Novel therapeutic concepts: the epidemic of cardiovascular disease in the developing world: global implications

Cardiovascular morbidity and mortality among persons diagnosed with tuberculosis: A systematic review and meta-analysis

INTRODUCTION

The emerging epidemiological evidence of increased cardiovascular disease (CVD) risk among persons diagnosed with tuberculosis (TB) has not been systematically reviewed to date. Our aim was to review the existing epidemiological evidence for elevated risk of CVD morbidity and mortality among persons diagnosed with TB compared to controls.

MATERIALS AND METHODS

EMBASE, MEDLINE, and Cochrane databases were searched (inception to January 2020) for terms related to "tuberculosis" and "cardiovascular diseases". Inclusion criteria: trial, cohort, or case-control study design; patient population included persons diagnosed with TB infection or disease; relative risk (RR) estimate and confidence interval reported for CVD morbidity or mortality compared to suitable controls. Exclusion criteria: no TB or CVD outcome definition; duplicate study; non-English abstract; non-human participants. Two reviewers screened studies, applied ROBINS-I tool to assess risk of bias, and extracted data independently. Random effects meta-analysis estimated a pooled RR of CVD morbidity and mortality for persons diagnosed with TB compared to controls.

RESULTS

6,042 articles were identified, 244 full texts were reviewed, and 16 were included, meta-analyzing subsets of 8 studies' RR estimates. We estimated a pooled RR of 1.51 (95% CI: 1.16-1.97) for major adverse cardiac events among those diagnosed with TB compared to non-TB controls (p = 0.0024). A 'serious' pooled risk of bias was found across studies with between-study heterogeneity (I2 = 75.3%).

CONCLUSIONS

TB appears to be a marker for increased CVD risk; however, the literature is limited and is accompanied by serious risk of confounding bias and evidence of publication bias. Further retrospective and prospective studies are needed. Pending this evidence, best practice may be to consider persons diagnosed with TB at higher risk of CVD as a precautionary measure.

Cardiovascular risk factor mapping and distribution among adults in Mukono and Buikwe districts in Uganda: small area analysis

Background

Sub-Saharan Africa (SSA) is experiencing an increasing burden of Cardiovascular Diseases (CVDs). Modifiable risk factors including hypertension, diabetes, obesity, central obesity, sedentary behaviours, smoking, poor diet (characterised by inadequate vegetable and fruit consumption), and psychosocial stress are attributable to the growing burden of CVDs. Small geographical area mapping and analysis of these risk factors for CVD is lacking in most of sub-Saharan Africa and yet such data has the potential to inform monitoring and exploration of patterns of morbidity, health-care use, and mortality, as well as the epidemiology of risk factors. In the current study, we map and describe the distribution of the CVD risk factors in 20 parishes in two neighbouring districts in Uganda.

Methods

A baseline survey benchmarking a type-2 hybrid stepped wedge cluster randomised trial design was conducted in December 2018 and January 2019. A sample of 4372 adults aged 25–70 years was drawn from 3689 randomly selected households across 80 villages in 20 parishes in Mukono and Buikwe districts in Uganda. Descriptive statistics and generalized linear modelling controlled for clustering were conducted for this analysis in Stata 13.0, and a visual map showing risk factor distribution developed in QGIS.

Results

Mapping the prevalence of selected CVD risk factors indicated substantial gender and small area geographic heterogeneity which was masked on aggregate analysis. Patterns and clustering were observed for hypertension, physical inactivity, smoking, alcohol consumption and risk factor combination. Prevalence of unhealthy diet was very high across all parishes with no significant observable differences across areas.

Conclusion

Modifiable cardiovascular risk factors are common in this low-income context. Moreover, across small area geographic setting, it appears significant differences in distribution of risk factors exist. These differences suggest that underlying drivers such as sociocultural, environmental and economic determinants may be promoting or inhibiting the observed risk factor prevalences which should be further explored. In addition, the differences emphasize the value of small geographical area mapping and analysis to inform more targeted risk reduction interventions.

Assessment of medical intern's knowledge, awareness and practice of familial hypercholesterolemia at academic institutes in Jeddah, Saudi Arabia

Background

Familial Hypercholesterolemia (FH) is a serious under-diagnosed disease characterized by raised low-density lipoprotein cholesterol (LDL-C) and premature coronary artery diseases (CAD). The scarcity of FH reported patients in Saudi Arabia indicates lack of FH awareness among physicians.

Objective

The goal of this research was to assess knowledge, awareness, and practice (KAP) about FH disorder among Saudi medical interns and to identify areas that need educational attention.

Methods

This cross-sectional study involved 170 Saudi medical interns (83 males and 87 females) from academic institutes in Jeddah, Saudi Arabia. The interns were asked to fill an online FH-KAP questionnaire. Total score for each separate domain measured by adding correct answers.

Results

Although, knowledge of FH definition (76.5%) and classical lipid profile (52.4%) were reasonable; knowledge on inheritance (43.5%), prevalence (12.4%) and CAD risks (7.1%) were poor. Knowledge score was significantly higher in female than male (7.5 ± 3 vs. 5.3 ± 2.6, P < 0.001). Regarding awareness, 54.1% were familiar with FH disorder, 50.6% with the presence of lipid clinic but only 16.5% were acquainted with guidelines. Furthermore, in the practice domain 82.9% selected statin as first line treatment and 62.9% chose routinely checking the rest of the family, while 15.3% chose ages 13–18 years to screen for hypercholesterolemia in patients with a positive family history of premature CAD.

Conclusion

Substantial defects in FH-KAP among Saudi medical interns were found, emphasizing the importance of professional training. Extensive and constant medical education programs as early as an internship are required to close the gap in CAD prevention.

Prevalence of self-reported coronary heart disease and its associated risk factors in Tabari cohort population

BACKGROUND

Prevalence of coronary heart disease (CHD) risk factors are increasing in developing countries. The present study aimed to assess the prevalence of self-reported CHD and evaluate the role of various risk factors on its prevalence in the Tabari cohort study (TCS) population.

METHODS

The enrollment phase of TCS was performed between June 2015 and November 2017. In the current study, data were derived from information collecting from the enrollment phase of TCS. In the enrollment phase, 10,255 individuals aged 35-70 living in urban and mountainous areas of Sari (northern part of Iran) were entered into the study. Educational level, socioeconomic and marital status, history of smoking, opium and alcohol abuse/addiction, level of daily physical activity, indices of obesity, and traditional risk factors of the participants were determined.

RESULTS

The prevalence of CHD was measured at 9.2%. Older individuals (P<0.001), people with a body mass index≥30kg/m2 (P<0.001), diabetics (P<0.001), and hypertensive (P<0.001) have been shown to have an increased risk for CHD compared with participants of without CHD. Furthermore, the CHD was more prevalent in individuals with higher waist circumference (P<0.001), higher low-density lipoprotein cholesterol (P<0.001), lower high-density lipoprotein cholesterol (P<0.001), and a higher waist to hip ratio (P<0.001). In addition, individuals with low socioeconomic status, illiterate people, and opium users had a higher prevalence of CHD (P<0.001). The results of the multivariable logistic regression analysis showed that the probability of CHD among individuals who had 8-10 risk factors was estimated at 8.41 (95% confidence interval: 5.75-12.31) times higher than those with less than 3 risk factors.

CONCLUSION

According to the results of the present study, it seems that the prevalence of CHD in the Iranian population is relatively high.

Blood Cd levels and carotid intima-media thickness in young adults living in Padang, Indonesia

Objective

Cd exposure is a non-traditional risk factor of cardiovascular disease and mortality by promoting the development of atherosclerosis. The development of atherosclerosis can be monitored non-invasively by measuring carotid intima-media thickness (CIMT). This study aimed to measure the level of blood Cd and other factors known to be associated with CIMT, measured at the segment of common carotid artery (CCA) and of internal carotid artery (ICA), in young adults from Padang, West Sumatera, Indonesia, and we analyzed whether blood Cd is a predictor of CIMT.

