Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015 Physicians' perception, knowledge and awareness of cardiovascular risk factors and adherence to prevention guidelines: the PERCRO-DOC survey. Cardiovascular disease risk reduction in rural China: a clustered randomized controlled trial in Zhejiang National Study of Women’s Awareness, Preventive Action, and Barriers to Cardiovascular Health Association of cardiovascular health screening with mortality, clinical outcomes, and health care cost: a nationwide cohort study. Risk factors for cardiovascular and cerebrovascular death among African Americans and Hispanics in Los Angeles, California. A prospective study of variability in systolic blood pressure and mortality in a rural Bangladeshi population cohort. Long-term mortality after 5-year multifactorial primary prevention of cardiovascular diseases in middle-aged men. Coronary heart disease and all-causes mortality in the Multiple Risk Factor Intervention Trial: subgroup findings and comparisons with other trials. Mortality in participants and non-participants of a multifactorial prevention study of cardiovascular diseases: a 28 year follow up of the Helsinki Businessmen Study. Cardiovascular Risk Factor Screening Satisfaction in the Heart of New Ulm Project Evaluating the impact of population and high-risk strategies for the primary prevention of cardiovascular disease. Physical activity and cardiovascular mortality risk: possible protective mechanisms? Methods for establishing a surveillance system for cardiovascular diseases in Indian industrial populations. Relationship between baseline risk factors and coronary heart disease and total mortality in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group. Using an online, personalized program reduces cardiovascular risk factor profiles in a motivated, adherent population of participants. Overall and coronary heart disease mortality rates in relation to major risk factors in 325,348 men screened for the MRFIT. Multiple Risk Factor Intervention Trial.
Background The burden of cardiovascular diseases ( CVDs ) remains unclear in many regions of the world . Objectives The GBD ( Global Burden of Disease ) 2015 study integrated data on disease incidence , prevalence , and mortality to produce consistent , up-to- date estimates for cardiovascular burden . Methods CVD mortality was estimated from vital registration and verbal autopsy data . CVD prevalence was estimated using modeling software and data from health surveys , prospect i ve cohorts , health system administrative data , and registries . Years lived with disability ( YLD ) were estimated by multiplying prevalence by disability weights . Years of life lost ( YLL ) were estimated by multiplying age-specific CVD deaths by a reference life expectancy . A sociodemographic index ( SDI ) was created for each location based on income per capita , educational attainment , and fertility . Results In 2015 , there were an estimated 422.7 million cases of CVD ( 95 % uncertainty interval : 415.53 to 427.87 million cases ) and 17.92 million CVD deaths ( 95 % uncertainty interval : 17.59 to 18.28 million CVD deaths ) . Declines in the age-st and ardized CVD death rate occurred between 1990 and 2015 in all high-income and some middle-income countries . Ischemic heart disease was the leading cause of CVD health lost globally , as well as in each world region , followed by stroke . As SDI increased beyond 0.25 , the highest CVD mortality shifted from women to men . CVD mortality decreased sharply for both sexes in countries with an SDI > 0.75 . Conclusions CVDs remain a major cause of health loss for all regions of the world . Sociodemographic change over the past 25 years has been associated with dramatic declines in CVD in regions with very high SDI , but only a gradual decrease or no change in most regions . Future up date s of the GBD study can be used to guide policymakers who are focused on reducing the overall burden of noncommunicable disease and achieving specific global health targets for CVD BACKGROUND Cardiovascular diseases ( CVD ) are the major cause of premature death in the world . This study was design ed to examine the physicians ' knowledge and perception of CVD risk factors and perceived implementation of CVD prevention guidelines as well as barriers to their implementation . METHODS A question naire survey by face-to-face interviews was performed among 1382 r and omly selected physicians ( general practitioners/family medicine specialists , internists and cardiologists ) from different regions of Croatia . RESULTS Most physicians believe that guidelines are useful but only 56.9 % are really using some guidelines . 40.2 % favour Joint European guidelines . More primary care physicians use their own personal experience in prevention while internists and cardiologists tend more to use the guidelines . 