Ist die «Polypille» in der kardiovaskulären Prävention eine Option [Is the "polypill" in cardiovascular prevention an option]

Fallvignette: Ein 58-jähriger Mann hatte vor einem Jahr einen Herzinfarkt, der mit einem beschichteten Stent versorgt wurde. Im Beruf hat er eine verantwortungsvolle Position und ist häufig geschäftlich unterwegs. Er gibt an, dass er Mühe mit der Einnahme seiner fünf Medikamente (Statin, β-Blocker, ACE-Hemmer, Clopidogrel, Acetylsalizylsäure) hat und dass er ab und zu vergisst, eines zu nehmen. Frage: Könnte ihm ein Kombinationspräparat (Polypille) helfen, seine Medikamente regelmässig einzunehmen? Hintergrund: Weltweit sind Herz-Kreislauf-Erkrankungen die führende Ursache für Tod und Behinderung. Um diese Krankheitslast zu vermindern, ist eine bevölkerungsbezogene Prävention entscheidend, bei der bekannte kardiovaskuläre Risikofaktoren kontrolliert werden. Das Konzept der Polypille mit einer fixen Kombination von mindestens einem Antihypertensivum und einem Statin wurde vor allem in Hinblick auf Entwicklungs- und Schwellenländer entwickelt. Die Primärprävention ist in diesen Ländern schwierig durch führbar; eine einzige Tablette wäre dort eine kostengünstige Variante. Aber auch in reichen Ländern könnte die Polypille sinnvoll sein, um z.B. die Compliance bei multimorbiden Patienten zu verbessern. Als Polypille werden verschiedene Kombinationen von Medikamenten angeboten, ihre Wirksamkeit und möglichen Nebenwirkungen sind jedoch unklar. Ziel dieses Reviews war, ihre Wirksamkeit in der primären und sekundären Prävention bezüglich Mortalität, nicht-tödliche kardiovaskuläre Ereignisse und Blutdruck-bzw. Lipidsenkung zu überprüfen.

Recommendations for malaria prevention in moderate to low risk areas: travellers' choice and risk perception.

BACKGROUND: The considerable malaria decline in several countries challenges the strategy of chemoprophylaxis for travellers visiting moderate- to low-risk areas. An international consensus on the best strategy is lacking. It is essential to include travellers' opinions in the decision process. The preference of travellers regarding malaria prevention for moderate- to low-risk areas, related to their risk perception, as well as the reasons for their choices were investigated. METHODS: Prior to pre-travel consultation in the Travel Clinic, a self-administered questionnaire was given to travellers visiting moderate- to low-risk malaria areas. Four preventive options were proposed to the traveller, i.e., bite prevention only, chemoprophylaxis, stand-by emergency treatment alone, and stand-by emergency treatment with rapid diagnostic test. The information was accompanied by a risk scale for incidence of malaria, anti-malarial adverse drug reactions and other travel-related risks, inspired by Paling palettes from the Risk Communication Institute. RESULTS: A total of 391 travellers were included from December 2012 to December 2013. Fifty-nine (15%) opted for chemoprophylaxis, 116 (30%) for stand-by emergency treatment, 112 (29%) for stand-by emergency treatment with rapid diagnostic test, 100 (26%) for bite prevention only, and four (1%) for other choices. Travellers choosing chemoprophylaxis justified their choice for security reasons (42%), better preventive action (29%), higher efficacy (15%) and easiness (15%). The reasons for choosing stand-by treatment or bite prevention only were less medication consumed (29%), less adverse drug reactions (23%) and lower price (9%). Those who chose chemoprophylaxis were more likely to have used it in the past (OR = 3.0 (CI 1.7-5.44)), but were not different in terms of demographic, travel characteristics or risk behaviour. CONCLUSIONS: When travelling to moderate- to low-risk malaria areas, 85% of interviewees chose not to take chemoprophylaxis as malaria prevention, although most guidelines recommend it. They had coherent reasons for their choice. New recommendations should include shared decision-making to take into account travellers' preferences.