Results

We recruited 156 subjects. Median blood Cd level was 0.61 μg/L (range 0.01–5.96 μg/L), with no difference in male compared to female subjects (Mann–Whitney U test, p = 0.60). Multiple regression analysis showed that sex is the predictor of CCA IMT (adjusted R² = 0.219; β = −0.438 [95% CI − 0.662, − 0.214]; p < 0.001) and ICA IMT (adjusted R² = 0.165; β = − 0.529 [95% CI − 0.761, − 0.297]; p < 0.001). Blood Cd was not a predictor of CCA IMT (adjusted R² = 0.219; β = − 0.101 [95% CI − 0.257, 0.055]; p = 0.203) and ICA IMT (adjusted R² = 0.165; β = − 0.055 [95% CI − 0.217, 0.107]; p = 0.503) in young adults from Padang, Indonesia.

Cardiac arrhythmias in low- and middle-income countries

Many low- and middle-income countries (LMICs) are undergoing an epidemiological transition. With an improvement in socioeconomic conditions and an aging population, cardiovascular diseases (CVDs), like cardiac arrhythmias, are expected to increase in these countries. However, there are limited studies on the epidemiology and management of cardiac arrhythmias in LMICs. This review will highlight the unique challenges and opportunities that these countries face when managing cardiac arrhythmias.

Injectable Hydrogel-Based Nanocomposites for Cardiovascular Diseases

Cardiovascular diseases (CVDs), including a series of pathological disorders, severely affect millions of people all over the world. To address this issue, several potential therapies have been developed for treating CVDs, including injectable hydrogels as a minimally invasive method. However, the utilization of injectable hydrogel is a bit restricted recently owing to some limitations, such as transporting the therapeutic agent more accurately to the target site and prolonging their retention locally. This review focuses on the advances in injectable hydrogels for CVD, detailing the types of injectable hydrogels (natural or synthetic), especially that complexed with stem cells, cytokines, nano-chemical particles, exosomes, genetic material including DNA or RNA, etc. Moreover, we summarized the mainly prominent mechanism, based on which injectable hydrogel present excellent treating effect of cardiovascular repair. All in all, it is hopefully that injectable hydrogel-based nanocomposites would be a potential candidate through cardiac repair in CVDs treatment.

Decomposition of Gender Differences in Body Mass Index in Saudi Arabia using Unconditional Quantile Regression: Analysis of National-Level Survey Data

Understanding gender differences in body mass index (BMI) between males and females has been much debated and received considerable attention. This study aims to decompose gender differentials in the BMI of people of the Kingdom of Saudi Arabia. The study decomposed the BMI gender gap into its associated factors across the entire BMI distribution by using counterfactual regression methods. The main method of analysis was newly developed unconditional quantile regression-based decomposition, which applied Blinder-Oaxaca decomposition using data from the Saudi Health Interview Survey. Gender differentials were found in the BMI, with females showing a higher BMI than males. The aggregate decomposition showed that both the covariate effect and the structural effect were significant at the 25th and 50th quantiles. Detailed decomposition indicated that income level and employment status as well as soda consumption and the consumption of red meat were significantly correlated in explaining gender differentials in BMI across various quantiles, but the magnitude varied by quantile. Our study suggests the government should consider introducing programs that specifically target women to help them reduce BMI. These programs could include organizing sporting events at the workplace and at the national level. Furthermore, the effect of soda consumption could be reduced by levying a tax on beverages, which might reduce the demand for soda due to the increased price.

HIV-related cardiovascular diseases: the search for a unifying hypothesis

Although the extensive rollout of antiretroviral (ARV) therapy resulted in a longer life expectancy for people living with human immunodeficiency virus (PLHIV), such individuals display a relatively increased occurrence of cardiovascular diseases (CVD). This health challenge stimulated significant research interests in the field, leading to an improved understanding of both lifestyle-related risk factors and the underlying mechanisms of CVD onset in PLHIV. However, despite such progress, the precise role of various risk factors and mechanisms underlying the development of HIV-mediated CVD still remains relatively poorly understood. Therefore, we review CVD onset in PLHIV and focus on 1) the spectrum of cardiovascular complications that typically manifest in such persons and 2) underlying mechanisms that are implicated in this process. Here, the contributions of such factors and modulators and underlying mechanisms are considered in a holistic and integrative manner to generate a unifying hypothesis that includes identification of the core pathways mediating CVD onset. The review focuses on the sub-Saharan African context, as there are relatively high numbers of PLHIV residing within this region, indicating that the greater CVD risk will increasingly threaten the well-being and health of its citizens. It is our opinion that such an approach helps point the way for future research efforts to improve treatment strategies and/or lifestyle-related modifications for PLHIV.

Age-Dependent Disparities in the Prevalence of Single and Clustering Cardiovascular Risk Factors: A Cross-Sectional Cohort Study in Middle-Aged and Older Adults

Background

Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide; with age acknowledged as an independent cardiovascular risk factor (CRF) in adults. Appreciating the association between age and classic CRFs is believed to boost all potential benefits of prevention.

Purpose

Assessment of the prevalence of single and clustered CRFs and their association with age.

Patients and Methods

The survey involved 4735 people (33.6% men) who were PONS project attendees aged 45-64. The study protocol comprised the Health Status Questionnaire, general medical examination, anthropometric measurements, and blood and urine sampling. The prevalence of single and clustered CRFs (hypertension, dyslipidemia, diabetes mellitus, and obesity) in the incrementally split age groups was calculated. The incidence rate of CRFs, against their absence, was determined by Poisson regression models with robust standard errors.

Results

The prevalence of CRFs was established in 90% of the respondents. Except dyslipidemia and ≥1 CRFs, prevalence of risk factors increased with age, although this trend was the weakest in men. In the total group, and in women, prevalence of dyslipidemia and ≥1 CRFs was unrelated to age, whereas in men, it was on the rise in the younger age groups. The incidence rate of CRFs was strongly related to age, and, with the exception of dyslipidemia, was higher in the older age groups.

Conclusion

Cardiovascular risk factors are common in the adult population, while their prevalence and clustering are more prevalent in seniors. Apart from dyslipidemia, the risk of CRFs is appreciably age-related, and higher in seniors.

Real-Time Quality Assessment of Long-Term ECG Signals Recorded by Wearables in Free-Living Conditions

OBJECTIVE

Nowadays, methods for ECG quality assessment are mostly designed to binary distinguish between good/bad quality of the whole signal. Such classification is not suitable to long-term data collected by wearable devices. In this paper, a novel approach to estimate long-term ECG signal quality is proposed.

METHODS

The real-time quality estimation is performed in a local time window by calculation of continuous signal-to-noise ratio (SNR) curve. The layout of the data quality segments is determined by analysis of SNR waveform. It is distinguished between three levels of ECG signal quality: signal suitable for full wave ECG analysis, signal suitable only for QRS detection, and signal unsuitable for further processing.

RESULTS

The SNR limits for reliable QRS detection and full ECG waveform analysis are 5 and 18 dB respectively. The method was developed and tested using synthetic data and validated on real data from wearable device.

CONCLUSION

The proposed solution is a robust, accurate and computationally efficient algorithm for annotation of ECG signal quality that will facilitate the subsequent tailored analysis of ECG signals recorded in free-living conditions.

SIGNIFICANCE

The field of long-term ECG signals self-monitoring by wearable devices is swiftly developing. The analysis of massive amount of collected data is time consuming. It is advantageous to characterize data quality in advance and thereby limit consequent analysis to useable signals.

Elevated Plasma von Willebrand Factor Antigen and Activity Levels Are Associated With the Severity of Coronary Stenosis

von Willebrand factor (VWF) acts as a bridge between platelets and the subendothelial matrix following vessel damage and plays a vital role in coronary artery disease (CAD). The aim of this study was to investigate the association between VWF and the severity of coronary stenosis quantified by the Gensini score in acute myocardial infarction (AMI), the most dangerous complication of CAD. Plasma VWF antigen (VWF: Ag) and VWF-collagen binding (VWF: CB) in normal controls (n = 123) and in patients with AMI (n = 205) were tested, and then the patients were divided based on Gensini scores. The levels of VWF: Ag and VWF: CB in patients with AMI were significantly higher than those in the control group (P < .001). Plasma levels of VWF: Ag and VWF: CB were positively correlated with both Gensini score and the number of affected vessels. Both VWF: Ag and VWF: CB were independent factors for coronary stenosis, adjusting confounding factors. Thus, the levels of VWF: Ag and VWF: CB were positively correlated with the severity of coronary stenosis. Screening of VWF at time of AMI may have prognostic value in terms of the severity of coronary stenosis.