80.6 % believe that they treat their patients with dyslipidemia well but only 53.3 % knew the LDL-cholesterol goal value for high-risk patients and only 56.2 % knew which HDL-cholesterol level is the marker of increased risk . Hypertension was perceived as the most important risk factor , particularly by primary care physicians , while cardiologists tend to favour diabetes . Although most physicians considered the lack of financial re sources as the main barrier in CVD prevention , at the same time most of them believe that it could primarily be improved by better patient education . CONCLUSIONS Although most physicians support the guidelines use , only half of them use them and in average their knowledge of guidelines is not satisfactory . This is , together with the lack of time and finances and perceived lack of patients ' awareness , probably one of the main causes why they do not manage risk factors better Background Cardiovascular disease ( CVD ) is a major cause of death in China . Despite government efforts , the majority of hypertensive and diabetic patients in China do not receive proper treatment . Reducing CVD events requires long-term care that is proactive , patient-centred , community-based , and sustainable . We have design ed a package of interventions for patients at high risk of CVD to be implemented by family doctors based in township hospitals ( providers of primary care ) in rural Zhejiang , China . This trial aims to determine whether the systematic CVD risk reduction package results in reduced CVD events among patients at risk of CVD compared with usual care , and whether the package is cost-effective and suitable for routine implementation and scale-up . Methods / Design This is a prospect i ve , open-label , cluster r and omized controlled trial ( RCT ) with blinded data analysis . The trial will r and omize 67 township hospitals with 31,708 participants in three counties in Zhejiang Province . Participants will be identified from existing health records and will comprise adults aged 50 to 74 years , with a calculated 10-year CVD risk of 20 % or higher , or diabetes . In the intervention arm , participants will receive a package of interventions including : 1 ) healthy lifestyle counseling ( smoking cessation , and salt , oil , and alcohol reduction ) ; 2 ) prescription of a combination of drugs ( antihypertensives , aspirin , and statin ) ; and 3 ) adherence support for drug compliance and healthy lifestyle change . In the control arm , participants will receive usual care for hypertension and diabetes management at individual clinicians ’ discretion . The primary outcome is the incidence of severe CVD events over 24 months of follow-up . All CVD events will be defined according to the World Health Organization ( WHO ) monitoring of trends and determinants in cardiovascular disease ( MONICA ) definitions , diagnosed at the county hospital or higher level , and reported by the Zhejiang surveillance system . Secondary outcomes include : mean systolic and diastolic blood pressure , blood glucose , serum total cholesterol ( TC ) , and adherence to appointments , and drugs and lifestyle changes . Discussion This trial focuses on risk reduction of CVD rather than specific diseases . It is not design ed to compare therapeutic and healthy lifestyle interventions , but rather their combined effects in primary care setting s. Through the trial , we intend to underst and the effectiveness of the comprehensive CVD reduction package in routine practice . We also intend to underst and the barriers and facilitators to implementing the package , and thus to advise on policy and practice change . Trial registration Current Controlled Trials : IS RCT Background — There is growing awareness of cardiovascular disease ( CVD ) as the leading cause of death in women , but whether this greater awareness is associated with increased action by women to lower their personal or family ’s risk is unknown . Methods and Results — A nationally representative sample of 1008 women selected through r and om-digit dialing were given a st and ardized question naire about history of CVD/risk factors , awareness of leading cause of death , knowledge of healthy and personal levels of CVD risk factors , self-reported actions taken to reduce risk  , and barriers to heart health . The rate of awareness of CVD as the leading cause of death has nearly doubled since 1997 ( 55 % versus 30 % ) was significantly greater for whites compared with blacks and Hispanics ( 62 % versus 38 % and 34 % , respectively ) and was independently correlated with increased physical activity ( odds ratio , 1.35 ; 95 % CI , 1.00 to 1.83 ) and weight loss ( odds ratio , 1.47 ; 95 % CI , 1.14 to 2.02 ) in the previous year in logistic regression models . Fewer than half of the respondents were aware of healthy levels of risk factors . Awareness