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The Asian Cardiovascular Market Outlook to 2014
From: Business Insight
This chapter of the report provides information on the prevalence and incidence of CV disease in the Asian markets in 2007, and forecast epidemiological data for major CV indications over the period 2008–14. It is believed that, by 2025, approximately three quarters of the world’s hypertensive population will be in economically developed countries (WHO, 2005). As a region, Asia is unrivalled in terms of population and is estimated to feature a high prevalence rate associated with CV diseases and risk factors, especially in India and China. Asia therefore represents an important current and important potential market for CV therapeutics.
This chapter of the report focuses on the epidemiology of the following components of CV diseases and conditions:
- CV risk factors: hypertension, hypercholesterolemia, diabetes;
- CV disease: heart failure, atrial fibrillation (AF), stable angina and peripheral artery disease (PAD);
- Acute thrombotic events: myocardial infarction (MI), deep vein thrombosis (DVT), and stroke.
The range of conditions under the umbrella of CV disease is wide, although the basic etiology of CV disease is generally well understood. The focus of treatment in CV disease is two-fold: firstly, lowering the risk associated with CV risk factors in order to prevent an acute CV event; and secondly, delaying or preventing the onset of chronic CV disease. An illustration of the relationship of CV disease and the associated risk factors and conditions is presented in Figure 1.
Figure 1: Relationship between CV disease and risk factors
Source: author’s research & analysis
CV disease is chronic and progressive, with the presence of one CV risk factor predisposing an individual to other risk factors. This cumulative and self-reinforcing risk can trigger the development of CV disease and associated conditions, which in turn are directly associated with increased mortality. Although there are many therapies indicated for the treatment of CV risk factors and conditions, the long-term mortality rate for patients with CV disease and associated conditions is typically high and requires pharmacological intervention to prevent progression to more severe CV disease.
Defining patient potential
Epidemiology is the study of factors influencing the occurrence, distribution, prevention and control of disease, injury, and other health-related events in a defined human population. The focus is on estimating current and future prevalence and incidence of diseases, along with relevant patient segmentations (e.g. age, sex and co-morbidity) in order to define the patient potential of drugs, medical devices and other therapies being marketed or in development.
Limitations of cardiovascular epidemiology data
Although the breadth of epidemiological research available has increased considerably over recent years, there continues to be an insufficient level of comprehensive epidemiological data in the CV area. This information deficit is a result of the sheer complexity of the task of epidemiological studies in patient populations, the chronic nature of CV disease, and the complexity of the interactions that arise between CV risk factors, CV disease and its consequences. The epidemiological complexity of the CV area has implications for epidemiological research, favoring observational studies that track large numbers of patients over the long term. Such studies are time-consuming and expensive and, as a result, the majority are based on specific populations, typically characterized by ethnicity, gender or the prevalence of specific CV risk factors. In Asian countries, insufficient research around CV disease has been further compounded by a lack of resources allocated to epidemiological research in this area.
Cardiovascular risk factors
CV risk factors are defined as conditions, often occurring co-morbidly, that predispose individuals to developing CV disease later in life and thus increase the likelihood of an acute CV event occurring. CV risk factors are often related, and the presence of one risk factor in an individual often increases the likelihood of another risk factor happening over time, thereby increasing the risk of an individual developing a CV disease.
CV risk factors are typically simple to diagnose as well as to treat, although most treatments offer little more than effective control, particularly in the absence of a corresponding change in the patient’s lifestyle. However, because of the ease of diagnosis and the chronic nature associated with these conditions, CV risk factors have historically been the most prominent targets for medical campaigns and drug developers.
Hypertension, or high blood pressure, is a common and typically chronic condition that can occur early in life and that is implicated in the development of CV disease. The immediate causes of hypertension lie in the regulation and control of cardiac output and peripheral resistance, which lead to an increase in blood pressure.
In broad terms, hypertension can be defined as blood pressure that exceeds 140mmHg of systolic blood pressure (SBP), and 90mmHg of diastolic blood pressure (DBP), when an individual is at rest. SBP refers to the pressure of the blood during the contraction of the heart muscles, and DBP refers to blood pressure during the relaxation of the ventricles. While this measure of hypertension is a useful yardstick, it is not applicable across all patient populations, and therefore a more practical definition could be that of a sustained level of blood pressure above which blood-pressure-lowering treatment is more beneficial than harmful.
Hypertension is simple to diagnose, and tests can be administered with instantaneous results. The only complications associated with the diagnostic test are the posture of the patient (sitting or standing), the duration of the reading, and the consumption of substances such as alcohol or tobacco that may result in elevated blood pressure readings.
Usually hypertension is an asymptomatic condition, with approximately one-third of the patients unaware of their condition. Symptoms usually do not interfere with a patient’s normal life until the condition has become severe, potentially having led to the development of a serious CV disease. Treatment of hypertension typically starts with a change in lifestyle, with an emphasis on diet and exercise. If the condition needs to be controlled, the patient is usually prescribed drug therapy. The unmet needs in the pharmacological treatment and behavioral treatment of hypertension are the reluctance to change lifestyle and habits, and the side effects and dosing regimens associated with pharmacological therapy. In an attempt to improve compliance rates, pharmaceutical companies are focusing their efforts on developing more innovative products with improved side effects and dosing profiles.
Between 90% and 95% of high blood pressure cases have no discernable cause (essential hypertension). If a cause is identified, the initial goal of treatment is to eliminate the underlying cause; otherwise, it is treated symptomatically. Consequently, while hypertension can be successfully controlled in the vast majority of cases (although this is by no means the case in practice); there is no curative treatment except lifestyle modification in certain cases. As a result, most patients will remain hypertensive, or on medication, leading to a steady increase in the prevalence of hypertension with age.
Table 1 shows the prevalence of hypertension in 10 Asian markets in 2007, broken down by prevalence, prevalence rate and market share.
Table 1: Estimated prevalence of hypertension in the Asian region, 2007
|Country||Prevalence (000s)||Prevalence (%)||Share (%)|
|Note: Figures are rounded*statistics refer to age group of 4+years**statistics refer to SBP of 160+ mm Hg and DBP of 95+ mm Hg|
Source: author’s research & analysis, WHO, 2005
South Korea and Taiwan have the highest prevalence rates of hypertension in Asia. However, the prevalent populations in China and India dwarf those in these Southeast Asian countries. China, with an estimated prevalence rate of 14.4%, had 190.7 million people who suffered from hypertension in 2007. This was closely followed by India, which had a prevalence rate of 16.4% and an estimated prevalent population of 184.1 million.
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