Silk Fibroin as a Coating Polymer for Sirolimus-Eluting Magnesium Alloy Stents

Magnesium (Mg) alloy-based, bioresorbable scaffolding is a promising candidate for next-generation stents. Rapid corrosion of Mg alloy in the physiological environment, however, hinders its clinical application. Hydrofluoric acid (HF) treatment and biodegradable polymer coating have been widely reported to enhance corrosion resistance of the Mg alloy. Poor biocompatibility of biodegradable polymers, however, is known to promote adverse events such as intimal hyperplasia and thrombosis. We selected silk fibroin (SF) as the polymer for stent coating and evaluated drug release from the SF layer, corrosion resistance of the Mg alloy, and biocompatibility. After the stent was coated with SF, ethanol treatment of the SF layer enriched the β-sheet content. Release of sirolimus (SRL), a drug that prevents intimal hyperplasia, from the SF layer was slower than that with a poly(ε-caprolactone), the conventional biodegradable polymer used on medical devices. Ethanol treatment of the SF-coated stent further slowed SRL release from the SF layer. Crystalline domains in SF formed by the β-sheet structure could contribute to the slow release of SRL. The SF coating suppressed local and deep corrosion of the Mg alloy stent, although total corrosion remained unaffected. Uniform corrosion without local or deep corrosion prolongs the stent's radial strength. The SF coating showed excellent biocompatibility with human umbilical vein endothelial cells and minimal platelet adhesion. SF is expected to replace traditional biodegradable polymers for use on bioresorbable stents.

Original research Socio-demographic patterning of self-reported physical activity and sitting time in Latin American countries: findings from ELANS

Background

Low levels of physical activity (PA) and prolonged sitting time (ST) increase the risk of non-communicable diseases and mortality, and can be influenced by socio-demographic characteristics. The aim of this study was to use self-report data to characterise socio-demographic patterns of PA and ST in eight Latin American countries.

Methods

Data were obtained from the Latin American Study of Nutrition and Health (ELANS), a household population-based, multi-national, cross-sectional survey (n = 9218, aged 15–65 years), collected from September 2014 to February 2015. Transport and leisure PA and ST were assessed using the International Physical Activity Questionnaire–long version. Overall and country-specific mean and median levels of time spent in transport and leisure PA and ST were compared by sex, age, socioeconomic and education level.

Results

Mean levels of transport and leisure PA were 220.3 min/week (ranging from 177.6 min/week in Venezuela to 275.3 min/week in Costa Rica) and 316.4 min/week (ranging from 272.1 min/week in Peru to 401.4 min/week in Ecuador). Transport and leisure PA were higher (p < 0.005) in men than women with mean differences of 58.0 and 34.0 min/week. The mean and median for transport PA were similar across age groups (15–29 years: mean 215.5 and median 120 min/week; 30–59 years: mean 225.0 and median 120 min/week; ≥60 years: mean 212.0 and median 120 min/week). The median time spent in transport and leisure PA between three strata of socioeconomic and education levels were similar. The prevalence of not meeting PA recommendations were 69.9% (95% CI: 68.9–70.8) for transport and 72.8% (95% CI: 72.0–73.7) for leisure. Men, younger people (15–29 years), individuals with higher socioeconomic and education levels spent significantly (p < 0.001) more time sitting than women, older people (30–59 years and ≥ 60 years) and those in the middle and low socioeconomic and education groups, respectively.

Conclusions

Transport and leisure PA and ST range widely by country, sex, and age group in Latin America. Programs for promoting leisure and transport PA and reducing ST in Latin America should consider these differences by age and gender and between countries.

Trial registration

ClinicalTrials.Gov NCT02226627. Retrospectively registered on August 27, 2014.

Stressors in open-heart surgery patients: A qualitative study

BACKGROUND

Open-heart surgery is a stressful experience for the patients and their families. From the moment that patients are told they must undergo surgery until discharge, they experience different degrees of worry and nervousness. This study was conducted with the aim of identifying stress factors in heart surgery patients.

METHODS

This study was performed using a qualitative method on 21 participants (14 patients and 7 caregivers). The research environment was open-heart surgery wards of two educational hospitals in Ahwaz (south of Iran) in 2017. The participants were selected through purposive sampling. The data were collected through semi-structured interviews, and then, analyzed using the qualitative approach of content analysis proposed by Graneheim and Lundmnan (2004).

RESULTS

The 5 themes of “physical stressors”, “self-care stressors”, “psychological stressors”, “religious stressors”, and “hospital stressors” were obtained. These themes were the result of the patients’ experiences and dimensions of patients’ perceptions regarding stressors in open-heart surgery.

CONCLUSION

Stress in patients undergoing open-heart surgery is a contextual and relative concept and a subjective experience, which is experienced as a sense of worry. Identifying and clarifying stressors in open-heart surgery patients for nurses is vital, like a key for improving care quality. Nursing managers in clinical practice can also benefit from these findings regarding heart surgery in improving the care quality and professional performance of nurses.

Evaluation of the cardioprotective effect of Casuarina suberosa extract in rats

The aim of the current study was to examine and compare the cardioprotective activities of the chloroform and petroleum extracts the leaves of Casuarina suberosa in isoproterenol (ISO)-induced cardiac tissue oxidative stress. Rats were categorized into 6 groups as follows: control group, vehicle or Tween 80-treated group, ISO-treated group, chloroform extract + ISO treated group, petroleum ether extract + ISO treated group and Reference drug (Captopril) + ISO treated group. ISO injection significantly (p < 0.05) increased the activities of cardiac marker enzymes (CK-MB, LDH, ALT, and AST), cardiac troponin-I, levels of lipid peroxides (MDA), nitric oxide (NO), and vascular endothelial growth factor (VEGF), serum angiotensin-converting enzyme (ACE) activity and neutrophil infiltration marker; myeloperoxidase (MPO) in the cardiac tissues. Pretreatment with chloroform or petroleum ether extracts significantly (p < 0.05) prevented the ISO-induced alteration; they upregulated VEGF expression. Histopathological findings corroborated biochemical results. These extracts exerted a cardioprotective effect by alleviating oxidative stress.

Metabolic syndrome (MetS) and associated factors in middle-aged women: a cross-sectional study in Northeast Brazil

We determined the prevalence of Metabolic Syndrome (MetS) and associated factors in 419 women (aged 40 to 65 years) in Northeast Brazil in a cross-sectional study conducted from April to November 2013. We defined MetS using the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. Socio-demographic variables, reproductive factors, lifestyle factors, anthropometrics, body composition, quality of life, and physical performance were assessed for their associations. We constructed multivariate Poisson regression models to estimate prevalence rate ratios (PRR) and 95% confidence intervals (CI). We identified 275 (65.6%) cases of MetS. The three most prevalent indicators were obesity (73.5%), reduced high-density lipoprotein level (63.0%), and elevated blood pressure (60.9%). In the final adjusted model, black race (PR 1.30, 95% CI: 1.07-1.57), lower grip strength/body mass index (PR 1.31, 95% CI: 1.15-1.50), and low estradiol levels (PR 1.17, 95% CI: 1.00-1.35) were associated with MetS. MetS is a long-term threat to the health of middle-aged women and a potential public health burden. These results may help in developing health promotion strategies to prevent morbidity and mortality associated with MetS in this vulnerable population.

Association between Dietary Intakes of Tea, Coffee, and Soft Drinks in Patients Undergoing Coronary Angiography with Coronary Artery Stenosis

Background:

Coronary artery disease (CAD) is one of the major causes of mortality that is related to the nutritional habits and lifestyle. The aim of this study was to examine the association between tea, coffee, and soft drink consumption and coronary artery stenosis in patients undergoing coronary angiography.

Methods:

Out of all the patients, 208 cases (101 Female) with 57.81 ± 12.18 (mean ± SD) were assigned to participate in this cross-sectional study. In total, 168-items, semi-quantitative food frequency questionnaire collected for assessments of dietary intakes of black tea, coffee, caffeine, and soft drinks and record demographic and clinical questionnaire.