A promising new device for the prevention of parastomal hernia.

Parastomal hernia (PSH) is the most frequent long-term stoma complication with serious negative effects on quality of life. Surgical revision is often required and has a substantial morbidity and recurrence rate. The development of PSH requires revisional surgery with a substantial perioperative morbidity and high failure rate in the long-term follow-up. Prophylactic parastomal mesh insertion during stoma creation has the potential to reduce the rate of PSH, but carries the risk of early and late mesh-related complications such as infection, fibrosis, mesh shrinkage, and/or bowel erosion. We developed a new stomaplasty ring (KORING), which is easy to implant, avoids potential mesh-related complications, and has a high potential of long-term prevention of PSH. Here we describe the technique and the first use.

PREVENTION OF CHILLING INJURY IN 'TOMMY ATKINS' MANGOES PREVIOUSLY STORED AT 5 ºC, USING HEAT TREATMENT AND RADIATION UV (UV-C)

ABSTRACT The objective of this study was to evaluate the effect of heat treatment and ultraviolet radiation (UV-C) in the prevention of chilling injury in mangoes cv. Tommy Atkins previously stored or not under injury condition after their transference to ambient condition. Fruits were divided into groups: two were hydrothermally treated (46.1 ºC/90 min; 55 ºC/5 min) and two were exposed to UV-C radiation (1.14 kJ m-2; 2.28 kJ m-2). These groups were stored under chilling injury conditions (5 ºC for 14 days), as established in preliminary tests. Other untreated groups were stored at 12 ºC or 5 ºC. After the storage period, they were transferred to ambient conditions (21.9 ºC; 55% RH) and the quality was evaluated. All the data were submitted to multivariate analysis as the tool to verify the simultaneous effect of the treatments under the quality parameters. The multivariate analysis indicated that the hydrothermal treatments at 46.1 °C/90 min and 55 °C/5 min and the UV-C radiation at doses of 1.14 kJ m-2 and 2.28 kJ m-2 were effective in minimized the symptoms of chilling injury in mangoes ‘Tommy Atkins’ stored at 5 °C for 14 days. However, after their transference to environmental condition at 21.9 °C, only the UV-C kept this control, especially at a dose of 2.28 kJ m-2. This treatment did not prevent the development of the characteristic color or affected the normal ripening and allowed the conservation of fruit for a period of 14 days at 5 °C, plus seven days of storage at environmental condition, which corresponds to the shipping transportation plus the time for sale.

High blood pressure in Sub-Saharan Africa: why prevention, detection, and control are urgent and important

In 2010, hypertension in Sub-Saharan Africa was theleading risk for death, incr easing by 67% since 1990.Hypertension was estimated to cause more than500,000 deaths and 10 million years of life lost in2010 in Sub-Saharan Africa. It was also the sixthleading risk for disability (contributing to more than 11million disability-adjusted life years).3In Sub-Saharan Africa, stroke, the major clinical outcome of uncon-trolled hypertension, has increased 46% since 1990 tobecome the fifth leading risk for death.

Prévention des troubles du rythme cardiaque en hémodialyse: quels sont les facteurs modulables [Prevention of cardiac arrhythmias in hemodialysis: what are the modulating factors?].

La mort subite est la première cause de mortalité chez les patients souffrant d'une insuffisance rénale terminale traités par dialyse chronique. La technique de dialyse utilisée et la composition chimique du dialysat influencent l'incidence des arythmies. Des études pilotes démontrent que l'utilisation d'un dialysat sans acétate avec perfusion de bicarbonate de sodium en aval du filtre de dialyse, couplée à une modulation du profil de potassium pendant la séance de dialyse, ou acetate free biofiltration with potassium profiled dialysate, permet de réduire l'incidence des arythmies, l'intervalle QT et sa dispersion. La limitation du volume de soustraction liquidienne pendant la dialyse et l'augmentation de la concentration de calcium dans le dialysat constituent d'autres stratégies anti-arythmogènes possibles Sudden death is the first cause of mortality in patients with end stage renal disease undergoing chronic dialysis treatment. The technique of dialysis as well as the chemical composition of the dialysate can impact on the incidence of cardiac arrhythmias. Pilot studies reveal that the use of an acetate-free dialysate with a downstream filter infusion of sodium bicarbonate, coupled with a modulated potassium-profiled dialysate during hemodialysis, or acetate free biofiltration with potassium profiled dialysate, reduces the incidence of arrhythmias, the QT interval and QT dispersion. The limitation of the ultrafiltration volume during the dialysis session, and the increase in calcium concentration in the dialysate are other possible strategies to reduce cardiac arrhythmias.