that personal level was not healthy was positively associated with action . Most women took steps to lower risk in family members and themselves . The most frequently cited barriers for heart health were confusion in the media ( 49 % ) , the belief that health is determined by a higher power ( 44 % ) , and caretaking responsibilities ( 36 % ) . Conclusions — General awareness of CVD risk among women is associated with preventive action . Educational interventions need to be targeted at racial/ethnic minority women OBJECTIVE To determine whether a  cardiovascular disease ( CVD ) health screening program is associated with CVD-related health conditions , incidence of cardiovascular events , mortality , healthcare utilization , and costs . METHODS Cohort study of a 3 % r and om sample of all Korea National Health Insurance members 40years of age or older and free of CVD or CVD-related health conditions was conducted . A total 443,337 study participants were followed-up from January 1 , 2005 through December 31 , 2010 . RESULTS In primary analysis , the hazard ratios for CVD mortality , all-cause mortality , incident composite CVD events , myocardial infa rct ion , cerebral infa rct ion , and cerebral hemorrhage comparing participants who attended a screening exam during 2003 - 2004 compared to those who did not were 0.58 ( 95 % CI : 0.53 - 0.63 ) , 0.62 ( 95 % CI : 0.60 - 0.64 ) , 0.82 ( 95 % CI : 0.78 - 0.85 ) , 0.84 ( 95 % CI : 0.75 - 0.93 ) , 0.84 ( 95 % CI : 0.79 - 0.89 ) , and 0.73 ( 95 % CI : 0.67 - 0.80 ) , respectively . Screening attenders had higher rates of newly diagnosed hypertension , diabetes mellitus , and dyslipidemia , lower inpatient days of stay and cost , and lower outpatient cost compared to non-attenders . CONCLUSIONS Participation in CVD health screening was associated with lower rates of CVD , all-cause mortality , and CVD events , higher detection of CVD-related health conditions , and lower healthcare utilization and costs OBJECTIVE To describe the risk factors associated with cardiovascular mortality in the African American ( AA ) and Hispanic population s in Los Angeles County in an effort to define causes for the excess mortality seen in AAs . METHODS This was a longitudinal analysis of all-cause , cardiovascular , and cerebrovascular mortality in a large , prospect i ve multiethnic cohort of individuals aged 45 - 74 years . Death rates between AA and Hispanic men and women during the six-year period from 1993 to 1998 due to hypertension , cardiomyopathy , acute myocardial infa rct ion ( AMI ) , ischemic heart disease , and stroke were compared . RESULTS There were 1,157 deaths due to cardiovascular disease ( CVD ) or cerebrovascular disease among the 71,798 eligible members of the cohort included in these analyses .  Age-adjusted mortality rates were two to five times higher in AAs as compared with Hispanics ( e.g. , 373.15 in AAs for hypertensive disease vs 50.37 in Hispanics ) . A history of hypertension was the most common significant risk factor for CVD ; other risk factors significantly associated with CVD mortality included cigarette smoking and a past history of diabetes and stroke . Adjusting for these factors did not remove the significance of AA ethnicity as a risk factor for CVD mortality in either subjects reporting or subjects not reporting hypertension at baseline . CONCLUSIONS The evidence for both higher relative severity and higher incidence of hypertensive disease among AAs , and the consistency of the effect across gender , suggests that a major determinant of risk may be a gene environment interaction OBJECTIVE Limited studies suggest that blood pressure variability over time is a risk factor of long-term cardiovascular outcomes . However , most of these were in population s with pre-existing cardiovascular diseases ( CVD ) and studies in general population are lacking . METHODS The study included 11,153 participants in a population -based , prospect i ve cohort study in Araihazar , Bangladesh .  Resting blood pressure was measured at baseline and every two years thereafter . Participants were followed up for an average of 6.5 years ( 2002 - 2009 ) . RESULTS Male gender , older age , baseline systolic blood pressure ( SBP ) , and absence of betel leaf use were independently positively associated with greater SBP variability over time . There was a significant association between SBP variability and the risk of death from overall CVD , especially from major CVD events . The positive association with the risk of death from any cause and stroke in age- and sex-adjusted models was attenuated in fully-adjusted models . In addition , the hazard ratio ( HR ) of stroke mortality was greater for individuals with both high baseline and high SBP variability . Similar patterns of HRs were observed for all-cause and CVD mortalities . CONCLUSION In this rural Bangladeshi