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1. Tobacco use and risk of acute stroke in 32 countries in the INTERSTROKE study: a case–control study

Author

Wang, Xingyu, Liu, Xin, O’Donnell, Martin J., McQueen, Matthew, Sniderman, Allan, Pare, Guillaume, Hankey, Graeme J., Rangarajan, Sumathy, Chin, Siu Lim, Rao-Melacini, Purnima, Ferguson, John, Xavier, Denis, Zhang, Hongye, Lisheng, Liu, Pais, Prem, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Langhorne, Peter, Rosengren, Annika, Dans, Antonio L., Elsayed, Ahmed, Avezum, Alvaro, Mondo, Charles, Judge, Conor, Diener, Hans-Christoph, Ryglewicz, Danuta, Czlonkowska, Anna, Pogosova, Nana, Weimar, Christian, Iqbal, Romana, Diaz, Rafael, Yusoff, Khalid, Yusufali, Afzalhussein, Oguz, Aytekin, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu S., Ogunniyi, A., Iversen, Helle K., Malaga, German, Rumboldt, Zvonko, Oveisgharan, Shahram, Al Hussain, Fawaz, Nilanont, Yongchai, and Yusuf, Salim

Published
2024
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3. Variations in the prevalence of atrial fibrillation, and in the strength of its association with ischemic stroke, in countries with different income levels: INTERSTROKE case–control study.

Author

Murphy, Robert, Damasceno, Albertino, Reddin, Catriona, Hankey, Graeme J, Iversen, Helle K, Oveisgharan, Shahram, Lanas, Fernando, Czlonkowska, Anna, Langhorne, Peter, Ogunniyi, Adesola, Wasay, Mohammad, Rumboldt, Zvonko, Judge, Conor, Oguz, Aytekin, Mondo, Charles, Winter, Yaroslav, Rosengren, Annika, Pogosova, Nana, Avezum, Alvaro, and Nilanont, Yongchai

Subjects
ISCHEMIC stroke, ATRIAL fibrillation, HEART valve diseases, CASE-control method, STROKE
Abstract

Background: The contribution of atrial fibrillation (AF) to the etiology and burden of stroke may vary by country income level. Aims: We examined differences in the prevalence of AF and described variations in the magnitude of the association between AF and ischemic stroke by country income level. Methods: In the INTERSTROKE case–control study, participants with acute first ischemic stroke were recruited across 32 countries. We included 10,363 ischemic stroke cases and 10,333 community or hospital controls who were matched for age, sex, and center. Participants were grouped into high-income (HIC), upper-middle-income (subdivided into two groups—UMIC-1 and UMIC-2), and lower-middle-income (LMIC) countries, based on gross national income. We evaluated the risk factors for AF overall and by country income level, and evaluated the association of AF with ischemic stroke. Results: AF was documented in 11.9% (n = 1235) of cases and 3.2% (n = 328) of controls. Compared to HIC, the prevalence of AF was significantly lower in UMIC-2 (aOR 0.35, 95% CI 0.29–0.41) and LMIC (aOR 0.50, 95% CI 0.41–0.60) on multivariable analysis. Hypertension, female sex, valvular heart disease, and alcohol intake were stronger risk factors for AF in lower-income countries, and obesity a stronger risk factor in higher-income countries. The magnitude of association between AF and ischemic stroke was significantly higher in lower-income countries compared to higher-income countries. The population attributable fraction for AF and stroke varied by region and was 15.7% (95% CI 13.7–17.8) in HIC, 14.6% (95% CI 12.3–17.1) in UMIC-1, 5.7% (95% CI 4.9–6.7) in UMIC-2, and 6.3% (95% CI 5.3–7.3) in LMIC. Conclusion: Risk factors for AF vary by country income level. AF contributes to stroke burden to a greater extent in higher-income countries than in lower-income countries, due to a higher prevalence and despite a lower magnitude of odds ratio. [ABSTRACT FROM AUTHOR]

Published
2024
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4. Javno dostupna rana defibrilacija – jučer, danas, sutra.

Author

Rakić, Drago, Luetić, Leo, Jurišić, Zrinka, Berović, Nina, Cvitković, Ivana, and Rumboldt, Zvonko

Abstract

Copyright of Cardiologia Croatica is the property of Croatian Cardiac Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2024
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5. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study

Author

O'Donnell, Martin J, Chin, Siu Lim, Rangarajan, Sumathy, Xavier, Denis, Liu, Lisheng, Zhang, Hongye, Rao-Melacini, Purnima, Zhang, Xiaohe, Pais, Prem, Agapay, Steven, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Langhorne, Peter, McQueen, Matthew J, Rosengren, Annika, Dehghan, Mahshid, Hankey, Graeme J, Dans, Antonio L, Elsayed, Ahmed, Avezum, Alvaro, Mondo, Charles, Diener, Hans-Christoph, Ryglewicz, Danuta, Czlonkowska, Anna, Pogosova, Nana, Weimar, Christian, Iqbal, Romaina, Diaz, Rafael, Yusoff, Khalid, Yusufali, Afzalhussein, Oguz, Aytekin, Wang, Xingyu, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu S, Ogunniyi, Adesola, Iversen, Helle K, Malaga, German, Rumboldt, Zvonko, Oveisgharan, Shahram, Al Hussain, Fawaz, Magazi, Daliwonga, Nilanont, Yongchai, Ferguson, John, Pare, Guillaume, and Yusuf, Salim

Published
2016
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7. Association of Lipids, Lipoproteins, and Apolipoproteins with Stroke Subtypes in an International Case Control Study (INTERSTROKE)

Author

O’Donnell, Martin J, McQueen, Matthew, Sniderman, Allan, Pare, Guillaume, Wang, Xingyu, Hankey, Graeme J, Rangarajan, Sumathy, Chin, Siu Lim, Rao-Melacini, Purnima, Ferguson, John, Xavier, Denis, Lisheng, Liu, Zhang, Hongye, Pais, Prem, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Langhorne, Peter, Rosengren, Annika, Dans, Antonio L, Elsayed, Ahmed, Avezum, Alvaro, Mondo, Charles, Judge, Conor, Diener, Hans-Christoph, Ryglewicz, Danuta, Czlonkowska, Anna, Pogosova, Nana, Weimar, Christian, Iqbal, Romana, Diaz, Rafael, Yusoff, Khalid, Yusufali, Afzalhussein, Oguz, Aytekin, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu S, Ogunniyi, Adesola, Iversen, Helle K., Malaga, German, Rumboldt, Zvonko, Oveisgharan, Shahram, Hussain, Fawaz Al, Nilanont, Yongchai, Yusuf, Salim, O’Donnell, Martin J, McQueen, Matthew, Sniderman, Allan, Pare, Guillaume, Wang, Xingyu, Hankey, Graeme J, Rangarajan, Sumathy, Chin, Siu Lim, Rao-Melacini, Purnima, Ferguson, John, Xavier, Denis, Lisheng, Liu, Zhang, Hongye, Pais, Prem, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Langhorne, Peter, Rosengren, Annika, Dans, Antonio L, Elsayed, Ahmed, Avezum, Alvaro, Mondo, Charles, Judge, Conor, Diener, Hans-Christoph, Ryglewicz, Danuta, Czlonkowska, Anna, Pogosova, Nana, Weimar, Christian, Iqbal, Romana, Diaz, Rafael, Yusoff, Khalid, Yusufali, Afzalhussein, Oguz, Aytekin, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu S, Ogunniyi, Adesola, Iversen, Helle K., Malaga, German, Rumboldt, Zvonko, Oveisgharan, Shahram, Hussain, Fawaz Al, Nilanont, Yongchai, and Yusuf, Salim

