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A Systematic Evaluation of Risk Factors associated with the Epidemiology of Heart Diseases in Australia

Research Problem

This research proposal attempts to identify and emphasize evidence related to the requirement of undertaking systematic study for exploring the influence of non-modifiable (i.e. cardiometabolic) and modifiable (i.e. psychosocial and life style related) risk factors on the predisposition of Australian residents in terms of acquiring heart diseases across the community environment. The conventional risk factors facilitating the establishment of cardiovascular conditions include diseases like diabetes mellitus, hypercholesterolemia, hypertension as well as smoking history and family history of heart diseases. The clinicians and healthcare professionals require evaluating the levels of lipoprotein, C-reactive protein and coronary artery calcium score of Australian natives with the objective of tracking their risk for acquiring cardiovascular conditions (Akhabue, et al., 2014). Furthermore, evaluation of functionality of high-density lipoprotein, lipoprotein-associated phospholipase A2 and homocysteine is also required for calculating the likelihood of individuals in terms of acquiring coronary heart disease and associated manifestations. The precise evaluation of cardiovascular risk factors will assist the healthcare teams in reducing the burden of heart diseases following the systematic administration of preventive and prophylactic healthcare approaches and remedial interventions in predisposed individuals (Akhabue, et al., 2014). Evidence-based literature reveals the high burden of cardiovascular diseases in the Australian population (Waters, Trinh, Chau, Bourchier, & Moon, 2013). The higher percentage of indigenous groups, people residing in remote locations and individuals pertaining to the underprivileged sections of Australian society experience an elevated risk of acquiring cardiovascular manifestations, in comparison to the established sections of the society. Evidence-based findings confirm that despite considerable decrease in hospitalization rates and mortalities among the Australian natives, cardiovascular disease significantly affects the health status and wellness outcomes of individuals across the community environment (Waters, Trinh, Chau, Bourchier, & Moon, 2013). These evidence-based findings substantiate the requirement of undertaking a research study for the systematic assessment of cardiovascular risk factors of Australian individuals.

What is Already Known — Background

The analysis by (Dassanayake, Dharmage, Gurrin, Sundararajan, & Payne, 2009) reveals the pattern of physical inactivity and smoking that leads to the establishment of heart diseases among the Australian immigrants. These immigrants also acquire alcoholism that significantly influence their predisposition towards experiencing cardiometabolic manifestations. The South European and Middle Eastern immigrants in Australia remain affected with hypertensive episodes and hypercholesterolemia manifestations that substantially increase their risk of experiencing heart diseases and associated clinical complications (Dassanayake, Dharmage, Gurrin, Sundararajan, & Payne, 2009). Research analysis by (Guo, Lucas, Joshy, & Banks, 2015) reveals obesity and elevated body mass index of Australian individuals as significant risk factors for cardiovascular conditions. The findings also indicate the diabetic pattern of Southeast Asian immigrants that increase their predisposition towards acquiring cardiovascular disorders. Australian individuals with Northeast Asian origin experience lesser risk factors related to heart diseases. Indeed, sociodemographic variables considerably influence the cardiovascular health profile of individuals across various geographical confinements (Guo, Lucas, Joshy, & Banks, 2015). For example, people with lower educational level experience high-risk of acquiring cardiac conditions because of their deficient knowledge regarding the pattern of health and wellness. These people remain unaware of the requirement of administering preventive interventions for reducing their cardiovascular disease risk across the community environment (Guo, Lucas, Joshy, & Banks, 2015). Similarly, the individuals below the poverty line experience sustained deficit in terms of healthcare resources due to that they experience various epidemic conditions and chronic disease states that facilitate the establishment of cardiovascular conditions across their community.

