Background: Opportunistic case-finding is recommended as a means to identify the one-third of people with undiagnosed AF.Recent studies have demonstrated the benefit of engaging community pharmacists to 'screen' for these patients.Know Your Pulse is a proprietary initiative of the UK's leading heart rhythm charity that facilitates manual pulse rhythm checks for the general public and connects those found to have an irregular rhythm with their primary care practitioner.Global AF Awareness Week is run on an annual basis during which a 'Know Your Pulse campaign' is held in multiple settings where the general public can receive a free manual pulse rhythm check.Settings have included GP surgeries, Hospital reception areas, Community Pharmacy and public places with a high footfall of the general public, such as railway stations and shopping malls.In 2016, this initiative involved partnership between patient advocacy and an international pharmacists group.AF Aware Week took place 21-27 November 2016.Aims: Raise awareness of AF and importance of pulse rhythm checks to general public across multiple countries Assess feasibility of implementing pulse checks in community pharmacy Methods: Five countries of an international pharmacy taskforce were engaged, with Community Pharmacy partners identified to deliver the campaign.Educational and campaign materials were provided, in local language, by the Heart Rhythm Charity, including a training tool to teach pharmacists how to run pulse checks, a template for recording results and a patient referral process.Results: 1699 pulse checks were undertaken in 56 pharmacies across 5 countries.77 people had an irregular heart rhythm detected and were referred to their clinical practitioner.Outcomes: see table

Background: The relative and absolute risks of stroke and heart failure attributable to atrial fibrillation (AF) have not been sufficiently examined.Methods: A prospective study of 23,731 community-dwelling Japanese individuals was conducted. Participantswere divided into two groups based on the presence or absence of prevalent AF (n = 338 and n = 23,393, respectively). Excess events (EE) due to AF and relative risks (RRs) determined using the non-AF group as the reference for incident stroke and heart failurewere estimated using Poisson regression stratified by age groups (middle-aged: 40-69 years old; elderly: 70 years of age or older) after adjustment for sex and age.Results: There were 611 cases of stroke and 98 cases of heart failure during the observation period 131,088 person-years). AF contributed to a higher risk of stroke both in middle-aged individuals (EE 10.4 per 1000 person-years; RR4.88; 95% confidenceinterval [CI], 2.88-8.29) andelderlyindividuals (EE18.3per1000 personyears; RR 3.05; 95% CI, 2.05-4.54). AFalso contributed to a higher risk of heart failure in middle-aged individuals (EE 3.7 per 1000 person-years; RR 8.18; 95% CI, 2.41-27.8) and elderly individuals (EE 15.4 per 1000 personyears; RR 7.82; 95% CI, 4.11-14.9). Results obtained from multivariate-adjusted analysis were similar (stroke: EE 8.9 per 1000 person-years; RR 4.40; 95% CI, 2.57-7.55 inmiddle-aged and EE 17.4 per 1000 person-years; RR 2.97; 95% CI, 1.99-4.43 in elderly individuals; heart failure: EE 3.1 per 1000 person-years; RR 7.22; 95% CI, 2.06e25.3 in middle-aged and EE 14.1 per 1000 person-years; RR 7.41; 95% CI, 3.86-14.2 in elderly individuals).Conclusions: AF increased the risk of stroke by the same magnitude as that reported previously in Western countries. AF increased the RR of heart failure more than that in Western populations. (C) 2017 The Authors. Publishing services by Elsevier B.V. on behalf of The Japan Epidemiological Association.

Background: Smoking is an important risk factor for cardiovascular disease, however, to what extent smoking increases excessive deaths and strokes in a general population has not been sufficiently examined especially in women. Methods: A total of 10,382 female and male participants aged 65 years or older were divided into two groups according to smoking status (current smoker; never smoker). Past smokers were excluded. Main outcomes were all-cause death and incident stroke. Age-adjusted mortality and incidence rates were estimated in the groups using Poisson’s regression analysis. Age-adjusted rate ratios (RR) and excess events (EE per 1000 person-years) attributable to smoking were determined using the rate in never smokers as a reference. Results: There were 1410 deaths and 735 strokes during the 9.0-year observation period (90,099 person-years). Smoking contributed to a 2.3-fold higher risk of death in women and 1.8-fold higher risk in men. It contributed to 12 excess deaths per 1000 person-years in both men and women. The rate ratio and excessive events of stroke were likely to be higher in women than those in men (RR: 2.6 vs. 1.6; EE: 9.3 vs 5.0, see table). Conclusion: Smoking significantly increases risks of death and stroke not only in men but also in women. Absolute risk difference of stroke attributable to smoking is likely to be larger in women than in men.