Abstract

Background and Purpose The association of dyslipidemia with stroke has been inconsistent, which may be due to differing associations within etiological stroke subtypes. We sought to determine the association of lipoproteins and apolipoproteins within stroke subtypes. Methods Standardized incident case-control STROKE study in 32 countries. Cases were patients with acute hospitalized first stroke, and matched by age, sex and site to controls. Concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apoA1), and apoB were measured. Non-HDL-C was calculated. We estimated multivariable odds ratio (OR) and population attributable risk percentage (PAR%). Outcome measures were all stroke, ischemic stroke (and subtypes), and intracerebral hemorrhage (ICH). Results Our analysis included 11,898 matched case-control pairs; 77.3% with ischemic stroke and 22.7% with ICH. Increasing apoB (OR, 1.10; 95% confidence interval [CI], 1.06 to 1.14 per standard deviation [SD]) and LDL-C (OR, 1.06; 95% CI, 1.02 to 1.10 per SD) were associated with an increase in risk of ischemic stroke, but a reduced risk of ICH. Increased apoB was significantly associated with large vessel stroke (PAR 13.4%; 95% CI, 5.6 to 28.4) and stroke of undetermined cause. Higher HDL-C (OR, 0.75; 95% CI, 0.72 to 0.78 per SD) and apoA1 (OR, 0.63; 95% CI, 0.61 to 0.66 per SD) were associated with ischemic stroke (and subtypes). While increasing HDL-C was associated with an increased risk of ICH (OR, 1.20; 95% CI, 1.14 to 1.27 per SD), apoA1 was associated with a reduced risk (OR, 0.80; 95% CI, 0.75 to 0.85 per SD). ApoB/A1 (OR, 1.38; 95% CI, 1.32 to 1.44 per SD) had a stronger magnitude of association than the ratio of LDL-C/HDL-C (OR, 1.26; 95% CI, 1.21 to 1.31 per SD) with ischemic stroke (P<0.0001). Conclusions The pattern and magnitude of association of lipoproteins and apolipoproteins with stroke varies by etiological s

Published
2022

8. Sleep Patterns and the Risk of Acute Stroke: Results From the INTERSTROKE International Case-Control Study.

Author

Mc Carthy, Christine Eileen, Yusuf, Salim, Judge, Conor, Alvarez-Iglesias, Alberto, Hankey, Graeme J., Oveisgharan, Shahram, Damasceno, Albertino, Iversen, Helle Klingenberg, Rosengren, Annika, Avezum, Alvaro, Lopez-Jaramillo, Patricio, Xavier, Denis, Wang, Xingyu, Rangarajan, Sumathy, O'Donnell, Martin, Diaz, Rafael, Varigos, John, Liu, Lisheng, Zhang, Hongye, and Rumboldt, Zvonko

Published
2023
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9. Association of Lipids, Lipoproteins, and Apolipoproteins with Stroke Subtypes in an International Case Control Study (INTERSTROKE)

Author

O'Donnell, Martin J., McQueen, Matthew, Sniderman, Allan, Pare, Guillaume, Wang, Xingyu, Hankey, Graeme J., Rangarajan, Sumathy, Chin, Siu Lim, Rao-Melacini, Purnima, Ferguson, John, Xavier, Denis, Lisheng, Liu, Zhang, Hongye, Pais, Prem, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Langhorne, Peter, Rosengren, Annika, Dans, Antonio L., Elsayed, Ahmed, Avezum, Alvaro, Mondo, Charles, Judge, Conor, Diener, Hans-Christoph, Ryglewicz, Danuta, Czlonkowska, Anna, Pogosova, Nana, Weimar, Christian, Iqbal, Romana, Diaz, Rafael, Yusoff, Khalid, Yusufali, Afzalhussein, Oguz, Aytekin, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu S., Ogunniyi, Adesola, Iversen, Helle K., Malaga, German, Rumboldt, Zvonko, Oveisgharan, Shahram, Al Hussain, Fawaz, Nilanont, Yongchai, Yusuf, Salim, and on Behalf of the INTERSTROKE Investigators

Subjects
Stroke, Apolipoproteins, Dyslipidemia, Lipoproteins, Medizin, lipids (amino acids, peptides, and proteins), cardiovascular diseases, Neurology (clinical), Risk factor, Case-control, Cardiology and Cardiovascular Medicine
Abstract

Background and Purpose:\ud The association of dyslipidemia with stroke has been inconsistent, which may be due to differing associations within etiological stroke subtypes. We sought to determine the association of lipoproteins and apolipoproteins within stroke subtypes.\ud Methods:\ud Standardized incident case-control STROKE study in 32 countries. Cases were patients with acute hospitalized first stroke, and matched by age, sex and site to controls. Concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apoA1), and apoB were measured. Non-HDL-C was calculated. We estimated multivariable odds ratio (OR) and population attributable risk percentage (PAR%). Outcome measures were all stroke, ischemic stroke (and subtypes), and intracerebral hemorrhage (ICH).\ud Results:\ud Our analysis included 11,898 matched case-control pairs; 77.3% with ischemic stroke and 22.7% with ICH. Increasing apoB (OR, 1.10; 95% confidence interval [CI], 1.06 to 1.14 per standard deviation [SD]) and LDL-C (OR, 1.06; 95% CI, 1.02 to 1.10 per SD) were associated with an increase in risk of ischemic stroke, but a reduced risk of ICH. Increased apoB was significantly associated with large vessel stroke (PAR 13.4%; 95% CI, 5.6 to 28.4) and stroke of undetermined cause. Higher HDL-C (OR, 0.75; 95% CI, 0.72 to 0.78 per SD) and apoA1 (OR, 0.63; 95% CI, 0.61 to 0.66 per SD) were associated with ischemic stroke (and subtypes). While increasing HDL-C was associated with an increased risk of ICH (OR, 1.20; 95% CI, 1.14 to 1.27 per SD), apoA1 was associated with a reduced risk (OR, 0.80; 95% CI, 0.75 to 0.85 per SD). ApoB/A1 (OR, 1.38; 95% CI, 1.32 to 1.44 per SD) had a stronger magnitude of association than the ratio of LDL-C/HDL-C (OR, 1.26; 95% CI, 1.21 to 1.31 per SD) with ischemic stroke (P

