk assessments and hypnosis are unlikely to help smokers to quit. 5. We can not draw conclusions on the effects on smoking rates of training of health professionals, school-based or family-based programs, acupuncture, physical activity, interventions for preventing tobacco sales to minors or relapse prevention. 6. Physical activity interventions moderately improve self-reported physical activity and cardio-respiratory fitness, and help achieving a predetermined activity level. 7. Exercise for overweight and type 2 diabetes supports weight reduction and reduces cardiovascular disease risk factors even if no weight is lost. 8. Calorie restricted diets in overweight hypertensive persons can give modest weight loss and blood pressure decreases. 9. Weight loss strategies in prediabetes may reduce weight and diabetes incidence. 10. Dietary advice, advice to reduce or modify fat intake and reduce intake of salt may have a small, but important effect on cardiovascular risk factors. 11. There are no high quality data on the efficacy of the dietary treatment of type 2 diabetes or familial hypercholesterolaemia. 12. An organized system of regular review may reduce blood pressure. 13. We have not assessed cost effectiveness of the interventions. 14. We need more evidence on effects of interventions to reduce social inequalities in risk for and incidence of cardiovascular disease. 15. We need evidence from studies of high quality and longer follow-up measuring morbidity and mortality, for several of the interventions that we have assessed.
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