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Muacevic A, Adler JR, Malani SK, Manade VV. Comparative Study of Transradial Versus Transfemoral Route Percutaneous Coronary Intervention in Acute ST-Elevation Myocardial Infarction. Cureus 2022; 14:e32983. [PMID: 36712754 PMCID: PMC9877718 DOI: 10.7759/cureus.32983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2022] [Indexed: 12/28/2022] Open
Abstract
Introduction Percutaneous coronary intervention (PCI) is the first choice of treatment for myocardial infarction (MI). However, entry site failure is still one of the major complications faced by the interventionist. Hence the present study compared the efficacy and complications of radial and femoral approaches in PCI in ST-elevation myocardial infarction (STEMI). Methods A hospital-based prospective study was conducted on patients with acute STEMI. A total of 100 patients were enrolled that were randomly divided into two groups of 50 each, i.e., patients that had undergone PCI by radial approach (N=50) and those who had undergone PCI by femoral approach (N=50). Results The male-to-female ratio was 1.5:1 and 1.6:1 in the transradial (TR) and transfemoral (TF) groups, respectively. With respect to age, both the groups were dominated by the age group of 50-60 years, with 42% in the TR group and 34% in the TF group having an age >60 years. The mean access time, fluoroscopy time, and procedural time in the TR group were 6.0 ± 0.7 minutes, 5.9 ± 0.6 minutes, and 29.55 ± 0.9 minutes, respectively. In the TF group, the mean access time, fluoroscopy time, and procedural time were 5.1 ± 0.5 minutes, 5.5 ± 0.7 minutes, and 26.7 ± 2.1 minutes, respectively. In the TR group, ecchymosis and loss of radial pulse were observed in 10% of the patients, thrombophlebitis in 4%, and bleeding complications in 2%. While in the TF group, ecchymosis was observed in 26%, followed by thrombophlebitis (24%), minor hematoma, and bleeding complications (14%). Conclusion The present study emphasizes the use of radial access in patients with ST-segment elevation acute coronary syndrome, as this approach was associated with significant clinical benefits. Moreover, bleeding complications were more in patients undergoing TF intervention.
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Li Z, Gao J, Sun D, Jiao Q, Ma J, Cui W, Lou Y, Xu F, Li S, Li H. LncRNA MEG3: Potential stock for precision treatment of cardiovascular diseases. Front Pharmacol 2022; 13:1045501. [PMID: 36523500 PMCID: PMC9744949 DOI: 10.3389/fphar.2022.1045501] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/11/2022] [Indexed: 10/13/2023] Open
Abstract
The prevalence and mortality rates of cardiovascular diseases are increasing, and new treatment strategies are urgently needed. From the perspective of basic pathogenesis, the occurrence and development of cardiovascular diseases are related to inflammation, apoptosis, fibrosis and autophagy of cardiomyocytes, endothelial cells and other related cells. The involvement of maternally expressed gene 3 (MEG3) in human disease processes has been increasingly reported. P53 and PI3K/Akt are important pathways by which MEG3 participates in regulating cell apoptosis. MEG3 directly or competitively binds with miRNA to participate in apoptosis, inflammation, oxidative stress, endoplasmic reticulum stress, EMT and other processes. LncRNA MEG3 is mainly involved in malignant tumors, metabolic diseases, immune system diseases, cardiovascular and cerebrovascular diseases, etc., LncRNA MEG3 has a variety of pathological effects in cardiomyocytes, fibroblasts and endothelial cells and has great clinical application potential in the prevention and treatment of AS, MIRI, hypertension and HF. This paper will review the research progress of MEG3 in the aspects of mechanism of action, other systemic diseases and cardiovascular diseases, and point out its great potential in the prevention and treatment of cardiovascular diseases. lncRNAs also play a role in endothelial cells. In addition, lncRNA MEG3 has shown biomarker value, prognostic value and therapeutic response measurement in tumor diseases. We boldly speculate that MEG3 will play a role in the emerging discipline of tumor heart disease.
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Affiliation(s)
- Zining Li
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Master’s Degree Student, Beijing, China
- Cardiovascular Division, Beijing, China
| | - Jialiang Gao
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Cardiovascular Division, Beijing, China
- Deputy Chief Physician, Beijing, China
| | - Di Sun
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Master’s Degree Student, Beijing, China
- Cardiovascular Division, Beijing, China
| | - Qian Jiao
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Master’s Degree Student, Beijing, China
- Cardiovascular Division, Beijing, China
| | - Jing Ma
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Master’s Degree Student, Beijing, China
- Cardiovascular Division, Beijing, China
| | - Weilu Cui
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Master’s Degree Student, Beijing, China
- Cardiovascular Division, Beijing, China
| | - Yuqing Lou
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Master’s Degree Student, Beijing, China
- Cardiovascular Division, Beijing, China
| | - Fan Xu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Master’s Degree Student, Beijing, China
- Cardiovascular Division, Beijing, China
| | - Shanshan Li
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Master’s Degree Student, Beijing, China
- Cardiovascular Division, Beijing, China
| | - Haixia Li
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Cardiovascular Division, Beijing, China
- Chief Physician, Beijing, China
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103
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Shen R, Zhao N, Wang J, Guo P, Shen S, Liu D, Liu D, Zou T. Association between socioeconomic status and arteriosclerotic cardiovascular disease risk and cause-specific and all-cause mortality: Data from the 2005-2018 National Health and Nutrition Examination Survey. Front Public Health 2022; 10:1017271. [PMID: 36483261 PMCID: PMC9723397 DOI: 10.3389/fpubh.2022.1017271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Morbidity and mortality of arteriosclerotic cardiovascular disease (ASCVD) varied according to socioeconomic status (SES), and evidence on the association between SES and ASCVD risk, and cause-specific and all-cause mortality was nevertheless lacking in large-scale or population-based studies. Methods A multicycle cross-sectional design and mortality linkage study was conducted using data from Continuous National Health and Nutrition Examination Survey (NHANES) in the United States, including public use linked mortality follow-up files through December 31, 2019. Poverty income ratio (PIR) served as a SES index. A series of weighted Logistic regressions and Cox proportional hazards regressions were used to investigate the association between the SES and the risk of ASCVD and mortality, respectively. Results The study sample was comprised of 30,040 participants aged 20-85 years old during the 2005-2018 period. Weighted Logistic regression models consistently indicated significant relationship between people experiencing poverty and increased risk of ASCVD, and linear trend tests were all statistically significant (all P for trend < 0.001). Additionally, weighted Cox regression analysis consistently demonstrated that the hazards of cause-specific and all-cause mortality increased, with the decrease of each additional income level, and trend analyses indicated similar results (all P for trend < 0.001). Conclusions Our study confirmed that the SES was strongly linked to living with ASCVD, and cause-specific and all-cause mortality, even after adjusting for other factors that could impact risk, such as the American Heart Association (AHA)'s Life's Simple 7 cardiovascular health score and variables of age, sex, marital status, education, and depression severity.