Published
2022

10. Variations in knowledge, awareness and treatment of hypertension and stroke risk by country income level

Author

O'Donnell, Martin, Hankey, Graeme J., Rangarajan, Sumathy, Chin, Siu Lim, Rao-Melacini, Purnima, Ferguson, John, Xavier, Denis, Lisheng, Liu, Zhang, Hongye, Pais, Prem, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Langhorne, Peter, Rosengren, Annika, Dans, Antonio L., Elsayed, Ahmed, Avezum, Alvaro, Mondo, Charles, Smyth, Andrew, Judge, Conor, Diener, Hans Christoph, Ryglewicz, Danuta, Czlonkowska, Anna, Pogosova, Nana, Weimar, Christian, Iqbal, Romana, Diaz, Rafael, Yusoff, Khalid, Yusufali, Afzalhussein, Oguz, Aytekin, Wang, Xingyu, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu Samuel, Ogunniyi, Adensola, Iversen, Helle K., Malaga, German, Rumboldt, Zvonko, Oveisgharan, Shahram, Alhussain, Fawaz, Daliwonga, Magazi, Nilanont, Yongchai, Yusuf, Salim, O'Donnell, Martin, Hankey, Graeme J., Rangarajan, Sumathy, Chin, Siu Lim, Rao-Melacini, Purnima, Ferguson, John, Xavier, Denis, Lisheng, Liu, Zhang, Hongye, Pais, Prem, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Langhorne, Peter, Rosengren, Annika, Dans, Antonio L., Elsayed, Ahmed, Avezum, Alvaro, Mondo, Charles, Smyth, Andrew, Judge, Conor, Diener, Hans Christoph, Ryglewicz, Danuta, Czlonkowska, Anna, Pogosova, Nana, Weimar, Christian, Iqbal, Romana, Diaz, Rafael, Yusoff, Khalid, Yusufali, Afzalhussein, Oguz, Aytekin, Wang, Xingyu, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu Samuel, Ogunniyi, Adensola, Iversen, Helle K., Malaga, German, Rumboldt, Zvonko, Oveisgharan, Shahram, Alhussain, Fawaz, Daliwonga, Magazi, Nilanont, Yongchai, and Yusuf, Salim

Abstract

Objective Hypertension is the most important modifiable risk factor for stroke globally. We hypothesised that country-income level variations in knowledge, detection and treatment of hypertension may contribute to variations in the association of blood pressure with stroke. Methods We undertook a standardised case-control study in 32 countries (INTERSTROKE). Cases were patients with acute first stroke (n=13 462) who were matched by age, sex and site to controls (n=13 483). We evaluated the associations of knowledge, awareness and treatment of hypertension with risk of stroke and its subtypes and whether this varied by gross national income (GNI) of country. We estimated OR and population attributable risk (PAR) associated with treated and untreated hypertension. Results Hypertension was associated with a graded increase in OR by reducing GNI, ranging from OR 1.92 (99% CI 1.48 to 2.49) to OR 3.27 (2.72 to 3.93) for highest to lowest country-level GNI (p-heterogeneity<0.0001). Untreated hypertension was associated with a higher OR for stroke (OR 5.25; 4.53 to 6.10) than treated hypertension (OR 2.60; 2.32 to 2.91) and younger age of first stroke (61.4 vs 65.4 years; p<0.01). Untreated hypertension was associated with a greater risk of intracerebral haemorrhage (OR 6.95; 5.61 to 8.60) than ischaemic stroke (OR 4.76; 3.99 to 5.68). The PAR associated with untreated hypertension was higher in lower-income regions, PAR 36.3%, 26.3%, 19.8% to 10.4% by increasing GNI of countries. Lifetime non-measurement of blood pressure was associated with stroke (OR 1.80; 1.32 to 2.46). Conclusions Deficits in knowledge, detection and treatment of hypertension contribute to higher risk of stroke, younger age of onset and larger proportion of intracerebral haemorrhage in lower-income countries.

Published
2021

14. Obesity and the risk of myocardial infarction in 27 000 participants from 52 countries: a case-control study

Author

Yusuf, Salim, Hawken, Steven, Ounpuu, Stephanie, Bautista, Leonelo, Franzosi, Maria Grazia, Commerford, Patrick, Lang, Chim C., Rumboldt, Zvonko, Onen, Churchill L., Lisheng, Liu, Tanomsup, Supachai, Wangai, Paul, Jr., Razak, Fahad, Sharma, Arya M., and Anand, Sonia S.

Subjects
Obesity -- Care and treatment, Obesity -- Risk factors, Obesity -- Complications and side effects, Obesity -- Statistics, Cardiovascular diseases -- Risk factors, Diabetes -- Health aspects, Diabetes -- Risk factors
Published
2005

15. Obesity and the risk of myocardial infarction in 27a[euro]000 participants from 52 countries: a case-control study

Author

Yusuf, Salim, Hawken, Steven, Ounpuu, Stephanie, Bautista, Leonelo, Franzosi, Maria Grazia, Commerford, Patrick, Lang, Chim C, Rumboldt, Zvonko, Onen, Churchill L, Lisheng, Liu, Tanomsup, Supachai, Wangai, Paul, Razak, Fahad, Sharma, Arya M, and Anand, Sonia S

Subjects
Heart attack -- Risk factors, Obesity -- Complications and side effects, Health risk assessment
Published
2005

16. Variations in knowledge, awareness and treatment of hypertension and stroke risk by country income level

Author

O' Donnell, Martin, primary, Hankey, Graeme J, additional, Rangarajan, Sumathy, additional, Chin, Siu Lim, additional, Rao-Melacini, Purnima, additional, Ferguson, John, additional, Xavier, Denis, additional, Lisheng, Liu, additional, Zhang, Hongye, additional, Pais, Prem, additional, Lopez-Jaramillo, Patricio, additional, Damasceno, Albertino, additional, Langhorne, Peter, additional, Rosengren, Annika, additional, Dans, Antonio L, additional, Elsayed, Ahmed, additional, Avezum, Alvaro, additional, Mondo, Charles, additional, Smyth, Andrew, additional, Judge, Conor, additional, Diener, Hans-Christoph, additional, Ryglewicz, Danuta, additional, Czlonkowska, Anna, additional, Pogosova, Nana, additional, Weimar, Christian, additional, Iqbal, Romana, additional, Diaz, Rafael, additional, Yusoff, Khalid, additional, Yusufali, Afzalhussein, additional, Oguz, Aytekin, additional, Wang, Xingyu, additional, Penaherrera, Ernesto, additional, Lanas, Fernando, additional, Ogah, Okechukwu Samuel, additional, Ogunniyi, Adensola, additional, Iversen, Helle K, additional, Malaga, German, additional, Rumboldt, Zvonko, additional, Oveisgharan, Shahram, additional, AlHussain, Fawaz, additional, Daliwonga, Magazi, additional, Nilanont, Yongchai, additional, and Yusuf, Salim, additional

Published
2020
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18. Urinary Sodium and Potassium, and Risk of Ischemic and Hemorrhagic Stroke (INTERSTROKE): A Case–Control Study

Author

Judge, Conor, primary, O’Donnell, Martin J, additional, Hankey, Graeme J, additional, Rangarajan, Sumathy, additional, Chin, Siu Lim, additional, Rao-Melacini, Purnima, additional, Ferguson, John, additional, Smyth, Andrew, additional, Xavier, Denis, additional, Lisheng, Liu, additional, Zhang, Hongye, additional, Lopez-Jaramillo, Patricio, additional, Damasceno, Albertino, additional, Langhorne, Peter, additional, Rosengren, Annika, additional, Dans, Antonio L, additional, Elsayed, Ahmed, additional, Avezum, Alvaro, additional, Mondo, Charles, additional, Ryglewicz, Danuta, additional, Czlonkowska, Anna, additional, Pogosova, Nana, additional, Weimar, Christian, additional, Diaz, Rafael, additional, Yusoff, Khalid, additional, Yusufali, Afzalhussein, additional, Oguz, Aytekin, additional, Wang, Xingyu, additional, Lanas, Fernando, additional, Ogah, Okechukwu S, additional, Ogunniyi, Adesola, additional, Iversen, Helle K, additional, Malaga, German, additional, Rumboldt, Zvonko, additional, Oveisgharan, Shahram, additional, Al Hussain, Fawaz, additional, and Yusuf, Salim, additional

Published
2020
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22. Adverse outcomes of underuse of beta-blockers in elderly patients

Author

Gambassi, Giovanni, Bernabei, Roberto, Carbonin, Pierugo, Holt, Robert J., Jay, Stephen J., Lapane, Kate L., Hume, Anne L., Rumboldt, Zvonko, Bozic, Ivo, Rakic, Drago, Hein, Herman A., Levinson, Daniel, Soumerai, Stephen B., McLaughlin, Thomas J., Spiegelman, Donna, Hertzmark, Ellen, Thibault, George, Goldman, Lee, Felch, William Campbell, and Scanlon, Donald M.

