Study On Cardiovascular Risk Assessment And Comprehensive Intervention In Older Adults

Background:Cardiovascular disease (CVD) is the most leading cause of human death worldwide. As the global population aging, CVD causes premature death and disability in the older adults, leading to serious social and economic burden. Therefore, there is an urgent need to take measures to prevent the epidemic of cardiovascular disease in the older adults. Cardiovascular risk assessment and management in high-risk groups is a research hotspot on CVD prevention. In China, hypertension, diabetes, high cholesterol and other CVD risk factors have not been effectively controlled in the older adults. Therefore, it is essential to carry out the assessment and management of cardiovascular risk, in the older adults. And the intervention mode for the primary prevention of cardiovascular disease is not yet mature, needing in-depth study. This project is to to investigate the relationship between cardiovascular risk and awareness of CVD knowledge by investigating the current situation of cardiovascular risk and awareness of CVD knowledge in older adults; and to carry out cardiovascular risk assessment and comprehensive intervention in the older adults to explore effective intervention model for primary prevention of cardiovascular disease; further to detect the role of inflammatory cytokines in the assessing and monitoring of cardiovascular risk.Objectives:The purposes of this study were to:1. describe the current situation of cardiovascular risk and awareness of CVD knowledge in older adults, and to investigate the relationship between cardiovascular risk and awareness of CVD knowledge.2. explore the effect of cardiovascular risk assessment and individualized comprehensive intervention on awareness of CVD knowledge, health behavior adherence, CVD self-management, quality of life, CVD risk factors, cardiovascular risk, and serum inflammatory cytokines hsCRP, visfatin, IL-6, TNF-a levels, and to understand the correlation of inflammatory cytokines with cardiovascular risk.3. observe the effect of lipid accumulation on the expression of inflammatory factors in THP-1macrophage to explore the mechanism on the changes of serum related inflammatory cytokines.Methods:1. A cross-sectional descriptive study.1200older adults were included by a cluster random sampling method, consecutively admitted to the health examination centers of the first and the second affiliated hospitals of University of South China. Socio-demographic data and knowledge of early warning symptoms and risk factors of cardiovascular disease were collected by face-to-face interviews using two self-designed questionnaires. Other data was collected by health measurement and laboratory biochemical detection. The cardiovascular risk of the older adults was assessed using the2008WHO/ISH Pocket Guide for cardiovascular risk assessment and management.2. A randomized clinical experimental study.200older adults with cardiovascular risk greater than10%were recruited from the research subjects in the first part of the study. Blood pressure, blood sugar, blood lipids, body mass index (BMI) and inflammatory factors (hsCRP Visfatin, IL-6, TNF-α) were tested to analyze their correlation with cardiovascular risk.200older adults were divided into control group(n=100) and intervention group(n=100) following the principle of matching and stratified random strictly. An experimental study on cardiovascular risk assessment and comprehensive intervention for the older adults was carried out. The control group was given the routine management, and the intervention group was given the individualized comprehensive intervention on the basis of routine management. Socio-demographic data and knowledge of early warning symptoms and risk factors of cardiovascular disease were collected by face-to-face interviews using two self-designed questionnaires. Status of Quality of Life and CVD self-management were assessed using Quality of Life Questionnaire and CVD self-management questionnaire. Other data was collected by health measurement and laboratory biochemical detection. The cardiovascular risk of the elderly was assessed using the2008WHO/ISH Pocket Guide for cardiovascular risk assessment and management. All data were collected before and after intervention. Comprehensive analysis of the intervention effects of the intervention and the control group was carried out.3. Experimental study. THP-1macrophages were treated using different doses of oxLDL combined with atorvastatin. Lipid accumulation in THP-1macrophages was detected by oil red O staining. Expression of visfatin, IL-6and TNF-a in the culture supernatants were detected by enzyme-linked immunosorbent assay. Expression of visfatin, IL-6and TNF-a in THP-1macrophages were detected using immunocytochemical method and western blot.Results:1. A total of1200older adults people participated in the study, and1120valid questionnaires were obtained.