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      A community pharmacy-based cardiovascular risk screening service implemented in Iran

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          Abstract

          Background:

          Cardiovascular disease is a major health concern around the world.

          Objective:

          To assess the outcomes and feasibility of a pharmacy-based cardiovascular screening in an urban referral community pharmacy in Iran.

          Methods:

          A cross sectional study was conducted in a referral community pharmacy. Subjects aged between 30-75 years without previous diagnose of cardiovascular disease or diabetes were screened. Measurement of all major cardiovascular risk factors, exercise habits, medical conditions, medications, and family history were investigated. Framingham risk score was calculated and high risk individuals were given a clinical summary sheet signed by a clinical pharmacist and were encouraged to follow up with their physician. Subjects were contacted one month after the recruitment period and their adherence to the follow up recommendation was recorded.

          Results:

          Data from 287 participants were analyzed and 146 were referred due to at least one abnormal laboratory test. The results showed 26 patients with cardiovascular disease risk greater than 20%, 32 high systolic blood pressure, 22 high diastolic blood pressures, 50 high total cholesterol levels, 108 low HDL-C levels, and 22 abnormal blood glucose levels. Approximately half of the individuals who received a follow up recommendation had made an appointment with their physician. Overall, 15.9% of the individuals received medications and 15.9% received appropriate advice for risk factor modification. Moreover, 7.5% were under evaluation by a physician.

          Conclusion:

          A screening program in a community pharmacy has the potential to identify patients with elevated cardiovascular risk factor. A plan for increased patient adherence to follow up recommendations is required.

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          Most cited references55

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          General cardiovascular risk profile for use in primary care: the Framingham Heart Study.

          Separate multivariable risk algorithms are commonly used to assess risk of specific atherosclerotic cardiovascular disease (CVD) events, ie, coronary heart disease, cerebrovascular disease, peripheral vascular disease, and heart failure. The present report presents a single multivariable risk function that predicts risk of developing all CVD and of its constituents. We used Cox proportional-hazards regression to evaluate the risk of developing a first CVD event in 8491 Framingham study participants (mean age, 49 years; 4522 women) who attended a routine examination between 30 and 74 years of age and were free of CVD. Sex-specific multivariable risk functions ("general CVD" algorithms) were derived that incorporated age, total and high-density lipoprotein cholesterol, systolic blood pressure, treatment for hypertension, smoking, and diabetes status. We assessed the performance of the general CVD algorithms for predicting individual CVD events (coronary heart disease, stroke, peripheral artery disease, or heart failure). Over 12 years of follow-up, 1174 participants (456 women) developed a first CVD event. All traditional risk factors evaluated predicted CVD risk (multivariable-adjusted P<0.0001). The general CVD algorithm demonstrated good discrimination (C statistic, 0.763 [men] and 0.793 [women]) and calibration. Simple adjustments to the general CVD risk algorithms allowed estimation of the risks of each CVD component. Two simple risk scores are presented, 1 based on all traditional risk factors and the other based on non-laboratory-based predictors. A sex-specific multivariable risk factor algorithm can be conveniently used to assess general CVD risk and risk of individual CVD events (coronary, cerebrovascular, and peripheral arterial disease and heart failure). The estimated absolute CVD event rates can be used to quantify risk and to guide preventive care.
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            Cardiovascular risk factors in an Iranian urban population: Tehran lipid and glucose study (phase 1).

            Coronary artery disease is becoming more prevalent in developing countries, particularly in urban areas. This study was conducted to determine the prevalence of cardiovascular risk factors among Tehran urban population. The prevalence and distribution of high blood pressure, cigarette smoking, dyslipoproteinemia, diabetes mellitus, and obesity was determined in 15,005 subjects, aged three years and over, selected by cluster random sampling in Tehran urban district-13 between February 1999 to August 2001. Total energy intake, percent of energy derived from protein, carbohydrate, and fat were assessed in a subsidiary of 1,474 persons by means of two 24-hour dietary recalls. In adults, 78% of men and 80% of women presented at least one CVD risk factor. The percentage of adult women with two or more risk factors was significantly greater than the one for men. Prevalence of DM, hypertension, obesity, high TC, low HDL, high TGs, and smoking was 9.8, 20.4, 14.4, 19.3, 32, 5.3, and 22.3%, respectively. In children and adolescents, two or more CVD risk factors were found in 9% of boys and 7% of girls. Prevalence of hypertension, obesity, high TC, low HDL, and high TGs, was 12.7, 5.2, 5.1, 10.2, and 5%, respectively. The mean percentage values of energy intake derived from carbohydrate, protein, and fat were 57.8 +/- 6.9, 11.1 +/- 1.8, and 30.9 +/- 7.2, respectively. The prevalence of cardiovascular risk factors among Tehran urban population is high; particularly of high total cholesterol, low HDL cholesterol levels, and high waist to hip ratio. An effective strategy for life style modification is a cornerstone of a population approach to the cardiovascular risk factors. Moreover, these results will serve as a baseline for assessment of future trends in the risk factors studied.
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              Sudden cardiac death: epidemiology, transient risk, and intervention assessment.