Subjects
Adrenergic beta blockers -- Health aspects, Cardiac patients -- Care and treatment, Heart attack -- Drug therapy
Published
1997

24. Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE):an international observational study

Author

Langhorne, Peter, O'Donnell, Martin J, Chin, Siu Lim, Zhang, Hongye, Xavier, Denis, Avezum, Alvaro, Mathur, Nandini, Turner, Melanie, MacLeod, Mary Joan, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Hankey, Graeme J, Dans, Antonio L, Elsayed, Ahmed, Mondo, Charles, Wasay, Mohammad, Czlonkowska, Anna, Weimar, Christian, Yusufali, Afzal Hussein, Hussain, Fawaz Al, Lisheng, Liu, Diener, Hans-Christoph, Ryglewicz, Danuta, Pogosova, Nana, Iqbal, Romana, Diaz, Rafael, Yusoff, Khalid, Oguz, Aytekin, Wang, Xingyu, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu S, Ogunniyi, Adesola, Iversen, Helle K., Malaga, German, Rumboldt, Zvonko, Magazi, Daliwonga, Nilanont, Yongchai, Rosengren, Annika, Oveisgharan, Shahram, Yusuf, Salim, Langhorne, Peter, O'Donnell, Martin J, Chin, Siu Lim, Zhang, Hongye, Xavier, Denis, Avezum, Alvaro, Mathur, Nandini, Turner, Melanie, MacLeod, Mary Joan, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Hankey, Graeme J, Dans, Antonio L, Elsayed, Ahmed, Mondo, Charles, Wasay, Mohammad, Czlonkowska, Anna, Weimar, Christian, Yusufali, Afzal Hussein, Hussain, Fawaz Al, Lisheng, Liu, Diener, Hans-Christoph, Ryglewicz, Danuta, Pogosova, Nana, Iqbal, Romana, Diaz, Rafael, Yusoff, Khalid, Oguz, Aytekin, Wang, Xingyu, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu S, Ogunniyi, Adesola, Iversen, Helle K., Malaga, German, Rumboldt, Zvonko, Magazi, Daliwonga, Nilanont, Yongchai, Rosengren, Annika, Oveisgharan, Shahram, and Yusuf, Salim

Abstract

BACKGROUND: Stroke disproportionately affects people in low-income and middle-income countries. Although improvements in stroke care and outcomes have been reported in high-income countries, little is known about practice and outcomes in low and middle-income countries. We aimed to compare patterns of care available and their association with patient outcomes across countries at different economic levels.METHODS: We studied the patterns and effect of practice variations (ie, treatments used and access to services) among participants in the INTERSTROKE study, an international observational study that enrolled 13 447 stroke patients from 142 clinical sites in 32 countries between Jan 11, 2007, and Aug 8, 2015. We supplemented patient data with a questionnaire about health-care and stroke service facilities at all participating hospitals. Using univariate and multivariate regression analyses to account for patient casemix and service clustering, we estimated the association between services available, treatments given, and patient outcomes (death or dependency) at 1 month.FINDINGS: We obtained full information for 12 342 (92%) of 13 447 INTERSTROKE patients, from 108 hospitals in 28 countries; 2576 from 38 hospitals in ten high-income countries and 9766 from 70 hospitals in 18 low and middle-income countries. Patients in low-income and middle-income countries more often had severe strokes, intracerebral haemorrhage, poorer access to services, and used fewer investigations and treatments (p<0·0001) than those in high-income countries, although only differences in patient characteristics explained the poorer clinical outcomes in low and middle-income countries. However across all countries, irrespective of economic level, access to a stroke unit was associated with improved use of investigations and treatments, access to other rehabilitation services, and improved survival without severe dependency (odds ratio [OR] 1·29; 95% CI 1·14-1·44; all p<0·0

Published
2018

26. Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE): an international observational study

