Brandstorm L oreal Essay Example

Brandstorm L oreal Paper In the travel industry it doesnt matter which language you speak, which traditions and cultural habits are appropriate or whether it is AM or PM. This industry seems to have its own culture, rules, traditions and inhabitants. LOreal calls the Travel retail market the 6th continent in the world. A borderless continent with its own economy (duty free shops which are ours open), its own capitals: top airports (e. G. Dublin, London Heathers, Hong Kong, Paris Rosins) and its own inhabitants (1 billion): the global shopper/ international traveler: families and business people. Nowadays, shopping has converted into determinant factor while traveling and in some cases a component of choosing a travel destination or the prime motivation to travel. The Economist even talks about the golden hour whenever a passenger steps through the security scanner into the world of travel retail. Travel retail has been growing at about 12 percent in the past few years (LOreal resource pack). A similar growth is expected in the next two to three years, putting it at double the growth rate for the luxury goods market, said Luck Cola, head of luxury goods research at financial services firm Examine BAN Paris. We will write a custom essay sample on Brandstorm L oreal specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Brandstorm L oreal specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Brandstorm L oreal specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Based on these developments Jean-Pula Agony, Chairman and CEO of LOreal Group, sees opportunities for LOreal in the retail travel industry. According to him is Travel retail a key channel for winning over one billion new consumers. This brand development plan aims to explore the opportunities for one of LOreal luxury brands: Lana ¶me, in the travel industry. The first part of this paper focuses on two core pillars; (1) the brand Lana ¶me and (2) the travel retail market. We will first define the segment, target group and positioning (STEP) of Lana ¶me. Additionally we will identify the core associations, strategy and challenges the brand Lana ¶me is facing. Furthermore, in we will identify the market of the travel industry by a racket analysis. Thereafter we will define the role of retail in the travel retail industry. Then we will dive into the competition for Lana ¶me within the travel retail industry by doing a Porter five forces analysis. We will also provide a customer analysis containing the needs and characteristics of the customers/ travelers within the travel retail market. Concluding, we will provide a full SOOT analysis for Lana ¶me in the travel industry and zoom into the opportunities for Lana ¶me in the travel retail industry by proposing an Innovative travel retail service. The second part of this paper consist of our innovative idea and introduces the sub-brand Lana ¶me Travel. We will pitch this innovative experience by addressing whom We see as our potential consumers and how we attract them to our service/experience at the airport. In addition we will provide the strategy, the positioning, the marketing communication initiatives and the brand elements for Lana ¶me I Travel. At the end, a sales pitch about our Lana ¶me I Travel will wrap up our thoughts. Our analysis, and content is based on a self-conducted survey (appendix 4) (N=65) where both free association about the brand Lana ¶me as questions on liker scale about shopping behavior, competitors and brand value are questioned. In this paper we refer to our self-conducted survey as: (Survey Lana ¶me, 2015). In addition to this survey we have used academic and non- academic articles, Rogers and Jorge survey referred as (Labile, 201 5) and the articles in the LOreal brainstorm package. Enjoy reading! 2. Lana ¶me This year, LOreal is celebrating 80 years of beauty with THE brand of women: Lana ¶me. Amanda Patient founded Lana ¶me in 1935, as a fragrance house. The name Lana ¶me comes from a small chateau Lana ¶me which inspired Patient who added the accent mark D to the o, in order to convey French elegance in every language. LOreal acquired the company in 1964 where it became part of LOreal luxury department and offers 3 product categories: skin care (45, 1 %), make-up (21 ,7%) and fragrances (33,2%) (LOreal resource pack). Now the brand has been developed itself in more than 130 countries. During its 80 years of existence, Lana ¶me has established a brand identity containing some key associations: Expensive, luxury, women, mascara, quality, beauty and trustworthy (Labile, 201 5; own survey, 201 5) appendix rod cloud. 2. 1 Lana ¶mes target group: The typical Lana ¶me customer is an elegant and sophisticated woman around the forty years old (Paupers Labile, 2015). Lana ¶me users view Lana ¶me as elegant, luxurious, and high in quality. Furthermore, they do consider Lana ¶me to be expensive however, compared to for example Channel they do not consider Lana ¶me to be overpriced (Paupers Labile, 2015). 2. 2 Lana ¶me performance: In the travel retail industry is LOreal the market leader. Lana ¶me has the largest market share in the Duty Free beauty products category with over 20% (source: generation). Lana ¶mes total brand value is ranked at the 90th place and valued at 6,3 billion USED (Source: Forbes) thanks to successful products such as their best-selling fragrance (ranked as 4th in the world) La vie est. belle, known for its iconic smiling bottle. . Define the travel retail market The Travel Retail market is an upcoming and increasingly growing market. The travel retail distribution channels consist Of; cruises (4%), airports (57%), downtown duty free shops (33%) and airlines (6%) (LOreal resource pack). Hence, the air traffic is the main driver for the travel retail industry and the focus in this paper . Air traffic is continuously growing by 5% on average per year, and represents over 6 billion international flights in 2013. In 201 3, 1. 87 billion people traveled by plane and spend 1 159 billion USED on various top product categories such as tobacco (7%), Wine and spirits (1 7%), Jewelry and Apparel (12%), Fine foods (12%) and Fragrance and cosmetics (30%) (source: illustriously. Com; LOreal resource pack). Asia-Pacific is the most vibrant region for travel Retail, accounting for 37% of all sales (TEA). The most visited airport in 2013 was London Heathers, with 67 Million passengers (Source: IAC). 3. Airport trends and developments In todays speed-driven, globally networked economy, airports are developing into hubs for commerce. Similar to a traditional metropolis of a central city and its outlying suburbs, the airport is becoming the focus of a sprawl of businesses in what has been dubbed the reiterations. What this means for cosmetics and perfumes is that airport shops will no longer be solely for duty- free gifts and indulgences. In the future airports will look like sophisticated shopping malls with not only shops but also a variety of entertainment opportunities such as golf clubs, cinemas and spa centers. Many airports are growing into bigger places focusing on an integrated and personalized experience for travelers while also considering sustainability. The focus areas for airports are (technological) developments such as: atomization and self-service, personalization and nature spaces where people don not have the feeling they are locked up. Retailers can effectively integrate those trends into their services. Several examples are; nature parks, a beauty spa, museum or for instance; loyalty programs, mobile advertising and higher level of in-store services by touch-screen technology which revive an on-the spot- personalized experience. In addition, some concept stores add digital imagery on a shop wall. Some representative modern top airports with top figures in terms of passenger traffic and providing the above mentioned examples are: Istanbul, Doth, Koala Lump, Taipei and Dublin international airport (traffic evolution; LOreal resource pack). 3. 2 What makes the travel retail market unique? There are several factors playing a role, which makes the Duty free travel retail market unique and distinct from the domestic market. Access to the shops is restricted to people who are traveling and in possession of a raiding pass. Travelers passing through airports are from across the globe, international multi-lingual context In travel retail, brands only have a small window of opportunity to attract and engage customers and convert sales Duty-free and travel retail stores are Often open 24/7 Food, drink and duty free tobacco products are normally intended for consumption outside of the country in which they are purchased, the final destination of the products could be anywhere in the world. Only a limited range of products (often luxury brands) are sold in duty free and travel retail shops and cannot be found on the High Street. In addition many products purchased at duty free and travel retail shops are intended for gift giving, with special editions of products and promotions being supplied only to the travel retail sector. Airport duty free and travel retail shops do not compete with the domestic market; rather they compete with each other as passengers have the option of shopping at different airports departure, arrival or transit airport. The European Commission most recently confirmed this position during their investigation into the acquisition of World Duty Free by Autograph, published in May 2008. . Consumer analysis of travel retail consumers The consumer in the travel retail market is the international shopper; they are not only shopping where they live but also wherever they are. Some important general demands of the International shopper are: high interest in good quality/ high end products, convenience and fast/quick service. The international shopper consists of both families and business peo ple who have different, purposes and needs while traveling. This means that retailers have a difficult mission: tailor their offerings to the different needs and purposes (private or business) of the global shopper, whether they are Brazilian, Chinese, Russians or middle Eastern. The upcoming paragraphs will provide an overview and a clear description about the potential global shopper, there needs, motivations and consumer expectations. 4. 1 Characteristics of the global shopper As the travel retail market has grown, the demographics of travel retail have changed dramatically. Indeed, the significance of Chinese and Russian travelers dwarfs other groups. China accounts for 27% of the total market and Russia for 15%. Number three is Indonesia with Its really linked to GAP per capita. As soon as GAP per capita starts to rise and people have ore disposable income, they want to travel, and when they travel, they want to shop. For 82 %of Chinese travelers, shopping is their number one priority, dropping to 56% and 48% respectively for Middle East ern and Russian consumers. The Chinese consider shopping a fundamental part of their travel experience (source: illustriously. Com). It is thus Important to notice that absolutely not solely European or the American travelers are of interest for Lana ¶me, but especially the new emerging nationalities such as the Chinese and Russian shoppers are the biggest spenders (LOreal case study). Another ewe phenomenon is called: the demagnification of traveling. Demagnification means an increase Of the middle class in traveling. This new influx of travelers transforms the travel retail market, which is evolving from a business model focused exclusively on luxury towards a more diversified offer. 