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Affiliation(s)
- Ruihuan Shen
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ning Zhao
- Department of Gastrointestinal and General Surgery, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jia Wang
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Peking University Fifth School of Clinical Medicine, Beijing, China
| | - Peiyao Guo
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Peking University Fifth School of Clinical Medicine, Beijing, China
| | - Shuhui Shen
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Detong Liu
- Department of Oncology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Donghao Liu
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Peking University Fifth School of Clinical Medicine, Beijing, China
| | - Tong Zou
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China,*Correspondence: Tong Zou
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Diaztagle Fernández JJ, Canal Forero JE, Castañeda González JP. Hipertensión arterial y riesgo cardiovascular. REPERTORIO DE MEDICINA Y CIRUGÍA 2022. [DOI: 10.31260/repertmedcir.01217372.1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introducción: la hipertensión arterial es una de las principales enfermedades a nivel mundial y constituye una importante causa de morbilidad y mortalidad para países de bajos y medianos ingresos. Objetivo: determinar la importancia epidemiológica de la hipertensión arterial como factor de riesgo cardiovascular en diferentes estudios realizados a nivel mundial, en Latinoamérica y Colombia. Metodología: se realizó una búsqueda de la literatura científica en las bases de datos de PudMed/Medline, Scielo, LILACS, así como también en revistas médicas y textos publicados por el Ministerio de Salud y Protección Social de Colombia. Discusión y conclusiones: más de 90% de los pacientes hipertensos padecen la forma primaria de la enfermedad, la cual está asociada con un aumento de la resistencia vascular periférica. Las características socioeconómicas de los países y el nivel educativo individual se relacionan con la prevalencia y el manejo adecuado de esta patología. El aumento en la prevalencia de las enfermedades crónicas, sumado a eventos históricos de importancia, fueron determinantes para el desarrollo de estudios epidemiológicos mundiales como el Framingham Heart Study. En América Latina y en Colombia se han realizado diferentes estudios que permiten establecer datos relacionados con la hipertensión arterial, demostrando cifras alarmantes en cuanto al conocimiento, tratamiento y control de esta condición, por lo cual, surge la necesidad de establecer programas para la detección de pacientes hipertensos con el fin de generar estrategias que disminuyan de manera significativa las enfermedades cardiovasculares.
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105
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Algur K, Sakpal R. Premature menopausal women and risk of cardiovascular diseases in India: Longitudinal Aging Study in India, 2017-18. Health Care Women Int 2022:1-13. [PMID: 36369776 DOI: 10.1080/07399332.2022.2141745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 10/07/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022]
Abstract
Women who have premature menopause are increasing in number and there is a wide regional diversity across the World, including India. However, in India, the relationship between age at menopause and cardiovascular diseases is still unclear. To fill this research gap, we undertook the present study using data from the Longitudinal Aging Study of India (Wave1, 2017-18). Bivariate logistic regression with three different models controlling for socio-economic and demographic characteristics, reproductive history, nutritional status, and co-morbidities of CVDs was used to show the relationship between CVDs and premature menopause. In all three models, the adjusted odds of having CVDs were higher for premature menopausal women than for those who had menopause between the ages of 45-50. There is a need to understand menopausal problems and their risk factors. The government should initiate a reproductive and sexual health awareness program at the macro level and provide treatment for the same.
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Affiliation(s)
- Kisan Algur
- International Institute for Population Sciences, Mumbai, India
| | - Ruchita Sakpal
- International Institute for Population Sciences, Mumbai, India
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106
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Minja NW, Nakagaayi D, Aliku T, Zhang W, Ssinabulya I, Nabaale J, Amutuhaire W, de Loizaga SR, Ndagire E, Rwebembera J, Okello E, Kayima J. Cardiovascular diseases in Africa in the twenty-first century: Gaps and priorities going forward. Front Cardiovasc Med 2022; 9:1008335. [PMID: 36440012 PMCID: PMC9686438 DOI: 10.3389/fcvm.2022.1008335] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
In 2015, the United Nations set important targets to reduce premature cardiovascular disease (CVD) deaths by 33% by 2030. Africa disproportionately bears the brunt of CVD burden and has one of the highest risks of dying from non-communicable diseases (NCDs) worldwide. There is currently an epidemiological transition on the continent, where NCDs is projected to outpace communicable diseases within the current decade. Unchecked increases in CVD risk factors have contributed to the growing burden of three major CVDs-hypertension, cardiomyopathies, and atherosclerotic diseases- leading to devastating rates of stroke and heart failure. The highest age standardized disability-adjusted life years (DALYs) due to hypertensive heart disease (HHD) were recorded in Africa. The contributory causes of heart failure are changing-whilst HHD and cardiomyopathies still dominate, ischemic heart disease is rapidly becoming a significant contributor, whilst rheumatic heart disease (RHD) has shown a gradual decline. In a continent where health systems are traditionally geared toward addressing communicable diseases, several gaps exist to adequately meet the growing demand imposed by CVDs. Among these, high-quality research to inform interventions, underfunded health systems with high out-of-pocket costs, limited accessibility and affordability of essential medicines, CVD preventive services, and skill shortages. Overall, the African continent progress toward a third reduction in premature mortality come 2030 is lagging behind. More can be done in the arena of effective policy implementation for risk factor reduction and CVD prevention, increasing health financing and focusing on strengthening primary health care services for prevention and treatment of CVDs, whilst ensuring availability and affordability of quality medicines. Further, investing in systematic country data collection and research outputs will improve the accuracy of the burden of disease data and inform policy adoption on interventions. This review summarizes the current CVD burden, important gaps in cardiovascular medicine in Africa, and further highlights priority areas where efforts could be intensified in the next decade with potential to improve the current rate of progress toward achieving a 33% reduction in CVD mortality.