population , variability in SBP contributes to the risk of death from CVD and may further potentiate the increased mortality risk associated with high SBP OBJECTIVE To investigate the long-term effects of multifactorial primary prevention of cardiovascular diseases ( CVD ) . DESIGN The 5-year r and omized , controlled trial was performed between 1974 and 1980 . The subjects and their risk factors were reevaluated in 1985 . Posttrial mortality follow-up was continued up to December 31 , 1989 . SETTING Institute of Occupational Health , Helsinki , Finl and , and Second Department of Medicine , University of Helsinki . PARTICIPANTS In all , 3490 business executives born during 1919 through 1934 participated in health checkups in the late 1960s . In 1974 , 1222 of these men who were clinical ly healthy , but with CVD risk factors , were entered into the primary prevention trial ; 612 were r and omized to an intervention and 610 to a control group . INTERVENTIONS During the 5-year trial , the subjects of the intervention group visited the investigators every fourth month . They were treated with intensive dietetic-hygienic measures and frequently with hypolipidemic ( mainly clofibrate and /or probucol ) and antihypertensive ( mainly beta-blockers and /or diuretics ) drugs . The control group was not treated by the investigators . MAIN OUTCOME MEASURES Total mortality , cardiac mortality , mortality due to other causes . RESULTS Total coronary heart disease risk was reduced by 46 % in the intervention group as compared with the control group at end-trial . During 5 posttrial years , the risk factor and medication differences were largely leveled off between the groups . Between 1974 and 1989 the total number of deaths was 67 in the intervention group and 46 in the control group ( relative risk [ RR ] , 1.45 ; 95 % confidence interval [ CI ] , 1.01 to 2.08 ; P = .048 ) ; there were 34 and 14 cardiac deaths ( RR , 2.42 ; 95 % CI , 1.31 to 4.46 ; P = .001 ) , two and four deaths due to other CVD ( not significant ) , 13 and 21 deaths due to cancer ( RR , 0.62 ; 95 % CI , 0.31 to 1.22 ; P = .15 ) , and 13 and one deaths due to violence ( RR , 13.0 ; 95 % CI , 1.70 to 98.7 ; P = .002 ) , respectively . Multiple logistic regression analysis of treatments in the intervention group did not explain the 15-year excess cardiac mortality . CONCLUSION These unexpected results may not question multifactorial prevention as such but do support the need for research on the selection and interaction(s ) of methods used in the primary prevention of cardiovascular diseases The Multiple Risk Factor Intervention Trial ( MRFIT ) was a r and omized primary prevention trial to test whether a special intervention ( SI ) program to reduce high blood pressure , elevated blood cholesterol , and /or cigarette smoking could lower  coronary heart disease ( CHD ) mortality in middle-aged men at above average risk . After an average follow-up period of 7 years , risk factor levels were reduced substantially more in SI than in usual-care ( UC ) men ; however , SI-UC differences in CHD mortality ( 7.1 % ) and total mortality ( -2.1 % ) were not statistically significant . Subgroup analysis showed 35 % fewer SI than UC CHD deaths ( P = 0.14 ) but no all-causes mortality difference in men comparable to the cohort having dietary and smoking intervention in Oslo ( the " Oslo-like " cohort ) . Among the subgroup hypertensive at entry , SI-UC differences in CHD and total mortality appeared to be heterogeneous : CHD mortality was 24 % lower in SI than UC men with a normal resting ECG at baseline , but 67 % higher if baseline ECG abnormalities were present ( nominal P = 0.02 , for difference in relative risk estimates ) . These findings were supported by within-group analyses and are generally consistent with results of other CHD/cardiovascular disease prevention trials . They pose a new hypothesis about possible adverse effects of diuretic therapy in a minority of the hypertensive population OBJECTIVE --To investigate pretrial risk factors and long term mortality ( 1964 - 1992 ) in participants and non- participants of a multifactorial primary prevention trial . DESIGN --A prospect i ve study among 3313 initially healthy businessmen . During the 1960s ( 1964 onwards ) , 3490 healthy male business executives born between 1919 and 1934 participated in voluntary health checks at the Institute of Occupational Health in Helsinki . From that period cardiovascular disease ( CVD ) risk factors were available in 3313 men . In the beginning of the 1970s these men were invited to join a multifactorial primary prevention trial of CVD . Six groups were formed : ( I ) healthy participants in a high risk intervention group ( n = 612 ) , and ( II ) their r and omised control group ( n = 610 ) ; ( III ) a non-participant low risk group ( n = 593 ) ; ( IV ) an excluded