4. The needs of the global shopper The global shopper can travel for two purposes; private or business. These two purposes determine the needs of the global shopper. Generally, business travelers demand efficiency and convenience, whereas tourists are generally seeking for entertainment, and browse stores in order to reduce waiting time. Besides these two different purposes, retailers have to deal with the different nationalities of global shoppers. For instance Japanese women want translucent skin products, whereas European woman or North American woman demand bronzing powders. Lana ¶me has to respond to these different needs by, comprising more various products sets, tailor personal service (a beauty consultant who speaks every language) organize different festival or event by nationality (Ramadan, Chinese new year) and offer membership or free gifts after an expenditure of a certain amount and use in- depth data analysis to capture the needs of the potential customers. 4. The motivation to purchase at the airport The main purpose of visiting a duty free store is to purchase a gift, secondly to browse the store and thirdly to take advantage of airport prices (LOreal resource pack). However, we also asked in our self-conducted survey: what the motivation is Of people to buy cosmetic related products. Results show, that consumers purchase cosmetics in duty free stores mainly for personal use (63%) and secondly as a gift (20%) (Survey Lana ¶me, 2015). However, these results are not fully in alignment with Lana;mes resource pack (201 5), where buying a gift is the number one reason to purchase cosmetics. Several other factors affecting consumer behavior in buying beauty products are: store design, price, brand image, availability and good service, good design/ packaging, innovative features and excellent quality. An advantage for travel retail could be that airport travelers are known to be more receptive to marketing communication messages than the average consumer, as they are effectively stuck in airports in search for entertainment. 5. Competitor analysis of Lana ¶me The Travel Retail operating in the six continent results in a new level of competitors for Lana ¶me. On one hand is the national competition expunged. Nevertheless, the main competitors of Lana ¶me are campaigning all around the world on the same tax-free airport boutiques to attract the same global shoppers. In the upcoming paragraphs we will first discuss the main competitors Lana ¶erne is facing in the travel retail as suggested by Yodels (1999). This is theory is based on original ops marketing of McCarthy. Since we are solely focusing on Travel Retail, the Place will be left out. These are namely the airports worldwide and that was already a selection, for showing competitors. Instead of the place, we will show any special offers/campaigns done in the travel industry. According to our survey we detected the following main competitors for Lana ¶me when focusing on the travel retail business: nearly half of our respondents stated Clique as the main competitor in the market with 46%, followed by Channel (37%) Lana ¶me (31%) and Esteem Lauder (29%) (Lana ¶me survey, 2015). The other competitors mentioned in the survey were Clarions, Shied and Christian Dior. However, in the following researches we discovered that Christian Dior also takes a dominant position in the luxury beauty travel market. Therefore, we decided to focus on four main competitors and also included Christian Dior. We will introduce these competitors, their product, price, promotion and target group in table 1 . Additionally to the competitor analysis, we performed a Porter five forces analysis to identify the main threats in the travel retail industry (Porter, 2008). Looking at Porters five forces for the travel retail industry (figure 1), the travel retail industry looks competitive for Lana ¶me. The main threats are the high existing rivalry (the four dominant competitors mentioned in table 1), high buyer power and a high threat for substitutes. In the travel retail industry, there are many luxury brands offering similar products and services. This makes it hard to differentiate. In addition do the buyers in this industry have the power to easily switch to the competitor. However, incumbents such as NC ¶me and Channel have a competitive advantage compared to new entrants. The level of RD, technology, brand portfolio and distribution/ infrastructure are highly developed for incumbents and therefore hard to compete on for new entrance. Figure 1: Porters five forces (Porter, 2008). 6. SOOT Travel Retail for Lana ¶me Based on the results of our self-conducted survey, our competitor analysis and customer analysis, we made a SOOT-analysis (figure 2). We identified our main strengths pertain to Lana ¶me, namely: (1 ) An innovative product line and (2) high quality, (3) Lana ¶mes trustworthiness and lastly (4) Lana ¶mes cohesive brand image. Firstly, Lana ¶me seems to take advantage of LOreal distribution channels and RD investments, which makes the innovativeness and introduction of new products for the Lana ¶me possible. Secondly, based on our survey results and the results of Lullabies survey (2015), do people have high quality perceptions of the brand Lana ¶me. Additionally, is the brand well established and does it have a strong heritage because Of its 80 years Of existence. This Strong heritage has gained the brand trustworthiness and credibility. Lastly, the associative networks of our self conducted survey and Lullabies survey (2015) look very similar. It seems that people come up with the same associations, when they think of the brand Lana ¶me. Even between men and women there are not many differences in the associative network of Lana ¶me (Appendix. However, this cohesive brand image could also be seen as a weakness for the brand. As the brand primary targets women it is weird that men come up with the same associations and women do not have more unique associations with the rand. One of the major problems could be this last point. The brand Lana ¶me does not evoke many unique associations, which could function as a point of difference in their product category. In addition, does a cohesive brand images makes the brand inflexible (difficult to introduce a product line for men). A general threat in the travel retail industry is terrorism. The 9/11 terrorism attacks caused the travel industry a major drop in passengers. These external factors are beyond the control of any retailer but can have immense influences on sales. In addition can security restrictions cause imitations for beauty travel related products, such as liquid volume or package size. This is also beyond the control of retailers. Another threat could be the rise in demand of organic natural products. However, this could also be an opportunity for Lana ¶me. Another big opportunity for Lana ¶me is the growing luxury goods market in BRICK economies (Chinese, Russian travelers having the highest shopping budget). Lastly, we consider personalization and atomization; such as self-service an opportunity for Lana ¶me to differentiate on. Figure 2: SOOT analysis Of Lana ¶me in the Travel Retail industry Case study 2 7. Brand development plan Lana ¶me I Travel 7. 1 Introduction of Lana ¶me I Travel Fasten your stables and discover Lana ¶me I Travel. The objectives of Lana ¶me I travel are twofold: (1) creating brand awareness by development and visibility of Lana ¶me in the travel retail industry, (2) enhance customer loyalty and recruit new customers by responding to current trends at airports: efficiency, self-service and personalization. 7. 2 Introducing the Lana ¶me Travel experience Taking all the above into consideration, we came up with the following innovative experience: a high end Lana ¶me Travel beauty wall, wrapping all rodents in high quality leather tests with a personal message (see appendix 2 3). The wall will have a very exclusive appearance and has to stand for luxury and high quality, as this is found to be expected of Lana ¶me (Paupers Labile, 2015). This unique wall will entail five different rows of content. The rows within the wall can be divided into: skin care, make-up, fragrances, travel kits and a gift packages. Research by paupers and Labile (2015) pointed out that people strongly associate Lana ¶me with Perfume, make-up and cream/care, for that reason they most definitely had to be incorporated onto the wall. Regarding the skin care, make-up and fragrances the most iconic products will be used; advance genuine (skin care), absolute rouge lipstick and hype ¶SE mascara (regarding make-up) and the La vie est. belle fragrance (see picture below). These products are chosen due to the fact that they are world wide most known and used. In 2009 for example, Genuine won 130 international awards and sold more than 9 million bottles (LOreal online article). For this reason they Will be most likely to satisfy the desires of the global traveler, which Lana ¶me is trying to target. The travel kit of Lana ¶me I Travel will consist of a miniature version of the above-mentioned iconic products, except for the lipstick. In addition there will be several customized Lana ¶me I Travel products: a miniature sewing kit, a nail file, ear plugs, a toothbrush and a sleeping mask and a nail polish, which changes with the seasons (see picture below). The mask will be in black silk with the Lana ¶me travel logo on the front in pearliest white. Furthermore, the Lana ¶me I Travel gift package will consist of a La vie est. belle fragrance, a body lotion and a small passport telling the history of Lana ¶me. The most unique attribute is the personalized leather etude. Every product or package extracted from the wall will be placed into a high quality leather etude (appendix 2). This etude can be personalized by choosing a desired color (four options) and by writing a message in gold on the leather etude through a screen on the machine. After completing the desired color and message, the leather etude will be created and issued within only 5 minutes. Below you can find a suggestion how the machine will look like. The focus will be on the high- end appearance and it would be possible to larger the machine to create the o-called wall.

Sweden 1600-1700 essays

Sweden 1600-1700 essays In the period between 1600 and 1700, Sweden saw its fortunes rise and fall. It went from a sparsely populated medieval country to a great European power and finally ended up as a country with great influence within its own region . Some historians even call the 17th century the Swedish Great Power Period. There were both internal and external reasons for Swedens rise to power and eventual fall. Before 1612 Sweden was a country where most of the population were farmers, the country was threatened by Denmark, Swedens army and navy were very small, the country had no universities and very little trade with other countries. Gustavus Adolphus became king when he was only 17 and by the time he died in the battlefield in 1632, he had turned Sweden into a great power. In the middle of the 16th century, when the German Order State fell apart, Sweden, Denmark, Russia, and Poland fought for control over territories in the Baltic area. Sweden took control of the northern part of Estonia. This was the beginning of a very expansive foreign policy that even included settlements in America. During this time Sweden took advantage of the chaos in Russia, because of their Civil War. When a peace treaty was signed, new territories were added to the Finnish part of Sweden. Many countries were anxious to take control of the Baltic States because they wanted to have control of the important customs revenues from trading between Russia and Western Europe. King Gustav II Adolf realized that it would be very difficult to control the northern route so he concentrated on the Baltic Sea. When he was able to get control of the important harbor cities in Polish Prussia the new customs revenues were over 25% of the Swedish state income. There were also internal factors that helped Sweden become a great power: Sweden had a well managed economy, growing domestic iron and weapons industry, and a well governed state. The exter...

