Twelve-year Blood Pressure Dynamics in Adults in Ljubljana Area, Slovenia: Contribution of WHO Countrywide Integrated Noncommunicable Diseases Intervention Program

Aim: To determine 12-year dynamics of the average value of arterial blood pressure and arterial hypertension prevalence among adult residents of Ljubljana area in Slovenia, and to assess the probable contribution of World Health Organization’s Countrywide Integrated Noncommunicable Diseases Intervention Program (CINDI) to observed dynamics. Methods: A total of 4409 adults aged 25-64 participated in three successive cross-sectional surveys performed in Ljubljana area from late autumn to early spring 1990/1991, 1996/1997, and 2002/2003 (n1990/91=1692, n1996/97=1342, n1990/91=1375). Standardized measurements of systolic and diastolic blood pressure were performed. The subjects were considered to have hypertension if systolic/diastolic blood pressure was ≥140/90 mm Hg. The dynamics of average values of systolic and diastolic blood pressures and arterial hypertension was statistically assessed with multiple linear or logistic regression. Results: After the adjustment for the effects of sex, age, and education, the average value of systolic blood pressure remained almost the same between 1990/1991 and 1996/1997 (130.6±20.3 and 130.6±19.6 mm Hg, respectively; P=0.728), whereas it significantly decreased to 127.6±17.8 mm Hg in 2002/2003 (P<0.001). The average value of diastolic blood pressure was not significantly different in 1990/1991, 1996/1997, and 2002/2003 (83.4±11.6 mm Hg, 84.1±11.4 mm Hg, and 83.5±11.2 mm Hg, respectively; P=0.059). The odds ratio for arterial hypertension increased significantly between 1990/1991 and 1996/1997 (P=0.001), but decreased between 1996/1997 and 2002/2003 (P=0.135). Conclusions: The values of blood pressure remained unchanged or increased during the first half of 12-year period, but decreased during the second half. The favorable decrease in average blood pressure could be attributed to systematic intervention promoted by CINDI program activities in Slovenia, which started in the late 1990s

The WHO Countrywide Integrated Non-communicable Diseases (CINDI) programme in Slovenia

Many different community based intervention projects/programmes were designed and/or implemented since the early 1970s to combat chronic non-communicable diseases, many of them being international. Countrywide Integrated Non-communicable Diseases Intervention programme (CINDI) of the World Health Organization (WHO), Regional Office for Europe, which started to spread its ideas in the 1980s, is one of them. Slovenia as a state officially joined international CINDI programme at the beginning of the 1990s, when its activities were limited to Ljubljana demonstrational area. First few years were used as an introductory period of the programme, while more systematically organized activities begun in the late 1990s. The paper presents the historical development of the CINDI programme in Slovenia, and the role of CINDI Slovenia Preventive Unit in it

Public Health Intervention Programmes and Their Evaluation

A public health intervention is an intervention, which is applied to many, most, or all members of a community, with the aim of delivering a net benefit to the community or population as well as benefits to individuals. Every intervention programme has its cycle. One of most important phases in this cycle is the evaluation phase. One of the most important physiological risk factors for noncommunicable diseases is arterial hypertension. In Slovenia high prevalence of severe arterial hypertension was registered at the beginning of the 1990s what classified Slovenia among countries with the highest prevalence of severe arterial hypertension. Consecutively it was realized that an interventional and systematic programme to deal with the problem was strongly needed. Slovenia as a state officially joined international CINDI programme at the beginning of the 1990s, when its activities were limited to Ljubljana demonstrational area. First few years were used as an introductory period of the programme, while more systematically organized activities begun in the late 1990s. The paper presents the different types of evaluation and as an illustration of evaluation in practice the case of evaluationg of CINDI programme activities in Slovenia to reduce arterial hypertension prevalence effectiveness

Airborne spread of SARS-CoV-2 – a commentary by the Division of Internal Medicine, University Medical Centre Ljubljana

Slovenia is one of the countries that have been most affected by the autumn/winter 2020/21 wave of the COVID-19 pandemic regarding the incidence and excess mortality among the general population as well as regarding the incidence among health care workers and nursing personnel. The World Health Organization has underestimated the importance of the airborne spread of SARS-CoV-2 and the recommended safety measures have not been entirely sufficient. When people breathe, talk, sing, cough, or sneeze, they emit respiratory droplets of various sizes, most of which are always smaller than 1 μm. Respiratory droplets smaller than 5 μm stay airborne in indoor spaces for a long time and travel over distances much longer than 2 m. Thus, an infected person in an indoor environment creates an infectious aerosol that may infect other people without close interpersonal contact. This short review presents the mathematical model and internet application by authors from the Massachusetts Institute of Technology for calculating the safe time before probable airborne infection occurs in indoor spaces. The importance of ventilation, air filtration, air humidity, and air disinfection by ultraviolet light is briefly discussed. The principles of preventing the airborne spread of SARS-CoV-2 are summarized