group with signs of CVD ( n = 563 ) ; ( V ) a refused group ( n = 867 ) ; and ( VI ) dead ( n = 68 ) . Groups I and II participated in the five year prevention trial which started in 1974 . Other groups were followed up through registers , with no personal contact . MEASUREMENTS --Cardiovascular risk factors during the 1960s . Mortality follow up using national registers up to 31 December , 1992 . MAIN RESULTS --Baseline risk factors were lowest in the low risk group , highest in the excluded group , intermediate and comparable in other groups . Eighteen-year ( 1974 - 1992 ) mortality ( per 1000 ) was 79.3 , 106.6 , 155.2 , 179.9 , and 259.3 in the low risk , control , intervention , refused , and excluded groups , respectively ( P < 0.001 ) . In the whole population of 3313 men , the 28-year ( 1964 - 1992 ) total ( n = 577 ) and coronary deaths ( n = 199 ) were significantly predicted by smoking , blood pressure , and cholesterol ; cancer deaths ( n = 163 ) by smoking only ; and violent deaths ( n = 83 ) by none of the risk factors . One-hour postload glucose was significantly associated with total mortality in the intervention group only . When the intervention and control groups were included in the same model , the effect of group on total mortality tended to be dependent on the 1 h blood glucose value ( P = 0.06 for the group by 1 h glucose interaction term ) . CONCLUSION --The traditional risk factors ( smoking , blood pressure , and cholesterol ) are significantly associated with 28-year mortality in this high social class population with previous health education . Conversely , a " clustering " of low risk factors predicted low total , coronary , and cancer mortality . The findings on 1 h blood glucose suggest that factors related to glucose tolerance explain in part the excess mortality in the intervention group compared with the control group Objective Community-based cardiovascular disease ( CVD ) risk factor screening programs have been used successfully in rural health improvement initiatives . However , little is known about what consumers like or dislike about them , which is a barrier to the design of future process improvements . The objective of this study was to examine the degree to which health risks and participant characteristics predicted screening satisfaction . Design This study utilized a cross-sectional survey design . Setting Data was collected as part of the broader Heart of New Ulm Project , which is a community-based CVD prevention demonstration project based in rural Minnesota . Participants There were 126 r and omly invited individuals from the CVD risk factor screenings , with 118 individuals who agreed to participate and had complete data available for analyses . Methods A multivariate logistic regression analysis was used to examine the association between demographics , lifestyle , and biometric risk factors and screening satisfaction . Results Twenty percent of respondents indicated some level of dissatisfaction with the screening process . Satisfied participants were more likely to be female ( OR=4.15 ) , not have an optimal lifestyle ( OR=3.47 ) , and have an intention to improve their lifestyle habits ( OR=3.26 ) . Age , education , and CVD risk level were not significant predictors in the final model . Conclusion Satisfaction was high in this screening program , with healthy males being least satisfied with their experience . This has implication s for the design of future intervention efforts , as they may require specific programmatic features and more specialized , targeted marketing strategies to attract a broad spectrum of participants likely to benefit AIMS To estimate the potential effectiveness of different " high-risk " and " population " approaches to the primary prevention of  cardiovascular disease ( CVD ) in middle-aged British men , after correction for regression dilution bias . METHODS AND RESULTS We used a combination of cohort and r and omised controlled trial evidence to estimate the effectiveness of high-risk strategies , based on the identification of high-risk factors or high absolute risk , and strategies based on population -wide reductions in cholesterol and blood pressure . High-risk strategies were potentially effective but would need to be used widely to have a substantial effect on CVD in the population . Aggressive pharmacological treatment ( using statins , beta-blockers , ACE-inhibitors and aspirin ) in individuals with a 10-year Framingham event risk of > or=30 % ( 6 % of population ) would have reduced major CVD by at most 11 % . This figure increased to 34 % at a > or=20 % treatment threshold ( 26 % of population ) . In contrast , modest downwards shifts in the population distributions of serum total cholesterol and systolic blood pressure led to marked expected reductions in major CVD . Taking regression dilution bias into