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Affiliation(s)
- Neema W. Minja
- Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala, Uganda
- Kilimanjaro Clinical Research Institute (KCRI), Moshi, Tanzania
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Doreen Nakagaayi
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Twalib Aliku
- Department of Pediatric Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Wanzhu Zhang
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Isaac Ssinabulya
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Juliet Nabaale
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Willington Amutuhaire
- Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Sarah R. de Loizaga
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Emma Ndagire
- Department of Pediatric Cardiology, Uganda Heart Institute, Kampala, Uganda
| | | | - Emmy Okello
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - James Kayima
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Zhang J, Fang Y, Yao Y, Zhao Y, Yue D, Sung M, Jin Y, Zheng ZJ. Disparities in cardiovascular disease prevalence among middle-aged and older adults: Roles of socioeconomic position, social connection, and behavioral and physiological risk factors. Front Cardiovasc Med 2022; 9:972683. [PMID: 36312247 PMCID: PMC9614039 DOI: 10.3389/fcvm.2022.972683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/26/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Cardiovascular disease (CVD) remains the leading cause of premature death globally and a major contributor to decreasing quality of life. In the present study, we investigated the contribution of social, behavioral, and physiological determinants of CVD and their different patterns among middle-aged and older adults. Methods We used harmonized data from 6 nationally representative individual-level longitudinal studies across 25 countries. We restricted the age to ≥50 years and defined cases as a self-reported history of CVD. The exposure variables were the demographic status (age and sex), socioeconomic position (education level, employment, and household income level), social connections (marital status and family size), behavioral factors (smoking, alcohol drinking, and frequency of moderate to vigorous physical activity), and physiological risk factors (obesity, presence of hypertension, and presence of diabetes). Mixed logistic regression models were fitted to investigate the associations, and dominance analysis was conducted to examine the relative contributions. Results In total, 413,203 observations were included in the final analysis, with the CVD prevalence ranging from 10.4% in Mexico to 28.8% in the United States. Physiological risk factors were the main driver of CVD prevalence with the highest dominance proportion, which was higher in developing countries (China, 57.5%; Mexico, 72.8%) than in developed regions (United States, England, 10 European countries, and South Korea). Socioeconomic position and behavioral factors also highly contributed but were less significant in developing countries than in developed regions. The relative contribution of socioeconomic position ranged from 9.4% in Mexico to 23.4% in the United States, and that of behavioral factors ranged from 5.7% in Mexico to 26.1% in England. Conclusion The present study demonstrated the different patterns of determinant contributions to CVD prevalence across developing and developed countries. With the challenges produced by different risk factors, the implementation of tailored prevention and control strategies will likely narrow disparities in the CVD prevalence by promoting health management and enhancing the capacity of health systems across different countries.
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Affiliation(s)
- Ji Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Yian Fang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Yao Yao
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Yang Zhao
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia,The George Institute for Global Health China, Beijing, China
| | - Dahai Yue
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD, United States
| | | | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, Beijing, China,Institute for Global Health and Development, Peking University, Beijing, China,*Correspondence: Yinzi Jin
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, China,Institute for Global Health and Development, Peking University, Beijing, China,Zhi-Jie Zheng
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108
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Walli-Attaei M, Rosengren A, Rangarajan S, Breet Y, Abdul-Razak S, Sharief WA, Alhabib KF, Avezum A, Chifamba J, Diaz R, Gupta R, Hu B, Iqbal R, Ismail R, Kelishadi R, Khatib R, Lang X, Li S, Lopez-Jaramillo P, Mohan V, Oguz A, Palileo-Villanueva LM, Poltyn-Zaradna K, R SP, Pinnaka LVM, Serón P, Teo K, Verghese ST, Wielgosz A, Yeates K, Yusuf R, Anand SS, Yusuf S. Metabolic, behavioural, and psychosocial risk factors and cardiovascular disease in women compared with men in 21 high-income, middle-income, and low-income countries: an analysis of the PURE study. Lancet 2022; 400:811-821. [PMID: 36088949 DOI: 10.1016/s0140-6736(22)01441-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is a paucity of data on the prevalence of risk factors and their associations with incident cardiovascular disease in women compared with men, especially from low-income and middle-income countries. METHODS In the Prospective Urban Rural Epidemiological (PURE) study, we enrolled participants from the general population from 21 high-income, middle-income, and low-income countries and followed them up for approximately 10 years. We recorded information on participants' metabolic, behavioural, and psychosocial risk factors. For this analysis, we included participants aged 35-70 years at baseline without a history of cardiovascular disease, with at least one follow-up visit. The primary outcome was a composite of major cardiovascular events (cardiovascular disease deaths, myocardial infarction, stroke, and heart failure). We report the prevalence of each risk factor in women and men, their hazard ratios (HRs), and population-attributable fractions (PAFs) associated with major cardiovascular disease. The PURE study is registered with ClinicalTrials.gov, NCT03225586. FINDINGS In this analysis, we included 155 724 participants enrolled and followed-up between Jan 5, 2005, and Sept 13, 2021, (90 934 [58·4%] women and 64 790 [41·6%] men), with a median follow-up of 10·1 years (IQR 8·5-12·0). At study entry, the mean age of women was 49·8 years (SD 9·7) compared with 50·8 years (9·8) in men. As of data cutoff (Sept 13, 2021), 4280 major cardiovascular disease events had occurred in women (age-standardised incidence rate of 5·0 events [95% CI 4·9-5·2] per 1000 person-years) and 4911 in men (8·2 [8·0-8·4] per 1000 person-years). Compared with men, women presented with a more favourable cardiovascular risk profile, especially at younger ages. The HRs for metabolic risk factors were similar in women and men, except for non-HDL cholesterol, for which high non-HDL cholesterol was associated with an HR for major cardiovascular disease of 1·11 (95% CI 1·01-1·21) in women and 1·28 (1·19-1·39) in men, with a consistent pattern for higher risk among men than among women with other lipid markers. Symptoms of depression had a HR of 1·09 (0·98-1·21) in women and 1·42 (1·25-1·60) in men. By contrast, consumption of a diet with a PURE score of 4 or lower (score ranges from 0 to 8), was more strongly associated with major cardiovascular disease in women (1·17 [1·08-1·26]) than in men (1·07 [0·99-1·15]). The total PAFs associated with behavioural and psychosocial risk factors were greater in men (15·7%) than in women (8·4%) predominantly due to the larger contribution of smoking to PAFs in men (ie, 1·3% [95% CI 0·5-2·1] in women vs 10·7% [8·8-12·6] in men). INTERPRETATION Lipid markers and depression are more strongly associated with the risk of cardiovascular disease in men than in women, whereas diet is more strongly associated with the risk of cardiovascular disease in women than in men. The similar associations of other risk factors with cardiovascular disease in women and men emphasise the importance of a similar strategy for the prevention of cardiovascular disease in men and women. FUNDING Funding sources are listed at the end of the Article.