Dépistage du risque d'allergie et prévention en maternité : enquête des pratiques AllerNaiss [Screening for the risk of allergy and prevention in French maternity units: A survey].

Allergy has been on the rise for half a century and concerns nearly 30% of children; it has now become a real public health problem. The guidelines on prevention of allergy set up by the French Society of Paediatrics (SFP) and the European Society of Paediatric Allergology and Clinical Immunology (ESPACI) are based on screening children at risk through a systematic search of the family history and recommend, for children at risk, exclusive breastfeeding whenever possible or otherwise utilization of hypoallergenic infant formula, which has demonstrated efficacy. The AllerNaiss practice survey assessed the modes of screening and prevention of allergy in French maternity units in 2012. The SFP guidelines are known by 82% of the maternity units that took part in the survey, and the ESPACI guidelines by 55% of them. A screening strategy is in place in 59% of the participating maternity wards, based on local consensus for 36% of them, 13% of the units having a written screening procedure. Screening is based on the search for a history of allergy in first-degree relatives (99%) during pregnancy (51%), in the delivery room (50%), and after delivery (89%). A mode of prevention of the risk of allergy exists in 62% of the maternity units, most often in writing (49%). A hypoallergenic infant formula is prescribed for non-breastfed children in 90% of the units. The survey shows that there is a real need for formalization of allergy risk screening and prevention of allergy in newborns in French maternity units.

Recommandations for malaria prevention in moderate to low risk areas : traveller's choice and risk perception

Background. Le considérable déclin de la malaria au niveau mondial remet en question la stratégie de chimioprophylaxie pour les voyageurs à destination de pays à risque modéré à faible de malaria. Un consensus international de la meilleure stratégie de prévention reste à trouver. Suivant le mouvement actuel de partage décisionnel, cette étude invite le voyageur au sein du débat comme acteur du processus de décision. Objectifs. Investiguer les préférences des voyageurs à destination de pays à risque modéré à faible de malaria en matière de prévention contre la malaria, en mettant en perspective leur perception du risque et les raisons de leur choix. Méthodologie. Dans la salle d'attente du Centre de Vaccination et Médecine de Voyage, les voyageurs à destination de risque modéré à faible de malaria remplissent un questionnaire et choisissent la méthode de prévention qu'ils préfèrent aidés d'un tableau leur proposant 4 choix possible ; mesure de prévention des piqûres de moustique uniquement, chimioprophylaxie, traitement de réserve seul et traitement de réserve avec test diagnostic rapide. Ils reçoivent aussi une échelle de risque illustrant les risques de malaria et d'effets indésirables des anti-malariques comparés à différents autres risques liés au voyage, inspirée par les palettes de Paling de la Communication Risk Institut. Résultats. De décembre 2012 à décembre 2013, 391 voyageurs on été inclus. 59 (15%) ont choisi la chimioprophylaxie, 116 (30%) un traitement de réserve, 112 (29%) un traitement de réserve avec test rapide diagnostic, 100 (26%) une prévention des piqûre de moustiques uniquement, and 4 (1%) plusieurs alternatives. Les raisons de choisir une chimioprophylaxie étaient la sécurité (42%), l'action préventive (29%), l'efficacité (15%) et la facilité d'utilisation (15%). Les raisons de choisir un traitement de réserve étaient moins de prise de médicament (29%), moins d'effets secondaires de ceux-ci (23%) et le prix (9%). Les voyageurs choisissant la chimioprohylaxie l'avaient plus souvent déjà utilisée par le passé [OR=3.0 (CI 1.7-5.44)], sans différence en terme de profil démographique, caractéristique du voyage ou comportement à risque. Conclusions. Quand interrogés, 85% des voyageurs à destination de pays à risque modéré à faible de malaria préfèrent ne pas prendre la chimioprophylaxie, bien que la plupart des pays la recommande encore. Les raisons avancées sont cohérentes avec leur choix. Les nouvelles recommandations devraient prendre en compte la préférence des voyageurs et inclure un processus de décision partagé.