chronic heart failure, atrial fibrillation) both in PRP (dyslipidaemia: beta estimate, β:1.1, [95% CI: 0.52; 1.6], p=0.00014; CVD: β:1.2, [0.43; 2.0], p=0.0023) and PFP (dyslipidaemia: β:0.93, [0.48; 1.4], p<0.0001; CVD: β:1.3, [0.62; 1.9], p=0.00011). Furthermore, longer lag time was related with obesity in PRP (β:0.65, [0.039; 1.2], p=0.037) and diabetes in PFP (β:1.5, [0.82; 2.2], p<0.0001). Obesity was further positively associated with ETP (β:103 [19; 187], p=0.017) in PRP only. Antithrombotic agents, including both antiplatelet and anticoagulants, were strongly (p<0.0001) and positively associated to lag time and negatively with ETP and peak height in both PRP and PFP samples. Conclusion: Our findings support that TG, particularly in PRP, relates to traditional cardiovascular risk factors in a sample from a population-based study. Longer lag time was associated, both in PRP and PFP, to dyslipidaemia and CVD, in PRP with obesity and in PFP with diabetes. ETP, representing the total amount of thrombin that a plasma sample can generate, showed an association with obesity, independently of age and sex in PRP only. Further investigations are necessary to understand if TG in presence and/or absence of platelets improves the risk stratification of individuals for CVD. Acknowledgement/Funding: Stiftung Rheinland-Pfalz für Innovation, Wissen schafft Zukunft, contract with Boehringer Ingelheim and PHILIPS Medical Systems

This study compared the combination of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) vs. eGFR and urine protein reagent strip testing to determine chronic kidney disease (CKD) prevalence, and each method’s ability to predict the risk for cardiovascular events in the general Japanese population.

Background: While it is assumed that dialysis patients in Japan have a higher prevalence of atrial fibrillation (AF) than the general population, the magnitude of this difference is not known. Methods: Standardized prevalence ratios (SPRs) for AF in dialysis patients (n = 1510) were calculated compared to data from the general population (n = 26 454) living in the same area. Results: The prevalences of AF were 3.8% and 1.6% in dialysis patients and the general population, respectively. In male subjects, these respective values were 4.9% and 3.3%, and in female subjects they were 1.6% and 0.6%. The SPRs for AF were 2.53 (95% confidence interval [CI], 1.88–3.19) in all dialysis patients, 1.80 (95% CI, 1.30–2.29) in male dialysis patients, and 2.13 (95% CI, 0.66–3.61) in female dialysis patients. Conclusions: The prevalence of AF in dialysis patients was twice that in the population-based controls. Since AF strongly contributes to a higher risk of cardiovascular mortality and morbidity in the general population, further longitudinal studies should be conducted regarding the risk of several outcomes attributable to AF among Japanese dialysis patients.

Background: The relative and absolute risks of outcomes other than all-cause death (ACD) attributable to atrial fibrillation (AF) stratified age have not been sufficiently investigated.Methods: A prospective study of 23,634 community dwellers aged 40 years or older without organic cardiovascular disease (AF = 335, non-AF = 23,299) was conducted. Multivariate-adjusted rates, rate ratios (RRs) and excess deaths (EDs) for ACD, cardiovascular death (CVD) and non-cardiovascular death (non-CVD), and sex-and age-adjusted RR and ED in middle-aged (40 to 69) and elderly (70 years or older) for ACD, CVD, non-CVD, sudden cardiac death (SCD), stroke-related death (Str-D), neoplasm-related death (NPD), and infection-related death (IFD) attributable to AF were estimated using Poisson regression.Results: Multivariate-adjusted analysis revealed that AF significantly increased the risk of ACD (RR [95% confidence interval]: 1.70 [1.23-2.95]) and CVD (3.86 [2.38-6.27]), but not non-CVD. Age-stratified analysis revealed that AF increased the risk of Str-D in middle-aged (14.5 [4.77-44.3]) and elderly individuals (4.92 [1.91-12.7]), SCD in elderly individuals (3.21 [1.37-7.51]), and might increase the risk of IFD in elderly individuals (2.02 [0.80-4.65], p = 0.098). The RR of CVD was higher in middle-aged versus elderly individuals (RRs, 6.19 vs. 3.57) but the absolute risk difference was larger in elderly individuals (EDs: 7.6 vs. 3.0 per 1000 person-years).Conclusions: Larger absolute risk differences for ACD and CVD attributable to AF among elderly people indicate that the absolute burden of AF is higher in elderly versus middle-aged people despite the relatively small RR. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