Research analysis by (Eilat-Adar, Sinai, Yosefy, & Henkin, 2013) indicates the influence of lifestyle factors on the aetiology of cardiovascular conditions. Australian individuals who remain on high-fat and high-carbohydrate diet experience risk of acquiring an elevation in body-mass index and cardiovascular manifestations. Overweight Australian natives who do not follow Mediterranean dietary approaches remain at elevated risk of acquiring heart disease and associated debilitating manifestations (Martinez-Gonzalez & Bes-Rastrollo, 2014). This Mediterranean diet includes the plant based food items and protein sources that substantially elevate the cardiovascular health of people who consume them on a regular basis (Anand, et al., 2015). The research study by (Willett, 2012) reveals the adverse influence of trans fatty acids on cardiovascular health of individuals who consistently consume hydrogenated vegetable oils on a regular basis. The absence of consumption of N-3 and N-6 polyunsaturated fatty acids by underprivileged Australian natives increases their risk of acquiring heart diseases across the community environment (Willett, 2012). Furthermore, the consumption of dairy products and red meat elevates the establishment of cardiovascular manifestations. Australian individuals who refrain from consuming nonhydrogenated vegetable oils, soy products, fish and nuts also experience high-risk of acquiring coronary heart disease. Evidence-based research literature advocates the adverse influence of dietary cholesterol on cardiovascular disease risk of Australian individuals (Berger, Raman, Vishwanathan, Jacques, & Johnson, 2015). The elevated concentration of dietary cholesterol reciprocally increases the ratio of LDL cholesterol and serum total cholesterol that substantially increase the likelihood of acquiring cardiovascular conditions across the community environment. The pattern of dietary carbohydrate revealed through the systematic assessment of glycaemic load determines the risk of acquiring cardiovascular disease conditions in the Australian natives (Siri-Tarino, Sun, Hu, & Krauss, 2010). The elevated blood glucose concentration acquired following the consumption of refined carbohydrates reduces the cardiovascular health of individuals. The concomitant consumption of carbohydrate and saturated fat increases the relative risk of individuals towards acquiring heart diseases and associated life threatening manifestations. The statistical findings evaluated by (Tuso, Ismail, Ha, & Bartolotto, 2013) reveal the potential of non-plant based diets in causing cardiovascular mortalities. Contrarily, the administration of plant-based diets containing essential amino acids, iron, vitamin B-12, calcium, vitamin D and fatty acids reduces the risk of development of heart diseases and associated symptomatology. The Australian natives who continue to consume non-vegetarian diet on regular basis experience high-risk of acquiring heart diseases across the community environment. The absence of vegetarian elements in diet leads to elevation in diastolic and systolic blood pressure that increases the risk of developing cardiovascular abnormalities. The acquisition of sedentary life style and high salt intake induces the renin-angiotensin system as well as the sympathetic nervous system, thereby leading to the development of cardiac hypertrophy and congestive heart failure (Kannan & Janardhanan, 2014). Evidence-based research literature advocates high prevalence of hypertensive cases in the Australian population (Gallego, et al., 2013). Hypertension attributes to 45% of cardiovascular mortalities as well as the pattern of disabilities among the affected patients. Individuals who consume inappropriate diet and remain socioeconomically underprivileged experience increased risk of developing uncontrolled blood pressure and associated risk of acquiring cardiovascular conditions. Elderly patients affected with kidney disease also experience the risk of developing heart disease and associated adverse manifestations (Gallego, et al., 2013). The clinical findings in (Fox, 2010) confirm diabetes complications as the significant risk factors that result in the pattern of mortalities from cardiovascular abnormalities. Australian patients affected with diabetes experience 4-fold risk of acquiring life threatening conditions like cerebrovascular accident, peripheral arterial disease, congestive heart failure and myocardial infarction. The diabetic women indeed, remain at elevated risk of acquiring heart diseases in comparison to the men counterparts. The key risk-factors (of diabetes) also contribute to the development of cardiovascular conditions as associated co-morbid states (Fox, 2010). Overweight patients affected with metabolic syndrome develop the pattern of abnormal waist circumference, reduced HDL cholesterol, increased triglycerides and blood sugar level and impaired fasting glucose that significantly increases their likelihood of developing diabetic pattern and cardiovascular conditions (Fox, 2010). The development of hyperlipidaemia under the influence of metabolic and vascular abnormalities also leads to the establishment of heart diseases among the Australian natives.