account , 10 % reductions in long-term mean blood cholesterol and blood pressure could have reduced major CVD by 45 % . CONCLUSIONS If high-risk strategies are to have a major impact on CVD in the population , they need to be more widely used than previously envisaged . Population -wide reduction of major risk factors is needed if CVD is to be substantially reduced INTRODUCTION The biological mechanisms through which increased physical activity or structured exercise training lowers the risk of recurrent cardiac events are incompletely understood . We examined the extent to which modification of primary risk markers explains the association between physical activity and cardiovascular death in participants with diagnosed cardiovascular disease ( CVD ) . METHODS AND RESULTS In a prospect i ve study of 1429 participants with physician-diagnosed CVD living in Engl and and Scotl and ( age = 66.5 ± 11.1 yr ( mean ± SD ) , 54.2 % men ) , we measured physical activity and several risk markers ( body mass index , total-to-HDL cholesterol ratio , diagnosed diabetes , systolic blood pressure , resting heart rate , C-reactive protein ) at baseline . The main outcome was CVD death . There were a total of 446 all-cause deaths during an average of 7.0 ± 3.1 yr of follow-up , of which 213 were attributed to cardiovascular causes . Participation in moderate to vigorous physical activity at least three sessions per week was associated with lower risk of CVD death ( hazard ratio = 0.61 , 95 % confidence interval = 0.38 - 0.98 ) . Physically active participants demonstrated significantly lower levels of body mass index , diabetes , and inflammatory risk ( C-reactive protein ) . Metabolic ( body mass index , total-to-HDL cholesterol ratio , and physician-diagnosed diabetes ) and inflammatory risk factors explained an estimated 12.8 % and 15.4 % , respectively , of the association between physical activity and CVD death . CONCLUSIONS Physical activity may reduce the risk of secondary CVD events , in part , by improving metabolic and inflammatory risk markers OBJECTIVE To establish a surveillance network for cardiovascular diseases ( CVD ) risk factors in industrial setting s and estimate the risk factor burden using st and ardized tools . METHODS We conducted a baseline cross-sectional survey ( as part of a CVD surveillance programme ) of industrial population s from 10 companies across India , situated in close proximity to medical colleges that served as study centres . The study subjects were employees ( selected by age and sex stratified r and om sampling ) and their family members . Information on behavioural , clinical and biochemical determinants was obtained through st and ardized methods ( question naires , clinical measurements and biochemical analysis ) . Data collation and analyses were done at the national coordinating centre . FINDINGS We report the prevalence of CVD risk factors among individuals aged 20 - 69 years ( n = 19 973 for the question naire survey , n = 10 442 for biochemical investigations ) ; mean age was 40 years . The overall prevalence of most risk factors was high , with 50.9 % of men and 51.9 % of women being overweight , central obesity was observed among 30.9 % of men and 32.8 % of women , and 40.2 % of men and 14.9 % of women reported current tobacco use . Self-reported prevalence of diabetes ( 5.3 % ) and hypertension ( 10.9 % ) was lower than when measured clinical ly and biochemically ( 10.1 % and 27.7 % , respectively ) . There was marked heterogeneity in the prevalence of risk factors among the study centres . CONCLUSION There is a high burden of CVD risk factors among industrial population s across India . The surveillance system can be used as a model for replication in India as well as other developing countries The relationship between selected baseline risk factors and subsequent coronary heart disease ( CHD ) death and total mortality among participants in the Multiple Risk Factor Intervention Trial ( MRFIT ) was studied in order to determine whether the three risk factors used to identify high-risk men for the trial were associated with CHD death ; whether other risk factors measured at baseline , especially lipoprotein cholesterol levels , were associated with CHD and total mortality ; and whether there were any differences between special intervention ( SI ) and usual care ( UC )  participants in the relationship of the specific levels of risk factors to CHD or total mortality . The three main risk factors ( blood cholesterol , cigarette smoking , and diastolic blood pressure ) and age were significantly associated with CHD mortality ; age , diastolic blood pressure , and cigarette smoking were associated with total mortality . The risk score based on the multiple logistic equation developed from the Framingham Study was also strongly associated with CHD mortality . When the joint