An examination of colossians Dissertation Example | Topics and Well Written Essays - 2500 words

An examination of colossians - Dissertation Example On the other hand, there are some scholars who are looking into the past using the lens of the current period. 4This approach also suffers from the pitfall of failing to see the uniqueness of the situation of the past, thus distinguishing it from the current human condition.5 The problem of ethnocentrism is crucial in interpreting past events, contexts, and narratives. In this regard, Colossians 1.12-13 presents an old theme and promise repeatedly told in the Old Testament that is fulfilled by Jesus in the New Testament and yet a seeming contradiction to many in contemporary society, †¦Constantly give thanks to the Father who has empowered us to receive our share in the inheritance of the saints in his kingdom of light. He has rescued us from the dominion of darkness and transferred us to the kingdom of his beloved Son †¦ The verse offers a summary of God’s redemptive act of love. It speaks no longer of a promise, but of a reality that is made available to those â₠¬Å"the Father who has qualified .. to share in the inheritance of His holy people in the kingdom of light†.6 Likewise, it uses the imagery of â€Å"deliverance as presented in Exodus and Jesus theme of Kingdom†. ... The second concern raise against Colossians 1.12-13 is the fact that, the contemporary period, lives in the â€Å"age of syncretism†. The contemporary period is marked by the continued effort of many to harmonize existing religious differences. This is not in itself wrong, but it creates a system wherein Jesus is relegated as one of the founders of religion and Christianity is just one of the many religions.8 In the effort to create a harmonious space for the co-existence of various recognized religions, beliefs, ideologies, and other principles and philosophies, Jesus becomes just one of the leaders of religion, â€Å"they are not denying him , but they are dethroning Him and robbing Him of His rightful place of preeminence†. 9As such, there is a crisis in contemporary Christian faith. Since, many fail to give to God what is due to Him as they focus on other teachings, principles, teachings and beliefs that reduce their obedience, trust, and faithfulness to the Word of God. This same scenario is the primary concern that the faithful in Colossae were facing. In fact, one of the major themes of Colossians is how to address false beliefs that threatened faith of Christians in Colossae. Geographically, Colossae was one of the three cities situated 100 miles from Ephesus.10 The other two cities were Laodicea and Hierapolis.11 Colossae was considered as the melting pot of the East and West. There was a time that it was an important trade route. However, economic activities within the city started to slow down until it became a small town. Nonetheless, Colossae remained a significant city because of the numerous beliefs and philosophies mingled within the city. Ideas continued to influx the city.12 These ideas and

Insights at IT Essay Example | Topics and Well Written Essays - 250 words

Insights at IT - Essay Example Moreover due to lack of interest of customers in the software products owing to their high prices, the software companies have started offering web-based services in which the software programs are not installed on the computer of the customers but services are offered to the customers on web. The customers have started to think that they are not getting the proper business value from the software programs because they think that they are spending more and the return is less. One of the reasons behind this thinking of the customers is the large maintenance costs that they have to pay when the subscription expires. The proof of this lack of interest on part of the customers is the discount offers by various software companies and the increase in the use of web-based software services. The article Six IT Decisions Your IT People Shouldn’t Make, I have observed that the most disastrous practice which is very common in the IT organizations these days is letting IT people prioritiz e the projects according to their business magnitude. No doubt IT people are best at their work and can actually carry out projects successfully but deciding about the projects that which project is the most beneficial for the company is not the job of IT people.

Developing a Sustained Drug Delivery System

Developing a Sustained Drug Delivery System 1. INTRODUCTION In last few years, Formulations that are able to extend the release of drug have become an integral part of Pharmaceutical research. It is a centre of exploration due to its many benefits over conventional dosage form. Sustained drug delivery system was aimed to release the medication in a prolonged rate. The basic concept of the sustained release dosage form development is to reduce the frequency of dosage administration, to reduce the fluctuations of drug in the plasma by maintain plasma drug level1 thus improves. Various expressions such as sustained-release ,controlled-release, prolonged-action and repeat action have also been used to describe.. Sustained release offers prolonged delivery of drugs and maintenain plasma levels within a therapeutic range, steady-state plasma levels can be maintained without oscillation2,3. The sustained level of the medication was obtained by controlling the plasma blood level and less frequent dosing4 (Lachman et al., 1987). 1.1 Matrix system is classified into 5 types based on Hydrophilic Matrix System and insoluble hydrophobic Inert Matrix system (6-8) 1.1.1 Hydrophobic Matrix tablet In this technique of sustained release from an oral dosage form the drug is mixed with an inert or hydrophobic polymer and then compressed into a tablet. The sustained release is obtained by dissolving drug and was diffused through a network of channels that exist between compacted polymer particles. The materials used as inert or hydrophobic matrices consist of polyvinyl chloride, polyethylene, and ethyl cellulose and ammonia methacrylate copolymers. The rate controlling phase in these formulations is the solvent penetration into the matrix. The possible mechanism of drug release in the hydrophobic matrix tablet was by diffusion. Hydrophobic matrix tablet consist of porous and nonporous matrix systems. 1.1.2 Hydrophilic matrix tablets The drug molecules are combined with the polymer and erode slowly in body fluids. Hydroxy propyl methyl cellulose is commonly used polymer in the hydrophilic matrix tablets.It is a simple method and widely accepted due to its desirable global regulatory acceptance, cost effective, flexibility in drug release profile matching and ease of commercial scale-up. The different grades of Hydroxypropylmethylcellulose were available for the design of sustained drug delivery system. The viscosity range of the Hydroxypropyl methylcellulose assist in the percentage release rate of drug release. The low viscosity range polymer cause increase in the drug release. The hydrophilic matrix system the mechanism of drug release occurs mainly by diffusion and erosion. In the hydrophilic matrix system the use of cellulosic polymer cause gel formation on the surface of polymer and cause tablet erosion with continuous release of drug. The polymers commonly used in the hydrophilic matrixes are classified into three categories. Cellulose derivatives- hydroxyethylcellulose, Methylcellulose, Hydroxy propylmethylcellulose grades like K4M, K100M, 5cPs, 15cPs and Sodium carboxymethylcellulose. Semi synthetic polymers- Modified starches, Alginates and Chitosan. Acrylic acid Polymers -Carbopol 934 1.1.3. Wax matrix tablets The drugs are embedded into lipid matrix by spray congealing in air and Wax-matrix tablet core consisting of semi-synthetic glycerides and blend congealing in an aqueous media. The congealing process use with or without the aid of surfactants, the wax matrix components are prepared from the blend of powdered ingredients. 1.1.4. Gum type matrix tablets In this type of matrix system the excipients produce gel like consistency in presence of water and the dispersion of the active drug of the tablet was maintained by gel barrier. For example xanthan gum and sodium alginate in water soluble polysaccharides used in gum type matrix systems. appropriate method depends on the properties of the drug, polymer and selection of other ingredients. Many statistical experiments are useful tool to develop sustained release formulation with an optimized formulation with an appropriate dissolution rate with a minimum number of trials. For this reason, a computer based optimization technique with a response surface methodology (RSM) utilizing a polynomial equation and artificial neural network (ANN) has been widely used (Ghosh et al., 2008andBozic et al., 1997). 2.0  KINETICS OF DRUG RELEASE Various mathematical models utilized to interpret the mechanism of the drug release from ER dosage form, with the available dissolution data these release kinetics can be calculated using the model that best fit is selected based on the correlation coefficient (r) value in various models, which gives higher ‘r’ value is considered as the best fit of the release data. The following are the various Release kinetics Cumulative percentage drug released Vs time (In-Vitro drug release plots) Cumulative percentage drug released Vs Square root of time (Higuchi’s plots) Log cumulative percentage drug remaining Vs Time (First order plots) Log cumulative percentage drug released Vs log time (Peppas plots) Calculated regression coefficients for zero order, first order, Higuchi and Korsmeyer-Peppas. The best fit model with the highest correlation coefficient. Table No. 3. Analysis of diffusion release mechanisms Release exponent (n) Overall solute diffusion mechanism 0.5 Fickian diffusion 0.5 Non-Fickian diffusion 1.0 Case II transport n > 1.0 Super Case II transport Zero order release is calculated from the following equation Qt = Q0 + K0 t where Q0 = initial amount of drug Qt = cumulative amount of drug release at time â€Å"t† K0 = zero order release constant t = time in hours It describes the systems where the drug release rate is independent of its concentration of the dissolved substance. The first order release equation is calculated from the following equation Log Qt = Log Q0+ Kt /2.303 where Q0 = initial amount of drug Qt = cumulative amount of drug release at time â€Å"t† K = first order release constant t = time in hours Here, the drug release rate depends on its concentration The Hixson Crowell release is calculated from the following equation is Where Q0 = Initial amount of drug Qt = Cumulative amount of drug release at time â€Å"t† KHC = Hixson crowell release constant t = Time in hours. It describes the drug releases by dissolution and with the changes in surface area and diameter of the particles or tablets A linear plot of the cube root of the initial concentration minus the cube root of percent remaining versus time in hours for the dissolution data in accordance with the Hixson-crowell equation. The Higuchi release is calculated from the following equation Q=KHt1/2 where Q = cumulative amount of drug release at time â€Å"t† KH = Higuchi constant t = time in hours The Higuchi equation suggests that the drug release by diffusion. A graph is plotted between the square root of time taken on x-axis and the cumulative percentage of drug release on y-axis and it gives a straight line. Korsmeyer – peppas equation is F = (Mt /M ) = Kmtn Where F = Fraction of drug released at time ‘t’ Mt = Amount of drug released at time ‘t’ M = Total amount of drug in dosage form Km = Kinetic constant n = Diffusion or release exponent t = Time in hours An optimal experimental formulation was compared with the original product, in order to compare the profile of the in vitro release of the drug. 3.0  BIOAVAILABILITY STUDY: Stabilitytesting of Drug products conducted as per ICH conditions the formulations which are stable up to 6M 40 °C/75% RH and 25 °C/60% considered as stable formula taken up for in vivo absorption study. In current scenario in vitro and in vivo performance of the dosage forms is essential part of Product development. The FDA guidelines respecting the IVIVC method evaluation used to set dissolution specifications; which can be applied for surrogate for in vivo bioequivalence for certain pre- or post approval changes, such as Equipment, facility or Manufacturing process changes and minimizes the bioavailability or bioequivalence study after the formulation design optimization The ultimate aim of IVIVC is to select the suitable dissolution method of in vivo absorption of the test compound. In IR tablets the release is more rapid in ER, the excipients also having bio pharmaceutical activity and controls the release within the body. Generally HPMC matrices are biocompatible and do not have enzyme degradation by gastric fluids. For Biovailability study the following Pharmacokinetic parameters to be studied they are Tmax, Cmax and AUC can be evaluated via Plasma or Urine data. Pharmacokinetic assessment the plasma drug concentrations determined by HPLC analysis. Drug extracted from plasma sample by liquid-liquid extraction method, To study the rate and extent of absorption of Cilostazol and Etodolac extended release matrix tablets 100 with that of 100 mg reference(R) conventional marketed formulations and IR tablets The research study was performed in rabbit model to evaluate the pharmacokinetics and then for IVIVC studies. The simple HPLC method used to evaluate to determine the drug content in plasma, the in-vitro studies shows the release pattern is slow first order, For Cilostazol the overall Cmax, Tmax, AUC0-t, Kel and T1/2 were completely different between both test and reference formulation (IR). Therefore the prepared formulation was releasing the drug for a prolonged period of time In case of Etodolac the Cmax, Tmax, AUC0-t, Kel and T1/2 were completely comparable with the reference product; therefore the prepared formulation was releasing the drug for a prolonged period of time and bioequivalent with reference product.