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Affiliation(s)
- Marjan Walli-Attaei
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Yolandi Breet
- Hypertension in Africa Research Team (HART) and MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Suraya Abdul-Razak
- Faculty of Medicine, Universiti Teknologi MARA (UiTM), Cardio Vascular and Lungs Research Institute (CaVaLRI), Selangor, Malaysia
| | - Wadeia Al Sharief
- Medical Education & Research Department, Medical College, University of Sharjah, Sharjah, United Arab Emirates
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | - Jephat Chifamba
- Physiology Department, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Rafael Diaz
- Estudios Clinicos Latinoamerica (ECLA), Rosario, Santa Fe, Argentina
| | - Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Jaipur, India
| | - Bo Hu
- Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing, China
| | - Romaina Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Rosnah Ismail
- Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Medical Centre, Kuala Lumpur, Malaysia
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rasha Khatib
- Institute for Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Xinyue Lang
- Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing, China
| | - Sidong Li
- Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing, China
| | - Patricio Lopez-Jaramillo
- Masira Research Institute, Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Aytekin Oguz
- Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Türkiye
| | | | | | - Sreelakshmi P R
- SUT Academy of Medical Sciences, Vattapara, Trivandrum, Kerala, India
| | - Lakshmi V M Pinnaka
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pamela Serón
- Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Koon Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sejil T Verghese
- Department of Physiology, St John's Medical College and Hospital, Bangalore, India
| | - Andreas Wielgosz
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Sonia S Anand
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
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Wei W, Liang Y, Guo D, Xu X, Xu Q, Li S, Li Y, Liu J, Liu Y, Tu M, Chen K, Chen H, Chen S. Hyperglycemia newly detected by glycated hemoglobin affects all-cause mortality in coronary artery disease patients: a retrospective cohort study. Diabetes Res Clin Pract 2022; 191:110053. [PMID: 36038089 DOI: 10.1016/j.diabres.2022.110053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022]
Abstract
AIMS We aim to assess the relationship between hyperglycemia and long-term prognosis in CAD patients without known diabetes. METHODS In this retrospective observational study, we enrolled 11,384 CAD patients without known diabetes. Newly detected diabetes was defined as HbA1c ≥ 6.5 %, and prediabetes was defined as HbA1c ranging from 5.7 to 6.4 %.The association between hyperglycemia and long-term all-cause mortality was examined using Cox proportional hazards regression analysis. RESULTS According to HbA1c level, 8207 (72.1 %) patients had hyperglycemia, including 13.0 % with diabetes and 59.1 % with prediabetes. During a median follow-up of 4.9 years, 1157(10.2 %) patients died. Compared with normoglycemia, hyperglycemia was associated with increased risk for long-term mortality (adjusted hazard ratio for diabetes and prediabetes: 1.23 [95 % confidence interval (CI): 1.00 to 1.51] and 1.17 [95 % CI: 1.01 to 1.36], respectively). CONCLUSIONS Hyperglycemia detected by HbA1c was common in CAD patients without known diabetes and was associated with increased long-term mortality. It is necessary to routinely use HbA1c to assess glucose metabolic status in CAD patients and treat hyperglycemia as early as possible to reduce the risk of adverse outcomes.
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Affiliation(s)
- Wen Wei
- Global Health Research Center,Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Department of Endocrinology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
| | - Yan Liang
- Department of Cardiology, Maoming People's Hospital, Maoming 525000, China
| | - Dachuan Guo
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Xinghao Xu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Qingbo Xu
- Department of Cardiology, Maoming People's Hospital, Maoming 525000, China
| | - Shanggang Li
- Global Health Research Center,Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yuqi Li
- Department of Cardiology, Zhong Shan City People's Hospital, Zhong Shan 528403, China
| | - Jin Liu
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yong Liu
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China; Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510100, China
| | - Mei Tu
- Department of Endocrinology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China
| | - Kaihong Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, China.
| | - Hong Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China; Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China.
| | - Shiqun Chen
- Global Health Research Center,Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
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Carey JJ, Chih-Hsing Wu P, Bergin D. Risk assessment tools for osteoporosis and fractures in 2022. Best Pract Res Clin Rheumatol 2022; 36:101775. [PMID: 36050210 DOI: 10.1016/j.berh.2022.101775] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Osteoporosis is one of the frequently encountered non-communicable diseases in the world today. Several hundred million people have osteoporosis, with many more at risk. The clinical feature is a fragility fracture (FF), which results in major reductions in the quality and quantity of life, coupled with a huge financial burden. In recognition of the growing importance, the World Health Organisation established a working group 30 years ago tasked with providing a comprehensive report to understand and assess the risk of osteoporosis in postmenopausal women. Dual-energy X-ray absorptiometry (DXA) is the most widely endorsed technology for assessing the risk of fracture or diagnosing osteoporosis before a fracture occurs, but others are available. In clinical practice, important distinctions are essential to optimise the use of risk assessments. Traditional tools lack specificity and were designed for populations to identify groups at higher risk using a 'one-size-fits-all' approach. Much has changed, though the purpose of risk assessment tools remains the same. In 2022, many tools are available to aid the identification of those most at risk, either likely to have osteoporosis or suffer the clinical consequence. Modern technology, enhanced imaging, proteomics, machine learning, artificial intelligence, and big data science will greatly advance a more personalised risk assessment into the future. Clinicians today need to understand not only which tool is most effective and efficient for use in their practice, but also which tool to use for which patient and for what purpose. A greater understanding of the process of risk assessment, deciding who should be screened, and how to assess fracture risk and prognosis in older men and women more comprehensively will greatly reduce the burden of osteoporosis for patients, society, and healthcare systems worldwide. In this paper, we review the current status of risk assessment, screening and best practice for osteoporosis, summarise areas of uncertainty, and make some suggestions for future developments, including a more personalised approach for individuals.