Results:

There were negative association between arteries with stenosis of more than 50% number with dietary intakes of tea (P = 0.011, r = – 0.187), coffee (P = 0.069, r = – 0.098) intakes, and dietary caffeine intake (P = 0.043, r = –0.118). The high consumptions of soft drinks (P = 0.005, r = 0.387) were associated with an enhancement in arteries with stenosis of more than 50% number. In addition, dietary consumption of black tea have a negatively significant association with the history of previous angiography (P = 0.044, r = –0.121), the history of previous Stanton (P = 0.035, r = –0.132), and coronary artery bypass graft surgery nomination (P = 0.008, r = –0.216). Coffee consumption showed a significant negative relationship with engagement for coronary artery bypass graft surgery (P = 0.004, r = –0.598).

Conclusions:

Dietary intakes of tea, coffee, and caffeine may have a negative relationship with CAD and cardio vascular diseases. Healthy dietary lifestyle is an important issue for the prevention of chronic diseases.

Cluster Randomized Trial for Hypertension Control: Effect on Lifestyles and Body Weight

INTRODUCTION

Lifestyle modification, such as healthy diet habits, regular physical activity, and maintaining a normal body weight, must be prescribed to all hypertensive individuals. This study aims to test whether a multicomponent intervention is effective in improving lifestyle and body weight among low-income families.

STUDY DESIGN

Cluster randomized trial conducted between June 2013 and October 2016.

SETTING/PARTICIPANTS

A total of 1,954 uninsured adult patients were recruited in the study within 18 public primary healthcare centers of Argentina.

INTERVENTION

Components targeting the healthcare system, providers, and family groups were delivered by community health workers; tailored text messages were sent for 18 months.

MAIN OUTCOME MEASURES

Changes in the proportion of behavioral risk factors and body weight from baseline to end of follow-up. Data were analyzed in 2017.

RESULTS

Low fruit and vegetable consumption (fewer than 5 servings per day) decreased from 96.4% at baseline to 92.6% at 18 months in the intervention group, whereas in the control group it increased from 97.0% to 99.9% (p=0.0110). The proportion of low physical activity (<600 MET-minutes/week) decreased from 54.3% at baseline to 46.2% at 18 months in the intervention group and kept constant around 52% (p=0.0232) in the control group. The intervention had no effect on alcohol intake (p=0.7807), smoking (p=0.7607), addition of salt while cooking or at the table (p=0.7273), or body weight (p=0.4000).

CONCLUSIONS

The multicomponent intervention was effective for increasing fruit and vegetable intake and physical activity with no effect on alcohol consumption, smoking, addition of salt, or body weight among low-income families in Argentina.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT01834131.

Relação entre composição corporal e dislipidemias em crianças e adolescentes

Resumo Verificou-se a relação entre diferentes índices antropométricos e os lipídios plasmáticos. Os dados foram coletados de 2014 a 2016 em 854 escolares (6-18 anos). Foram aferidas a circunferência da cintura (CC), o percentual de gordura corporal (%G) por bioimpedância, o índice de massa corporal (IMC) e relação da cintura/estatura (RCE). Em sangue coletado em jejum mediu-se o colesterol total (CT), HDLc, e triglicerídeos e calculou-se o colesterol não HDL (Não HDLc). Os dados são apresentados por média ± desvio padrão, porcentagens. A comparação de médias foi feita pelo teste t ou ANOVA seguida de teste de Tukey. A associação entre variáveis foi testada por regressão linear. O estudo foi aprovado pelo Comitê de Ética da Universidade Federal do Espírito Santo. Meninos obesos tinham CT, Não HDLc e LDLc mais elevados do que os eutróficos. Em meninas este achado foi apenas para o Não HDLc. Crianças com o %G e RCE inadequados apresentaram LDLc e Não HDLc maiores (p < 0,001), os quais associaram-se positivamente (p < 0,001) com as frações lipídicas (CT e Não HDLc). O excesso de gordura corporal elevou em 21% a probabilidade de ocorrência de colesterol acima da referência (170 mg/dL). O excesso de gordura corporal associou-se com o perfil lipídico aterogênico (maior Não HDLc), principalmente em meninos.

Cost-Effectiveness Analysis of Non-Statin Lipid-Modifying Agents for Secondary Cardiovascular Disease Prevention Among Statin-Treated Patients in Thailand

BACKGROUND

Using non-statin lipid-modifying agents in combination with statin therapy provides additional benefits for cardiovascular disease (CVD) risk reduction, but their value for money has only been evaluated in high-income countries (HICs). Furthermore, studies mainly derive effectiveness data from a single trial or older meta-analyses.

OBJECTIVES

Our study used data from the most recent network meta-analysis (NMA) and local parameters to assess the cost effectiveness of non-statin agents in statin-treated patients with a history of CVD.

METHODS

A published Markov model was adopted to investigate lifetime outcomes: (1) number of recurrent CVD events prevented, (2) quality-adjusted life-years (QALYs) gained, (3) costs and (4) incremental cost-effectiveness ratios (ICERs) of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) and ezetimibe added to statin therapy. Event rates and effectiveness inputs were obtained from the NMA. Cost and utility data were gathered from published studies conducted in Thailand. A series of sensitivity analyses were performed.

RESULTS

Patients receiving PCSK9i and ezetimibe experienced fewer recurrent CVD events (number needed to treat [NNT] 17 and 30) and more QALYs (0.168 and 0.096 QALYs gained per person). However, under the societal perspective and at current acquisition costs in 2018, ICERs of both agents were $US1,223,995 and 27,361 per QALY gained, respectively. Based on threshold analyses, the costs need to be reduced by 97 and 85%, respectively, for PCSK9i and ezetimibe to be cost-effective.

CONCLUSIONS

Despite the proven effectiveness of PCSK9i and ezetimibe, the costs of these agents need to reduce to a much greater extent than in HICs to be cost-effective in Thailand.

A critical review on diet-induced microbiota changes and cardiovascular diseases

Background: Cardiovascular diseases (CVDs) commonly denote the disorders that generally occur as a result of unhealthy food habits. Heart failure, cerebrovascular illness, rheumatic heart disease are the common CVDs. The prevalence of CVD is increased considerably in recent decades upon unhealthy food habits and varied alternative factors such as diabetes, smoking and excessive use of alcohol. A change into a healthy food habit can reverse the strategy during a course of time.Objectives of the study: The objective of this review is to summarize the research findings and elaborate the relationship between the diet, gut microbiota, and CVD.Results: The dietary products containing the least saturated, trans-fat and cholesterol have the tendency to scale back the burden of CVDs, for instance, vegetables and fruits. The potential reason for the cardioprotective activity of the diet ought to be its high-unsaturated fatty acid composition and less saturated fat. Recent studies have found that gut microbiota plays a key role in mediating disease prevention. The metabolism of dietary products into varied bioactive metabolites is regulated by gut microbiota. The contributory role of gut microbiota in dietary metabolism and CVD prevention studies are increasing with promising outcomes.Conclusion: Hence, the review was proposed to reach the researchers within this field of study and share the available knowledge in gut microbiota-mediated CVD prevention. In our current review, we have updated all the research findings within the field of diet-mediated cardiovascular prevention through gut microbiota.

Efficient reabsorption of transintestinally excreted cholesterol is a strong determinant for cholesterol disposal in mice

Transintestinal cholesterol excretion (TICE) is a major route for eliminating cholesterol from the body and a potential therapeutic target for hypercholesterolemia. The underlying mechanism, however, is largely unclear, and its contribution to cholesterol disposal from the body is obscured by the counteracting process of intestinal cholesterol reabsorption. To determine the quantity of TICE independent from its reabsorption, we studied two models of decreased intestinal cholesterol absorption. Cholesterol absorption was inhibited either by ezetimibe or, indirectly, by the genetic inactivation of the intestinal apical sodium-dependent bile acid transporter (ASBT; SLC10A2). Both ezetimibe treatment and Asbt inactivation virtually abrogated fractional cholesterol absorption (from 46% to 4% and 6%, respectively). In both models, fecal neutral sterol excretion and net intestinal cholesterol balance were considerably higher than in control mice (5- and 7-fold, respectively), suggesting that, under physiological conditions, TICE is largely reabsorbed. In addition, the net intestinal cholesterol balance was increased to a similar extent but was not further increased when the models were combined, suggesting that the effect on cholesterol reabsorption was already maximal under either condition alone. On the basis of these findings, we hypothesize that the inhibition of cholesterol (re)absorption combined with stimulating TICE will be most effective in increasing cholesterol disposal.