Ethical judgements Essay

Our entire life is a continuous process of gaining and retaining information, expanding our knowledge as individuals. Most people spend quite a bit of time in their childhood years in school learning, taking in knowledge that has been produced. As a species humans have produced a wealth of knowledge in a variety of ways. However there comes a time where you have to wonder what extent people would go to, to produce knowledge. Where is the line? When are we doing something ethically wrong? All of these questions bring up another question, do ethics get in the way of producing knowledge? The arts and natural sciences are two areas of knowledge that deal a lot with ethics. The arts are a very free area of knowledge in with people are allowed to express themselves, the natural sciences require a lot of experimentation. In my opinion, knowledge is very valuable, and the production of it should be a priority if the sacrifice is reasonable. The arts are a valuable source of knowledge, producers of art tend to try to convey a message through their artwork. Art comes in many different forms, ranging from visual arts to music and even literary arts. Throughout all forms most of art there are lessons embedded in the art piece, or at least messages conveyed through the art. Similarly, most art contains some form of censorship, artists are not allowed to touch on certain topics. Even if artists decide to make art that touches on controversial or different topics, their art is typically not accepted in society and does not receive any publicity. Again, this is the case with almost all art, however for the purpose of this essay I am going to focus on literary art. An example that is very prevalent in my mind is the ban of _The Book of Negroes_ by Lawrence Hill. A dutchman named Roy Groenberg wrote a letter to Lawrence Hill. In the letter he wrote that a group of people in the Netherlands were going to burn Hill’s book because in contained the word ‘negro’ in the title (Hopper). _The Book of Negroes_ is an award winning book that is about the life of an 11 year-old girl who is kidnapped in a village near Segu in Africa, and sent to North Carolina to be a slave. The book continues to tell the reader about her life as a slave (Hill). _The Book of Negroes_ is widely considered as very moving and a book that conveys important messages (Hopper). Unfortunately, because of the title it was misconceived as a book that was critical of African-Americans. Groenberg was the only person to act on his feelings, however that does not mean he was the only person to see this book as negatively directed at African-Americans. _The Book of Negroes_ was likely misconceived by many more people just because of the inclusion of the word ‘negro’ in the title. Unfortunately, society has made many ethical judgements about the word ‘negro’ which are usually justified but in this case prevent people expanding their knowledge (Hopper). This one of many examples, in which an ethical judgement limited methods available in the production of knowledge. This brings up the question in my mind, why do people shy away from certain words? An attempt to find the answer lead me to the Theory of Knowledge diagram, more specifically the ways of knowing. One way of knowing that intrigues me is language, this seems to answer my question. Language is a very powerful way of knowing, as words can be very powerful. There are handful of words in the english language that are not spoken because of how powerful they are. It seems to me that because of this some words are not tolerated even if the context is appropriate. Which sort of explains why The Book of Negroes received some criticism. It almost makes the criticism understandable, and I can begin to justify Groenberg’s actions. Like I said before, almost all art forms have artwork that is not socially  accepted, and up to this point I’ve only discussed literary art. However in my personal life I have learned about art not being accepted, when it comes to hip-hop music. I regularly listen to hip-hop music and it is a very important part of my life. In the eighth grade for a social studies class I had the opportunity to play a song in class as part of a project. This for me was especially difficult because a lot of hip-hop music is not completely suitable for a eighth grade class setting. Even though I had found a couple of songs that were perfect for what I needed, but had a little too much profanity. I completely understand that there are some inappropriate elements to hip-hop music that are not the best thing for a class room environment. However, I believe by the eighth grade students have developed a level of maturity, and should be able to listen to hip-hop music. All that needed to happen was for my classmates to disregard any profanity and see the song for what it truly is. Similarly, people should have looked past the title â€Å"The Book of Negroes† and read the book to see it for it’s value. Ethical judgments are as prevalent in the arts as they are in the natural sciences. From stem cell research to animal testing, there are a plethora of examples for natural sciences. The arts are as much about entertainment as they are gaining knowledge, or maybe even more. On the other hand the natural sciences is almost entirely about gaining new knowledge and improving what is already known. In this age, developments in natural sciences are nearly only about human advancement. Whether is medically or discovering new things. I am going to mainly focus on how various countries, such as Argentina, the United States, Russia, Iran and France, tested their space equipment. From the mid 1940s all the way to 2013, the mentioned countries have sent monkeys into space (Gray). Before leaders were confident enough to send humans into space, they sent monkeys into space to see how their equipment fared. As expected, most of these monkeys died horrible deaths in flight with no way of knowing what is happening or any way to help themselves (Gray). The most notable instances were the first few monkeys in space. In 1948 NASA sent a  rhesus monkey named Albert 39 miles into the air in a rocket. Albert died of suffocation mid flight, however NASA sent another monkey in the air named Albert II. Albert II survived the flight but died due to a parachute malfunction (Gray). When I discussed the Book of Negroes I reached a conclusion that gaining knowledge is more important than ethical issues. However, when discussing NASA monkeys it is much harder to decide. This is because lives are at stake, although they are not human lives it is still hard to think about something dying for space research. Majority of people agree that sending monkeys into space is wrong. How is it that NASA can design equipment to go into space, but can not create a machine that can detect air pressure and oxygen levels. Again, understanding this point of view is much easier but the theory of knowledge diagram came to my mind again. In the ways of knowing there is emotion, and that is likely the main way of knowing affecting people when they imagine monkeys dying for space research. It is easy to create an emotional bond with an animal as cute as a monkey, and most people can agree monkeys are cute. When reacting on emotions people reach rash conclusions. Which I think can be applied here, I am curious what the reaction would be if NASA tested with uglier or at least less cute animals. What if NASA sent warthogs into space? This is a situation when I personally hate to play devils advocate, however if I was an astronaut in the 1940s I would certainly not go into a space rocket. I have absolutely nothing against monkeys, but if I were forced to make a decision between a monkey dying and a human dying I would choose the monkey, without hesitation. In conclusion, knowledge is very valuable and has been something humans have cherished through the ages. The production of knowledge has been vital to the advancement of the human race. Under most circumstances in the arts and natural sciences, the production of knowledge does not require a major sacrifice, just a small loss or temporary discomfort. There are times in which it is not worth the sacrifice to learn something. However the vast majority of circumstances provide a reasonable loss for the production of  knowledge. Overall, I believe knowledge and the production of knowledge is extremely valuable and should be a priority when it comes to he arts and natural sciences. Works Cited Gray, Tara. â€Å"A Brief History of Animals In Space.† NASA. NASA HQ, 02 Aug 2004. Web. 16 Sep 2013. Hill, Lawrence. The Book of Negroes. Toronto, Ontario, Canada: HarperCollins, 2007. Print. Hopper, Tristin. â€Å"Dutchman threatens to burn The Book of Negroes.† National Post. National Post, 10 Jun 2011. Web. 16 Sep 2013. .

