BACKGROUND: Chronic heart failure (HF) disease as an emerging epidemic has a high economic burden, hospitalization, readmission, morbidity rates despite many clinical practice guidelines recommendations.

OBJECTIVE: To show that the attributed survival and hospitalization-free event rates in the reviewed chronic HF clinical practice guidelines' Class I-A recommendations as "initial HF drug therapy" is basically "add-on HF drug therapy" to the "baseline HF drug therapy" thereby under-estimating the "baseline HF drug therapy" significant contribution to the clinical outcome.

METHODOLOGY: The references cited in the chronic HF clinical practice guidelines of the American Heart Association/American College of Cardiology (AHA/ACC), the Heart Failure Society of America (HFSA), and the European Society of Cardiology (ESC) were reviewed and compared with the respective guidelines' and other countries' recommendations.

RESULTS: The "baseline HF drug therapy" using glycosides and diuretics is 79-100% in the cited HF trials. The survival and hospitalization event-free rates attributed to the "baseline HF drug therapy" are 46-89% and 61.8-90%, respectively. The survival and hospitalization-free event rate of the "initial HF drug therapy" is 61-92.8% and 61.8-90%, respectively. Thus the survival and hospitalization event-free rates of the "add-on HF drug therapy" are 0.4-15% and 4.6% to 14.7%, respectively. The extrapolated "baseline HF drug therapy" survival is 8-51% based on a 38% natural HF survival rate for the time period.

CONCLUSION: The contribution of "baseline HF drug therapy" is relevant in terms of survival and hospitalization event-free rates compared to the HF Class 1-A guidelines proposed "initial HF drug therapy" which is in essence an "add-on HF drug therapy" in this analysis.

Human ; Heart Failure-Drug Therapy, Survival

BACKGROUND: The 2nd National Nutrition and Health Survey (NNHeS II) was conducted in 2008 to measure the prevalence of lifestyle-related diseases and risk factors among adult Filipinos 20 years or older. One of the risk factors measured was smoking.

METHODS: The survey used a stratified multi-stage sampling design and covered the 17 regions of the country. The clinical component included Filipino adults 20 years or older. Data was collected using health questionaires; anthropometric measurements were made, and blood examinations performed on all participants. The prevalence of smoking was determined.

RESULTS: A total of 7,700 subjects were included in the survey. The over-all prevalence of current smokers was 31% (53.2% and 12.5% for men and women, respectively). 14% were former smokers (20.9% of men and 9.5% of women) while 25.9% of men and 78.1% of women were never smokers.Among current male smokers, the highest prevalence (57.7%) belonged to the 20-29 age group. While among current female smokers, the highest prevalence (23.2%) belonged to the greater than 70-year-old category.There were more current smokers in the rural areas (33.1%) than the urban areas (28.9%) and there were more current and former smokers among respondents whose educational attainment was at least tertiary level (62.7%).

CONCLUSION: Tobacco use in the Philippines is still prevalent at 31% and is predominantly composed of males in the 20-29 age group. Current smoking is highest among rural dwellers and among individuals with elementary education, while majority of women and college level respondents are never smokers.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Smoking ; Risk Factors ; Tobacco Use Disorder ; Health Surveys ; Tobacco Use ; Life Style

OBJECTIVES: To determine prevalence of coronary artery disease (CAD) among adult patients with congenital heart disease (CHD), who underwent Coronary Angiography (CA) at the UP-PGH. Secondary: to determine severity of CAD lesions among these patients.

METHODS: This is a descriptive study of adult patients with Congenital Heart Disease who underwent selective coronary angiography from September 1998 to December 2010 at the Philippine General Hospital.

