Effective policies to control hypertension require an understanding of its distribution in the population and the barriers people face along the pathway from detection through to treatment and control. One key factor is household wealth, which may enable or limit a household’s ability to access health care services and adequately control such a chronic condition. This study aims to describe the scale and patterns of wealth-related inequalities in the awareness, treatment and control of hypertension in 21 countries using baseline data from the Prospective Urban and Rural Epidemiology study. A cross-section of 163,397 adults aged 35 to 70 years were recruited from 661 urban and rural communities in selected low-, middle- and high-income countries (complete data for this analysis from 151,619 participants). Using blood pressure measurements, self-reported health and household data, concentration indices adjusted for age, sex and urban-rural location, we estimate the magnitude of wealth-related inequalities in the levels of hypertension awareness, treatment, and control in each of the 21 country samples. Overall, the magnitude of wealth-related inequalities in hypertension awareness, treatment, and control was observed to be higher in poorer than in richer countries. In poorer countries, levels of hypertension awareness and treatment tended to be higher among wealthier households; while a similar pro-rich distribution was observed for hypertension control in countries at all levels of economic development. In some countries, hypertension awareness was greater among the poor (Sweden, Argentina, Poland), as was treatment (Sweden, Poland) and control (Sweden). Inequality in hypertension management outcomes decreased as countries became richer, but the considerable variation in patterns of wealth-related inequality - even among countries at similar levels of economic development - underscores the importance of health systems in improving hypertension management for all. These findings show that some, but not all, countries, including those with limited resources, have been able to achieve more equitable management of hypertension; and strategies must be tailored to national contexts to achieve optimal impact at population level.

Background and Purpose The association of dyslipidemia with stroke has been inconsistent, which may be due to differing associations within etiological stroke subtypes. We sought to determine the association of lipoproteins and apolipoproteins within stroke subtypes.Methods Standardized incident case-control STROKE study in 32 countries. Cases were patients with acute hospitalized first stroke, and matched by age, sex and site to controls. Concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apoA1), and apoB were measured. Non-HDL-C was calculated. We estimated multivariable odds ratio (OR) and population attributable risk percentage (PAR%). Outcome measures were all stroke, ischemic stroke (and subtypes), and intracerebral hemorrhage (ICH).Results Our analysis included 11,898 matched case-control pairs; 77.3% with ischemic stroke and 22.7% with ICH. Increasing apoB (OR, 1.10; 95% confidence interval [CI], 1.06 to 1.14 per standard deviation [SD]) and LDL-C (OR, 1.06; 95% CI, 1.02 to 1.10 per SD) were associated with an increase in risk of ischemic stroke, but a reduced risk of ICH. Increased apoB was significantly associated with large vessel stroke (PAR 13.4%; 95% CI, 5.6 to 28.4) and stroke of undetermined cause. Higher HDL-C (OR, 0.75; 95% CI, 0.72 to 0.78 per SD) and apoA1 (OR, 0.63; 95% CI, 0.61 to 0.66 per SD) were associated with ischemic stroke (and subtypes). While increasing HDL-C was associated with an increased risk of ICH (OR, 1.20; 95% CI, 1.14 to 1.27 per SD), apoA1 was associated with a reduced risk (OR, 0.80; 95% CI, 0.75 to 0.85 per SD). ApoB/A1 (OR, 1.38; 95% CI, 1.32 to 1.44 per SD) had a stronger magnitude of association than the ratio of LDL-C/HDL-C (OR, 1.26; 95% CI, 1.21 to 1.31 per SD) with ischemic stroke (P<0.0001). Conclusions The pattern and magnitude of association of lipoproteins and apolipoproteins with stroke varies by etiological stroke subtype. While the directions of association for LDL, HDL, and apoB were opposing for ischemic stroke and ICH, apoA1 was associated with a reduction in both ischemic stroke and ICH. The ratio of apoB/A1 was the best lipid predictor of ischemic stroke risk.

Impaired lung function and insulin resistance have been associated and thereby have also been indicated to be powerful predictors of cardiovascular mortality. Therefore, the co-existence of insulin resistance and impaired lung function accompanied with cardiovascular risk factors should induce cardiovascular mortality even in patients without known respiratory disease in a cumulative pattern. It could be useful to determine the lung function of patients with insulin resistance in order to decrease cardiovascular mortality by means of taking measures that minimize the risk of decline in lung function. However, no prior studies have been done on association between insulin resistance and lung function in adults in Turkey. We aimed to determine if insulin resistance plays a detrimental role in lung function in outpatients admitted to internal medicine clinics in adults from Turkey. A total of 171 outpatients (mean ± SD) age: 43.1 ± 11.9) years) admitted to internal medicine clinics were included in this single-center cross-sectional study, and were divided into patients with (n = 63, mean ± SD) age: 43.2 ± 12.5) years, 83.5 % female) or without (n = 108, mean ± SD) age: 43.0 ± 11.6) years, 93.5 % female) insulin resistance. All patients were non-smokers. Data on gender, age, anthropometrics, blood pressure, blood biochemistry, metabolic syndrome (MetS), and lung function tests were collected in each patient. Correlates of insulin resistance were determined via logistic regression analysis. Insulin resistance was present in 36.8 % of patients. Logistic regression analysis revealed an increase in the likelihood of having insulin resistance of 1.07 times with every 1-point increase in waist circumference, 1.01 times with every 1-point increase in triglycerides, 0.93 times with every 1-point decrease in HDL (high density lipoprotein) cholesterol, and 0.86 times with every 1-point decrease in percentage of FEV1/FVC pre (FEV1%pre: Forced expiratory volume in the first second of expiration for predicted values; FVC%pre.: Forced vital capacity for predicted values). Insulin resistance should also be considered amongst the contributing factors for decline in lung function.