Most patients affected with coronary heart disease experience at least one of the cardiovascular risk factors including smoking, hypercholesterolemia, hypertension and diabetes (Canto, et al., 2011). Patients who exhibit measurable cardiovascular risk factors develop arteriosclerosis manifestations that lead to the development of heart conditions like coronary artery disease and congestive heart failure. Evidence-based findings also reveal the decreased mortalities among patients affected with the pattern of MI in the absence of traditional cardiovascular risk factors. Patients who undertake medical management for controlling the cardiovascular risk factors at an early stage experience improved prognosis and reduced pattern of mortality. Indeed, measurable risk factors assist the healthcare professionals in calculating the likelihood of patients for acquiring heart diseases and associated clinical manifestations. The clinical findings in (Lemstra, Rogers, & Moraros, 2015) indicate the pattern of socioeconomic status as a significant contributory factor that influences the establishment of heart diseases among the Australian natives. The having low household income remain predisposed towards the development of cardiovascular conditions and associated mortalities across the community environment. The pattern of low household income also adversely influences the behavioural state of the affected people. Behavioural abnormalities lead to the development of smoking habit and physical inactivity that eventually assist in the establishment of heart diseases. The pattern of distress experienced by people under economic constrains deprives them from attaining qualitative healthcare interventions that facilitate the development of chronic heart conditions among the affected individuals. The poor lifestyle and underprivileged status of Australian indigenous groups increases their burden of heart diseases across the community environment (Woods, Katzenellenbogen, Davidson, & Thompson, 2012). Aboriginal and indigenous people experience elevated episodes of rheumatic fever, myocardial infarction, coronary heart disease and hypertension. The reduced quality of life and cultural dissimilarities of the indigenous groups restrain them from acquiring healthy dietary habits and accessing healthcare services for the enhancement of their wellness outcomes. The cultural and language barriers restrict the delivery of qualitative healthcare interventions to the aboriginal natives and resultantly, they experience elevated risk of acquiring the conditions like chronic obstructive pulmonary disease and diabetes that substantially increases their predisposition towards acquiring cardiovascular conditions and associated debilitating manifestations (Woods, Katzenellenbogen, Davidson, & Thompson, 2012). Indigenous as well as underprivileged sections of Australian society also experience knowledge gaps regarding the cardiovascular risk factors. Eventually, they fail to undertake health service planning and increase their risk of developing cardiovascular conditions and related mortalities. The underprivileged Australians who exhibit personal history of MI and other heart conditions experience high-risk of experiencing a relapse of cardiovascular co-morbid states and associated adverse manifestations. The lack of primary and prophylactic healthcare interventions further increases the predisposition of underprivileged Australians in terms of acquiring cardiovascular conditions across the community environment (Woods, Katzenellenbogen, Davidson, & Thompson, 2012). The state of psychosocial isolation and discrimination by healthcare professionals experienced by the aboriginal groups (due to cultural and economic barriers) increases their likelihood for developing debilitating heart diseases. Indeed, the pattern of marginalization of underprivileged Australian population is a significant contributory factor that considerably adds to the burden of cardiovascular conditions and associated manifestations (Woods, Katzenellenbogen, Davidson, & Thompson, 2012). Health disparities experienced by underprivileged Australians lead to dietary inadequacies that elevate their levels of blood glucose and cholesterol, thereby increasing their risk of acquiring heart diseases. Evidence-based research literature advocates the causation of cardiovascular diseases among individuals (having a history of pre-existing chronic kidney disease, diabetes and heart disease) under the influence of adverse psychosocial conditions (Brown, et al., 2014). The absence of community-based interventions for the underprivileged Australians increases their healthcare challenges and eventually, they fail to attain evidence-based medical management for treating their nutritional inconsistencies (Reading, 2015). This further reduces their quality of life and the physically inactive indigenous Australians thereby elevate their risk of acquiring cardiovascular conditions across the community environment. The historical trauma and discrimination experienced by the underprivileged Australians, along with the absence of integrative medical management increases their risk of acquiring chronic disease states and debilitating cardiovascular abnormalities (Heart, Chase, Elkins, & Altschul, 2011).

Gap in Knowledge

Evidence-based research literature reveals serious gaps in existing knowledge regarding the extent of influence of modifiable risk factors on the pattern of cardiovascular diseases and associated clinical symptomatology experienced by the Australian natives (Kandula, et al., 2010). The absence of knowledge regarding the cardiovascular risk factors among the Australian natives as well as healthcare professionals leads to the elevation in the burden heart diseases across the community environment. The statistical analysis of the epidemiology of coronary heart disease in Australian regions is highly warranted with the objective of evaluating the modifiable, non-modifiable and environmental factors contributing to the causation of cardiac manifestations among the predisposed individuals. Evidence-based research literature exhibits limited knowledge regarding the causative mechanisms undertaken by various risk factors in establishing the pattern of cardiovascular illness among the Australian natives (Koniak-Griffin & Brecht, 2015). The attribution of health risk behaviours as well as environmental and geographical factors on the causation of heart diseases requires prospective analysis through systematic research interventions. Healthcare professionals need to investigate the exact mechanism involved in the causation of heart diseases because of inappropriate dietary habits. Accordingly, preventive dietary strategies require configuration for reducing the establishment of heart diseases among the Australian individuals. Evidence-based research literature also reveals limited knowledge regarding the genetic predisposition of individuals towards acquiring cardiovascular conditions (Michelena, et al., 2014). The biochemical pathways induced by the cardiac risk factors in individuals of various age groups in the context of establishing cardiovascular conditions require further exploration by the research community. The interplay between non-genetic factors and various genes leading to the development of elevated LDL cholesterol level and pattern of MI is not well elaborated in the evidence-based literature. Therefore, the cardiovascular risk factors arising from this complex interplay require exploration by the research community for understanding the complicated mechanisms that induce the pattern of heart diseases in predisposed individuals (Kathiresan & Srivastava, 2012). Evidence-based analysis by (Kivimäki & Kawachi, 2015) indicates the influence of psychosocial burden on the pattern of chronic cardiovascular conditions. Work stress on individuals increases their predisposition towards the acquisition of diabetes mellitus that further elevates their risk of acquiring heart disease across the community environment. However, the cause and effect relationship between the pattern of work stress and acquisition of cardiovascular conditions is not evidentially described in the clinical literature (Kivimäki & Kawachi, 2015). Therefore, the research community requires exploring the pathways acquired by the modifiable and non-modifiable risk factors in the context of developing heart diseases and associated adverse manifestations among the predisposed Australian natives.