Author

Langhorne, Peter, primary, O'Donnell, Martin J, additional, Chin, Siu Lim, additional, Zhang, Hongye, additional, Xavier, Denis, additional, Avezum, Alvaro, additional, Mathur, Nandini, additional, Turner, Melanie, additional, MacLeod, Mary Joan, additional, Lopez-Jaramillo, Patricio, additional, Damasceno, Albertino, additional, Hankey, Graeme J, additional, Dans, Antonio L, additional, Elsayed, Ahmed, additional, Mondo, Charles, additional, Wasay, Mohammad, additional, Czlonkowska, Anna, additional, Weimar, Christian, additional, Yusufali, Afzal Hussein, additional, Hussain, Fawaz Al, additional, Lisheng, Liu, additional, Diener, Hans-Christoph, additional, Ryglewicz, Danuta, additional, Pogosova, Nana, additional, Iqbal, Romana, additional, Diaz, Rafael, additional, Yusoff, Khalid, additional, Oguz, Aytekin, additional, Wang, Xingyu, additional, Penaherrera, Ernesto, additional, Lanas, Fernando, additional, Ogah, Okechukwu S, additional, Ogunniyi, Adesola, additional, Iversen, Helle K, additional, Malaga, German, additional, Rumboldt, Zvonko, additional, Magazi, Daliwonga, additional, Nilanont, Yongchai, additional, Rosengren, Annika, additional, Oveisgharan, Shahram, additional, Yusuf, Salim, additional, O'Donnell, M., additional, Yusuf, S., additional, Rangarajan, S., additional, Rao-Melacini, P., additional, Zhang, X. Michelle, additional, Islam, S., additional, Kabali, C., additional, Casanova, A., additional, Chin, S.L., additional, DeJesus, J., additional, Dehghan, M., additional, Agapay, S., additional, McQueen, M., additional, Hall, K., additional, Keys, J., additional, Wang, X., additional, Devanath, A., additional, Gupta, R., additional, Prabhakaran, D., additional, Diaz, R., additional, Schygiel, P., additional, Garrote, M., additional, Rodriguez, M.A., additional, Caccavo, A., additional, Duran, R.G., additional, Sposato, L., additional, Molinos, J., additional, Valdez, P., additional, Cedrolla, C.M., additional, Nofal, P.G., additional, Huerta, M.F., additional, Desmery, P.M., additional, Zurru, M.C., additional, Della Vedova, B., additional, Varigos, J., additional, Hankey, G., additional, Kraemer, T., additional, Gates, P., additional, Bladin, C., additional, Herkes, G., additional, Avezum, A., additional, Pereira, M.P., additional, Minuzzo, L., additional, Oliveira, L., additional, Teixeira, M., additional, Reis, H., additional, Carvalho, A., additional, Ouriques Martins, S., additional, Carvalho, J.J., additional, Gebara, O., additional, Minelli, C., additional, Oliveira, D.C., additional, Sobral Sousa, A.C., additional, Ferraz de Almeida, A.C., additional, Hernandez, M.E., additional, Friedrich, M., additional, Mota, D.M., additional, Ritt, L.E., additional, Correa Vila Nova, D., additional, Teal, P., additional, Gladstone, D., additional, Shuaib, A., additional, Silver, F., additional, Dowlatshahi, D., additional, Lanas, F., additional, Carcamo, D., additional, Santibañez, C., additional, Garces, E., additional, Liu, L.S., additional, Zhang, H.Y., additional, Fang, H.P., additional, Lian, M.F., additional, Shen, F., additional, Luo, F.X., additional, Wen, X.X., additional, Xu, Z.Q., additional, Liu, Z.Z., additional, Yan, W., additional, Yu, J.F., additional, Wang, W.K., additional, Liu, L.H., additional, Sun, Y.H., additional, Zhou, L.C., additional, Zhang, Z.F., additional, LV, J., additional, Zhang, C.S., additional, Chen, G., additional, Wang, H.L., additional, Chen, Y., additional, Zheng, H., additional, Huang, J.J., additional, Li, W.Z., additional, Wang, L.J., additional, Shi, J.X., additional, Hu, C.Y., additional, Song, H.F., additional, Ji, R.Y., additional, Wang, D.L., additional, Meng, L.H., additional, Meng, Q.W., additional, Duan, L.J., additional, Liu, H.F., additional, Luo, Y.C., additional, Zhang, Q.Y., additional, Wu, Y.B., additional, Wang, C.R., additional, Zhao, J.G., additional, Liu, S.G., additional, Shi, C.L., additional, Wang, X.Y., additional, Lopez-Jaramillo, P., additional, Martinez, A., additional, Sanchez-Vallejo, G., additional, Molina, D.I., additional, Espinosa, T., additional, Garcia Lozada, H., additional, Gomez-Arbelaez, D., additional, Camacho, P.A., additional, Rumboldt, Z., additional, Lusic, I., additional, Iversen, H.K., additional, Truelsen, T., additional, Back, C., additional, Pedersen, M.M., additional, Peñaherrera, E., additional, Duarte, Y.C., additional, Cevallos, S., additional, Tettamanti, D., additional, Caceres, S., additional, Diener, H.C., additional, Weimar, C., additional, Grau, A., additional, Rother, J., additional, Ritter, M., additional, Back, T., additional, Winter, Y., additional, Pais, P., additional, Xavier, D., additional, Sigamani, A., additional, Mathur, N., additional, Rahul, P., additional, Murali, A., additional, Roy, A.K., additional, Sarma, G.R.K., additional, Matthew, T., additional, Kusumkar, G., additional, Salam, K.A., additional, Karadan, U., additional, Achambat, L., additional, Singh, Y., additional, Pandian, J.D., additional, Verma, R., additional, Atam, V., additional, Agarwal, A., additional, Chidambaram, N., additional, Umarani, R., additional, Ghanta, S., additional, Babu, G.K., additional, Sathyanarayana, G., additional, Sarada, G., additional, Navya Vani, S., additional, Sundararajan, R., additional, Sivakumar, S.S., additional, Wadia, R.S., additional, Bandishti, S., additional, Agarwal, R.R., additional, Mohan, I., additional, Joshi, S., additional, Kulkarni, S., additional, Partha Saradhi, S., additional, Joshi, P., additional, Pandharipande, M., additional, Badnerkar, N., additional, Joshi, R., additional, Kalantri, S.P., additional, Somkumar, S., additional, Chauhan, S., additional, Singh, H., additional, Varma, S., additional, Sidhu, G.K., additional, Singh, R., additional, Bansal, K.L., additional, Bharani, A., additional, Pagare, S., additional, Chouhan, A., additional, Mahanta, B.N., additional, Mahanta, T.G., additional, Rajkonwar, G., additional, Diwan, S.K., additional, Mahajan, S.N., additional, Shaikh, P., additional, Devendrappa, H.R., additional, Agrawal, B.K., additional, Agrawal, A., additional, Khurana, D., additional, Thakur, S., additional, Jain, V., additional, Oveisgharan, S., additional, Bahonar, A., additional, Kelishadi, R., additional, Hossienzadeh, A., additional, Raeisidehkordi, M., additional, Akhavan, H., additional, Walsh, T., additional, Albaker, O., additional, Yusoff, K., additional, Chandramouli, A., additional, Shahadan, S., additional, Ibrahim, Z., additional, Husin, A., additional, Damasceno, A., additional, Lobo, V., additional, Loureiro, S., additional, Govo, V.A., additional, Ogah, O.S., additional, Ogunniyi, A., additional, Akinyemi, R.O., additional, Owolabi, M.O., additional, Sani, M.U., additional, Owolabi, L.F., additional, Iqbal, R., additional, Wasay, M., additional, Raza, A., additional, Malaga, G.G., additional, Lazo-Porras, M., additional, Loza-Herrera, J.D., additional, Acuña-Villaorduña, A., additional, Cardenas-Montero, D., additional, Dans, A., additional, Collantes, E., additional, Morales, D., additional, Roxas, A., additional, Villarruz-Sulit, M.V.C., additional, Czlonkowska, A., additional, Ryglewicz, D., additional, Skowronska, M., additional, Restel, M., additional, Bochynska, A., additional, Chwojnicki, K., additional, Kubach, M., additional, Stowik, A., additional, Wnuk, M., additional, Pogosova, N., additional, Ausheva, A., additional, Karpova, A., additional, Pshenichnikova, V., additional, Vertkin, A., additional, Kursakov, A., additional, Boytsov, S., additional, Al-Hussain, F., additional, DeVilliers, L., additional, Magazi, D., additional, Mayosi, B., additional, Elsayed, A.S.A., additional, Bikhari, A., additional, Sawaraldahab, Z., additional, Hamad, H., additional, ElTaher, M., additional, Abdelhameed, A., additional, Alawad, M., additional, Alkabashi, D., additional, Alsir, H., additional, Rosengren, A., additional, Andreasson, M., additional, Kembro Johansson, J., additional, Cederin, B., additional, Schander, C., additional, Elgasen, A.C., additional, Bertholds, E., additional, Boström Bengtsson, K., additional, Nilanont, Y., additional, Nidhinandana, S., additional, Tatsanavivat, P., additional, Paryoonwiwat, N., additional, Poungvarin, N., additional, Suwanwela, N.C., additional, Tiamkao, S., additional, Tulyapornchote, R., additional, Boonyakarnkul, S., additional, Hanchaiphiboolkul, S., additional, Muengtaweepongsa, S., additional, Watcharasaksilp, K., additional, Sathirapanya, P., additional, Pleumpanupat, P., additional, Oguz, A., additional, Akalin, A.A., additional, Caklili, O.T., additional, Isik, N., additional, Caliskan, B., additional, Sanlisoy, B., additional, Balkuv, E., additional, Tireli, H., additional, Yayla, V., additional, Cabalar, M., additional, Culha, A., additional, Senadim, S., additional, Arpaci, B., additional, Dayan, C., additional, Argun, T., additional, Yilmaz, S., additional, Celiker, S., additional, Kocer, A., additional, Asil, T., additional, Eryigit, G., additional, Mondo, C., additional, Kayima, J., additional, Nakisige, M., additional, Kitoleeko, S., additional, Yusufali, A.M., additional, Zuberi, B.J., additional, Mirza, H.Z., additional, Saleh, A.A., additional, BinAdi, J.M., additional, Hussain, F., additional, Langhorne, P., additional, Muir, K., additional, Walters, M., additional, McAlpine, C., additional, Ghosh, S., additional, Doney, A., additional, Johnston, S., additional, Mudd, P., additional, Black, T., additional, Murphy, P., additional, Jenkinson, D., additional, Kelly, D., additional, Whiting, R., additional, Dutta, D., additional, Shaw, L., additional, Mcfarlane, C., additional, Ronald, E., additional, and McBurnie, K., additional