RESULTS: 52 adult patients with CHD underwent CA, Ten (19%) had angiographic evidence of coronary atherosclerosis visually. Significant CAD was found in 11.5% (n=6), all patients being ≥ 40 years old (mean age 54 ± 7.9 years; range 47 -61); 4 (66%) are female; Five (83%) have documented traditional CVD risk factors, mostly hypertensive (33%). None with significant CAD had cyanosis, 4 patients (66%) have typical chest pain. Majority of CHD's were simple (61%), mostly atrial septal defects (36%). Four (n=4)(70%) patients with Simple CHD, 2 (30%) patients with Intermediate CHD and none of those with Complex CHD had significant CAD.

CONCLUSION: Prevalence of CAD among ACHD patients using CA in this study is 11.5%. This study supports the notion of routine CA among patients with ACHD ≥ 35 years old with traditional CV risk factors. Need for primary prevention of CAD and modification of traditional CV risk factors among these patients is emphasized, as important with the general population.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Heart Diseases-congenital ; Coronary Artery Disease-Prevalence ; Coronary Angiography

OBJECTIVES: Noonan syndrome is a rare disease presenting with phenotypic features. Over two-thirds of patients with Noonan Syndrome have congenital heart defects with pulmonic stenosis as the most common cardiac abnormality. As a means of focusing on these complications, we report three patients with stigmata of Noonan Syndrome, each of whom had a combination of pulmonic stenosis and other cardiac abnormalities.

PATIENTS AND METHODS: The clinical features and cardiac abnormalities of three patients with Noonan Syndrome were studied, and a literature review on cardiovascular manifestations of this syndrome was undertaken.

RESULTS: The three patients we report had physical features compatible with Noonan Syndrome. Pulmonic stenosis is common among three cases and other cardiac abnormalities were also noted with the aid of 2D-echocardiogram.

CONCLUSION: The existence of several types of cardiac abnormalities within one syndrome is unusual and requires further investigation. Thorough history and physical examination is of utmost importance in diagnosing a rare condition with associated cardiac abnormalities. Recognition of common abnormalities in patients with Noonan Syndrome would aid both clinical course and management of this rare condition.

Human ; Female ; Adult ; Noonan Syndrome ; Craniofacial Abnormalities ; Pulmonary Valve Stenosis ; Heart Septal Defects, Atrial

OBJECTIVE: To describe the demographic and stress profile of the participants in the LIFECARE cohort.

METHODS: The Life Course Study in Cardiovascular Disease Epidemiology (LIFECARE) is a community-based prospective cohort of apparently healthy individuals aged 20 to 50 years old with no preexisting cardiovascular disease. The second phase out of four phases of study involves collection of baseline socio-demographic, anthropometric, biochemical and cardiovascular parameters and stress profiles. It was conducted via face-to-face interview using a survey questionnaire.

RESULTS AND CONCLUSION: A total of 3072 participants from Metro Manila and 4 provinces in Luzon were recruited. The female to male ratio was 1.3:1. Majority of the participants were aged 30 years old and above. Most were married, employed and literate. Majority attained at least high school level of education. Loss of job was the most common stressor experienced in the past year. Majority of the cohort reported occasional experience of general stress and moderate level of financial stress. Occurrence of general stress within the past year was higher among females (p < 0.001), younger age-group (p=0.006), and among those who reached college level of education (p<0.001). Furthermore, level of current financial stress was high to severe among older age-group (p=0.004), and among widow/widower/separated (p<0.0001). While the relationship between psychosocial stress and physical illness had not been established in this study, there is a need to investigate demographics and psychosocial stress, and their implications in increasing adverse health outcomes in general, and cardiovascular risk in particular.

Human ; Male ; Middle Aged ; Adult ; Cardiovascular Diseases-Risk Factors ; Demography

OBJECTIVE: This study aims to describe the socio-ecological and health profile of the Philippine LIFECARE study sites, its health care services and leading causes of mortality and morbidity.

METHODS: This is a prospective cohort study that recruited participants aged 20-50 years from Metro Manila and four provinces (Bulacan, Batangas, Quezon, Rizal). Study sites were characterized according to their geographical area, terrain and environmental profile, and available health care system.