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Affiliation(s)
- John J Carey
- National University of Ireland Galway, 1007, Clinical Sciences Institute, Galway, H91 V4AY, Ireland.
| | - Paulo Chih-Hsing Wu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Director, Obesity/Osteoporosis Special Clinic, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - Diane Bergin
- National University of Ireland Galway, 1007, Clinical Sciences Institute, Galway, H91 V4AY, Ireland; Galway University Hospitals, Ireland
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Zheng H, Li H, Wang Y, Li Z, Hu B, Li X, Fu L, Hu H, Nie Z, Zhao B, Wei D, Karlson BW, Bots ML, Meng X, Chen Y, Wang Y. Rosuvastatin Slows Progression of Carotid Intima-Media Thickness: The METEOR-China Randomized Controlled Study. Stroke 2022; 53:3004-3013. [PMID: 36017704 PMCID: PMC9508961 DOI: 10.1161/strokeaha.120.031877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atherosclerosis is the leading cause of cardiovascular disease worldwide, including in China. Primary prevention, through lipid-lowering, could avert development of atherosclerosis. Carotid intima-media thickness (CIMT) is a well-validated measure of atherosclerosis used in intervention studies as the primary outcome and alternative end point for cardiovascular disease events. METHODS This randomized, double-blind, placebo-controlled, multicenter, parallel-group study assessed the effects of rosuvastatin 20 mg/d compared with placebo on progression of CIMT over 104 weeks in Chinese people with subclinical atherosclerosis. The primary end point was the annualized rate of change in mean of the maximum CIMT measurements taken 7× over the study period from each of 12 carotid artery sites (near and far walls of the right and left common carotid artery, carotid bulb, and internal carotid artery). Secondary end points included CIMT changes at different artery sites and lipid-parameter changes. Safety was also assessed. RESULTS Participants were randomized (1:1) to receive rosuvastatin (n=272) or placebo (n=271). Baseline characteristics were well balanced between groups. The change in mean of the maximum CIMT of the 12 carotid sites was 0.0038 mm/y (95% CI, -0.0023-0.0100) for the rosuvastatin group versus 0.0142 mm/y (95% CI, 0.0080-0.0204) for the placebo group, with a difference of -0.0103 mm/y (95% CI, -0.0191 to -0.0016; P=0.020). For the CIMT secondary end points, the results were generally consistent with the primary end point. There were clinically relevant improvements in lipid parameters with rosuvastatin. We observed an adverse-event profile consistent with the known safety profile of rosuvastatin. CONCLUSIONS Rosuvastatin 20 mg/d significantly reduced the progression of CIMT over 2 years in Chinese adults with subclinical atherosclerosis and was well tolerated. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02546323.
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Affiliation(s)
- Huaguang Zheng
- Beijing Tiantan Hospital, Capital Medical University, China (H.Z., Yilong Wang, Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China (H.Z., Yilong Wang, Yongjun Wang)
| | - Hongwei Li
- Department of Cardiology, Beijing Friendship Hospital affiliated to Capital Medical University, China (H.L.)
| | - Yilong Wang
- Beijing Tiantan Hospital, Capital Medical University, China (H.Z., Yilong Wang, Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China (H.Z., Yilong Wang, Yongjun Wang)
| | - Zhanquan Li
- The People's Hospital of Liaoning Province, Shenyang, China (Z.L.)
| | - Bo Hu
- Department of Neurology, Union Hospital of Huazhong University of Science and Technology, Wuhan, China (B.H.)
| | - Xiaogang Li
- Department of Neurology, Peking University Third Hospital, Beijing, China (X.L.)
| | - Lu Fu
- The First Affiliated Hospital of Harbin Medical University, China (L.F.)
| | - Hongtao Hu
- Beijing Ji Shui Tan Hospital, China (H.H.)
| | - Zhiyu Nie
- Department of Neurology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China (Z.N.)
| | - Bilian Zhao
- AstraZeneca R&D, Shanghai, China (B.Z., D.W. [at the time the work was conducted], X.W.M.)
| | - Di Wei
- AstraZeneca R&D, Shanghai, China (B.Z., D.W. [at the time the work was conducted], X.W.M.).,Bayer Healthcare Co Ltd, Beijing, China (D.W.)
| | - Björn W Karlson
- AstraZeneca R&D Gothenburg, Mölndal, and Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (B.W.K.)
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands (M.L.B.)
| | - XiangWen Meng
- AstraZeneca R&D, Shanghai, China (B.Z., D.W. [at the time the work was conducted], X.W.M.)
| | - Yundai Chen
- Department of Cardiology, China PLA General Hospital, Beijing, China (Y.C.)
| | - Yongjun Wang
- Beijing Tiantan Hospital, Capital Medical University, China (H.Z., Yilong Wang, Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China (H.Z., Yilong Wang, Yongjun Wang)
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Leveraging Clinical Digitized Data to Understand Temporal Characteristics and Outcomes of Acute Myocardial Infarctions at a Tertiary Care Medical Centre in Pakistan from 1988–2018 – Methods and Results. Glob Heart 2022; 17:58. [PMID: 36051315 PMCID: PMC9389955 DOI: 10.5334/gh.1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Objective: Few data exist on trends in acute myocardial infarction (AMI) patterns spanning recent epidemiological shifts in low middle-income countries (LMICs). To understand temporal disease patterns of AMI characteristics and outcomes between 1988–2018, we used digitized legacy clinical data at a large tertiary care centre in Pakistan. Methods: We reviewed digital health information capture systems maintained across the Aga Khan University Hospital and obtained structured elements to create a master dataset. We included index admissions of patients >18 years that were discharged between January 1, 1988, and December 31, 2018, with a primary discharge diagnosis of AMI (using ICD-9 diagnoses). The outcome evaluated was in-hospital mortality. Clinical characteristics derived from the electronic database were validated against chart review in a random sample of cases (k 0.53–1.00). Results: The final population consisted of 14,601 patients of which 30.6% (n = 4,470) were female, 52.4% (n = 7,651) had ST elevation MI and 47.6% (n = 6,950) had non-ST elevation MI. The median (IQR) age at presentation was 61 (52–70) years. Overall unadjusted in-hospital mortality was 10.3%. Across the time period, increasing trends were noted for the following characteristics: age, proportion of women, prevalence of hypertension, diabetes, proportion with NSTEMI (all ptrend < 0.001). In-hospital mortality rates declined significantly between 1988–1997 and 2008–2018 (13.8% to 9.2%, p < 0.001). Conclusions: The patterns of AMI have changed over the last three decades with a concomitant decline in in-hospital mortality at a tertiary care centre in Pakistan. Clinical digitized data presents a unique opportunity for gaining insights into disease patterns in LMICs.