Published
2018
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28. Pokus dubokog udaha pri obradi hipertoničara u obiteljskoj medicini

Author

Tomičić, Marion, Rumboldt, Mirjana, Carević, Vedran, Petric. Dragomir, and Rumboldt Zvonko

Subjects
hipertenzija bijele kute, efekt bijele kute, KMAT, test dubokog disanja
Abstract

Dio hipertoničara je loše reguliran, što ponekad može biti posljedica efekta bijele kute. Današnji standard za utvrđivanje ovog efekta je usporedba ordinacijskog tlaka s kontinuiranim mjerenjem (KMAT). Cilj istraživanja bio je provjeriti pouzdanost testa dubokog disanja (TDD) u otkrivanju žilnih hiperreaktora u odnosnu na KMAT. U istraživanje je uključeno 214 nereguliranih, liječenih hipertoničara, randomiziranih u interventnu (N=106) i kontrolnu (N=108) skupinu. Ispitanici interventne skupine su u 5. i 15. min. izveli TDD (3-4 ciklusa u 30 s) nakon čega im je ponovljeno mjerenje tlaka. Svim sudionicima tlak je izmjeren u 5. i 15. min. uz KMAT. Kod sniženja sistoličkog tlaka nakon TDD od ≥15% koje je opaženo u 20% ispitanika specifičnost testa bila je 96% (95% CI 79%-100%), a pozitivna prediktivna vrijednost 94% (95% CI 72%-100%). Malo sniženje sistoličkog tlaka (

Published
2016

29. Variations in knowledge, awareness and treatment of hypertension and stroke risk by country income level

Author

O' Donnell, Martin, Hankey, Graeme J, Rangarajan, Sumathy, Chin, Siu Lim, Rao-Melacini, Purnima, Ferguson, John, Xavier, Denis, Lisheng, Liu, Zhang, Hongye, Pais, Prem, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Langhorne, Peter, Rosengren, Annika, Dans, Antonio L, Elsayed, Ahmed, Avezum, Alvaro, Mondo, Charles, Smyth, Andrew, Judge, Conor, Diener, Hans-Christoph, Ryglewicz, Danuta, Czlonkowska, Anna, Pogosova, Nana, Weimar, Christian, Iqbal, Romana, Diaz, Rafael, Yusoff, Khalid, Yusufali, Afzalhussein, Oguz, Aytekin, Wang, Xingyu, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu Samuel, Ogunniyi, Adensola, Iversen, Helle K, Malaga, German, Rumboldt, Zvonko, Oveisgharan, Shahram, AlHussain, Fawaz, Daliwonga, Magazi, Nilanont, Yongchai, and Yusuf, Salim

Abstract

ObjectiveHypertension is the most important modifiable risk factor for stroke globally. We hypothesised that country-income level variations in knowledge, detection and treatment of hypertension may contribute to variations in the association of blood pressure with stroke.MethodsWe undertook a standardised case-control study in 32 countries (INTERSTROKE). Cases were patients with acute first stroke (n=13 462) who were matched by age, sex and site to controls (n=13 483). We evaluated the associations of knowledge, awareness and treatment of hypertension with risk of stroke and its subtypes and whether this varied by gross national income (GNI) of country. We estimated OR and population attributable risk (PAR) associated with treated and untreated hypertension.ResultsHypertension was associated with a graded increase in OR by reducing GNI, ranging from OR 1.92 (99% CI 1.48 to 2.49) to OR 3.27 (2.72 to 3.93) for highest to lowest country-level GNI (p-heterogeneity<0.0001). Untreated hypertension was associated with a higher OR for stroke (OR 5.25; 4.53 to 6.10) than treated hypertension (OR 2.60; 2.32 to 2.91) and younger age of first stroke (61.4 vs 65.4 years; p<0.01). Untreated hypertension was associated with a greater risk of intracerebral haemorrhage (OR 6.95; 5.61 to 8.60) than ischaemic stroke (OR 4.76; 3.99 to 5.68). The PAR associated with untreated hypertension was higher in lower-income regions, PAR 36.3%, 26.3%, 19.8% to 10.4% by increasing GNI of countries. Lifetime non-measurement of blood pressure was associated with stroke (OR 1.80; 1.32 to 2.46).ConclusionsDeficits in knowledge, detection and treatment of hypertension contribute to higher risk of stroke, younger age of onset and larger proportion of intracerebral haemorrhage in lower-income countries.

Published
2021
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31. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE):a case-control study

Author

O'Donnell, Martin J, Chin, Siu Lim, Rangarajan, Sumathy, Xavier, Denis, Liu, Lisheng, Zhang, Hongye, Rao-Melacini, Purnima, Zhang, Xiaohe, Pais, Prem, Agapay, Steven, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Langhorne, Peter, McQueen, Matthew J, Rosengren, Annika, Dehghan, Mahshid, Hankey, Graeme J, Dans, Antonio L, Elsayed, Ahmed, Avezum, Alvaro, Mondo, Charles, Diener, Hans-Christoph, Ryglewicz, Danuta, Czlonkowska, Anna, Pogosova, Nana, Weimar, Christian, Iqbal, Romaina, Diaz, Rafael, Yusoff, Khalid, Yusufali, Afzalhussein, Oguz, Aytekin, Wang, Xingyu, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu S, Ogunniyi, Adesola, Iversen, Helle K, Malaga, German, Rumboldt, Zvonko, Oveisgharan, Shahram, Al Hussain, Fawaz, Magazi, Daliwonga, Nilanont, Yongchai, Ferguson, John, Pare, Guillaume, Yusuf, Salim, O'Donnell, Martin J, Chin, Siu Lim, Rangarajan, Sumathy, Xavier, Denis, Liu, Lisheng, Zhang, Hongye, Rao-Melacini, Purnima, Zhang, Xiaohe, Pais, Prem, Agapay, Steven, Lopez-Jaramillo, Patricio, Damasceno, Albertino, Langhorne, Peter, McQueen, Matthew J, Rosengren, Annika, Dehghan, Mahshid, Hankey, Graeme J, Dans, Antonio L, Elsayed, Ahmed, Avezum, Alvaro, Mondo, Charles, Diener, Hans-Christoph, Ryglewicz, Danuta, Czlonkowska, Anna, Pogosova, Nana, Weimar, Christian, Iqbal, Romaina, Diaz, Rafael, Yusoff, Khalid, Yusufali, Afzalhussein, Oguz, Aytekin, Wang, Xingyu, Penaherrera, Ernesto, Lanas, Fernando, Ogah, Okechukwu S, Ogunniyi, Adesola, Iversen, Helle K, Malaga, German, Rumboldt, Zvonko, Oveisgharan, Shahram, Al Hussain, Fawaz, Magazi, Daliwonga, Nilanont, Yongchai, Ferguson, John, Pare, Guillaume, and Yusuf, Salim