Background: It is not clear whether conventional vascular risk factors are responsible for most strokes in patients younger than 45 years of age. Our objective was to evaluate the association of common risk factors with stroke in individuals under 45 years. Methods: INTERSTROKE was a case-control study carried out in 32 countries between 2007 and 2015. Patients presenting within 5 days of symptom onset of a first stroke were enrolled as cases. Controls were age and sex matched to cases and had no history of stroke. Cases and controls underwent similar evaluations. Odds ratios (ORs) and population attributable risks (PARs) were calculated to determine the association of various risk factors with all stroke, ischemic stroke, and intracranial hemorrhage, for patients 45 years of age or younger. Findings: 1,582 case-control pairs were included in this analysis. The mean age of this cohort was 38.5 years (SD 6.32). Overall, 71% strokes were ischemic. Cardiac causes {OR: 8.42 (95% confidence interval [CI]: 3.01–23.5)}; binge drinking of alcohol (OR: 5.44 [95% CI: 1.81–16.4]); hypertension (OR: 5.41 [95% CI: 3.40–8.58]); ApoB/ApoA1 ratio (OR: 2.74 [95% CI: 1.69–4.46]); psychosocial stress (OR: 2.33 [95% CI: 1.01–5.41]); smoking (OR: 1.85 [95% CI: 1.17–2.94]); and increased waist-to-hip ratio (OR: 1.69 [95% CI: 1.04–2.75]) were the most important risk factors for ischemic stroke in these young cases. For intracerebral hemorrhage, only hypertension (OR: 9.08 [95% CI: 5.46–15.1]) and binge drinking (OR: 4.06 [95% CI: 1.27–13.0]) were significant risk factors. The strength of association and population attributable risk (PAR) for hypertension increased with age (PAR 23.3% in those <35 years of age, 50.7% in 35–45 years of age). Interpretation: Conventional risk factors such as hypertension, smoking, binge drinking of alcohol, central obesity, cardiac causes, dyslipidemia, and psychosocial stress are important risk factors for stroke in those younger than 45 years of age. Hypertension is the most significant risk factor in all age groups and across all regions and both stroke subtypes. These risk factors should be identified and modified in early adulthood to prevent strokes in young individuals.

Objective: Obesity is one of the most common comorbidities of diabetes mellitus (DM) whose frequency is rapidly increasing nowadays. Although obesity caused by excessive and unbalanced nutrition often accompanies diabetes; malnutrition is another complication of diabetes. This study was conducted to investigate the frequency of malnutrition in individuals with diabetes. Method: This study is a cross-sectional study. The patients with type 2 diabetes followed up in the diabetes outpatient clinic of a university hospital between February and March 2018 were included in the study. Anthropometric measurements of the patients and “Nutritional Risk Screening-2002” (NRS-2002) scores were recorded. Results: A total of 222 (F: 132 59.4%) patients were included in the study. When two groups with higher NRS (≥3) and lower NRS (<3) scores less than 3 were compared, any significant difference was not detected between two groups in terms of age, waist circumference and HbA1c values. Only BMI was found to be lower in the group with malnutrition risk (p: 0.030). When the patients were evaluated in terms of diabetes treatments and risk of malnutrition, any significant intergroup difference was not found (p: 0.847). Conclusion: It was found that there is a risk of malnutrition in one of every seven diabetics with a high body mass index who were being followed up in the diabetes outpatient clinic.

Objective: The Prospective Urban Rural Epidemiology (PURE) study is a prospective cohort study that collects data on social, environmental, and individual risk factors and chronic diseases among residents of 25 countries in the range of 35 to 70 years of age, living in rural and urban areas. The PURE study is directed by the Population Health Research Institute of McMaster University in Canada. In Turkey, the study is conducted by the Metabolic Syndrome Society. Methods: In Turkey, the study is being conducted in 8 cities. The initial fieldwork began in 2008. Questionnaires were completed, and anthropometric measurements, blood and urine samples, handgrip strength evaluations, electrocardiogram readings, and spirometer and body composition measurements were obtained. Each year, participants were followed up via telephone. Every third year, questionnaires, field measurements, and biological data sampling were repeated. Results: PURE Turkey has 4056 participants (female: 60.7%, male: 39.3%; mean age: 50 +/- 9.1 years). Among them, 43.9% had metabolic syndrome and 52.8% were obese. The prevalence of hypertension was 41.1% and proportion of controlled hypertension was 34%. A total of 2098 (51.7%) of the participants had a total cholesterol of >= 200 mg/dL or were using a lipid lowering agent. In patients with diabetes, 79.8% had low-density lipoprotein cholesterol levels >= 100 mg/dL. Although a dramatic change was not observed in those parameters in the follow-up years, the prevalence of diabetes mellitus increased from 13.7% in 2008 to 21% in 2015. The baseline and follow-up data of the PURE study were analyzed with the other countries participating in the study and reported for international publication. Conclusion: The PURE study is a large, ongoing, prospective epidemiological study that is investigating the "causes of the causes" of noncommunicable diseases in the world. In addition to revealing the health status of nations, the study also has the potential to affect health politics.