Cardiovascular Diseases

Cardiovascular disease Introduction Heart disease is No. 1 killer disease worldwide. It causes 12 million deaths annually. Thanks to the rising health awareness and government programmes this number significantly reduce during last 30 years. Coronary heart disease and cardiovascular disease Cardiovascular diseases are diseases of the heart (cardiac muscle ) or blood vessels (vasculature).Cardiovascular disease (CVD) means all the diseases of the heart and circulation (blood vessels disease) including coronary heart disease (angina and heart attack) and stroke, as well as coronary and periphery blood vessels disease (problems with circulation). Diseases from this group are the biggest killer in Europe and USA, but developing and non-develop countries too. The final and most tragic consequence of different types of heart disease is heart attack with tragic consequences. Heart diseases are caused by atherosclerosis, a disease of arterial blood vessels resulted from atheroma i. . plaques accumulated (forming; sticking) on artery walls which makes the blood vessels nonelastic and narrowed and leads to decreased blood flow. For the atherosclerosis doctors very often use alternative name chronic cardiovascular disease. The opposite group acute heart disease made group of diseases which are dangerous for patients lives. Acute heart diseases include conditions or illnesses which usually have a rapid onset of symptoms and may resolve within days with or without treatment.A condition or illness that is sudden or severe. On the other hand a condition or illness that arises slowly over days or weeks and may or may not resolve with treatment made a group of chronic heart disease. Both of them are caused by atheroma and the most known are next: a) Acute heart disease Heart attack is caused by lack of O2 in heart muscle cells. Very often it is caused by rupture of â€Å"hard plaques† patches which result in blood clots and partially or completely block blood flow and ca use a heart attack.When a fiber cap becomes thin, these â€Å"hard plaques† can suddenly rupture, spilling their contents, resulting in blood clots that partially or completely block blood flow and cause a heart attack http://www. authorstream. com/Presentation/nitin-35423-heart-diseases-science-technology-ppt-powerpoint/ Cholesterol glossary. http://www. mybwmc. org/library/28/000225 Stroke Stroke is death of brain cells caused by obstructed blood flow to parts of the brain. Since the level of LDL cholesterol is main cause of narrowed of blood vessels, it is necessary control it. If not treated properly, high LDL cholesterol can cause a stroke.Cholesterol glossary. http://www. mybwmc. org/library/28/000225 b) Coronary heart disease Heart disease (coronary heart disease), When the plaque build up in th conorary arteries heart does not get sufficient blood, the condition is called coronary artery disease or coronary heart disease. Atherosclerosis is a disease of arterial blood vessels in which plaques form on artery walls. This is a consequence of different substances circulating in the bloodstream (inflammatory cells, proteins, cholesterol and calcium) sticking inside the vessel walls. Plaque patches influence on narrowing blood flow in the artery. ttp://www. bodybuilding. com/fun/gastelu5. htm Peripheral artery disease (reduced blood flow in the limbs, usually the legs Coronary plaque Coronary plaque is a term which use in practice as a synonym for atheroma or atherosclerosis. Patches of atheroma are formed from substances that circulate in the bloodstream. They consist of lipid, or fat, cores covered by collagen fiber caps which are sticking to the inside of the vessel walls. Over time plaque or patch of atheroma increases making an artery narrower and the blood flow through the artery is reducing.We can see the changes in blood vessels caused by plaque in the Figure 1. Figure 1 Artery with the patches of atheroma – plaque Preventing Cardiovasc ular Diseases. Patient. co. uk. emis < www. patient. co. uk/health/Preventing-Cardiovascular-Diseases. htm> (March 13, 2013) http://medicineworld. org/blogs/heart/blog/permalinks/Jan-2006/coronary-plaque-detection-by-molecular-imaging. html> (March 13, 2013) Mature plaques typically consist of two main components: soft, lipid-rich atheromatous â€Å"gruel† and hard, collagen-rich sclerotic tissue.Lipid-rich and soft plaques are more dangerous than collagen-rich and hard plaques because they are more unstable and rupture-prone and highly thrombogenic after disruption. Researchers have found that many people who have heart attacks do not have arteries narrowed by plaque. Many heart attacks are now known to be caused by soft or vulnerable plaques, located on an inflamed part of an artery. This plaque can burst, leading to the formation of a blood clot that can cause a heart attack. The 2009 issue of â€Å"The American Journal Pathology† edited explanation of those relatio ns discovered by Olga Ovchinnikova and er colleagues. They found that inflammation results in the formation of soft (vulnerable) plaque which is filled with different cell types that promote blood clotting. This leads to a reduction of mature collagen, resulting in thinner caps that are more likely to rupture, even in the cases when total level of plaque isn’t extremely high. The authors advocate different viewpoints about relations between the plaque level and structure, i. e. its influence on heart attack. The first group claims that described types of blockages cause only about 30 percent of heart attacks.On the other hand, some sources state that more than two-thirds of acute coronary events result from rupture of coronary plaques. However problems that plaque creates are extremely dangerous for people’s life and it is very important to prevent and monitor its appearance and changes. Graphs of vulnerable plaque and rupture of plaque which causes a heart attack is p resented below. Figure 2 Vulnerable atherosclerotic plaques. Vulnerable atherosclerotic plaques. A. Atherosclerosis in a chronic disease that leads to plaque rupture and vascular occlusion. B.Cross-section of a lethal coronary plaque rupture. Adapted from Heistad D. Unstable coronary-artery plaques. N Engl J Med. 2003. Atherosclerosis Modeling In-vitro. http://www. remedi. uzh. ch/research/disease. html Figure 3 Plaque Rupture and Heart attack http://hon. nucleusinc. com/generateexhibit. php? ID=30468&A=1027 Factors influencing plaque growth and stability Based on everything mentioned above and medical experience the conclusion about relations between heart attack and other cardiovascular disease and the level of plaque increasing are found.The higher the level of plaque the higher risk of heart disease will be. The level of plaque will increase as the result of high level of cholesterol, type LDL, so called â€Å"bad cholesterol† in blood. When the level of LDL is normal, bl ood can pass in and out of the blood vessels without problems, but if it significantly increase particles of the blood will accumulate and sooner or later provoke trigger (cause) heart attack. Other very important factors influencing plaque level increasing are high blood pressure and cigarette smoking.Both factors accelerate the plaque formation changing (damaging) artery walls and even more, helping cholesterol forming. Medical experience proved that plaque composition and vulnerability (hard or soft plaque) is more responsible for the conversion of a stable disease to a life-threatening condition than the plaque size. Except the plaque vulnerability the risk of plaque disruption is are consequence of rupture triggers (extrinsic forces). Soft plaque – lipid-rich one is more dangerous because of its instability and higher probability for rupture.Even (IAKO) Although â€Å"hard plaque† that one having higher level of calcium influence on the blood vessels walls and the ir â€Å"hardness† experience show that heart attacks are mostly caused by soft plaque disruption. Figure 4 Plaque rupture and its consequences in the form of heart diseases http://www. nature. com/nrg/journal/v7/n3/fig_tab/nrg1805_F2. html Risk factors of coronary heart disease Risk factors influencing cardiovascular disease we can group based on their stability into the three groups: a) Modifiable risk factorsIn this group hypertension is the most dangerous risk factor for heart attacks, but even more for stroke. It is forming as the result of abnormal blood lipid levels which means high total cholesterol, high levels of triglycerides and high levels of low-density lipoprotein or low levels of high-density lipoprotein (HDL). Smoking, physical inactivity, Type 2 diabetes, and a diet full with saturated fats are risk factors strongly influencing the heart disease. All of them are treatable and patients (individuals) belonging into the different types of risk customersâ€℠¢ groups should avoid practice them. b) Non-modifiable risk factorsThe factors from this group mostly are constant, like the case in gender or family history. Others are changing when time is passing, like age and lifestyle and personal habits. Older people have more chance to get heart attack and the man, especially those having â€Å"bad medical history†. Ration between man and woman are changing when women past the menopause. After that the level of risk is similar as the men’s one. As I’ve presented there is direct correlation between cardiovascular disease and condition and health of blood vessels, more precisely of developing atheroma, means level and structure of plaque in vessels.On the other development of plaque and its level is directly influenced by level of cholesterol and some other elements which are connected with individual person and his/her life and genetic predispositions. As with the other diseases everybody has some risk of developing ather oma, but some risk factors increase the risk level for several categories. Those risk factors include: fn 12 †¢Fixed risk factors – factors that person cannot change: oA strong family history which means close relatives who developed heart disease or a stroke before they were 55 (for males) or 65 (for female). Severe baldness in men at the top of the head. oAn early menopause in women. oAge. Older people have more risk to develop atheroma. oEthnic group. Medical data show that people from different ethnic group have different risk for heart diseases. †¢Treatable or partly treatable risk factors include different health problems caused basically by the same causes as the: oHypertension (high blood pressure). oHigh cholesterol blood level. oHigh triglyceride (fat) blood level. oDiabetes. oKidney diseases causing diminished kidney function. All factors from this group have to be controlled and monitor.Any kind of their complication probably will trigger more serious pr oblems such as heart attack or stroke. †¢Lifestyle risk factors that can be prevented or changed. Actually these factors PRETHODE precede to those belonging to the second group. Except the genetic factors way of life and daily habits are the more responsible for different kind of heart diseases. Those factors are: oSmoking (Smoking cigarette increase blood pressure, decrease HDL; damages arteries and blood cells and increases heart attacks. Passive smoking is also a risk factor for cardiovascular disease ) oLack of physical activity. Obesity (People who are overweight (10-30% more than their normal body weight) have 2 to 6 times the risk of developing heart disease. ) oAn unhealthy diet and eating too much salt. oExcess alcohol. Looking on those three groups one can easily conclude that people with â€Å"bad predisposition† having high fixed risk factors have to think about their lifestyle risk factors even more, in order to try to decrease the second group of factors (t reatable or partly treatable risk factors). On the other hand some of risks are more dangerous than the others; for example smoking increases risk for heart disease more than obesity.And of course combination of two or more risk factors increases significantly the level of risks; older man (or woman) who smokes, without physical activity and with bad eating habits has more chance to get some of previously explained disease than the one who have â€Å"just one of bad habits†. The more risk factors someone has the greater is the likelihood that he/she will develop cardiovascular disease, unless taking action to modify his/her risk factors and working to prevent them compromising his/her heart health.That doesn’t mean that people with â€Å"good genes† can be irresponsible and ZANEMARITI risk factors from other groups. With or without genetic predisposition modern life significantly increases a risk of heart disease for everybody. Hormones impact on lipids and othe r risk factors Different numbers of