BACKGROUND AND METHODS:There have been no investigations concerning the association of each blood pressure (BP) reading with future cardiovascular disease (CVD) when multiple measurements are taken on one occasion. This community-based, prospective cohort study (n = 23 344, mean age = 62.4 years) investigated the associations between the BP obtained from the first and second of two consecutive measurements on one occasion and future cardiovascular events in men and women. RESULTS:During the mean follow-up of 5.5 years, 624 CVD events were identified. On the Cox regression analysis of age- and BP-adjusted models, the increased CVD risk of a hypertensive first measurement (systolic BP ≥ 140 mmHg) was independent from the second measurement in men. Even in subjects without a hypertensive second measurement, the CVD risk of the hypertensive first measurement was increased in men. In women, despite a hypertensive first measurement, subjects with a systolic BP < 130 mmHg on the second measurement showed a significantly reduced risk for CVD compared with subjects who retained a hypertensive level during the two measurements. CONCLUSIONS:An elevated BP on the first measurement should not be disregarded for CVD risk estimation in men, even if the second BP moves to the normal range. In women, elevated BP on the first measurement may have relatively less meaning for CVD prediction if the second BP shifts to a normal range.

Background: Although a higher heart rate is known to be a risk factor for cardiovascular disease (CVD) events, there have been no reports concerning bradycardia. Whether lower and higher resting pulse rates (RPRs) are associated with cardiovascular risk was investigated in subjects from a community-based, prospective cohort study.Methods: After subjects with atrial fibrillation, subjects with a history of CVD, and subjects receiving antihypertensive treatment were excluded, 17,766 subjects (5958 men), aged 40-79 (mean 61.5) years, were analyzed. The RPR at baseline was categorized into four groups (RPR< 60, 60-69.5, 70-79.5, >= 80 beats per minute (bpm)) using the average value of two consecutive measurements. The endpoint was set as the composite outcome of myocardial infarction, stroke, or sudden death.Results: During a mean follow up of 5.6 years, there were 213 events in men and 186 events in women. In Cox regression models, increased risks of CVD were found in the men group with RPR<60 bpm, as well as the group with RPR >= 80 bpm, compared with the reference group with RPR 60-69.5 bpm (hazard ratio [HR] = 1.73, p = 0.005 and HR = 2.01, p < 0.001). These increased risks were found even when adjusted for age and other CVD risk factors (HR = 1.55, p = 0.026 with RPR<60 bpm and HR = 1.72, p = 0.009 with RPR >= 80 bpm). In women, there were no significant associations between RPR and CVD risk.Conclusion: Bradycardia, as well as a higher pulse rate, may be an independent risk factor for future cardiovascular events in apparently healthy men. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

The authors regret that instead of sex- and age-adjusted prevalences for each risk factor, unadjusted prevalences were shown in Table 1. The authors would like to apologise for any inconvenience caused. The authors regret that instead of sex- and age-adjusted prevalences for each risk factor, unadjusted prevalences were shown in Table 1. The authors would like to apologise for any inconvenience caused. High risks of all-cause and cardiovascular deaths in apparently healthy middle-aged people with preserved glomerular filtration rate and albuminuria: A prospective cohort studyInternational Journal of CardiologyVol. 170Issue 2PreviewThe reason why coexistence of preserved estimated glomerular filtration rate (eGFR) and albuminuria contributes to a high risk of death and which cause of death increases all-cause mortality have not been elucidated. Full-Text PDF