              To integrate information from the various disciplines that contribute to the understanding of the cause and prevention of sudden cardiac death: identification of new approaches from applied clinical epidemiology; identification and control of transient risk factors; and evaluation of the results of interventions. A broad range of research reports and interpretations of data from English-language journal articles and reviews, published primarily between 1970 and 1993. The fields of study included epidemiology, experimental electrophysiology, clinical observations, and interventions. Continuous literature surveys, done in relation to ongoing clinical and experimental research on sudden cardiac death since 1972. Included on the basis of relevance to the topics discussed and with confirmation of data and concepts by more than one investigator when available. Information from several disciplines was integrated by the authors to synthesize new ways to view the problem of sudden cardiac death. Quantitative information was used primarily to derive qualitative statements about new perspectives on sudden cardiac death. Progress in the prevention of sudden death will require development of new approaches, including epidemiologic techniques to address risk characteristics specific to the problem; characterization of triggering events and identification of specific persons at risk for responding adversely to these events; and methods of evaluating outcomes appropriate to the nature of sudden cardiac death.
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                Author and article information

                Contributors
                Journal
                Pharm Pract (Granada)
                Pharm Pract (Granada)
                Pharmacy Practice
                Centro de Investigaciones y Publicaciones Farmaceuticas
                1885-642X
                1886-3655
                Apr-Jun 2017
                30 June 2017
                : 15
                : 2
                : 919
                Affiliations
                Assistant Professor of Clinical Pharmacy. Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences . Tehran (Iran). zjahangard@ 123456sina.tums.ac.ir
                PharmD. Faculty of Pharmacy, Tehran University of Medical Sciences . Tehran (Iran). negar.hakimzadeh@ 123456gmail.com
                PharmD. Research Center for Rational Use of Drugs, Tehran University of Medical Sciences , Tehran (Iran). sarayani@ 123456ufl.edu
                PharmD. Department of Pharmaceutical Care, Faculty of Pharmacy, Tehran University of Medical Sciences , Imam Khomeini Hospital Complex. Tehran (Iran). shayda8466@ 123456yahoo.com
                PhD (Epidemiol). School of Public Health, Tehran University of Medical Sciences . Tehran (Iran). k_heidari@ 123456razi.tums.ac.ir
                Professor of Clinical Pharmacy. Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences . Tehran (Iran). mrjavadi@ 123456sina.tums.ac.ir
                Professor of Clinical Pharmacy. Research center for rational use of drugs and faculty of pharmacy, Tehran university of Medical sciences , Tehran (Iran). Email: hajibaba@ 123456tums.ac.ir
                Professor of Clinical Pharmacy. Reseasrch Center for Rational Use of Drugs, Tehran, University of Medical Sciences . Tehran (Iran). khgholami@ 123456sina.tums.ac.ir
                Author information
                http://orcid.org/0000-0002-2050-5159
                http://orcid.org/0000-0003-2790-9938
                http://orcid.org/0000-0003-2790-9938
                http://orcid.org/0000-0003-1340-8454
                Article
                pharmpract-15-919
                10.18549/PharmPract.2017.02.919
                5499348
                28690693
                587072d3-684d-4571-872f-1577aa105dcb
                Copyright: © Pharmacy Practice

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY-NC-ND 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 04 January 2017
                : 11 April 2017
                Funding
                Funded by: Tehran University of Medical Sciences.
                Categories
                Original Research

                mass screening,community pharmacy services,pharmacies,cardiovascular diseases,diagnostic techniques,cardiovascular,iran

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