man and women died from heart attack initiated a lot of research about hormones' influence on the risk factor and heart disease development. Number of men died from the heart attack outnumbered the number of women in pre-menopause period, but in the post-menopause data show completely opposite situation.A percentage of women in post-menopause having heart disease and dying from heart attack increase dramatically and now outnumbered the men. The main reasons for those changes are connected to the level of hormones and their influence on level and structure of cholesterol and consequently on risk factors and heart disease. As mentioned before total cholesterol actually is made of two different types of cholesterol: LDL – low density lipoprotein (LDL), so called bad cholesterol and high density lipoprotein (HDL).High levels of LDL cholesterol lead to atherosclerosis increasing the risk of heart attack and ischemic stroke. HDL cholesterol redu ces the risk of cardiovascular disease as it carries cholesterol away from the blood stream. http://www. walgreens. com/marketing/library/careguides/careguide. jsp? docid=000225=28=High%20Cholesterol Estrogen, a female hormone, raises HDL cholesterol levels, partially explaining the lower risk of cardiovascular disease seen in premenopausal women.But after menopause (natural or surgical) when a level of estrogen significantly decreases total cholesterol rises, low density lipoprotein (LDL) cholesterol rises, and high density lipoprotein (HDL) cholesterol does not change or decreases slightly. This is the reason why negative hormones’ effect after menopause increasing more than proportionally. Some authors argue that even influence of estrogen on LDL and HDL level is proved it is yet unclear whether increase in risk is caused, at least partially, by increased level of androgen (the other of hormones belong to steroid as estrogen too), which is characteristics of menopause too. This sexual dimorphism means a lower incidence in atherosclerotic diseases in premenopausal women, which subsequently rises in postmenopausal women to eventually equal that of men. These observations point towards estrogen and progesterone playing a lifetime protective role against CAD in women. As exogenous estrogen and estrogen plus progesterone preparations produce significant reductions in low-density lipoprotein (LDL) cholesterol levels and significant increases in high-density lipoprotein (HDL) cholesterol, this should in theory lower the risk of CAD.UKLOPITI U ONO GORE Among estrogen's positive effects on the heart are: †¢Reducing the LDL (â€Å"bad†) cholesterol in the blood. †¢Increasing the HDL (â€Å"good†) cholesterol in the blood. †¢Helping to keep blood vessels open. †¢Lowering blood pressure at night. †¢Reducing blood viscosity (how sticky the blood is), a property that may cause blood clots which could result in a heart attack o r stroke. Estrogen's effects on clotting are complicated, however, since there also is an increased risk for thromboembolism (a blood clot that blocks a vessel) in women taking estrogen. Possibly enhancing fibrinolysis, which is the body's natural process for breaking down blood clots. Read more: http://ehealthmd. com/content/what-are-benefits-hrt#ixzz2NbWR3MxY http://ehealthmd. com/content/what-are-benefits-hrt#axzz2NbW1GJJN Nutrition guidelines As presented before three different groups of risk factor exist. Some of them people can change but the other are fixed, non-changeable because they caused by genetic heritage ( ) influences. Controllable factors are connected to the lifestyle of person.Lifestyle changes can prevent or slow the development of coronary plaque and heart disease. In order to prevent a disease development one have to keep track of his/her blood pressure and cholesterol levels. Choosing a heart-healthy diet is vital in controlling weight, which helps keep blood pressure and cholesterol levels down. Foods high in cholesterol and saturated fat should be avoided, and quitting smoking is imperative. Regular exercise and an increased overall activity level contribute to heart health and help reduce stress.The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. e. 150 mins/week minimum). Currently practiced measures to prevent cardiovascular disease include: †¢A low-fat, high-fiber diet including whole grains and plenty of fresh fruit and vegetables (at least five portions a d ay)[29][30] †¢Tobacco cessation and avoidance of second-hand smoke;[29] †¢Limit alcohol consumption to the recommended daily limits;[29] consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30%[31][32] However excessive alcohol intake increases the risk of cardiovascular disease. [33] †¢Lower blood pressures, if elevated, through the use of antihypertensive medications[citation needed]; †¢Decrease body fat (BMI) if overweight or obese;[34] Increase daily activity to 30 minutes of vigorous exercise per day at least five times per week;[29] †¢Decrease psychosocial stress. [35] Stress however plays a relatively minor role in hypertension. [36] Specific relaxation therapies are not supported by the evidence. [37] Routine counselling of adults to advise them to improve their diet and increase their physical activity has not been found to significantly alter behaviour, and thus is not recommended. [38] http://www. news-medical. net/health/What-i s-Cardiovascular-Disease. aspx http://www. barnesandnoble. om/w/prevent-halt-and-reverse-heart-disease-joseph-piscatella/1100260037 Primary and secondary prevention of heart disease It is necessary start with prevention from heart disease as early as possible. Changes in the number of people killed by heart attack in developed countries show that prevention and awareness about this group of disease help to http://circ. ahajournals. org/content/123/20/2274/F2. expansion. html health plans must continue to drive cardiovascular care further along the continuum toward primary prevention of cardiovascular disease (CVD).CVD risk factors should be managed not only after a coronary event has occurred, but also before the onset of such and event. Ideally, health lifestyles should be promoted with all patients so that risk factors for CVD never develop. In this way, CVD care can be moved from the inpatient setting to the outpatient setting. Sidney C. Smith Jr, MD. Focus on Cardiovascular Dise ase; A Word About the Quality of Care in Cardiovascular Disease. Director, Center for Cardiovascular Science and Medicine University of North Carolina at Chapel Hill. http://www. qualityprofiles. rg/leadership_series/cardiovascular_disease/cardiovascular_introduction. asp Key priorities for implementation Primary prevention of CVD †¢For the primary prevention of CVD in primary care, a systematic strategy should be used to identify people aged 40–74 who are likely to be at high risk †¢People should be prioritised on the basis of an estimate of their CVD risk before a full formal risk assessment. Their CVD risk should be estimated using CVD risk factors already recorded in primary care electronic medical records †¢Risk equations should be used to assess CVD risk People should be offered information about their absolute risk of CVD and about the absolute benefits and harms of an intervention over a 10-year period. This information should be in a form that: opresen ts individualised risk and benefit scenarios opresents the absolute risk of events numerically ouses appropriate diagrams and text (See www. npci. org. uk) †¢Before offering lipid modification therapy for primary prevention, all other modifiable CVD risk factors should be considered and their management optimised if possible.Baseline blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) thyroid-stimulating hormone (TSH) if dyslipidaemia is present †¢Statin therapy is recommended as part of the management strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD. This level of risk should be estimated using an appropriate risk calculator, or by clinical assessment for people for whom an appropriate risk calculator is not available or appropriate (for example, older people, people with diabetes or people in high-risk ethnic groups) †¢Treatment for the primary prevention of CVD should be initiated with simvastatin 40 mg.If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin may be chosen. Secondary prevention of CVD †¢For secondary prevention, lipid modification therapy should be offered and should not be delayed by management of modifiable risk factors. Blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated.Assessment sho uld include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) othyroid-stimulating hormone (TSH) if dyslipidaemia is present. Statin therapy is recommended for adults with clinical evidence of CVD †¢People with acute coronary syndrome should be treated with a higher intensity statin. Any decision to offer a higher intensity statin should take into account the patient’s informed preference, comorbidities, multiple drug therapy, and the benefits and risks of treatment †¢Treatment for the secondary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions, or simvasta tin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin ay be chosen †¢In people taking statins for secondary prevention, consider increasing to simvastatin 80 mg or a drug of similar efficacy and acquisition cost if a total cholesterol of less than 4 mmol/litre or an LDL cholesterol of less than 2 mmol/litre is not attained. Any decision to offer a higher intensity statin should take into account informed preference, comorbidities, multiple drug therapy, and the benefit and risks of treatment http://www. eguidelines. co. uk/eguidelinesmain/guidelines/summaries/cardiovascular/nice_lipid_modification. phpHow to lower the risk of cardiovascular disease The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All peop le, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. . 150 mins/week minimum). Cessation of smoking The aim of this measure is complete cessation of smoking and avoidance of second-hand smoke. Patient and their families need to stop smoking. Those who are unable to quit may need professional help in form of counselling, behavioral therapy and even pharmacological therapy. Nicotine replacement therapy (NRT) is the first line choice of medication. Nutrition The aim of this measure is to ensure a healthy diet. Total diet should have no more than 8% (of total energy intake) of saturated + trans fatty acids.All patients are advised to take approximately 1g Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) and more than 2g Alpha Linolenic Acid (ALA) daily. Diet should have vegetables, fruits and legumes, g rain-based foods, moderate amounts of lean meats, poultry, fish and reduced fat dairy products. EPA and DHA can be obtained from oily fish and marine n-3 (fish oil) capsule supplements. Alcohol consumption All patients should be advised to lower alcohol consumption. Men should drink no more than 2 standard drinks per day and women no more than 1 standard drink per day. Physical activityThe aim of this measure is to raise physical activity and exercise to the recommended goal of at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week (i. e. 150 mins/week minimum). Maintaining a healthy body weight The aim should be to achieve a waist measure of less than or equal to 94 cm in men and less than or equal to 80 cm in women. The body mass index (BMI) should be maintained at 18. 5–24. 9 kg/m2 Lowering blood cholesterol The aim of therapy should be to maintain blood cholesterol at: †¢Low density lipoprotein (LDL) at – less than 2. mmol/L †¢HDL – more than 1. 0 mmol/L †¢Triglyceride (TG) less than 1. 