associations of selected baseline risk factors with CHD and total mortality were considered , age , diastolic blood pressure , cigarette smoking , and low- and high-density lipoprotein cholesterol were significantly associated with CHD mortality ; age , cigarette smoking , and low-density lipoprotein cholesterol were positively associated with total mortality . Systolic blood pressure significantly improved the prediction of CHD mortality for SI and UC men when it was added to a regression model that included age , diastolic blood pressure , cigarettes smoked per day , body mass index , and lipoprotein levels , but improved the prediction of total mortality only for SI men . In similar analyses , serum thiocyanate improved the prediction of both CHD and total mortality for UC men . Among SI men the improved prediction gained by considering serum thiocyanate was less pronounced and not significant for CHD death . This latter finding may be due in part to the changes made in smoking behavior by SI participants during the course of the study . The estimated regression coefficients for CHD and total mortality endpoints were not significantly different between the SI and UC groups BACKGROUND Cardiovascular disease ( CVD ) is the leading cause of morbidity , mortality , and cost in Western society . Employer-sponsored work health programs ( WHPs ) and Web-based portals for monitoring and providing guidance based on participants ' health risk assessment s are emerging , yet online technologies to improve CVD health in the workplace are relatively unproven . We hypothesized that an online WHP , comprehensively addressing multiple facets of CVD , can be successfully implemented and improve the health of participants . METHODS A cohort of employees in Tennessee ( n = 1,602 ) was subjected to a health risk assessment at baseline . Those who did not meet all 5 healthy benchmarks ( n = 836)-body mass index , blood pressure , glucose , total cholesterol , and smoking status-were prospect ively assigned to a Web-based personal health assistant and had repeat measurements taken at 90 days . RESULTS Of those who both completed the personal health assistant program and underwent baseline plus 90-day assessment s ( 508/836 , 61 % ) , 75 % were female , mean age was 46.5 ± 11.1 years , and the mean number of risk factors  at baseline was 1.1 ± 0.9 with a mean 10-year Framingham Risk Score of 2.9 % . This cohort demonstrated a significant reduction in total cholesterol ( P < .0001 ) , low-density lipoprotein cholesterol ( P < .0001 ) , triglycerides ( P < .0001 ) , systolic blood pressure ( P = .009 ) , glucose ( P = .004 ) , weight ( P = .001 ) , and body mass index ( P = .001 ) . Most of the participants improved at least 1 risk factor . Framingham Risk 10-year cardiovascular risk percentages were significantly reduced ( P = .003 ) . CONCLUSIONS This study in a prospect i ve cohort of community-dwelling employees suggests that an online WHP can provide a viable means to improve surrogates of CVD risk factors The influence of risk factors on  CHD and all-cause mortality rates in 35- to 57-year-old men is examined by means of data on 325,348 white men who were screened for the MRFIT .  This large data set permits an unusually detailed analysis of factors associated with the 6968 deaths , including 2426 ascribed to CHD , that were detected in the Social Security Administration data set during 6 years of follow-up . Simple cross classification of the data confirms the independent effect of serum cholesterol concentration , diastolic blood pressure , and cigarette smoking as risk factors for CHD and all-cause mortality rates . A distinct escalation of risk is noted for combinations of these risk factors . The strength of the association of each of the risk factors with CHD and all-cause mortality rates diminished with increasing age , although the number of excess deaths attributable to the risk factors increased because of the higher death rates in older men . Comparison of these findings with those observed in the five population s studied in the Pooling Project revealed an overall similarity in the risk relationships . It is estimated that elimination of these risk factors has the potential for reducing the CHD mortality rate by two thirds in 35- to 45-year old men , and by one half in 46- to 57-year-old men
Conclusions Interventions using physician reminders , using dedicated personnel to deliver screening , and provision of financial incentives were found to be effective in increasing CVD risk factors screening uptake
Background Cardiovascular disease ( CVD ) is the leading cause of death globally .
However , many individuals are unaware of their CVD risk factors .
The objective of this systematic review is to determine the effectiveness of existing intervention strategies to increase uptake of  CVD risk factors screening .