Cardiovascular disease and high blood pressure trend analyses from 2002 to 2016: after the implementation of a salt reduction strategy

Abstract

BackgroundCardiovascular disease (CVD) is the leading cause of death around the world; however, many CVD events could be prevented if we focused on modification of the main risk factors.Increased salt consumption is estimated to have caused millions of deaths, mostly related to CVD, particularly stroke, which is the leading cause of death in Portugal.In our study, we aim to assess trends in the proportion of high blood pressure (HBP) in Acute Coronary Syndrome (ACS) patients as well as the trends in stroke and ACS in Portugal, especially after a set of public health initiatives were implemented to reduce salt intake.MethodsThe monthly proportion of ACS patients presenting with previously diagnosed HBP and the monthly rate of CVD admissions into public hospitals in Portugal were calculated. CVD rates were stratified into ACS rate and stroke rates. Data were stratified by demographics variables. An interrupted time-series model was used to assess changes over time.ResultsBreakpoint analysis revealed an estimated breakpoint around the year 2013 for the proportion of HBP patients, the following year there was a decreasing trend, however it was not significant. Analyses showed the trend before 2013 was increasing and started to decrease after this year. This decreased in proportion of HBP patients can be translated into a reduction of 555 people per year presenting with HBP in the ACS population.We analysed trends for ACS and stroke and tested the significance for a breakpoint in the year 2013. Although none of the remaining trends were significant for ACS crude rates and stroke crude rate, a decreasing trend was observed.ConclusionsThis research provides an indication about the impact a population-wide approach to CVD risk factors has on CVD trends themselves. Our results suggest that population-wide approaches can have an impact on the prevention and improvement of CVD control, reducing the number of CVD events, and eventually reducing premature death by CVD. As more restrictions on salt intake are being planned in Portugal in the next years, it is highly relevant to assess what is the current panorama and what further reductions we can expect.

Science of Salt: A regularly updated systematic review of salt and health outcomes studies (April to October 2018)

“…The weekly search identified 4141 citations over the period from April 3 to October 30, 2018, of which 19 studies including dietary sodium and health outcomes met the criteria for full review (Table ). These included systematic review and meta‐analyses (n = 2), randomized controlled trials (n = 3, including one post hoc analysis of a randomized controlled trial), a non‐randomized controlled trial (n = 1), prospective cohort studies (n = 4), a retrospective cohort study using population data (n = 1), and cross‐sectional studies (n = 8) . Two studies assessed mortality outcomes, four studies assessed morbidity outcomes, and one study assessed symptoms/quality of life/functional status outcomes .…”

“…These included systematic review and meta-analyses (n = 2), 22,23 randomized controlled trials (n = 3, including one post hoc analysis of a randomized controlled trial), [24][25][26] a non-randomized controlled trial (n = 1), 27 prospective cohort studies (n = 4), [28][29][30][31] a retrospective cohort study using population data (n = 1), 32 and cross-sectional studies (n = 8). [33][34][35][36][37][38][39][40] Two studies assessed mortality outcomes, 28,29 four studies assessed morbidity outcomes, [30][31][32][33] and one study assessed symptoms/quality of life/functional status outcomes. 22 Eight studies assessed clinical surrogate outcomes, [23][24][25][26][27][34][35][36] one study assessed physiologic surrogate outcomes, 37 and three studies assessed other outcomes [38][39][40] according to our pre-specified categories.…”

Mortality from cardiovascular diseases in the municipalities of mainland Portugal: spatiotemporal evolution between 1991 and 2017

“…In addition, important improvements in lifestyles determinants such as the decrease of tobacco and alcohol consumption have been registered during the last years and its impact must also be considered (Santana 2005;Santana and Almendra 2018). As an example, a set of public health initiatives were implemented to reduce salt intake which positively impacted the evolution of the number of CVD events, and eventually also impacted premature deaths (Abreu et al 2018). Measures addressing excessive tobacco and alcohol consumption were implemented and may also have impacted the evolution of the CVD mortality.…”

Antioxidant Blueberry Anthocyanins Induce Vasodilation via PI3K/Akt Signaling Pathway in High-Glucose-Induced Human Umbilical Vein Endothelial Cells

“…Cardiovascular disease (CVD) is the leading cause of death in the world, with 80-90% of cardiovascular disease patients having hypertension [1]. The World Health Organization estimated that 17.6 million people died from cardiovascular disease in 2016, representing 44% of all global deaths.…”