Research Question

How and to what extent the modifiable (psychosocial and life style related) and non-modifiable (cardiometabolic) risk factors individually influence the predisposition of Australian natives in terms of acquiring cardiovascular conditions across the community environment?

What Needs to be Known

The execution of prospective research intervention is highly warranted with the objective of evaluating the epidemiology of heart diseases in Australia on a wider scale. Research analysis by (Davis-Lameloise, et al., 2013) reveals the elevated prevalence of cardiovascular mortalities among the residents in remote and rural Australia locations as compared to the population located in urban regions. The prospective research study intends to inquire regarding the mechanism of influence of the environmental and geographical factors on the causation of heart diseases in the Australian population. Evidence-based research literature reveals the high influence of occupation of individuals on their risk of acquiring cardiovascular conditions. The individuals engaged in various professions on full-time, part-time and casual basis might experience variable risk of acquiring cardiovascular mortalities across the community environment. Non-working people might gain weight under the influence of distress and physical inactivity and increase their likelihood of acquiring cardiovascular conditions. The prospective research intervention attempts to systematically explore these occupational factors and the extent of their adverse influence of the cardiometabolic profile of the Australian natives. The research study also aspires to investigate the influence of prior knowledge of people regarding the cardiovascular risk factors in terms of their predisposition towards acquiring heart diseases. The absence of knowledge regarding the cardiovascular disease conditions and preventive approaches might elevate the risk of Australian natives in terms of experiencing coronary artery diseases. The prospective research intervention aims to investigate the mechanism of development of cardiovascular conditions under the influence of knowledge deficit among the Australian individuals. This will also provide concrete evidence regarding the extent and frequency of cardiovascular diseases among the Australian people who do not follow preventive approaches for reducing their likelihood of acquiring cardiovascular conditions and associated clinical manifestations.

Project Aims and Expected Benefits

The outcomes of prospective research intervention will open knowledge-based gateways for the healthcare professionals that might assist them in systematically dealing with the cardiovascular diseases in the Australian population. The research analysis will provide useful inputs to the physicians and nurses in terms of effectively treating the pattern of diabetes, hypertension and hypercholesterolemia with the objective of reducing the prevalence of cardiovascular diseases in the Australian region (WHF, 2017). The configuration of systematic strategies for controlling various cardiovascular risk factors (following outcomes of a prospective study) will substantially assist in controlling the pattern of cardiac arrest in the predisposed individuals. The outcomes of the prospective research analysis will provide a thorough insight regarding the requirement of undertaking therapeutic approaches, exercise and dietary interventions for effectively controlling the establishment of stroke and heart diseases across the community environment. The analysis of socioeconomic factors will provide insight regarding the requirement of cost-effectively administering equitable healthcare services to the underprivileged sections of Australian society for reducing their burden of cardiovascular manifestations. The analysis of unhealthy habits (attributing to nicotine dependence and alcoholism) acquired by the underprivileged Australian natives and immigrants (in relation to the establishment of cardiovascular conditions) will assist in proactively configuring prophylactic approaches and remedial interventions for the systematic enhancement of wellness outcomes of the aboriginal Australians. Analysis of frequency of heart conditions among physically inactive Australians will assist in the configuration of exercise regimen for controlling the pattern of obesity and associated cardiovascular manifestations among the affected individuals. The outcomes of the prospective research analysis will help the dieticians and nutritionists in customising dietary combinations for the Australian natives who experience an elevated risk of acquiring cardiovascular conditions across the community environment. The analysis of ethnic, cultural and genetic factors in relation to the establishment of cardiovascular diseases will assist healthcare professionals in preparing healthcare plans for the predisposed Australian individuals in the context of diagnosing and treating the onset of heart diseases at an early stage.

