Cohort Studies And Cardiovascular Disease Essay

1. Through cohort study designs and other evidence-based management studies, identify the major causes of CVD, and analyze the key steps, including current medications, used to address the disease.
Cohort studies are epidemiological observational studies in which two or more groups (called cohorts) of subjects are classified in terms of the presence or absence of exposure to a particular factor, and then they are followed for a specific period of time to study and determine how the disease develops in each exposure group (Hennekens, Buring & Doll, 1987). This type of studies requires a long time of follow-up period, in order to allow for an adequate number of subjects to develop the disease (Hennekens, Buring & Doll, 1987). Cohort studies can be prospective or retrospective, according to the whether or not the event (disease) has already occurred when the investigator initiates the study (Hennekens, Buring & Doll, 1987). Due to the longitudinal characteristics, cohorts studies have the advantage of elucidating temporal relationship between exposure and disease (Hennekens, Buring & Doll, 1987).
One of the most famous prospective cohort studies related to cardiovascular diseases is the Framingham Heart Study (Dawber, Meadors & Moore, 1951). It is famous partially not only because of its long duration, since it started in 1948 and it is still ongoing, but also because it was a pioneer in cardiovascular scientific research. By the time, no cardiovascular risk factors were known. Researchers focused on arteriosclerotic and hypertensive cardiovascular diseases and they studied them in a population from a small town called Framingham in Massachussets, U.S.A., which was selected mainly because it was a small residential area, with a town-meeting form of government, and indications of interest in response to the study (Dawber, Meadors & Moore, 1951). Between 1950 and 1952, researchers identified and examined 5127 men and women aged 30 to 59 years, who were free from coronary heart disease (Hennekens, Buring & Doll, 1987). They collected demographic information, past medical history, cigarette smoking, clinical and laboratory parameters at baseline and at regular intervals since the inception of the study, while monitoring the development of cardiovascular events (Hennekens, Buring & Doll, 1987).
Thanks to the Framingham Heart Study, it has been possible to determine major cardiovascular risk factors such as High-Blood Pressure (Kannel, Gordon & Schwartz, 1971), obesity and low levels of physical activity (Kannel, LeBauer, Dawber & McNamara, 1967), smoking (Freund, Belanger, D'Agostino & Kannel, 1993), dietary patterns (Sacks et al., 2001), cholesterol levels (Boden, 2000), etc.
Based on cohort and case-control studies, several prevention and treatment strategies have been implemented, and are nowadays recommended by cardiovascular societies throughout the world (Dasgupta et al., 2014; Halvorsen et al., 2014; Stone et al., 2013). This treatment consists of both pharmacological and non-pharmacological interventions. Non-pharmacological interventions include weight control, dietary measures, physical activity, stress management, etc. Pharmacological interventions include antihypertensive agents, statins or fibrates to lower cholesterol levels, aspirin for prevention of blood clots that might cause infarction or stroke, etc.
2. Develop at least five (5) leading questions that may be posed to your local health department in regard to mitigating the proliferation of the disease. Provide a sound rationale for raising these questions.
a) What are the current local prevalence and incidence rates for cardiovascular diseases, e.g. atherosclerosis, myocardial infarction, and stroke?
This question is based on the fact that it is necessary to establish an epidemiological baseline status in order to evaluate the burden of disease, and to further notice if local intervention strategies are working, or if more changes need to be implemented. In the United States, a 2013 report from the American Heart Association, indicates that the prevalence of high-blood pressure is 33%, hypercholesterolemia is 31.1%, total cardiovascular diseases 35.5%, stroke 2.8%, coronary heart disease 6.4%, myocardial infarction 2.9%, angina pectoris 3.2%, and heart failure 2.1% (Go et al., 2013). Although these are national statistics from the United States, it is important to assess if our local statistics reflect these numbers, or slightly differ.
b) What is the identified population at-risk from cardiovascular diseases?
Identifying the right population helps address specific prevention and intervention strategies to them. Although there are general recommendations that can be applied for the general population, it is not the same trying to mitigate cardiovascular diseases in a young, healthy and active population compared to an old, ill, and disabled one, for example.
c) Does the population have access to healthcare services for screening, diagnosis, monitoring, and treatment of cardiovascular diseases?