Abstract

BACKGROUND: Stroke is a leading cause of death and disability, especially in low-income and middle-income countries. We sought to quantify the importance of potentially modifiable risk factors for stroke in different regions of the world, and in key populations and primary pathological subtypes of stroke.METHODS: We completed a standardised international case-control study in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. Cases were patients with acute first stroke (within 5 days of symptom onset and 72 h of hospital admission). Controls were hospital-based or community-based individuals with no history of stroke, and were matched with cases, recruited in a 1:1 ratio, for age and sex. All participants completed a clinical assessment and were requested to provide blood and urine samples. Odds ratios (OR) and their population attributable risks (PARs) were calculated, with 99% confidence intervals.FINDINGS: Between Jan 11, 2007, and Aug 8, 2015, 26 919 participants were recruited from 32 countries (13 447 cases [10 388 with ischaemic stroke and 3059 intracerebral haemorrhage] and 13 472 controls). Previous history of hypertension or blood pressure of 140/90 mm Hg or higher (OR 2·98, 99% CI 2·72-3·28; PAR 47·9%, 99% CI 45·1-50·6), regular physical activity (0·60, 0·52-0·70; 35·8%, 27·7-44·7), apolipoprotein (Apo)B/ApoA1 ratio (1·84, 1·65-2·06 for highest vs lowest tertile; 26·8%, 22·2-31·9 for top two tertiles vs lowest tertile), diet (0·60, 0·53-0·67 for highest vs lowest tertile of modified Alternative Healthy Eating Index [mAHEI]; 23·2%, 18·2-28·9 for lowest two tertiles vs highest tertile of mAHEI), waist-to-hip ratio (1·44, 1·27-1·64 for highest vs lowest tertile; 18·6%, 13·3-25·3 for top two tertiles vs lowest), psychosocial factors (2·20, 1·78-2·72; 17·4%, 13·1-22·6), current smoking (1·67, 1·49-1·87; 12·4%, 10·2-14·9), cardiac causes (3·17, 2·68-3·75; 9·1%, 8·0-10·2), alcohol consumption (2·09, 1·64-2·67 for high

Published
2016

32. Trebaju li nam smjernice o smjernicama?

Author

Rumboldt, Zvonko

Subjects
smjernice, sukob interesa
Abstract

Raspravljeni su nedostaci suvremenih medicinskih smjernica s posebnim osvrtom na brojnost smjernica, na njihove različitosti i na nedostatke objavljenih istraživanja, uz prijedloge za podizanje svrhovitosti i kvalitete stručnih preporuka.

Published
2014

33. Pristanak obaviještenog pacijenta u Hrvatskoj

Author

Rumboldt, Zvonko

Subjects
informirani pristanak, ljudska prava
Abstract

Ukazano je na povijest informiranog pristanka u Hrvatskoj te na prvi obrazac takve vrste tiskan u Splitu 1973. godine.

Published
2014

34. Religioznost i medicinska etika

Author

Rumboldt, Zvonko

Subjects
kršćanstvo, vjera, medicinska etika, monoteizam, etičko rasuđivanje
Abstract

U odnosu religioznosti i medicinske etike ističe se kako sekularna medicina mora biti otvorena za raspravu s različitim duhovnim i moralnim stanovištima, kako je to navodio već sv. Augustin. Monoteizam, navlastito katoličanstvo, donosi u ovo područje osobito vrijedne poglede na ljudsko biće i na moralne dvojbe, pružajući transcendentni sadržaj i teorijsku potku za procjenu ljudskog dostojanstva pa poziva agnostike i ateiste zajedno sa svim vjernicima za okrugli stol. Premda je dvojbeno mogu li se vjerski obredi izravno primijeniti u zdravstvene svrhe, većina će se brzo složiti da je osobna autonomija ipak ograničena društvenim obvezama i zaštitom slabijih, a prednost će dati vrlinama poput mudrosti i samilosti pred odlikama poput oštroumnosti i dobrog izgleda.

Published
2014

35. Još o terapijskom entuzijazmu, ovaj put u arterijskoj hipertenziji

Author

Rumboldt, Zvonko

Subjects
arterijska hipertenzija, denervacija bubrežnih arterija
Abstract

Ukazano je na opasnosti brzopletog uključivanja u medicinsku praksu lijekova ili postupaka koji još nisu na primjeren način provjereni, u konkretnom slučaju riječ je o denervaciji bubrežnih arterija.

Published
2014

37. O nastavi medicinske etike na medicinskim fakultetima

Author

Rumboldt, Zvonko

Subjects
medicinska etika, obrazovni standardi, dodiplomska nastava
Abstract

U ovom se osvrtu razmatraju problemi nastave medicinske etike na hrvatskim medicinskim fakultetima. Ukazuje se na kasno uspostavljanje tog kurikuluma (prvi početci tek sredinom osamdesetih godina prošlog stoljeća), na kampanjsko organiziranje nastave umjesto “vertikaliziranja” (provlačenje kroz cijeli dodiplomski studij), na pogreške u etičkom prosuđivanju, kako studenata medicine, tako i liječnika, te na najčešća moralna pitanja koja zaokupljaju dodiplomce, a razlikuju se od onih koja navješćuju sredstva javnog priopćavanja.

Published
2013

38. Zašto liječeni hipertoničari ne poštuju naše savjete? Doprinos inicijativi 'CRASH'

Author

Pavličević, Ivančica, Rumboldt, Mirjana, Rumboldt, Zvonko, and Glavaški, Milan

Subjects
hipertenzija, natriurija, suradnja bolesnika
Abstract

Unos kuhinjske soli pridonosi porastu arterijskog tlaka i prevalenciji hipertenzije. U tromjesečnom istraživanju 110 liječenih hipertoničara utvrđene su trajno povišene vrijednosti natriurije (187, 9+-8, 5 mmol/dan, raspon 103-297). Liječeni hipertoničari unatoč suprotnim tvrdnjama unose pretjerane količine solči, što je uz nesuradljivost vjerojatno temeljni razlog nezadovoljavajuće kontrole hipertenzije.