RESULTS: 3,072 subejects were included, with male-to-female ratio of 1:1.3 and majority aged 30-50 years. Metro Manila was the most congested site. Two-thirds of the 62 villages (barangays) were rural, outside the town proper, and in lowlands. One-fourth were along coastal area. Almost all were accessible by public transportation. Majority have reduced forest cover, but were relatively safe from environmental hazards. Rural health units, hospitals, and professional health care workers were concentrated in Metro Manila. Leading cause of morbidity was respiratory tract infection, while cardiovascular diseases caused most of mortalities.

CONCLUSION: Study sites were mainly rural, outside the town proper and in lowlands, with available public transportation. There is an unequal distribution of health resources. Cardiovascular diseases is still the leading cause of mortality. The disparities in geographical access to health care play an important role in shaping human health.

Human ; Male ; Female ; Middle Aged ; Adult ; Health Care Facilities, Manpower, and Services ; Delivery of Health Care ; Health Resources

OBJECTIVE: To describe the self-reported preferences for food taste and cooking methods of adult Filipinos (20-50 years old).

METHODS: This is a cross-sectional community survey of 3,072 adults from Metro Manila, Bulacan, Batangas, Quezon, Rizal.

RESULTS AND CONCLUSION: There were differences in preferred tastes of males (food that tasted "just right", spicy) vs. females (salty); younger adults (sweet, spicy) vs. older adults (bland); urban (salty, spicy) vs. rural adults ("just right") adults with higher education (sweet, salty, spicy) vs. those with less schooling who liked food which tasted "just right." Smokers preferred spicy taste vs. non-smokers who liked sweet-tasting food. Adults who reported having had alcohol intake preferred spicy food. Those who reported feeling stressed liked savoury taste (sweet, salty) while those who were not stressed liked food which tasted "just right." Cooking with oil was the usual and the most preferred cooking method. Younger adults and smokers liked to use oil in cooking. Food which tasted "just right"/moderate was most preferred by adult Filipinos with hpertension or MeTS. Diabetics did not prefer sweet tasting food. More diabetics (p=0.05) and those with MeTS (p=0.003) usually use other cooking methods instead of frying. Eliciting self-reported taste preferences as well as the usual and preferred cooking methods is important for nutritional management and relevant lifestyle advice which healthcare providers should incorporate in their management of patients, especially those with hypertension, diabetes, and metabolic syndrome.

Human ; Male ; Female ; Middle Aged ; Adult ; Food ; Cooking ; Taste

OBJECTIVE: To describe the distribution of the clinical cardiovascular risk profile of the LIFECARE Philippine cohort in relation to its socio-demographic factors.

METHODS: We recruited a total of 3,072 apparently healthy participants from Manila and nearby provinces of Rizal, Batangas, Bulacan and Quezon. Face-to-face interview was done to obtain socio-demographic data. Baseline clinical parameters and biochemical tests were obtained. Prevalence of cardiovascular risk factors was determined by sex, place of residence, level of education and employment.

RESULTS: Overall prevalence of diabetes mellitus was at 5%, similar between sexes, area class, educational attainment and employment status. More smokers were male, employed or with an elementary level of education. Prevalence of hypertension was at 14.5% and was seen more in males, urban dwellers, employed or with an elementary level of education. Dyslipidemia was seen more in males, living in the rural areas, employed or with a college level of education. Lastly, obese participants were seen more in females, living in urban areas, employed with a college level of eduction.

CONCLUSION: Older, male and employed participants who are living in the urban areas have more cardiovascular risk factors.

Human ; Male ; Female ; Middle Aged ; Adult ; Cardiovascular Diseases-Risk Factors ; Demography

INTRODUCTION: Patients with acute coronary syndrome (ACS) exhibit a wide spectrum of early risk of death (one to 10 percent). High platelet counts may indicate a propensity for platelet-rich thrombi. Lymphocyte counts drop during ACS due to stress-induced cortisol release. Combining these two markers, recent studies have found that the platelet-tolymphocyte ratio (PLR) is associated with adverse cardiac events among patients with ACS, but local data is limited. The objective of this study is to determine if an elevated PLR taken on admission is associated with higher rates of adverse cardiac events.