Real-Time Cardiac Beat Detection and Heart Rate Monitoring from Combined Seismocardiography and Gyrocardiography

Cardiography is an indispensable element of health care. However, the accessibility of at-home cardiac monitoring is limited by device complexity, accuracy, and cost. We have developed a real-time algorithm for heart rate monitoring and beat detection implemented in a custom-built, affordable system. These measurements were processed from seismocardiography (SCG) and gyrocardiography (GCG) signals recorded at the sternum, with concurrent electrocardiography (ECG) used as a reference. Our system demonstrated the feasibility of non-invasive electro-mechanical cardiac monitoring on supine, stationary subjects at a cost of $100, and with the SCG-GCG and ECG algorithms decoupled as standalone measurements. Testing was performed on 25 subjects in the supine position when relaxed, and when recovering from physical exercise, to record 23,984 cardiac cycles at heart rates in the range of 36-140 bpm. The correlation between the two measurements had r2 coefficients of 0.9783 and 0.9982 for normal (averaged) and instantaneous (beat identification) heart rates, respectively. At a sampling frequency of 250 Hz, the average computational time required was 0.088 s per measurement cycle, indicating the maximum refresh rate. A combined SCG and GCG measurement was found to improve accuracy due to fundamentally different noise rejection criteria in the mutually orthogonal signals. The speed, accuracy, and simplicity of our system validated its potential as a real-time, non-invasive, and affordable solution for outpatient cardiac monitoring in situations with negligible motion artifact.

Cohort Profile: The Cardiovascular and Metabolic Diseases Etiology Research Center Cohort in Korea

Mortalities from cardiovascular disease in Korea have decreased markedly over the past three decades. The major cardiovascular and metabolic risk factors, however, remain prevalent, and their burden on health is large. The Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) planned a cohort study in order to identify novel risk factors and to develop evidence-based prevention strategies of cardiovascular and metabolic diseases. The CMERC deliberately designed two prospective cohorts, a community-based general population cohort (the CMERC cohort) and its sister cohort (a hospital-based high-risk patient cohort), covering a broad spectrum of cardiovascular and metabolic diseases. This paper describes the CMERC cohort study of community-dwelling adults aged 30 to 64 years. A total of 8097 adults completed baseline measurement between 2013 and 2018. Baseline measurements assessed socio-demographic factors, medical history, health-related behaviors, psychological health, social network and support, anthropometry, body composition, and resting blood pressure and comprised electrocardiography, carotid artery ultrasonography, fasting blood analysis, and urinalysis. Both active follow-up through an annual telephone survey and a 5-year on-site health examination survey and passive follow-up through secondary data linkage with national databases, such as national death records, have been applied. Researchers interested in collaborative research may contact the corresponding author.

Latin American convergence and divergence towards the mortality profiles of developed countries

It is uncertain whether Latin America and Caribbean (LAC) countries are approaching a single mortality regime. Over the last three decades, LAC has experienced major public health interventions and the highest number of homicides in the world. However, these interventions and homicide rates are not evenly shared across countries. This study documents trends in life expectancy and lifespan variability for 20 LAC countries, 2000-14. By extending a previous method, we decompose differences in lifespan variability between LAC and a developed world benchmark into cause-specific effects. For both sexes, dispersion of amenable diseases through the age span makes the largest contribution to the gap between LAC and the benchmark. Additionally, for males, the concentration of homicides, accidents, and suicides in mid-life further impedes mortality convergence. Great disparity exists in the region: while some countries are rapidly approaching the developed regime, others remain far behind and suffer a clear disadvantage in population health.

ST-segment elevation myocardial infarction

ST-segment elevation myocardial infarction (STEMI) is the most acute manifestation of coronary artery disease and is associated with great morbidity and mortality. A complete thrombotic occlusion developing from an atherosclerotic plaque in an epicardial coronary vessel is the cause of STEMI in the majority of cases. Early diagnosis and immediate reperfusion are the most effective ways to limit myocardial ischaemia and infarct size and thereby reduce the risk of post-STEMI complications and heart failure. Primary percutaneous coronary intervention (PCI) has become the preferred reperfusion strategy in patients with STEMI; if PCI cannot be performed within 120 minutes of STEMI diagnosis, fibrinolysis therapy should be administered to dissolve the occluding thrombus. The initiation of networks to provide around-the-clock cardiac catheterization availability and the generation of standard operating procedures within hospital systems have helped to reduce the time to reperfusion therapy. Together with new advances in antithrombotic therapy and preventive measures, these developments have resulted in a decrease in mortality from STEMI. However, a substantial amount of patients still experience recurrent cardiovascular events after STEMI. New insights have been gained regarding the pathophysiology of STEMI and feed into the development of new treatment strategies.

Outcome of cardiovascular risk assessment among rural community dwellers in ezionum, Nigeria-implications for public health

Background

Cardiovascular disease is a major cause of mortality worldwide. Risk assessment has been shown to reduce cardiovascular morbidity and mortality. In view of their proximity and accessibility, community pharmacies could be a suitable site for cardiovascular risk assessment and other preventive health activities especially in rural underserved populations. The objective of this study was to assess outcome of cardiovascular risk assessment among rural community dwellers.

Materials and methods

Five hundred and five community dwellers aged 40 to 80 years were recruited for the study. Cardiovascular risk assessment was performed using the region specific WHO/ISH risk assessment charts. Blood pressure, diabetes status, total non- fasting cholesterol, and age were used to estimate risk category. Demographic variables and clinical characteristics were expressed as frequency and percentage. Regression analysis was done to identify predictors of high risk category.

Results

More than 30% of subjects were hypertensive. Nearly 30% were overweight and had abnormal cholesterol levels. The proportion of subjects in the high risk category was 8.9%. Systolic blood pressure, random blood sugar and advancing age were the highest predictors of high risk category.

Conclusion

Accessibility, proximity and availability are unique characteristics of community pharmacies that could be exploited to support community based screening services.

Coronary artery calcium, HIV and inflammation in Uganda compared with the USA

Objectives

To compare the prevalence of detectable coronary artery calcium (CAC) among higher risk, older people living with HIV (PLWH) and uninfected persons in Uganda versus the USA, and second to explore associations of CAC with HIV-specific variables and biomarkers of inflammation.

Methods

This cross-sectional study of 430 total subjects compared 100 PLWH on antiretroviral therapy and 100 age-matched and sex-matched HIV-uninfected controls in Uganda with 167 PLWH on antiretroviral therapy and 63 uninfected controls in the USA. Multivariable logistic regression was used to examine associations with detectable CAC (CAC >0).

Results

Compared with US subjects, Ugandans were older (mean age 56 vs 52 years) and were more likely to have diabetes (36% vs 3%) and hypertension (85% vs 36%), but were less likely to be male (38% vs 74%) or smokers (4% vs 56%). After adjustment for HIV serostatus, age, sex and traditional risk factors, Ugandans had substantially lower odds of CAC >0 (adjusted OR 0.07 (95% CI 0.03 to 0.17), p<0.001). HIV was not associated with CAC >0 in either country (p>0.1). Among all PLWH, nadir CD4 count was associated with the presence of CAC, and among Ugandans soluble intercellular adhesion molecule (p=0.044), soluble CD163 (p=0.004) and oxidised low-density lipoprotein (p=0.043) were all associated with the presence of CAC.

Conclusions

Ugandans had a dramatically lower prevalence of any coronary calcification compared with US subjects. The role of HIV infection and inflammation as risk factors for subclinical coronary disease in sub-Saharan Africa merits further investigation.