5 mmol/L The blood cholesterol can be maintained with the use of pharmacotherapy. Statins are commonly used lipid lowering drugs. Those with diabetes and atherosclerosis need stringent blood cholesterol control as well. Other lipid lowering drugs include fibrates like gemfibrosil, clofibrates etc, Ezetimiber and niacin. Lowering blood pressure High blood pressure is one of the important risk factors for cardiovascular disease. Those with coronary heart disease, diabetes, kidney disease or stroke need tight blood pressure control.The aim should be a blood pressure of less than 130/80 mm of Hg. Diabetes and blood sugar control Those diagnosed with diabetes need stringent blood sugar control to prevent cardiovascular damage. HbA1c levels should be maintained at less than 7%. Other drugs to lower risk of cardiovascular disease Other drugs used to lower risk of cardiovascular diseases include: †¢ Antiplatelet agents – this includes Aspirin and Clopidogrel. These drugs when given to patients with risk of heart attacks may prevent such attacks and events. †¢ACE inhibitors like Enalapril, Captopril, Lsinopril and Cardiovascular Diseases Cardiovascular disease Introduction Heart disease is No. 1 killer disease worldwide. It causes 12 million deaths annually. Thanks to the rising health awareness and government programmes this number significantly reduce during last 30 years. Coronary heart disease and cardiovascular disease Cardiovascular diseases are diseases of the heart (cardiac muscle ) or blood vessels (vasculature).Cardiovascular disease (CVD) means all the diseases of the heart and circulation (blood vessels disease) including coronary heart disease (angina and heart attack) and stroke, as well as coronary and periphery blood vessels disease (problems with circulation). Diseases from this group are the biggest killer in Europe and USA, but developing and non-develop countries too. The final and most tragic consequence of different types of heart disease is heart attack with tragic consequences. Heart diseases are caused by atherosclerosis, a disease of arterial blood vessels resulted from atheroma i. . plaques accumulated (forming; sticking) on artery walls which makes the blood vessels nonelastic and narrowed and leads to decreased blood flow. For the atherosclerosis doctors very often use alternative name chronic cardiovascular disease. The opposite group acute heart disease made group of diseases which are dangerous for patients lives. Acute heart diseases include conditions or illnesses which usually have a rapid onset of symptoms and may resolve within days with or without treatment.A condition or illness that is sudden or severe. On the other hand a condition or illness that arises slowly over days or weeks and may or may not resolve with treatment made a group of chronic heart disease. Both of them are caused by atheroma and the most known are next: a) Acute heart disease Heart attack is caused by lack of O2 in heart muscle cells. Very often it is caused by rupture of â€Å"hard plaques† patches which result in blood clots and partially or completely block blood flow and ca use a heart attack.When a fiber cap becomes thin, these â€Å"hard plaques† can suddenly rupture, spilling their contents, resulting in blood clots that partially or completely block blood flow and cause a heart attack http://www. authorstream. com/Presentation/nitin-35423-heart-diseases-science-technology-ppt-powerpoint/ Cholesterol glossary. http://www. mybwmc. org/library/28/000225 Stroke Stroke is death of brain cells caused by obstructed blood flow to parts of the brain. Since the level of LDL cholesterol is main cause of narrowed of blood vessels, it is necessary control it. If not treated properly, high LDL cholesterol can cause a stroke.Cholesterol glossary. http://www. mybwmc. org/library/28/000225 b) Coronary heart disease Heart disease (coronary heart disease), When the plaque build up in th conorary arteries heart does not get sufficient blood, the condition is called coronary artery disease or coronary heart disease. Atherosclerosis is a disease of arterial blood vessels in which plaques form on artery walls. This is a consequence of different substances circulating in the bloodstream (inflammatory cells, proteins, cholesterol and calcium) sticking inside the vessel walls. Plaque patches influence on narrowing blood flow in the artery. ttp://www. bodybuilding. com/fun/gastelu5. htm Peripheral artery disease (reduced blood flow in the limbs, usually the legs Coronary plaque Coronary plaque is a term which use in practice as a synonym for atheroma or atherosclerosis. Patches of atheroma are formed from substances that circulate in the bloodstream. They consist of lipid, or fat, cores covered by collagen fiber caps which are sticking to the inside of the vessel walls. Over time plaque or patch of atheroma increases making an artery narrower and the blood flow through the artery is reducing.We can see the changes in blood vessels caused by plaque in the Figure 1. Figure 1 Artery with the patches of atheroma – plaque Preventing Cardiovasc ular Diseases. Patient. co. uk. emis < www. patient. co. uk/health/Preventing-Cardiovascular-Diseases. htm> (March 13, 2013) http://medicineworld. org/blogs/heart/blog/permalinks/Jan-2006/coronary-plaque-detection-by-molecular-imaging. html> (March 13, 2013) Mature plaques typically consist of two main components: soft, lipid-rich atheromatous â€Å"gruel† and hard, collagen-rich sclerotic tissue.Lipid-rich and soft plaques are more dangerous than collagen-rich and hard plaques because they are more unstable and rupture-prone and highly thrombogenic after disruption. Researchers have found that many people who have heart attacks do not have arteries narrowed by plaque. Many heart attacks are now known to be caused by soft or vulnerable plaques, located on an inflamed part of an artery. This plaque can burst, leading to the formation of a blood clot that can cause a heart attack. The 2009 issue of â€Å"The American Journal Pathology† edited explanation of those relatio ns discovered by Olga Ovchinnikova and er colleagues. They found that inflammation results in the formation of soft (vulnerable) plaque which is filled with different cell types that promote blood clotting. This leads to a reduction of mature collagen, resulting in thinner caps that are more likely to rupture, even in the cases when total level of plaque isn’t extremely high. The authors advocate different viewpoints about relations between the plaque level and structure, i. e. its influence on heart attack. The first group claims that described types of blockages cause only about 30 percent of heart attacks.On the other hand, some sources state that more than two-thirds of acute coronary events result from rupture of coronary plaques. However problems that plaque creates are extremely dangerous for people’s life and it is very important to prevent and monitor its appearance and changes. Graphs of vulnerable plaque and rupture of plaque which causes a heart attack is p resented below. Figure 2 Vulnerable atherosclerotic plaques. Vulnerable atherosclerotic plaques. A. Atherosclerosis in a chronic disease that leads to plaque rupture and vascular occlusion. B.Cross-section of a lethal coronary plaque rupture. Adapted from Heistad D. Unstable coronary-artery plaques. N Engl J Med. 2003. Atherosclerosis Modeling In-vitro. http://www. remedi. uzh. ch/research/disease. html Figure 3 Plaque Rupture and Heart attack http://hon. nucleusinc. com/generateexhibit. php? ID=30468&A=1027 Factors influencing plaque growth and stability Based on everything mentioned above and medical experience the conclusion about relations between heart attack and other cardiovascular disease and the level of plaque increasing are found.The higher the level of plaque the higher risk of heart disease will be. The level of plaque will increase as the result of high level of cholesterol, type LDL, so called â€Å"bad cholesterol† in blood. When the level of LDL is normal, bl ood can pass in and out of the blood vessels without problems, but if it significantly increase particles of the blood will accumulate and sooner or later provoke trigger (cause) heart attack. Other very important factors influencing plaque level increasing are high blood pressure and cigarette smoking.Both factors accelerate the plaque formation changing (damaging) artery walls and even more, helping cholesterol forming. Medical experience proved that plaque composition and vulnerability (hard or soft plaque) is more responsible for the conversion of a stable disease to a life-threatening condition than the plaque size. Except the plaque vulnerability the risk of plaque disruption is are consequence of rupture triggers (extrinsic forces). Soft plaque – lipid-rich one is more dangerous because of its instability and higher probability for rupture.Even (IAKO) Although â€Å"hard plaque† that one having higher level of calcium influence on the blood vessels walls and the ir â€Å"hardness† experience show that heart attacks are mostly caused by soft plaque disruption. Figure 4 Plaque rupture and its consequences in the form of heart diseases http://www. nature. com/nrg/journal/v7/n3/fig_tab/nrg1805_F2. html Risk factors of coronary heart disease Risk factors influencing cardiovascular disease we can group based on their stability into the three groups: a) Modifiable risk factorsIn this group hypertension is the most dangerous risk factor for heart attacks, but even more for stroke. It is forming as the result of abnormal blood lipid levels which means high total cholesterol, high levels of triglycerides and high levels of low-density lipoprotein or low levels of high-density lipoprotein (HDL). Smoking, physical inactivity, Type 2 diabetes, and a diet full with saturated fats are risk factors strongly influencing the heart disease. All of them are treatable and patients (individuals) belonging into the different types of risk customersâ€℠¢ groups should avoid practice them. b) Non-modifiable risk factorsThe factors from this group mostly are constant, like the case in gender or family history. Others are changing when time is passing, like age and lifestyle and personal habits. Older people have more chance to get heart attack and the man, especially those having â€Å"bad medical history†. Ration between man and woman are changing when women past the menopause. After that the level of risk is similar as the men’s one. As I’ve presented there is direct correlation between cardiovascular disease and condition and health of blood vessels, more precisely of developing atheroma, means level and structure of plaque in vessels.On the other development of plaque and its level is directly influenced by level of cholesterol and some other elements which are connected with individual person and his/her life and genetic predispositions. As with the other diseases everybody has some risk of developing ather oma, but some risk factors increase the risk level for several categories. Those risk factors include: fn 12 †¢Fixed risk factors – factors that person cannot change: oA strong family history which means close relatives who developed heart disease or a stroke before they were 55 (for males) or 65 (for female). Severe baldness in men at the top of the head. oAn early menopause in women. oAge. Older people have more risk to develop atheroma. oEthnic group. Medical data show that people from different ethnic group have different risk for heart diseases. †¢Treatable or partly treatable risk factors include different health problems caused basically by the same causes as the: oHypertension (high blood pressure). oHigh cholesterol blood level. oHigh triglyceride (fat) blood level. oDiabetes. oKidney diseases causing diminished kidney function. All factors from this group have to be controlled and monitor.Any kind of their complication probably will trigger more serious pr oblems such as heart attack or stroke. †¢Lifestyle risk factors that can be prevented or changed. Actually these factors PRETHODE precede to those belonging to the second group. Except the genetic factors way of life and daily habits are the more responsible for different kind of heart diseases. Those factors are: oSmoking (Smoking cigarette increase blood pressure, decrease HDL; damages arteries and blood cells and increases heart attacks. Passive smoking is also a risk factor for cardiovascular disease ) oLack of physical activity. Obesity (People who are overweight (10-30% more than their normal body weight) have 2 to 6 times the risk of developing heart disease. ) oAn unhealthy diet and eating too much salt. oExcess alcohol. Looking on those three groups one can easily conclude that people with â€Å"bad predisposition† having high fixed risk factors have to think about their lifestyle risk factors even more, in order to try to decrease the second group of factors (t reatable or partly treatable risk factors). On the other hand some of risks are more dangerous than the others; for example smoking increases risk for heart disease more than obesity.And of course combination of two or more risk factors increases significantly the level of risks; older man (or woman) who smokes, without physical activity and with bad eating habits has more chance to get some of previously explained disease than the one who have â€Å"just one of bad habits†. The more risk factors someone has the greater is the likelihood that he/she will develop cardiovascular disease, unless taking action to modify his/her risk factors and working to prevent them compromising his/her heart health.That doesn’t mean that people with â€Å"good genes† can be irresponsible and ZANEMARITI risk factors from other groups. With or without genetic predisposition modern life significantly increases a risk of heart disease for everybody. Hormones impact on lipids and othe r risk factors Different numbers of