Apolipoprotein B levels and related factors in a rural white South African community - the CORIS study

No Abstract

The intervention effects of a community-based hypertension control programme in two rural South African towns: the CORIS study

The objective of the hypertension programme of the Coronary Risk Factor Study (CORlS) was to evaluate the effectiveness of the first 4 years of community-based intervention. The hypertension intervention model comprised a blood pressure station where the whole population was screened for hypertension, non-drug management was provided and hypertensives were monitored after referral to general practitioners for drug therapy. Two levels of intervention were maintained: in the high-intensity intervention town (N =2 278) hypertensives were actively followed up, and in the low-intensity intervention town (N =2 620) no active follow-up procedure existed. A third town acted as control (N= 2 290).In the cohort which was hypertensive at baseline, the net decreases in systolic blood pressure (mean ± SE) after correction for changes in the control town were 0,5 ± 2,2 mmHg (men) and 4,5 ± 2,2 mmHg (women) in the low-intensity intervention town, and 5,6 ± 2,3 mmHg (men) and 7,5 ± 2,2 mmHg (women) in the high-intensity intervention town. The net decrease in diastolic blood pressure was 3,4 ± 1,2 mmHg (men) and 4,4 ± 1,1 mmHg (women) in the low-intensity intervention town, and 6,1 ± 1,2 mmHg (men) and 5,9 ± 1,1 mmHg (women) in the high-intensity intervention town. These reductions were statistically significant with one exception. The changes in the total population in the 3 communities after 4 years of intervention were similar to those found in the hypertensive cohort.Decreases in mean blood pressure were accompanied by marked increases in the proportion of hypertensives on drug treatment and the proportion under control (< 160/95 mmHg).Distribution curves of blood pressure indicated a large effect in the subgroup above the cut-off point for hypertension; however, the entire curve also shifted to the left, indicating, in addition, benefit to the whole population. An increase in the appropriate knowledge and action for hypertension control was observed in the intervention towns compared with the control town.The CORlS community-based hypertension control programme successfully reduced the risk for cardiovascular diseases in the intervention towns compared with the control town

Contributions of the Women's Health Initiative to Cardiovascular Research: JACC State-of-the-Art Review

The WHI (Women's Health Initiative) enrolled 161,808 racially and ethnically diverse postmenopausal women, ages 50-79 years, from 1993 to 1998 at 40 clinical centers across the United States. In its clinical trial component, WHI evaluated 3 randomized interventions (menopausal hormone therapy; diet modification; and calcium/vitamin D supplementation) for the primary prevention of major chronic diseases, including cardiovascular disease, in older women. In the WHI observational study, numerous clinical, behavioral, and social factors have been evaluated as predictors of incident chronic disease and mortality. Although the original interventions have been completed, the WHI data and biomarker resources continue to be leveraged and expanded through ancillary studies to yield novel insights regarding cardiovascular disease prevention and healthy aging in women

Genetic insights into biological mechanisms governing human ovarian ageing

Reproductive longevity is essential for fertility and influences healthy ageing in women, but insights into its underlying biological mechanisms and treatments to preserve it are limited. Here we identify 290 genetic determinants of ovarian ageing, assessed using normal variation in age at natural menopause in approximately 200,000 women of European ancestry. These common alleles were associated with clinical extremes of age at natural menopause; women in the top 1% of genetic susceptibility have an equivalent risk of premature ovarian insufficiency to those carrying monogenic FMR1 premutations. The identified loci implicate a broad range of DNA damage response (DDR) processes and include loss-of-function variants in key DDR-associated genes. Integration with experimental models demonstrates that these DDR processes act across the lifecourse to shape the ovarian reserve and its rate of depletion. Furthermore, we demonstrate that experimental manipulation of DDR pathways highlighted by human genetics increases fertility and extends reproductive life in mice. Causal inference analyses using the identified genetic variants indicate that extending reproductive life in women improves bone health and reduces risk of type 2 diabetes, but increases the risk of hormone-sensitive cancers. These findings provide insight into the mechanisms that govern ovarian ageing, when they act, and how they might be targeted by therapeutic approaches to extend fertility and prevent disease

Changes in smoking during a community-based cardiovascular disease intervention programme - The Coronary Risk Factor Study

A prospective anti-smoking clinical trial was conducted as part of a coronary risk factor Intervention study in three rural South African communities in the south western Cape over a period of 4 years. The aim of the part of the study was to reduce smoklng rates in two of the communities through application of high- and low-intensity intervention. The effect was evaluated by examining the net change in smoking habits, which was defined as the residual change in the intervention areas after allowing for change in the reference area. This paper presents the analyses of the estimated effect of the programme on the cohort aged 15 - 64 years at baseline who participated in the two surveys (4087 subjects). The intervention programme among men in the high-intensity intervention area resulted in a reduction of 8,4% in smoking rates and 13.0% in the amount smoked per day. Among women in this area there was a reduction of 30,6% in smoking rates and 20,5% in amount smoked. Smoking and the amount smoked per day also  decreased in the low-intensity intervention area, but less so than in the high-lntensity intervention area. Smoking quit rates were strongly " associated with initial smoking level, with light smokers being significanty more successful quitters than heavy smokers. The study has proved that a community based intervention programme can effectively reduce smoking