Published
2012

39. Prednosti paracetamola u liječenju osoba s hipertonijom i artrozom

Author

Pavličević, Ivančica, Kuzmanić, Marion, Rumboldt, Mirjana, and Rumboldt, Zvonko

Subjects
antireumatici, paracetamol, artroza, arterijska hipertenzija, kvaliteta života
Abstract

Cilj ispitivanja bio je odrediti mjesto paracetamola u liječenju hipertoničara s artrozom, i utvrditi najpovoljniju kombinaciju antihipertenziva i antireumatika za ove pacijente. U prospektivno ispitivanje provedeno u ordinaciji obiteljske medicine uključeno je 110 liječenih hipertoničara starijih od 55 godina ; 50 u kontrolnu i 60 u interventnu skupinu (uzimali i nesteroidne antireumatike zbog osteoartritisa). U tromjesečnom periodu uspoređivana su dva antihipertenziva, lizinopril/hidroklorotiazid i amlodipin s dva nesteroidna anrireumatika (NSAR): ibuprofenom i piroksikamom, te s paracetamolom. Nakon svakog jednomjesečnog razdoblja mjeren je arterijski tlak, učinak ispitivanih lijekova na intenzitet bola i kvalitetu života ispitanika. Ibuprofen i piroksikam pokazali su značajno prohipertenzivno djelovanje, a u paracetamol periodu ono je bilo neznatno i klinički zanemarivo. U podskupini amlodipin ± ibuprofen, prosječni rezultat na ljestvici boli statistički se značajno smanjivao tijekom pokusa. U lizinopril/hidroklorotiazid ± piroksikam podgrupi prosječna procijenjena kvaliteta života značajno se mijenjala. Paracetamol je pokazao podjednaku analgetsku djelotvornost kao ibuprofen, a tek nešto slabiju od piroksikama. Kvaliteta života je u NSAR fazama bila lošija nego tijekom uzimanja paracetamola. Samo paracetamol nije utjecao na antihipertenzivno djelovanje lizinopril/hidroklorotiazid kombinacije. U hipertoničara s artrozom paracetamol je analgetik prvog izbora, dok je antihipertenziv izbora jedan antagonist kalcija, navlastito amlodipin.

Published
2011

40. Parental history and myocardial risk across the world : the INTERHEART study

Author

Chow, Clara, Islam, Shofiqul, Bautista, Leonelo, Rumboldt, Zvonko, Yusufali, Afzal, Xie, Changcun, Anand, Sonia, Engert, James, Rangarajan, Sumathy, and Yusuf, Salim

Subjects
myocardial infarction, risk factors, parental history
Abstract

From the INTERHEART case-control study data it was shown that parental history (PH) is significantly associated with the risk of MI, independent of the 9 established risk factors, consistent across all world regions, income, age, and sex groups.

Published
2011

44. Predictive Impact of Coronary Risk Factors in Southern Croatia : Case Control Study

Author

Carević, Vedran, Kuzmanić, Marion, Rumboldt, Mirjana, and Rumboldt, Zvonko

Subjects
risk factors, myocardial infarction, Croatia, INTERHEART, family medicine
Abstract

Aim To compare the impact of coronary risk factors on the incidence of acute myocardial infarction (MI) between Croatia, Central and Eastern Europe, and the rest of the world. Methods As a part of the large international INTERHEART case-control study of acute MI in 52 countries (15, 152 cases and 14, 820 controls) we have investigated the relationship between several known risk factors (smoking, history of hypertension or diabetes, waist/hip ratio, dietary patterns, physical activity, consumption of alcohol, blood apolipoproteins, and psychosocial factors) and MI among patients without previously known coronary heart disease in Southern Croatia. Results The main identified MI risk factors in Southern Croatia were heavy smoking (≥ 20 cig/day ; OR 3.86 ; 95% CI 2.31-6.46), diabetes mellitus (OR 2.83 ; 95% CI 1.58-5.23), abnormal ratio of B-100 and A-1 apolipoproteins (OR 2.23 ; 95% CI 1.28-3.89), elevated waist to hip ratio (OR 1.96 ; 95% CI 1.21-3.18), and arterial hypertension (OR 1.68 ; 95% CI 1.15-2.45). Protective was moderate alcohol consumption (OR 0.63 ; 95% CI 0.40-0.99). Conclusion The prevalence of major MI risk factors in Croatia is similar to that in the surrounding countries and in the world, accounting for over 90% of the population attributable risk. However, physical activity, dietary and psychosocial factors are seemingly less important in this country, while moderate alcohol consumption is more protective than regionally or globally.

Published
2010

47. Interaction between antihypertensives and NSAIDs in primary care: a controlled trial

Author

Pavličević, Ivančica, Kuzmanić, Marion, Rumboldt, Mirjana, and Rumboldt, Zvonko

Subjects
Antihypertensive drugs, family practice, interaction, non-steroidal anti-inflammatory drugs
Abstract

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) may increase blood pressure (BP) and blunt the effects of many antihypertensives. It seems that NSAIDs and the antihypertensive drugs differ in their propensity to such an interaction. OBJECTIVES: To determine the extent of the interaction between two antihypertensives and three NSAIDs. METHODS: A prospective clinical trial in a family practice included 88 treated hypertensives aged over 55 years ; 39 controls and 49, also taking NSAIDs for osteoarthritis. During this 3-month study, two antihypertensives, lisinopril/hydrochlorothiazide and amlodipine, were compared with three NSAIDs: ibuprofen, acetaminophen, and piroxicam. BP was measured with standard mercury sphygmomanometer and with an automatic device, in standing, sitting, and supine position. RESULTS: The average starting blood pressure in the study group was 149.3A+/-9.8/88.6A+/-6.8 mm Hg. In the lisinopril/hydrochlorothiazide subgroup, both ibuprofen and piroxicam elevated systolic BP by 7.7-9.9% (p0.290) only, and there were no significant shifts in the follow-up periods. Analogous deviations were observed with both measurement devices, in all the examinee's positions. In the control group, BP did not change appreciably. CONCLUSIONS: Piroxicam and ibuprofen markedly blunt the effects of antihypertensive drugs while acetaminophen is almost inert. Lisinopril/hydrochlorothiazide combination is much more affected by this interaction than amlodipine

Published
2008

48. Clinical significance of the interaction between antihypertensive and antirheumatic drugs

Author

Pavličević, Ivančica, Rumboldt, Mirjana, Kuzmanić, Marion, and Rumboldt, Zvonko

Subjects
musculoskeletal diseases, antihypertensive drugs, family practice, interaction, non-steroidal anti-inflammatory drugs, skin and connective tissue diseases, digestive system, digestive system diseases
Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) may increase blood pressure (BP) and blunt the effects of many antihypertensives. It seems that NSAIDs and the antihypertensive drugs differ in their propensity to such an interaction.

Published
2007

49. Clinical significance of interaction between antihypertensive and antirheumatic drugs

Author

Pavličević, Ivančica, Rumboldt, Mirjana, Kuzmanić, Marion, and Rumboldt, Zvonko

Subjects
musculoskeletal diseases, antihypertensive drugs, family practice, interaction, non-steroidal anti-inflammatory drugs, skin and connective tissue diseases, digestive system, digestive system diseases
Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) may increase blood pressure (BP) and blunt the effects of many antihypertensives. It seems that NSAIDs and the antihypertensive drugs differ in their propensity to such an interaction.

Published
2007

50. Koronarni čimbenici rizika u Hravtskoj i u svijetu: rezultati INTERHEART studije

Author

Carević, Vedran, Rumboldt, Mirjana, and Rumboldt, Zvonko

Subjects
čimbenik rizika, akutni infarkt miokarda, kardiovaskularne bolesti, južna Hrvatska
Abstract

Rezultati INTERHEART studije parova, provedene u 52 zemlje, poazuju da se globalno i regionalno većina infarkta miokarda (IM) može predvidjeti s devet jednostavno mjerljivih čimbenika rizika. Cilj ovog istraživanja je odrediti vezu pojedinih čimbenika rizika s pojavnosti IM u hrvatskoj podskupini INTERHEART studije. Ukupno su analizirane 263 osobe s akutnim IM i 264 kontrolne osobe. Najveća razlika frekvencija između ovih skupina zabilježena je za sadašnje pušenje (p

Published
2007

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