METHODS: A retrospective cohort of adult patients with ACS admitted at the UP-Philippine General Hospital was analyzed. Leukocyte and platelet counts were measured by an automated hematology analyzer. The PLR values of these patients were computed, and they were stratified into two groups after determining the optimal cut-off from the receiver operating characteristic curve (ROC) curve. The primary outcome was in-hospital mortality. Secondary outcomes included development of heart failure, cardiogenic shock, reinfarction, and significant arrhythmias.

RESULTS: A total of 174 Filipinos with ACS were included. In-hospital mortality occurred in 30 patients (17%). These patients had a higher PLR compared to those who were discharged alive (p-value <0.0001). The optimal cutoff value of PLR to predict in-hospital mortality is 165, with a sensitivity of 77% and specificity of 70% (area under the ROC curve of 0.766). On multiple logistic regression analysis, a high PLR was an independent predictor of in-hospital mortality (RR 8.52; p 0.003) after controlling for the effect of other variables. The development of the predetermined secondary outcomes did not correlate with PLR on multivariate analysis.

CONCLUSION: Among Filipino patients with ACS, an elevated PLR taken within 24 hours of admission is a useful marker to predict in-hospital mortality, thus providing vital information for risk stratification and more aggressive management strategies.

Human ; Male ; Female ; Blood Platelets ; Acute Coronary Syndrome ; Shock, Cardiogenic ; Hospital Mortality ; Hydrocortisone ; Hospitals, General ; Philippines ; Lymphocyte Count ; Heart Failure ; Arrhythmias, Cardiac ; Leukocytes ; Hematology

Introduction: Lowering levels of low-density lipoprotein cholesterol (LDL-C) are proven to reduce cardiovascular risk. However, some individuals experience acute coronary events despite normal LDL-C levels. Recent studies have focused on modifiable lipoprotein targets, such as apolipoprotein B (apo-B) and apolipoprotein A-1 (apo A-1) and lipoprotein (a), as targets for therapy. Apo-B is the primary apolipoprotein of LDL-C representing total number of atherogenic particles. Apolipoprotein A-1 is the major component of HDL complex. This study will determine the prevalence of elevated apo-B and low apo A-1 among adult Filipinos with acute coronary syndrome (ACS). Methods: This is a cross-sectional study involving 95 patients with ACS admitted in a tertiary hospital from November 2015 to May 2016. Levels of apo-B, apoA-1, lipoprotein (a), total cholesterol, triglyceride, LDL-C, and high-density lipoprotein cholesterol (HDL-C) were measured within 24 hours upon admission. Results: Forty-eight (48%) percent of patients was diagnosed with Non ST-Elevation-ACS, 39% with ST-Elevation myocardial infarction (STEMI) and 13% with unstable angina.Thirtytwo (32%) percent were on low- to high-intensity statin treatment. The mean LDL-C, non-HDL-C, and HDL-C levels were 109 mg/dL, 135 mg/dL, and 36.89 mg/dL, respectively. The prevalence of elevated apo-B (mean=103.79 mg/ dL; target:<80 mg/dL) was 82%, while that of low apo A-1 (mean=119 mg/dL; target: >120 mg/dL for males, >140 mg/dL for females) was 63%. Lipoprotein (a) levels are high (mean = 48.51 nmol/L; normal:<35 nmol/L) in 42% of patients. Among those on statin therapy, the mean LDL-C was 85 mg/dl, but the mean apo B and lipoprotein (a) levels were elevated at 87.57 mg/dL and 41 nmol/L, respectively. Conclusion Elevated levels of apo B and lipoprotein (a) and low level of apo A-1 are highly prevalent in patients with ACS. Apo-B and lipoprotein (a) levels are likewise elevated among patients with normal LDL levels.
Acute Coronary Syndrome ; Apolipoproteins