Cardiovascular disease risk factor prevalence and estimated 10-year cardiovascular risk scores in Indonesia: The SMARThealth Extend study

BACKGROUND

The brunt of cardiovascular disease (CVD) burden globally now resides within low- and middle-income countries, including Indonesia. However, little is known regarding cardiovascular health in Indonesia. This study aimed to estimate the prevalence of elevated CVD risk in a specific region of Indonesia.

METHODS

We conducted full household screening for cardiovascular risk factors among adults aged 40 years and older in 8 villages in Malang District, East Java Province, Indonesia, in 2016-2017. 10-year cardiovascular risk scores were calculated based on the World Health Organization/International Society of Hypertension's region-specific charts that use age, sex, blood pressure, diabetes status and smoking behaviour.

RESULTS

Among 22,093 participants, 6,455 (29.2%) had high cardiovascular risk, defined as the presence of coronary heart disease, stroke or other atherosclerotic disease; estimated 10-year CVD risk of ≥ 30%; or estimated 10-year CVD risk between 10% to 29% combined with a systolic blood pressure of > 140 mmHg. The prevalence of high CVD risk was greater in urban (31.6%, CI 30.7-32.5%) than in semi-urban (28.7%, CI 27.3-30.1%) and rural areas (26.2%, CI 25.2-27.2%). Only 11% and 1% of all the respondents with high CVD risk were on blood pressure lowering and statins treatment, respectively.

CONCLUSIONS

High cardiovascular risk is common among Indonesian adults aged ≥40 years, and rates of preventive treatment are low. Population-based and clinical approaches to preventing CVD should be a priority in both urban and rural areas.

An implementation science study to enhance cardiovascular disease prevention in Mukono and Buikwe districts in Uganda: a stepped-wedge design

BACKGROUND

Uganda is experiencing a shift in major causes of death with cases of stroke, heart attack, and heart failure reportedly on the rise. In a study in Mukono and Buikwe in Uganda, more than one in four adults were reportedly hypertensive. Moreover, very few (36.5%) reported to have ever had a blood pressure measurement. The rising burden of CVD is compounded by a lack of integrated primary health care for early detection and treatment of people with increased risk. Many people have less access to effective and equitable health care services which respond to their needs. Capacity gaps in human resources, equipment, and drug supply, and laboratory capabilities are evident. Prevention of risk factors for CVD and provision of effective and affordable treatment to those who require it prevent disability and death and improve quality of life. The aim of this study is to improve health profiles for people with intermediate and high risk factors for CVD at the community and health facility levels. The implementation process and effectiveness of interventions will be evaluated.

METHODS

The overall study is a type 2-hybrid stepped-wedge (SW) design. The design employs mixed methods evaluations with incremental execution and adaptation. Sequential crossover take place from control to intervention until all are exposed. The study will take place in Mukono and Buikwe districts in Uganda, home to more than 1,000,000 people at the community and primary healthcare facility levels. The study evaluation will be guided by; 1) RE-AIM an evaluation framework and 2) the CFIR a determinant framework. The primary outcomes are implementation - acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, coverage, and sustainability.

DISCUSSION

The study is envisioned to provide important insight into barriers and facilitators of scaling up CVD prevention in a low income context. This project is registered at the ISRCTN Registry with number ISRCTN15848572. The trial was first registered on 03/01/2019.

Delineating the age-related attenuation of vascular function: Evidence supporting the efficacy of the single passive leg movement as a screening tool

Continuous passive leg movement (PLM) is a promising clinical assessment of the age-related decline in peripheral vascular function. To further refine PLM, this study evaluated the efficacy of a single PLM (sPLM), a simplified variant of the more established continuous movement approach, to delineate between healthy young and old men based on vascular function. Twelve young (26 ± 5 yr) and 12 old (70 ± 7 yr) subjects underwent sPLM (a single passive flexion and extension of the knee joint through 90°), with leg blood flow (LBF, common femoral artery with Doppler ultrasound), blood pressure (finger photoplethysmography), and leg vascular conductance (LVC) assessed. A receiver operator characteristic curve analysis was used to determine an age-specific cut score, and a factor analysis was performed to assess covariance. Baseline LBF and LVC were not different between groups (P = 0.6). The high level of covariance and similar predictive value for all PLM-induced LBF and LVC responses indicates LBF, alone, can act as a surrogate variable in this paradigm. The peak sPLM-induced increase in LBF from baseline was attenuated in the old (Young: 717 ± 227, Old: 260 ± 97 ml/min, P < 0.001; cut score: 372 ml/min), as was the total LBF response (Young: 155 ± 67, Old: 26 ± 17 ml, P < 0.001; cut score: 58 ml). sPLM, a simplified version of PLM, exhibits the prerequisite qualities of a valid screening test for peripheral vascular dysfunction, as evidenced by an age-related attenuation in the peripheral hyperemic response and a clearly delineated age-specific cut score. NEW & NOTEWORTHY Single passive leg movement (sPLM) exhibits the prerequisite qualities of a valid screening test for peripheral vascular dysfunction. sPLM displayed an age-related reduction in the peripheral hemodynamic response for amplitude, duration, initial rate of change, and total change with clearly delineated age-specific cut scores. sPLM has a strong candidate variable that is a simple single numeric value, for which to appraise peripheral vascular function, the 45-s hyperemic response (leg blood flow area under the curve: 45 s).

Prevalence of high blood pressure and associated factors among adolescents and young people in Tanzania and Uganda

We conducted a cross-sectional study among school/college students in Tanzania and Uganda to determine the prevalence of high blood pressure (BP) and associated factors. Participants were classified to have high BP if they had pre-hypertension or hypertension. Interviews were done using the WHO STEPS instrument. Using data from both countries (n = 1596), the overall prevalence of high BP was 40% (95% CI: 37-42). The prevalence of pre-hypertension was 29% (95% CI: 26-31) and that of hypertension was 11% (95% CI: 10-13). High BP was independently associated with obesity (aOR = 6.7, 95% CI: 2.2-20.0), male sex (aOR = 3.2, 95% CI: 2.4-4.4), and among males aged above 20 years (aOR = 5.5, 95% CI: 2.9-10.5). Consumption of fruits/vegetables was associated with decreased odds for high BP (aOR = 0.7, 95% CI: 0.50-0.98). The increasing burden of pre-hypertension across age groups could explain the early onset of hypertension and cardiovascular diseases (CVDs) among young African adults. There is a need for longitudinal studies to explore the drivers of pre-hypertension in East African adolescents.

The Effect of Two Methods of Relaxation and Prayer Therapy on Anxiety and Hope in Patients with Coronary Artery Disease: A Quasi-Experimental Study

Background

Mental health problems such as anxiety and disappointment are common in patients with heart disease, resulting in poor outcomes. The purpose of this study was to compare the effectiveness of two methods of relaxation and prayer therapy on anxiety and hope in patients with coronary artery disease (CAD).

Materials and Methods

A quasi-experimental study was conducted in three groups of 25 subjects (i.e., two groups of relaxation and prayer therapy and one control group) and two stages (i.e., pretest and posttest) in hospitals affiliated to Isfahan University of Medical Sciences, Iran. Data collection instrument consisted of three parts: (a) demographic and individual characteristics of the subjects, (b) Beck Anxiety Inventory, and (c) Snyder's Hope Scale. The interventions consisted of Benson's relaxation and prayer therapy. Data were analyzed using descriptive and inferential statistics.

Results

The results showed that there was a significant difference between the mean score of anxiety after intervention in the three groups which was related to each of the relaxation and prayer therapy group with the control group. Also, the result of analysis of covariance with controlling the effect of pretest revealed significant between-subject effects of interventions on posttest scores of hope (F(2, 71) = 8.55, p = 0.012, ηp ² = 0.12) and anxiety (F(2, 71) = 4.71, p < 0.001, ηp ² = 0.19).

Conclusions

Both relaxation and prayer therapy interventions are effective in promoting hope and reducing anxiety in patients with CAD and provide optimal, short-term, and easy-to-follow options for the health team.