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113
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Modifiable and Non-modifiable Factors Associated with Low Awareness of Hypertension Treatment in Indonesia: A Cross-Sectional Population-Based National Survey. Glob Heart 2022; 17:56. [PMID: 36051316 PMCID: PMC9389957 DOI: 10.5334/gh.1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction: Low awareness about hypertension treatment is recognized as a significant cause of treatment failure. Therefore, identifying its underlying factors is essential for developing effective intervention strategies. This study aims to identify the modifiable and non-modifiable factors associated with low awareness about hypertension treatment. Method: This national, cross-sectional, population-based survey used publicly available data from the Indonesian Family Life Survey (IFLS-5) for 2014 among respondents with hypertension aged ≥15 years. Depression and insomnia, as modifiable factors, were assessed using the Centre for Epidemiologic Studies—Depression (CES-D) and the Patient-Recorded Outcomes Measurement Information System (PROMIS) questionnaire, respectively. Non-modifiable factors, such as sociodemographic information, were obtained from self-reported data. Logistic regression analysis was used to assess the association between these factors and low awareness about hypertension treatment. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Result: The study recruited 7,920 respondents, the majority of whom were female (53.8%) and aged <60 years (71.1%). The prevalence of low awareness of hypertension treatment was 87.1% (51.8% in women and 48.2% in men). Being an elderly (OR: 1.60, 95%CI 1.36–1.88), being irregularly blood pressure control (OR: 4.40, 95% CI 3.78–5.13), having depressive symptoms (OR: 1.35, 95% CI 1.12–1.62), having insomnia (OR: 1.31, 95% CI 1.11–1.53), and having low satisfaction with health care (OR: 1.28, 95% CI 1.08–1.51) were associated with low awareness of hypertension treatment. Surprisingly, respondents with strong religiosity (OR: 1.62; 95% CI 1.25–2.09) were more likely to display low awareness of hypertension treatment. Conclusion: The main factors associated with low awareness of hypertension treatment are modifiable. Thus, health care professionals should integrate more patient-specific factors when designing tailored interventions.
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114
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Hendrickson MJ, Arora S, Vaduganathan M, Fonarow GC, MP G, Bansal A, Batra V, Kunal S, Bhatt DL, Gupta M, Qamar A. Prevalence and prognostic implications of reduced left ventricular ejection fraction among patients with STEMI in India. ESC Heart Fail 2022; 9:3836-3845. [PMID: 35950269 PMCID: PMC9773730 DOI: 10.1002/ehf2.14055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/21/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS To describe clinical characteristics and outcomes for those with STEMI and reduced left ventricular ejection fraction (LVEF) in low-income and middle-income countries (LMICs). METHODS AND RESULTS Adults presenting with STEMI to two government-owned tertiary care centres in Delhi, India were prospectively enrolled in the North India ST-elevation myocardial infarction (NORIN-STEMI) registry. LVEF was evaluated at presentation and clinical characteristics were compared across LVEF categories. Overall, 3597 patients were included, of whom 468 (13%) had LVEF >50%, 1482 (41%) had mildly reduced LVEF (40-49%), 1357 (38%) had moderately reduced LVEF (30-39%), and 290 (8%) had severely reduced LVEF (<30%). Presentation delay >24 h, prior MI, and hyperlipidaemia were associated with decreasing LVEF category. Although most patients with reduced LVEF were discharged on appropriate guideline-directed therapies, adherence at 1 year was low (ACE inhibitor/ARB 91% to 41%, beta blocker 98% to 78%, aldosterone receptor antagonist 69% to 6%). After multivariable adjustment, a Cox regression model showed moderately reduced LVEF (HR 1.77, 95% CI 1.20, 2.60) and severely reduced LVEF (HR 3.63, 95% CI 2.41, 5.48) were associated with increased risk of all-cause mortality compared with LVEF ≥50%. CONCLUSIONS On presentation for STEMI, almost 90% of NORIN-STEMI participants had at least mildly reduced LVEF and almost half had LVEF <40%. Patients with LVEF <40% had significantly higher risk of mortality at 1 year, and adherence to guideline-directed therapies at 1 year was poor. Systematic initiatives to improve access to timely revascularization and guideline-directed therapies are essential in advancing STEMI care in LMICs.
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Affiliation(s)
| | - Sameer Arora
- Division of CardiologyUniversity of North Carolina School of MedicineChapel HillNCUSA
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular InstituteHarvard Medical SchoolBostonMAUSA
| | - Gregg C. Fonarow
- Division of CardiologyUniversity of California Los AngelesLos AngelesCAUSA
| | - Girish MP
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Ankit Bansal
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Vishal Batra
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Shekhar Kunal
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Deepak L. Bhatt
- Brigham and Women's Hospital Heart and Vascular InstituteHarvard Medical SchoolBostonMAUSA
| | - Mohit Gupta
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Arman Qamar
- Section of Interventional Cardiology and Vascular Medicine, NorthShore University Health SystemUniversity of Chicago Pritzker School of MedicineEvanstonILUSA
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Li S, Lear SA, Rangarajan S, Hu B, Yin L, Bangdiwala SI, Alhabib KF, Rosengren A, Gupta R, Mony PK, Wielgosz A, Rahman O, Mazapuspavina MY, Avezum A, Oguz A, Yeates K, Lanas F, Dans A, Abat MEM, Yusufali A, Diaz R, Lopez-Jaramillo P, Leach L, Lakshmi PVM, Basiak-Rasała A, Iqbal R, Kelishadi R, Chifamba J, Khatib R, Li W, Yusuf S. Association of Sitting Time With Mortality and Cardiovascular Events in High-Income, Middle-Income, and Low-Income Countries. JAMA Cardiol 2022; 7:796-807. [PMID: 35704349 PMCID: PMC9201743 DOI: 10.1001/jamacardio.2022.1581] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/19/2022] [Indexed: 12/26/2022]
Abstract
Importance High amounts of sitting time are associated with increased risks of cardiovascular disease (CVD) and mortality in high-income countries, but it is unknown whether risks also increase in low- and middle-income countries. Objective To investigate the association of sitting time with mortality and major CVD in countries at different economic levels using data from the Prospective Urban Rural Epidemiology study. Design, Setting, and Participants This population-based cohort study included participants aged 35 to 70 years recruited from January 1, 2003, and followed up until August 31, 2021, in 21 high-income, middle-income, and low-income countries with a median follow-up of 11.1 years. Exposures Daily sitting time measured using the International Physical Activity Questionnaire. Main Outcomes and Measures The composite of all-cause mortality and major CVD (defined as cardiovascular death, myocardial infarction, stroke, or heart failure). Results Of 105 677 participants, 61 925 (58.6%) were women, and the mean (SD) age was 50.4 (9.6) years. During a median follow-up of 11.1 (IQR, 8.6-12.2) years, 6233 deaths and 5696 major cardiovascular events (2349 myocardial infarctions, 2966 strokes, 671 heart failure, and 1792 cardiovascular deaths) were documented. Compared with the reference group (<4 hours per day of sitting), higher sitting time (≥8 hours per day) was associated with an increased risk of the composite outcome (hazard ratio [HR], 1.19; 95% CI, 1.11-1.28; Pfor trend < .001), all-cause mortality (HR, 1.20; 95% CI, 1.10-1.31; Pfor trend < .001), and major CVD (HR, 1.21; 95% CI, 1.10-1.34; Pfor trend < .001). When stratified by country income levels, the association of sitting time with the composite outcome was stronger in low-income and lower-middle-income countries (≥8 hours per day: HR, 1.29; 95% CI, 1.16-1.44) compared with high-income and upper-middle-income countries (HR, 1.08; 95% CI, 0.98-1.19; P for interaction = .02). Compared with those who reported sitting time less than 4 hours per day and high physical activity level, participants who sat for 8 or more hours per day experienced a 17% to 50% higher associated risk of the composite outcome across physical activity levels; and the risk was attenuated along with increased physical activity levels. Conclusions and Relevance High amounts of sitting time were associated with increased risk of all-cause mortality and CVD in economically diverse settings, especially in low-income and lower-middle-income countries. Reducing sedentary time along with increasing physical activity might be an important strategy for easing the global burden of premature deaths and CVD.