①The control of CVD risk factors of the older adults was not ideal in Hengyang City. The prevalence of hypertension, dyslipidemia, hyperglycemia were37.5%,36.2%,18.9%and rates of medication treatment were:43.6%,7.6%,16.4%respectively. The10-year risk of cardiovascular events was higher in the older adults.②There were222(19.8%) older adults whose cardiovascular risk were<10%,510(45.5%) older adults whose cardiovascular risk were10%～-<40%of, cardiovascular risk≥40%of388(34.6%).③There was a lower level of CVD knowledge awareness in the older adults in Hengyang City. The awareness of stroke and heart attack warning symptoms was low (average score was3.10out of10points), and the awareness of cardiovascular disease risk was low (average score was4.98out of15points). The knowledge level of the older adults with cardiovascular disease was higher than the older adults without cardiovascular disease (P<0.05). The lower the CVD knowledge level, the higher the cardiovascular risk in the older adults.④The education level, history of cardiovascular disease, cardiovascular risk level were significantly associated with the level of CVD knowledge awareness in different degrees (P<0.05).2.①In addition to triglycerides, systolic blood pressure, fasting glucose, total cholesterol, HDL-C, LDL-C; BMI The hsCRP, visfatin, IL-6, TNF-a, the differences were statistically significant associated with the different levels of cardiovascular risk in the older adults (P<0.05). With the increasing of cardiovascular risk, the systolic blood pressure, fasting glucose, total cholesterol, LDL-C, BMI, serum hsCRP, visfatin, IL-6and TNF-a also increased.②A total of200older people participated in this study, and178people (86in control group,92in intervention group) completed all the measurement after the six month intervention. The follow-up rate was89%. After the intervention, the average score of CVD knowledge in the two groups have increased (P<0.05).In the control group, the number of older people with low score decreased and those with intermediate score increased significantly; in the intervention group, the number of older people with low score decreased and those with high score increased significantly (P<0.05). Compared with the control group, the effect of the intervention group was better, the number of older people with high score was significantly more than the control group after the intervention (P<0.05).③After the intervention, the health-related behavior of the control and intervention group, the level of CVD self-management and quality of life have improved. Compared with the control group, the effect of the intervention group was better (P<0.05). But there was no significant difference in the increase of smoking quit rates and the rate of high blood pressure medication taking between the two groups (P>0.05).④After the intervention, except (TG), the systolic blood pressure, fasting glucose, TG, TC, LDL-C, BMI decreased and HDL-C increased in the intervention group (P<0.05), while the control group did not change significantly,(P>0.05).⑤After the intervention, in the intervention group, there were15older adults whose cardiovascular risk reduced16degree cumulatively,4older adults elevated4degree cumulatively, a net reduction of12degree, and a decrease of5older adults with cardiovascular risk≥40%. In the control group, there were6older adults whose cardiovascular risk reduced6degree cumulatively,5older adults elevated5degree cumulatively, a net reduction of5degree, and a decrease of1older adult with cardiovascular risk≥40%.⑥After the intervention, serum visfatin, IL-6, TNF-a levels in the intervention group decreased significantly (P<0.05), but the hsCRP difference was not statistically significant (P>0.05). The level of serum inflammatory factors in the control group decreased after the intervention, but the difference was not significant (P>0.05).3.①oxLDL could promote lipid accumulation in THP-1macrophage in a dose-dependent manner. Atorvastatin can reduce lipid accumulation in THP-1macrophage;②The more lipid accumulation in THP-1macrophage, the higher expression of visfatin, IL-6, TNF-a in culture supernatant, and the higher expression of visfatin THP-1macrophage.Conclusion:1. The control of CVD risk factors of the older adults was not ideal in Hengyang City. The lower awareness of CVD knowledge, the higher cardiovascular risk in the older adults. The education level, history of cardiovascular disease, cardiovascular risk level were significantly associated with the level of CVD knowledge awareness.2. The comprehensive intervention could effectively improve the awareness of CVD knowledge, health behavior adherence, CVD self-management and quality of life; and reduce CVD risk factors, cardiovascular risk, serum inflammatory cytokines. The effect of comprehensive intervention on cardiovascular risk reduction was significantly superior to the routine management.3. There was correlation between serum inflammatory cytokines hsCRP, visfatin, IL-6, TNF-a and cardiovascular risk. These inflammatory cytokines might be used for assessing and monitoring of cardiovascular risk.