Strategic Opportunities for Leveraging Low-cost, High-impact Technological Innovations to Promote Cardiovascular Health in India

Accelerated epidemiological transition in India over the last 40 years has resulted in a dramatic increase in the burden of cardiovascular diseases and the related risk factors of diabetes and hypertension. This increase in disease burden has been accompanied by pervasive health disparities associated with low disease detection rates, inadequate awareness, poor use of evidence-based interventions, and low adherence rates among patients in rural regions in India and those with low socioeconomic status. Several research groups in India have developed innovative technologies and care-delivery models for screening, diagnosis, clinical management, remote-monitoring, self-management, and rehabilitation for a range of chronic conditions. These innovations can leverage advances in sensor technology, genomic tools, artificial intelligence, big-data analytics, and so on, for improving access to and delivering quality and affordable personalized medicine in primary care. In addition, several health technology start-ups are entering this booming market that is set to grow rapidly. Innovations outside biomedical space (eg, protection of traditional wisdom in diet, lifestyle, yoga) are equally important and are part of a comprehensive solution. Such low-cost, culturally tailored, robust innovations to promote health and reduce disparities require partnership among multi-sectors including academia, industry, civil society, and health systems operating in a conducive policy environment that fosters adequate public and private investments. In this article, we present the unique opportunity for India to use culturally tailored, low-cost, high-impact technological innovations and strategies to ameliorate the perennial challenges of social, policy, and environmental challenges including poverty, low educational attainment, culture, and other socioeconomic factors to promote cardiovascular health and advance health equity.

Prevalence and associations of depression among patients with cardiac diseases in a public health institute in Trinidad and Tobago

BACKGROUND

Psychosocial issues are major determinants as well as consequences of cardiovascular disease (CVD). This study sought to assess the prevalence and identify factors associated with depression among patients with cardiac disease in a public health institute in Trinidad and Tobago.

METHODS

A cross-sectional study was conducted with a convenience sample of 388 hospitalised, stable, adult patients with cardiac disease admitted in the only tertiary public health institute in South Trinidad. Patients were identified and interviewed 3 to 5 days after admission using a questionnaire comprising questions on demographic, medical, and lifestyle issues and the 9-item Patient Health Questionnaire (PHQ-9).

RESULTS

The prevalence of clinically significant depression (PHQ-9 > 9) among hospitalised patients with cardiac disease was 40.0%. However, the prevalence of non-minimal depression (PHQ-9 ≥ 5) in this study was 78.4%. It was greater among women (83.1%) than among men (72.9%). Non-minimal depression was associated with sex (p = 0.015), employment status (p = 0.007), hypertension (p = 0.017), stressful life (p ≤ 0.001), feelings of depression (p ≤ 0.001), regular exercise (p ≤ 0.001), and living alone (p = 0.006). Age, ethnicity, education level, income, or religious affiliations were not associated (p > 0.05) with depression. Participants diagnosed with depression commonly reported feeling tired (81.2%), having trouble sleeping (74.7%), and moving/speaking slowly (73.5%). Patients with self-claimed depression (past or current) were four times more likely to have depression and those with self-reported stress and loneliness were twice as likely to have depression. Employed patients and those who exercised regularly were approximately 50% less likely to have depression.

CONCLUSIONS

Clinical depression prevalence among hospitalised patients with cardiac disease was 40.0%. Approximately twice as many (78.4%) had non-minimal depression, with higher prevalence among women. Employment, sex, hypertension, stressful life, feelings of depression, regular exercise, and living alone were associated with non-minimal depression. Patients with self-claimed depression, stress, and those living alone had a much higher likelihood of having depression, while those who were employed and exercised regularly were approximately half as likely to have depression.

History of Pulmonary Tuberculosis

Tuberculosis (TB) parallels the history of human development from the Stone Age to the present. TB continues to be in the top 10 causes of global human mortality over that period. This article highlights the history of pulmonary TB from the onset of human existence to the present. Despite its long history, TB was slowly identified as a major cause of disease, and defined causation and significant treatment strategies advances over the past 150 years. TB remains a major challenge for definitive global prevention and cure. This article gives a brief overview of the history of TB.

Reducing chronic disease through changes in food aid: A microsimulation of nutrition and cardiometabolic disease among Palestinian refugees in the Middle East

BACKGROUND

Type 2 diabetes mellitus and cardiovascular disease and have become leading causes of morbidity and mortality among Palestinian refugees in the Middle East, many of whom live in long-term settlements and receive grain-based food aid. The objective of this study was to estimate changes in type 2 diabetes and cardiovascular disease morbidity and mortality attributable to a transition from traditional food aid to either (i) a debit card restricted to food purchases, (ii) cash, or (iii) an alternative food parcel with less grain and more fruits and vegetables, each valued at $30/person/month.

METHODS AND FINDINGS

An individual-level microsimulation was created to estimate relationships between food aid delivery method, food consumption, type 2 diabetes, and cardiovascular disease morbidity and mortality using demographic data from the United Nations (UN; 2017) on 5,340,443 registered Palestinian refugees in Syria, Jordan, Lebanon, Gaza, and the West Bank, food consumption data (2011-2017) from households receiving traditional food parcel delivery of food aid (n = 1,507 households) and electronic debit card delivery of food aid (n = 1,047 households), and health data from a random 10% sample of refugees receiving medical care through the UN (2012-2015; n = 516,386). Outcome metrics included incidence per 1,000 person-years of hypertension, type 2 diabetes, atherosclerotic cardiovascular disease events, microvascular events (end-stage renal disease, diabetic neuropathy, and proliferative diabetic retinopathy), and all-cause mortality. The model estimated changes in total calories, sodium and potassium intake, fatty acid intake, and overall dietary quality (Mediterranean Dietary Score [MDS]) as mediators to each outcome metric. We did not observe that a change from food parcel to electronic debit card delivery of food aid or to cash aid led to a meaningful change in consumption, biomarkers, or disease outcomes. By contrast, a shift to an alternative food parcel with less grain and more fruits and vegetables was estimated to produce a 0.08 per 1,000 person-years decrease in the incidence of hypertension (95% confidence interval [CI] 0.05-0.11), 0.18 per 1,000 person-years decrease in the incidence of type 2 diabetes (95% CI 0.14-0.22), 0.18 per 1,000 person-years decrease in the incidence of atherosclerotic cardiovascular disease events (95% CI 0.17-0.19), and 0.02 decrease per 1,000 person-years all-cause mortality (95% CI 0.01 decrease to 0.04 increase) among those receiving aid. The benefits of this shift, however, could be neutralized by a small (2%) increase in compensatory (out-of-pocket) increases in consumption of refined grains, fats and oils, or confectionaries. A larger alternative parcel requiring an increase in total food aid expenditure by 27% would be more likely to have a clinically meaningful improvement on type 2 diabetes and cardiovascular disease incidence.

CONCLUSIONS

Contrary to the supposition in the literature, our findings do not robustly support the theory that transitioning from traditional food aid to either debit card or cash delivery alone would necessarily reduce chronic disease outcomes. Rather, an alternative food parcel would be more effective, even after matching current budget ceilings. But compensatory increases in consumption of less healthy foods may neutralize the improvements from an alternative food parcel unless total aid funding were increased substantially. Our analysis is limited by uncertainty in estimates of modeling long-term outcomes from shorter-term trials, focusing on diabetes and cardiovascular outcomes for which validated equations are available instead of all nutrition-associated health outcomes, and using data from food frequency questionnaires in the absence of 24-hour dietary recall data.

Benefits and limitations of implementing Chronic Care Model (CCM) in primary care programs: A systematic review

BACKGROUND

Chronic Care Model (CCM) has been developed to improve patients' health care by restructuring health systems in a multidimensional manner. This systematic review aims to summarize and analyse programs specifically designed and conducted for the fulfilment of multiple CCM components. We have focused on programs targeting diabetes mellitus, hypertension and cardiovascular disease.

METHOD AND RESULTS

This review was based on a comprehensive literature search of articles in the PubMed database that reported clinical outcomes. We included a total of 25 eligible articles. Evidence of improvement in medical outcomes and the compliance of patients with medical treatment were reported in 18 and 14 studies, respectively. Two studies demonstrated a reduction of the medical burden in terms of health service utilization, and another two studies reported the effectiveness of the programs in reducing the risk of heart failure and other cardiovascular diseases. However, CCMs were still restricted by limited academic robustness and social constraints when they were implemented in primary care. Higher professional recognition, tighter system collaborations and increased financial support may be necessary to overcome the limitations of, and barriers to CCM implementation.