One of the barriers of prevention is adequate medical care and healthcare access. If the population at-risk is not able to access healthcare services, the burden of cardiovascular diseases might be underestimated, and intervention strategies might be harder to formulate.
d) Which are the public health campaigns that are currently running to prevent cardiovascular disease in our community?
Prevention is more cost-effective than treatment. In order to effectively achieve prevention, the effort from individuals, medical societies, non-profit organizations, research institutes, local and national governments are needed. Public health campaigns provide awareness to the whole community about a specific problem. Furthermore, they provide with educational methods to reach bigger populations, and help individuals to start or maintain a healthy lifestyle.
e) Are there any local green areas (e.g. parks) where people can go and perform physical activities?
A city infrastructure might determine physical activity patterns of a population. Local health departments could be able to use Geographical Information Systems to correlate areas of lower or higher prevalence or incidence of cardiovascular diseases to green areas. Conversely, these methods might be also useful for assessing proximity to places traditionally considered unhealthy (e.g. fast food restaurants).
3. Based on the five (5) questions you developed in Question two (2), provide a rudimentary protocol to disseminate this information to your local community leaders.
The information collected from the previous questions would be compiled in a report about cardiovascular risk in the local community. This report will then be presented or sent by mail directly to local community leaders (mayor, governor, religious leaders, foundation directors, etc.). In case these local leaders are not easily reachable, a tour through local television and radio stations might be useful to raise awareness of the community, and eventually reach the community leaders. The use of virtual social networks and implementing a free or financially feasible webpage could also help.
The report and spread information would include the incidence and prevalent rates collected, population at risk, the causes of cardiovascular disease, modifiable and non-modifiable risk factors, current public health campaigns available, public places for performing physical activities, contact information (including virtual social networks), and all possible relevant information.
4. Recommend six (6) steps that may be given to your current or previous place of employment to prevent the proliferation of CVD. Provide support for your recommendations.
a) Visual reminders at the workplace: Visual reminders have been explored in other contexts; mostly in terms of adherence to treatment o lifestyle practices (Ho, Camejo, Kahook & Noecker, 2008). Following this rationale, the use of visual aids such as posters or screensavers depicting messages motivating workers to perform physical activity or eat healthier even at the office might create an impact on their cardiovascular health.
b) Revising and improving the cafeteria menu: With the help of nutritionists and dieticians, it is possible to create a cafeteria menu that is nutritive, healthy, and cost-effective. These menus could follow the line of previously presented dietary measures such as the DASH diet, Mediterranean diet, or step 1 diet to prevent cardiovascular diseases (Kris-Etherton, Eckel, Howard, Jeor & Bazzarre, 2001).
c) Providing an alternative to sugar at coffee stations: Since sugar intake is metabolized and transformed into free fatty acids and stored as triglycerides (Charlton, 2004), it could be helpful to encourage workers to reduce sugary foods intake by presenting them with the option of sweeteners at coffee stations.
d) Encourage workers to perform active pauses during their shift: Physical activity during work has been associated with a reduction in mortality, according to cohort studies (Andersen, Schnohr, Schroll & Hein, 2000). Encouraging workers to perform 5-minute pauses for each hour of work and doing streching and other physical exercises might reduce their risk of cardiovascular diseases.
e) Counselling workers on cardiovascular diseases by a dietitician and a medical doctor: There is evidence that group and personal counselling at the workplace by a health professional such as a dietician or a medical doctor might help to lower cholesterol and triglycerides levels (Karlehagen & Ohlson, 2003), which in turn might lower the risk for cardiovascular diseases.
f) Advise employers and project leaders to address issues such as job-strain, shift-work, and psychosocial stressors: All of these factors have been associated with a higher risk of cardiovascular disease (Sorensen et al., 2011). There is always room for improvement in terms of better schedule planning, educational sessions about stress management, increasing rewards at work, etc.

References

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