The research analysis requires execution in terms of systematic-review that will lead to the acquisition and analysis of results and dissemination of findings (Uman, 2011). The data will be extracted from various epidemiological studies conducted by hospitals and clinics in relation to the evaluation of cardiovascular risk factors, associated co-morbid states and mortalities experienced by Australian natives across the community environment. These study findings will require exploration in evidence-based literature and their authenticity and plausibility will be tested through statistical analysis.

The research investigation will be conducted in the computer lab of Western Sydney University under the supervision of IT team.

Sampling Description & Sample Size

The systematic analysis will take into consideration the research studies conducted within a span of 10 years (i.e. between 2007-2017). The study findings registered in terms of Abstract only will be summarily excluded from analysis. Studies substantiated with complete documented evidence in the clinical literature will require inclusion in the systematic review. The research investigations focusing on the epidemiology of heart diseases in the Australian subcontinents in relation to their risk factors will acquire preference in the systematic analysis. The research findings focusing on the establishment of co-morbid states under the influence of cardiovascular conditions will be excluded from the systematic review. The research studies requiring exploration will be selected in the context of analysing the cardiovascular risk factors and therefore, the studies dealing merely with the pathophysiology and biochemical mechanisms of heart diseases (in the absence of analysis of modifiable and non-modifiable risk factors) will be excluded from the prospective systematic review. More than 500 research studies will be targeted for their inclusion in the systematic review in the context of retrieving the evidence-based findings. The research studies conducted before the year 2007 will be summarily excluded from the prospective systematic review.

Sampling Method, Recruitment and Retention

Sampling of the study interventions will be executed while searching the studies of interest in the evidence-based literature. Various search terms matching the subject of study will be utilized in the context of retrieving the desirable research studies conducted for evaluating the influence of cardiovascular risk factors on the wellness outcomes of the Australian natives of various age groups, ethnicity and socio-economic profile. The study samples will be retained in the systematic review while analysing the retrieved findings in terms of their relevance regarding the cardiovascular risk factors and associated heart disease outcomes.

Measures and Materials

The systematic review will require the utilization of various search terms matching with the cardiovascular risk factors in the acquisition of desirable outcomes. The electronic searches will be performed while combining the search terms in various permutations. The findings of these search strategies will lead to the acquisition of various research studies that require further investigation in the context of taking a decision regarding their inclusion or exclusion from the systematic analysis. The specificity and sensitivity of the systematic intervention will lead to desirable outcomes obtained after analysing the findings from primary research studies. Therefore, for the accomplishment of this objective, the secondary studies and systematic reviews will be excluded from the research analysis. The predictive values will be calculated from the retrieved findings and specificity and pooled sensitivity approaches will be utilized for the meta-analysis of the research findings (Honest & Khan, 2002). The study results will be measured in the format of values or plot for their systematic analysis.

Procedures

The following search terms and combinations will be undertaken with the utilization of Boolean variables.

The above-mentioned search-terms combinations will be utilized in searching the research findings through the following databases.

1. PubMed Medline

6. Cochrane

7. Research Gate

10. NHS Evidence

Data Analysis

The study data will be analysed statistically with the objective of evaluating the attribution of cardiovascular risk factors in the context of the development of heart diseases among the Australian natives. The percentages of various cardiovascular variables in relation to their influence on health status of the predisposed individuals will be calculated and subsequently these variables will be categorised in terms of means and medians for their meta-analysis and calculation of p-values.

Ethical Considerations

The research study must deploy ethically approved investigation methods while searching evidence in the clinical literature. The researchers must ensure authenticity of the study findings while undertaking systematic measures to ascertain the publishing of unbiased findings and study outcomes. Research studies must be selected strictly in accordance with the predefined protocols and older evidences must be filtered out for surpassing the scope of inclusion of extraneous variables. Ethical approval must be obtained from the Western Sydney University prior to the execution of the systematic review.

Scope and Limitations

The study findings will prove advantageous in terms of evaluating the relevance and relationship of cardiovascular risk factors with the pattern of existence of heart diseases in the Australian sub-continent. The study findings will assist the Australian clinicians and healthcare professionals in customizing healthcare approaches with the objective of reducing the burden of heart diseases across the community environment. The study will remain confined in terms of inclusion of limited research studies and therefore the outcomes will remain questionable on a broader scale.

The tentative study budget is mentioned below.

Timeline

The research review is expected to accomplish within a tenure of 60 days after initiation.

References