BackgroundThe reason why coexistence of preserved estimated glomerular filtration rate (eGFR) and albuminuria contributes to a high risk of death and which cause of death increases all-cause mortality have not been elucidated.MethodsA total of 16,759 participants aged 40 to 69years with normal or mildly reduced eGFR (45–119ml/min/1.73m2) were enrolled and divided into six groups (group 1, eGFR: 90–119 without albuminuria; group 2, eGFR: 90–119 with albuminuria; group 3, eGFR: 60–89 without albuminuria (reference); group 4, eGFR: 60–89 with albuminuria; group 5, eGFR: 45–59 without albuminuria; group 6, eGFR: 45–59 with albuminuria) based on GFR estimated by using the CKD-EPI study equation modified by a Japanese coefficient and albuminuria (urine albumin–creatinine ratio ≥30mg/g). Outcomes included all-cause death (ACD), cardiovascular death (CVD) and neoplasm-related death (NPD). Multivariable-adjusted mortality rate ratios (RR) and their 95% confidence intervals (CIs) in the groups were estimated by Poisson's regression analysis.ResultsThe highest risk of ACD (RR (95% CIs): 3.95 (2.08–7.52)), CVD (7.15 (2.25–22.7)) and NPB (3.25 (1.26–8.38)) was observed in group 2. Subjects in group 2 were relatively young and had the highest levels of body mass index, blood pressure and HbA1c and the highest prevalence of diabetes and metabolic syndrome.ConclusionCoexistence of preserved eGFR and albuminuria increases risks for ACD, CVD and NPD. Relatively young metabolic persons having both preserved eGFR and albuminuria should be considered as a very high-risk population.

OBJECTIVES: Atrial fibrillation (AF) is a significant public health issue due to its high prevalence in the general population, and is associated with an increased risk of cardiovascular (CV) events including systemic thrombo-embolism, heart failure, and coronary artery disease. The relationship between plasma B-type natriuretic peptide (BNP) and CV risk in real world AF subjects remains unknown. METHODS: The subject of the study (n = 228; mean age = 69 years) was unselected individuals with AF in a community-based population (n = 15,394; AF prevalence rate = 1.5%). The CV event free rate within each BNP tertile was estimated, and Cox regression analysis was performed to examine the relative risk of the onset of CV events among the tertiles. The prognostic ability of BNP was compared to an established risk score for embolic events (CHADS2 score). In addition, to determine the usefulness of BNP as a predictor in addition to CHADS2 score, we calculated Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) indices. RESULTS: During the follow-up period 58 subjects experienced CV events (52 per 1,000 person-years). The event-free ratio was significantly lower in the highest tertile (p < 0.02). After adjustment for established CV risk factors, the hazard ratio (HR) of the highest tertile was significantly higher than that of the lowest tertile (HR = 2.38; p < 0.02). The predictive abilities of plasma BNP in terms of sensitivity and specificity for general CV events were comparable to those of CHADS2 score. Adding BNP to the CHADS2 score only model improved the NRI (0.319; p < 0.05) and the IDI (0.046; p < 0.05). CONCLUSION: Plasma BNP is a valuable biomarker both singly or in combination with an established scoring system for assessing general CV risk including stroke, heart failure and acute coronary syndrome in real-world AF subjects.

BACKGROUND:The risk of cardiovascular diseases is lower among moderate alcohol drinkers than among both nondrinkers and heavy drinkers. However, factors that can account for the U-shaped or J-shaped relationship between daily alcohol consumption and incident cardiovascular diseases remain obscure.PURPOSE:The present cross-sectional study investigated the relationship between alcohol consumption and serum adiponectin levels.METHOD:Total adiponectin was measured in 527 males participating in health check-up programs (age range 40-86 years, mean 60.5 years). Based on questionnaire responses, alcohol intake was categorized into three groups: none or occasional (A1); <50 g/day and ≥3 days/week (A2); and ≥50 g/day and ≥3 days/week (A3).RESULTS:No significant differences in adiponectin levels were observed among the three alcohol consumption groups of subjects without the metabolic syndrome (MetS). In subjects with the MetS, the adiponectin level was significantly higher in the A2 (moderate drinker) group than in both the A1 and A3 groups. MetS subjects in group A2 had higher HDL-C levels than those in A1, but levels in group A3 were not significantly different from those in group A2.CONCLUSION:An increased adiponectin level in moderate alcohol drinkers who have MetS may contribute to the U-shaped relationship between alcohol consumption and risk of cardiovascular events, in addition to the involvement of HDL-C.