man and women died from heart attack initiated a lot of research about hormones' influence on the risk factor and heart disease development. Number of men died from the heart attack outnumbered the number of women in pre-menopause period, but in the post-menopause data show completely opposite situation.A percentage of women in post-menopause having heart disease and dying from heart attack increase dramatically and now outnumbered the men. The main reasons for those changes are connected to the level of hormones and their influence on level and structure of cholesterol and consequently on risk factors and heart disease. As mentioned before total cholesterol actually is made of two different types of cholesterol: LDL – low density lipoprotein (LDL), so called bad cholesterol and high density lipoprotein (HDL).High levels of LDL cholesterol lead to atherosclerosis increasing the risk of heart attack and ischemic stroke. HDL cholesterol redu ces the risk of cardiovascular disease as it carries cholesterol away from the blood stream. http://www. walgreens. com/marketing/library/careguides/careguide. jsp? docid=000225=28=High%20Cholesterol Estrogen, a female hormone, raises HDL cholesterol levels, partially explaining the lower risk of cardiovascular disease seen in premenopausal women.But after menopause (natural or surgical) when a level of estrogen significantly decreases total cholesterol rises, low density lipoprotein (LDL) cholesterol rises, and high density lipoprotein (HDL) cholesterol does not change or decreases slightly. This is the reason why negative hormones’ effect after menopause increasing more than proportionally. Some authors argue that even influence of estrogen on LDL and HDL level is proved it is yet unclear whether increase in risk is caused, at least partially, by increased level of androgen (the other of hormones belong to steroid as estrogen too), which is characteristics of menopause too. This sexual dimorphism means a lower incidence in atherosclerotic diseases in premenopausal women, which subsequently rises in postmenopausal women to eventually equal that of men. These observations point towards estrogen and progesterone playing a lifetime protective role against CAD in women. As exogenous estrogen and estrogen plus progesterone preparations produce significant reductions in low-density lipoprotein (LDL) cholesterol levels and significant increases in high-density lipoprotein (HDL) cholesterol, this should in theory lower the risk of CAD.UKLOPITI U ONO GORE Among estrogen's positive effects on the heart are: †¢Reducing the LDL (â€Å"bad†) cholesterol in the blood. †¢Increasing the HDL (â€Å"good†) cholesterol in the blood. †¢Helping to keep blood vessels open. †¢Lowering blood pressure at night. †¢Reducing blood viscosity (how sticky the blood is), a property that may cause blood clots which could result in a heart attack o r stroke. Estrogen's effects on clotting are complicated, however, since there also is an increased risk for thromboembolism (a blood clot that blocks a vessel) in women taking estrogen. Possibly enhancing fibrinolysis, which is the body's natural process for breaking down blood clots. Read more: http://ehealthmd. com/content/what-are-benefits-hrt#ixzz2NbWR3MxY http://ehealthmd. com/content/what-are-benefits-hrt#axzz2NbW1GJJN Nutrition guidelines As presented before three different groups of risk factor exist. Some of them people can change but the other are fixed, non-changeable because they caused by genetic heritage ( ) influences. Controllable factors are connected to the lifestyle of person.Lifestyle changes can prevent or slow the development of coronary plaque and heart disease. In order to prevent a disease development one have to keep track of his/her blood pressure and cholesterol levels. Choosing a heart-healthy diet is vital in controlling weight, which helps keep blood pressure and cholesterol levels down. Foods high in cholesterol and saturated fat should be avoided, and quitting smoking is imperative. Regular exercise and an increased overall activity level contribute to heart health and help reduce stress.The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. e. 150 mins/week minimum). Currently practiced measures to prevent cardiovascular disease include: †¢A low-fat, high-fiber diet including whole grains and plenty of fresh fruit and vegetables (at least five portions a d ay)[29][30] †¢Tobacco cessation and avoidance of second-hand smoke;[29] †¢Limit alcohol consumption to the recommended daily limits;[29] consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30%[31][32] However excessive alcohol intake increases the risk of cardiovascular disease. [33] †¢Lower blood pressures, if elevated, through the use of antihypertensive medications[citation needed]; †¢Decrease body fat (BMI) if overweight or obese;[34] Increase daily activity to 30 minutes of vigorous exercise per day at least five times per week;[29] †¢Decrease psychosocial stress. [35] Stress however plays a relatively minor role in hypertension. [36] Specific relaxation therapies are not supported by the evidence. [37] Routine counselling of adults to advise them to improve their diet and increase their physical activity has not been found to significantly alter behaviour, and thus is not recommended. [38] http://www. news-medical. net/health/What-i s-Cardiovascular-Disease. aspx http://www. barnesandnoble. om/w/prevent-halt-and-reverse-heart-disease-joseph-piscatella/1100260037 Primary and secondary prevention of heart disease It is necessary start with prevention from heart disease as early as possible. Changes in the number of people killed by heart attack in developed countries show that prevention and awareness about this group of disease help to http://circ. ahajournals. org/content/123/20/2274/F2. expansion. html health plans must continue to drive cardiovascular care further along the continuum toward primary prevention of cardiovascular disease (CVD).CVD risk factors should be managed not only after a coronary event has occurred, but also before the onset of such and event. Ideally, health lifestyles should be promoted with all patients so that risk factors for CVD never develop. In this way, CVD care can be moved from the inpatient setting to the outpatient setting. Sidney C. Smith Jr, MD. Focus on Cardiovascular Dise ase; A Word About the Quality of Care in Cardiovascular Disease. Director, Center for Cardiovascular Science and Medicine University of North Carolina at Chapel Hill. http://www. qualityprofiles. rg/leadership_series/cardiovascular_disease/cardiovascular_introduction. asp Key priorities for implementation Primary prevention of CVD †¢For the primary prevention of CVD in primary care, a systematic strategy should be used to identify people aged 40–74 who are likely to be at high risk †¢People should be prioritised on the basis of an estimate of their CVD risk before a full formal risk assessment. Their CVD risk should be estimated using CVD risk factors already recorded in primary care electronic medical records †¢Risk equations should be used to assess CVD risk People should be offered information about their absolute risk of CVD and about the absolute benefits and harms of an intervention over a 10-year period. This information should be in a form that: opresen ts individualised risk and benefit scenarios opresents the absolute risk of events numerically ouses appropriate diagrams and text (See www. npci. org. uk) †¢Before offering lipid modification therapy for primary prevention, all other modifiable CVD risk factors should be considered and their management optimised if possible.Baseline blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) thyroid-stimulating hormone (TSH) if dyslipidaemia is present †¢Statin therapy is recommended as part of the management strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD. This level of risk should be estimated using an appropriate risk calculator, or by clinical assessment for people for whom an appropriate risk calculator is not available or appropriate (for example, older people, people with diabetes or people in high-risk ethnic groups) †¢Treatment for the primary prevention of CVD should be initiated with simvastatin 40 mg.If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin may be chosen. Secondary prevention of CVD †¢For secondary prevention, lipid modification therapy should be offered and should not be delayed by management of modifiable risk factors. Blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated.Assessment sho uld include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) othyroid-stimulating hormone (TSH) if dyslipidaemia is present. Statin therapy is recommended for adults with clinical evidence of CVD †¢People with acute coronary syndrome should be treated with a higher intensity statin. Any decision to offer a higher intensity statin should take into account the patient’s informed preference, comorbidities, multiple drug therapy, and the benefits and risks of treatment †¢Treatment for the secondary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions, or simvasta tin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin ay be chosen †¢In people taking statins for secondary prevention, consider increasing to simvastatin 80 mg or a drug of similar efficacy and acquisition cost if a total cholesterol of less than 4 mmol/litre or an LDL cholesterol of less than 2 mmol/litre is not attained. Any decision to offer a higher intensity statin should take into account informed preference, comorbidities, multiple drug therapy, and the benefit and risks of treatment http://www. eguidelines. co. uk/eguidelinesmain/guidelines/summaries/cardiovascular/nice_lipid_modification. phpHow to lower the risk of cardiovascular disease The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All peop le, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. . 150 mins/week minimum). Cessation of smoking The aim of this measure is complete cessation of smoking and avoidance of second-hand smoke. Patient and their families need to stop smoking. Those who are unable to quit may need professional help in form of counselling, behavioral therapy and even pharmacological therapy. Nicotine replacement therapy (NRT) is the first line choice of medication. Nutrition The aim of this measure is to ensure a healthy diet. Total diet should have no more than 8% (of total energy intake) of saturated + trans fatty acids.All patients are advised to take approximately 1g Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) and more than 2g Alpha Linolenic Acid (ALA) daily. Diet should have vegetables, fruits and legumes, g rain-based foods, moderate amounts of lean meats, poultry, fish and reduced fat dairy products. EPA and DHA can be obtained from oily fish and marine n-3 (fish oil) capsule supplements. Alcohol consumption All patients should be advised to lower alcohol consumption. Men should drink no more than 2 standard drinks per day and women no more than 1 standard drink per day. Physical activityThe aim of this measure is to raise physical activity and exercise to the recommended goal of at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week (i. e. 150 mins/week minimum). Maintaining a healthy body weight The aim should be to achieve a waist measure of less than or equal to 94 cm in men and less than or equal to 80 cm in women. The body mass index (BMI) should be maintained at 18. 5–24. 9 kg/m2 Lowering blood cholesterol The aim of therapy should be to maintain blood cholesterol at: †¢Low density lipoprotein (LDL) at – less than 2. mmol/L †¢HDL – more than 1. 0 mmol/L †¢Triglyceride (TG) less than 1. 5 mmol/L The blood cholesterol can be maintained with the use of pharmacotherapy. Statins are commonly used lipid lowering drugs. Those with diabetes and atherosclerosis need stringent blood cholesterol control as well. Other lipid lowering drugs include fibrates like gemfibrosil, clofibrates etc, Ezetimiber and niacin. Lowering blood pressure High blood pressure is one of the important risk factors for cardiovascular disease. Those with coronary heart disease, diabetes, kidney disease or stroke need tight blood pressure control.The aim should be a blood pressure of less than 130/80 mm of Hg. Diabetes and blood sugar control Those diagnosed with diabetes need stringent blood sugar control to prevent cardiovascular damage. HbA1c levels should be maintained at less than 7%. Other drugs to lower risk of cardiovascular disease Other drugs used to lower risk of cardiovascular diseases include: †¢ Antiplatelet agents – this includes Aspirin and Clopidogrel. These drugs when given to patients with risk of heart attacks may prevent such attacks and events. †¢ACE inhibitors like Enalapril, Captopril, Lsinopril and