Public Health Intervention Programmes and Their Evaluation

A public health intervention is an intervention, which is applied to many, most, or all members of a community, with the aim of delivering a net benefit to the community or population as well as benefits to individuals. Every intervention programme has its cycle. One of most important phases in this cycle is the evaluation phase. One of the most important physiological risk factors for noncommunicable diseases is arterial hypertension. In Slovenia high prevalence of severe arterial hypertension was registered at the beginning of the 1990s what classified Slovenia among countries with the highest prevalence of severe arterial hypertension. Consecutively it was realized that an interventional and systematic programme to deal with the problem was strongly needed. Slovenia as a state officially joined international CINDI programme at the beginning of the 1990s, when its activities were limited to Ljubljana demonstrational area. First few years were used as an introductory period of the programme, while more systematically organized activities begun in the late 1990s. The paper presents the different types of evaluation and as an illustration of evaluation in practice the case of evaluationg of CINDI programme activities in Slovenia to reduce arterial hypertension prevalence effectiveness

The WHO Countrywide Integrated Non-communicable Diseases (CINDI) programme in Slovenia

Many different community based intervention projects/programmes were designed and/or implemented since the early 1970s to combat chronic non-communicable diseases, many of them being international. Countrywide Integrated Non-communicable Diseases Intervention programme (CINDI) of the World Health Organization (WHO), Regional Office for Europe, which started to spread its ideas in the 1980s, is one of them. Slovenia as a state officially joined international CINDI programme at the beginning of the 1990s, when its activities were limited to Ljubljana demonstrational area. First few years were used as an introductory period of the programme, while more systematically organized activities begun in the late 1990s. The paper presents the historical development of the CINDI programme in Slovenia, and the role of CINDI Slovenia Preventive Unit in it

Personalized management of dyslipidemias in patients with diabetes-it is time for a new approach (2022)

Dyslipidemia in patients with type 2 diabetes (DMT2) is one of the worst controlled worldwide, with only about 1/4 of patients being on the low-density lipoprotein cholesterol (LDL-C) target. There are many reasons of this, including physicians' inertia, including diabetologists and cardiologists, therapy nonadherence, but also underusage and underdosing of lipid lowering drugs due to unsuitable cardiovascular (CV) risk stratification. In the last several years there is a big debate on the risk stratification of DMT2 patients, with the strong indications that all patients with diabetes should be at least at high cardiovascular disease (CVD) risk. Moreover, we have finally lipid lowering drugs, that not only allow for the effective reduction of LDL-C and do not increase the risk of new onset diabetes (NOD), and/or glucose impairment; in the opposite, some of them might effectively improve glucose control. One of the most interesting is pitavastatin, which is now available in Europe, with the best metabolic profile within statins (no risk of NOD, improvement of fasting blood glucose, HOMA-IR, HbA1c), bempedoic acid (with the potential for the reduction of NOD risk), innovative therapies-PCSK9 inhibitors and inclisiran with no DMT2 risk increase, and new forthcoming therapies, including apabetalone and obicetrapib-for the latter one with the possibility of even decreasing the number of patients diagnosed with prediabetes and DMT2. Altogether, nowadays we have possibility to individualize lipid lowering therapy in DMT2 patients and increase the number of patients on LDL-C goal without any risk of new onset diabetes and/or diabetes control worsening, and in consequence to reduce the risk of CVD complications due to progression of atherosclerosis in this patients' group

CRISPR Gene Editing in Lipid Disorders and Atherosclerosis: Mechanisms and Opportunities

Elevated circulating concentrations of low-density lipoprotein cholesterol (LDL-C) have been conclusively demonstrated in epidemiological and intervention studies to be causally associated with the development of atherosclerotic cardiovascular disease. Enormous advances in LDL-C reduction have been achieved through the use of statins, and in recent years, through drugs targeting proprotein convertase subtilisin/kexin type 9 (PCSK9), a key regulator of the hepatic LDL-receptor. Existing approaches to PCSK9 targeting have used monoclonal antibodies or RNA interference. Although these approaches do not require daily dosing, as statins do, repeated subcutaneous injections are nevertheless necessary to maintain effectiveness over time. Recent experimental studies suggest that clustered regularly interspaced short palindromic repeats (CRISPR) gene-editing targeted at PCSK9 may represent a promising tool to achieve the elusive goal of a ‘fire and forget’ lifelong approach to LDL-C reduction. This paper will provide an overview of CRISPR technology, with a particular focus on recent studies with relevance to its potential use in atherosclerotic cardiovascular disease