Reducing Cardiovascular Mortality Through Prevention and Management of Raised Blood Pressure: A World Heart Federation Roadmap.

Prospective epidemiological data have shown that blood pressure has a graded, continuous adverse effect on the risk of various forms of CVD (including stroke, myocardial infarction, heart failure, peripheral arterial disease and end-stage renal disease). 'Raised blood pressure' is frequently considered to be any systolic blood pressure greater than 115 mmHg. It accounts for 45% of all heart disease deaths and 51% of all stroke-related deaths [1], which together are the biggest causes of morbidity and mortality worldwide [2,3,4]. Annually, there are >17 million deaths due to CVD worldwide, of which 9.4 million are attributable to complications of raised blood pressure. This highlights the importance of both high-risk and population-based strategies in blood pressure management and control.

Effect of cocoa powder in the prevention of cardiovascular disease: biological, consumption and inflammatory biomarkers. A metabolomic approach

Numerous health benefits have been attributed to cocoa and its derived products in the last decade including antioxidant, anti-platelet and positive effects on lipid metabolism and vascular function. Inflammation plays a key role in the initiation and progression of atherosclerosis. However, cocoa feeding trials focused on inflammation are still rare and the results yielded are controversial. Health effects derived from cocoa consumption have been partly attributed to its polyphenol content, in particular of flavanols. Bioavailability is a key issue for cocoa polyphenols in order to be able to exert their biological activities. In the case of flavanols, bioavailability is strongly influenced by several factors, such as their degree of polymerization and the food matrix in which the polyphenols are delivered. Furthermore, gut has become an active site for the metabolism of procyanidins (oligomeric and polymeric flavanols). Estimation of polyphenol consumption or exposure is also a very challenging task in Food and Nutrition Science in order to correlate the intake of phytochemicals with in vivo health effects. In the area of nutrition, modern analytical techniques based on mass spectrometry are leading to considerable advances in targeted metabolite analysis and particularly in Metabolomics or global metabolite analysis. In this chapter we have summarized the most relevant results of our recent research on the bioavailability of cocoa polyphenols in humans and the effect of the matrix in which cocoa polyphenols are delivered considering both targeted analysis and a metabolomic approach. Furthermore, we have also summarized the effect of long-term consumption of cocoa powder in patients at high risk of cardiovascular disease (CVD) on the inflammatory biomarkers of atherosclerosis.

The pseudo-high-risk prevention strategy

Key Messages: A fundamental failure of high-risk prevention strategies is their inability to prevent disease in the large part of the population at a relatively small average risk and from which most cases of diseases originate. The development of individual predictive medicine and the widening of high-risk categories for numerous (chronic) conditions lead to the application of pseudo-high-risk prevention strategies. Widening the criteria justifying individual preventive interventions and the related pseudo-high-risk strategies lead to treating, individually, ever healthier and larger strata of the population. The pseudo-high-risk prevention strategies raise similar problems compared with high-risk strategies, however on a larger scale and without any of the benefit of population-based strategies. Some 30 years ago, the strengths and weaknesses of population-based and high-risk prevention strategies were brilliantly delineated by Geoffrey Rose in several seminal publications (Table 1).1,2 His work had major implications not only for epidemiology and public health but also for clinical medicine. In particular, Rose demonstrated the fundamental failure of high-risk prevention strategies, that is, by missing a large number of preventable cases.