CONCLUSION

This review has identified the benefits of implementing CCM, and recommended suggestions for the future development of CCM.

New insights on relaxant effects of (-)-borneol monoterpene in rat aortic rings

The monoterpene alcohol (-)-borneol has many biological effects such as sedative, anti-inflammatory, analgesic, anti-nociceptive, antithrombotic and vasorelaxant effects. Our objective in this study was to investigate the mechanism of action of (-)-borneol and determine its vasorelaxant effect. (-)-Borneol was tested on isolated aortic rings contracted with PE (10^-6  m). This study was performed in the absence or in the presence of endothelium, L-NAME (100 μm), indomethacin (10 μm), TEA (1 and 10 mm), 4-AP (1 mm) or glibenclamide (1 mm) to assess the participation of EDRF, nitric oxide, prostanoids and potassium channels on the relaxing effect of (-)-borneol. In this work, (-)-borneol induced a relaxant effect in aortic rings, with and without endothelium, in a concentration-dependent manner. The pharmacological characterization obtained using L-NAME, indomethacin, TEA, 4-AP and glibenclamide demonstrates that the effect of (-)-borneol was modified in the presence of L-NAME, indomethacin and glibenclamide showing that these signal transduction pathways are involved in the relaxing effect of the monoterpene. (-)-Borneol has a vasorelaxant effect that depends on the presence of vascular endothelium, with the participation of nitric oxide and prostanoids. Also, (-)-borneol displayed a direct action on the vascular smooth muscle, greatly dependent on K_ATP channels.

Modern Management of ST-Segment Elevation Myocardial Infarction

Disruption of intracoronary plaque with thrombus formation resulting in severe or total occlusion of the culprit coronary artery provides the pathophysiologic foundation for ST-segment elevation myocardial infarction (STEMI). Management of STEMI focuses on timely restoration of coronary blood flow along with antithrombotic therapies and secondary prevention strategies. The purpose of this review is to discuss the epidemiology, pathophysiology, and diagnosis of STEMI. In addition, the review will focus on guideline-directed therapy for these patients and review potential associated complications.

A narrative review of the success of intramuscular gluteal injections and its impact in psychiatry

There are 12 billion injections given worldwide every year. For many injections, the intramuscular route is favoured over the subcutaneous route due to the increased vascularity of muscle tissue and the corresponding increase in the bioavailability of drugs when administered intramuscularly. This paper is a review of the variables that affect the success of intramuscular injections and the implications that these success rates have in psychiatry and general medicine. Studies have shown that the success rates of intended intramuscular injections vary between 32 and 52%, with the rest potentially resulting in inadvertent subcutaneous drug deposition. These rates are found to be even lower for certain at-risk populations, such as obese patients and those on antipsychotic medications. The variables associated with an increased risk of injection failure include female sex, obesity, site of injection, and subcutaneous fat depth. New guidelines and methods are needed in order to address this challenge and ensure that patients receive optimum care. Looking forward, the best way to improve the delivery of intramuscular injections worldwide is to develop uniform algorithms or innovative medical devices to confirm or guarantee successful delivery at the bedside.

Associations of Anthropometric Characteristics, Dietary Habits, and Aerobic Capacity With Cardiovascular Risk Factors of Health-Science Students

The aim of this cross-sectional study was to study the relative importance of dietary habits and aerobic capacity in parameters related to cardiovascular risk in 271 female and 95 male health-science students (mean age = 19.1 ± 1.4 years). In females, fatty-meat consumption predicted triglycerides (β = .649, p < .001) and high-density lipoprotein (HDL; β = -.242, p = .001) and low-density lipoprotein (LDL; β = .373, p < .001) cholesterol levels. Consumption of nuts, legumes, and complex carbohydrates predicted triglyceride (β = -.099, p = .074), HDL (β = .231, p = .001), and LDL (β = -.155, p = .025) levels, respectively. Aerobic capacity (β = -.245, p < .001) and fatty-meat intake (β = .230, p < .001) predicted diastolic blood pressure (BP); body mass index (BMI) predicted systolic BP (β = .340, p < .001). In males, body fat percentage was the strongest predictor of triglycerides (β = .348, p = .004), cholesterol (β = .366, p = .006), HDL (β = -.378, p = .004), and LDL (β = .271, p = .043) levels. Aerobic capacity (β = -.263, p = .013) and fatty-meat consumption (β = .334, p = .005) independently predicted triglyceride levels. Nut (β = -.286, p = .013) and fatty-meat intake (β = .361, p = .002) predicted systolic BP, while BMI predicted diastolic BP (β = .209, p = .045). As health sciences students, these participants are future health professionals; targeting such populations is important for chronic disease prevention.

Downregulation of microRNA-1 attenuates glucose-induced apoptosis by regulating the liver X receptor α in cardiomyocytes

Diabetic cardiomyopathy (DCM) is characterized by abnormal myocardial structure or performance. It has been suggested that microRNA-1 (miR-1) may be abnormally expressed in the hearts of patients with diabetes. In the present study, the role of miR-1 in glucose-induced apoptosis and its underlying mechanism of action was investigated in rat cardiomyocyte H9C2 cells. Cells were transfected with anti-miR-1 or miR-1-overexpression plasmids and the expression of miR-1 and liver X receptor α (LXRα) were determined by reverse transcription-quantitative polymerase chain reaction analysis. The proportion of apoptotic cells was determined using an Annexin-V-FITC apoptosis detection kit and the mitochondrial membrane potential (ΔΨ) was measured following staining with rhodamine 123. In addition, the expression of apoptosis-associated proteins was measured by western blot analysis. The results demonstrated that expression of miR-1 was significantly increased, whereas the expression of LXRα was significantly decreased in H9C2 cells following treatment with glucose. miR-1 knockdown significantly inhibited apoptosis, increased the ΔΨ and suppressed the cleavage of poly (adenosine diphosphate-ribose) polymerase, caspase-3 and caspase-9. It also significantly downregulated the expression of Bcl-2 and upregulated the expression of Bax. In addition, it was demonstrated that miR-1 regulates LXRα; transfection with anti-miR-1 significantly increased the expression of LXRα. Furthermore, treatment of cells with the LXR agonist GW3965 inhibited apoptosis in glucose-induced anti-miR-1 cells. These results suggest a novel function of miR-1: The regulation of cardiomyocyte apoptosis via LXRα, and provide novel insights into regarding the complex mechanisms involved in DCM.

Type 2 Diabetes and Adiposity Induce Different Lipid Profile Disorders: A Mendelian Randomization Analysis

CONTEXT

Type 2 diabetes and obesity often coexist, so it is difficult to judge whether diabetes or obesity induce certain types of hyperlipidemia due to mutual confounds and reverse causation. We used Mendelian randomization analyses to explore the causal relationships of diabetes and adiposity with lipid profiles.

DESIGN, SETTING, AND MAIN OUTCOME MEASURES

From 23 sites in East China, 9798 participants were enrolled during 2014 to 2016. We calculated two weighted genetic risk scores as instrumental variables for type 2 diabetes and body mass index (BMI). These scores were used to measure the causal relationships of diabetes and BMI with lipid profiles that included total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TGs).

RESULTS

The causal regression coefficients (βIV) of genetically determined diabetes for the total cholesterol, LDL-C, and log10TG were 0.130 [95% confidence interval (CI): 0.020, 0.240; P = 0.014], 0.125 (96% CI: 0.041, 0.209; P = 0.001), and 0.019 (95% CI: -0.001, 0.039; P = 0.055), respectively. The βIV for HDL-C was -0.008 (95% CI: -0.032. 0.016), which was not significant (P = 0.699). The causal regression coefficients of a genetically determined 10 kg/m2 increase in BMI for HDL-C and log10TG were -0.409 (96% CI: -0.698, -0.120; P = 0.004) and 0.227 (95% CI: 0.039, 0.415; P = 0.026), respectively. The βIVs for TGs and LDL-C were not significant.

CONCLUSIONS

This study has provided evidence for the biologically plausible causal effects of diabetes and adiposity by BMI on different elements of the lipid profile using Mendelian randomization analyses.