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Affiliation(s)
- Sidong Li
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Scott A. Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences & McMaster University, Hamilton, Ontario, Canada
| | - Bo Hu
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Yin
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shrikant I. Bangdiwala
- Population Health Research Institute, Hamilton Health Sciences & McMaster University, Hamilton, Ontario, Canada
| | - Khalid F. Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jawahar Circle, Jaipur, India
| | - Prem K. Mony
- St John’s Medical College & Research Institute, Bangalore, India
| | - Andreas Wielgosz
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Omar Rahman
- University of Liberal Arts, Dhaka, Bangladesh
| | - M. Y. Mazapuspavina
- Department of Primary Care Medicine, Faculty of Medicine UiTM Sg Buloh Campus, University Teknologi MARA UiTM, Malaysia
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz and UNISA, São Paulo, Brazil
| | - Aytekin Oguz
- Faculty of Medicine, Department of Internal Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Antonio Dans
- Department of Medicine, University of the Philippines, Manila, Philippines
| | - Marc Evans M. Abat
- Division of Adult Medicine, Department of Medicine, Philippine General Hospital, Ermita, Manila, Philippines
| | - Afzalhussein Yusufali
- Hatta Hospital, Dubai Health Authority/Dubai Medical College, Dubai, United Arab Emirates
| | - Rafael Diaz
- Estudios Clínicos Latino América, Instituto Cardiovascular de Rosario, Rosario, Argentina
| | | | - Lloyd Leach
- University of the Western Cape, Bellville, Cape Town, South Africa
| | - P. V. M. Lakshmi
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jephat Chifamba
- Department of Biomedical Sciences Physiology Unit, University of Zimbabwe, Harare, Zimbabwe
| | - Rasha Khatib
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, Illinois
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Wei Li
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences & McMaster University, Hamilton, Ontario, Canada
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Kristensen SL, Barasa A, Thune JJ. The Challenge of Addressing Heart Failure in Low and Middle Income Countries. Eur J Heart Fail 2022; 24:1491-1492. [PMID: 35781911 DOI: 10.1002/ejhf.2598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/26/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Anders Barasa
- Department of Cardiology, Glostrup University Hospital, Copenhagen, Denmark
| | - Jens Jakob Thune
- Department of Cardiology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
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Zhao LH, Liu Y, Xiao JY, Wang JX, Li XW, Cui Z, Gao J. Prognostic Value of Metabolic Syndrome in Patients With Non-ST Elevated Myocardial Infarction Undergoing Percutaneous Coronary Intervention. Front Cardiovasc Med 2022; 9:912999. [PMID: 35811732 PMCID: PMC9260082 DOI: 10.3389/fcvm.2022.912999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/23/2022] [Indexed: 12/12/2022] Open
Abstract
Objective We aim to investigate the prognostic effects of metabolic syndrome (MS) on patients with non-ST elevated myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI). Methods Patients with NSTEMI undergoing PCI were consecutively collected. According to the presence or absence of MS, they were divided into two groups and followed up for 1 year. The endpoint was major adverse cardiovascular events (MACE), including all-cause death, unstable angina hospitalization, heart failure (HF) hospitalization, non-fatal recurrent myocardial infarction (MI), and target lesion revascularization. Also, six subgroups were made according to gender, age, left ventricular ejection fraction (LVEF), Global Registry of Acute Coronary Events (GRACE) score, hypersensitive troponin (hsTNT), and several diseased vessels. Cox proportional hazard model was adopted to analyze the effect of MS on MACE in all the patients and different subgroups. Results A total of 1,295 patients were included in the current analysis and 660 (50.97%) of them had MS. About 88 patients were lost to follow-up, and the overall average follow-up was 315 days. MS was an independent risk factor for MACE (HR 1.714, CI 1.265–2.322, p = 0.001), all-cause death, heart failure (HF) hospitalization, and non-fatal recurrent MI. In the MS component, BMI ≥28 kg/m2 was positively associated with MACE. Subgroup analysis indicated the prognostic value of MS was more striking for patients with the following: age of >60, LVEF of ≤40%, GRACE of >140, multivessel disease, or hsTNT of >0.1 ng/ml. Conclusions The MS was a robust adverse prognostic factor in patients diagnosed with NSTEMI, especially among those of older age and at higher ischemic risk. A BMI of ≥28 kg/m2 independently predicted the occurrence of MACE. Prognosis may be improved by controlling abdominal obesity.
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Affiliation(s)
- Li-Hong Zhao
- Graduate School, Tianjin Medical University, Tianjin, China
- Cardiac Function Department, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
| | - Yin Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jian-Yong Xiao
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Ji-Xiang Wang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Xiao-Wei Li
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Zhuang Cui
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jing Gao
- Tianjin Cardiovascular Institute, Tianjin Chest Hospital, Tianjin, China
- Thoracic Clinical College, Tianjin Medical University, Tianjin, China
- *Correspondence: Jing Gao
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Sharma K, Basu-Ray I, Sayal N, Vora A, Bammidi S, Tyagi R, Modgil S, Bali P, Kaur P, Goyal AK, Pal DK, Arvind H, Jindal K, Garg V, Matyal B, Thakur N, Chhikara A, Kaur N, Maanju P, Bhatia KS, Pannu V, Gupta V, Malik N, Malik R, Kumar R, Kaur R, Bhatt V, Bhalla A, Mohanty M, Singh G, Sharma SK, Sivapuram MS, Mathur D, Khanra D, Anand A. Yoga as a Preventive Intervention for Cardiovascular Diseases and Associated Comorbidities: Open-Label Single Arm Study. Front Public Health 2022; 10:843134. [PMID: 35769774 PMCID: PMC9234218 DOI: 10.3389/fpubh.2022.843134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/27/2022] [Indexed: 11/20/2022] Open
Abstract
Aim Common Yoga Protocol (CYP) is a standardized yoga protocol authored by experts from all over the world under the aegis of the Ministry of AYUSH, Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa Rigpa and Homeopathy (AYUSH). The potential of CYP can be determined as a cost-effective lifestyle modification to prevent the risk of developing cardiovascular diseases (CVD). Methods In this prospective trial, we compared the effect of CYP at baseline and after 1 month. A total of 374 yoga-naïve participants performed CYP under the supervision of experienced trainers. Physiological [body mass index (BMI), blood pressure, percent oxygen saturation], biochemical (fasting blood glucose and lipid profile), and neurocognitive parameters were measured before and after the intervention. Results At day 30 of yoga practice, serum levels of low-density lipoprotein (LDL), total cholesterol (TC), and high-density lipoprotein (HDL) were found significantly improved as compared to the baseline levels observed at the time of enrollment. Similarly, the lipid profile was also obtained from experienced trainers and found to be significantly different from those of yoga-naïve volunteers. When the intervention was compared between the healthy yoga-naïve participants with yoga-naïve participants suffering from medical issues, it was found that cholesterol profile improved significantly in the healthy-naive group as compared to the diseased group (hypertension, diabetes, underwent surgery, and CVD). Conclusion These results highlight the need for further research to better understand the effects of yoga on the primary prevention of CVD.
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Affiliation(s)
- Kaushal Sharma
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
- Centre for Systems Biology and Bioinformatics, Panjab University, Chandigarh, India
| | - Indranill Basu-Ray
- Department of Cardiology, St. Francis Hospital, Memphis, TN, United States
- Department of Cardiology, All India Institute of Medical Sciences, Virbhadra Marg, Rishikesh, India
- Department of Cardiology, Swami Vivekananda Yoga Anusandhana Samsthana, Union Territory (SVYASA), Bengaluru, India
| | - Natasha Sayal
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ariana Vora
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, United States
| | - Sridhar Bammidi
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Tyagi
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shweta Modgil
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
- Department of Zoology, Panjab University, Chandigarh, India
| | - Parul Bali
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
- Department of Biophysics, Panjab University, Chandigarh, India
| | - Paramvir Kaur
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Kumar Goyal
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
- Department of Otolaryngology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Kumar Pal
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harshita Arvind
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Khushboo Jindal
- Department of Bioinformatics, Jaypee University, Shimla, India
| | - Vincy Garg
- Department of Cardiology, Swami Vivekananda Yoga Anusandhana Samsthana, Union Territory (SVYASA), Bengaluru, India
| | - Bandu Matyal
- Department of Zoology, Panjab University, Chandigarh, India
| | - Neha Thakur
- Department of Zoology, Panjab University, Chandigarh, India
| | - Amit Chhikara
- Department of Physical Education, Panjab University, Chandigarh, India
| | - Navneet Kaur
- Department of Physical Education, Panjab University, Chandigarh, India
| | - Preety Maanju
- Department of Physical Education, Panjab University, Chandigarh, India
| | | | | | | | - Neeru Malik
- Department of Physical Education, Dev Samaj College of Education, Chandigarh, India
| | - Rakesh Malik
- Department of Physical Education and Sports, Panjab University, Chandigarh, India
| | | | - Ravneet Kaur
- Department of Zoology, Panjab University, Chandigarh, India
| | - Vinod Bhatt
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manju Mohanty
- Department of Neurosurgery, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gurmeet Singh
- Department of Physical Education, Panjab University, Chandigarh, India
| | - Suresh Kumar Sharma
- Centre for Systems Biology and Bioinformatics, Panjab University, Chandigarh, India
- Department of Statistics, Panjab University, Chandigarh, India
| | - Madhava Sai Sivapuram
- Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, India
| | - Deepali Mathur
- School of Biotechnology, KIIT University, Bhubaneswar, India
| | - Dibbendu Khanra
- Department of Cardiology, All India Institute of Medical Sciences, Virbhadra Marg, Rishikesh, India
| | - Akshay Anand
- Neuroscience Research Lab, Department of Neurology, Post-graduate Institute of Medical Education and Research, Chandigarh, India
- *Correspondence: Akshay Anand
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Trends in Mortality from Ischemic Heart Disease in Peru, 2005 to 2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127047. [PMID: 35742296 PMCID: PMC9222979 DOI: 10.3390/ijerph19127047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 12/03/2022]
Abstract
The highest proportion of deaths among patients with cardiovascular diseases is due to ischemic heart disease (IHD), which is the second most common cause of death in Peru. This study aims to measure and identify changes in the temporal trend in mortality from ischemic heart disease in the Peruvian population. An ecological study was carried out with data from individual death records from the Ministry of Health between 2005 and 2017. A death was considered attributable to IHD if it was registered with the codes I20 to I25 of the ICD-10. Crude and adjusted mortality rates for IHD were calculated for the general population by age and according to sex. A joinpoint regression analysis was performed to assess trends in IHD mortality. There were 61,524 deaths due to IHD (55.69% men) from 2005 to 2017. According to the ICD-10, acute myocardial infarction (I21) accounted for the highest proportion of deaths (88.16%), followed by chronic IHD (I25), with 6.53%. In general, a decrease in adjusted IHD mortality rates was found in the general population over time (45.34 in 2005; 22.18 in 2017). By sex, men possessed a 1.5-fold higher rate than women. The highest mortality rates from IHD were found in the natural coastal region (68.55%) and in urban areas (86.43%). A joinpoint regression analysis showed a reduction in the mortality trend over time due to IHD for both the general population and the population when grouped by sex. In conclusion, there was a continuous decrease in mortality rates due to IHD in the Peruvian population between 2005 and 2017. Strategies focused on mitigating the impact of this disease are required and should emphasize the subgroups most likely to die from this cause.
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Won K, Park H, Heo R, Lee BK, Lin FY, Hadamitzky M, Kim Y, Sung JM, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Chun EJ, Cademartiri F, Maffei E, Marques H, Gonçalves PDA, Leipsic JA, Lee S, Shin S, Choi JH, Virmani R, Samady H, Chinnaiyan K, Berman DS, Narula J, Bax JJ, Min JK, Chang H. Longitudinal quantitative assessment of coronary atherosclerosis related to normal systolic blood pressure maintenance in the absence of established cardiovascular disease. Clin Cardiol 2022; 45:873-881. [PMID: 35673995 PMCID: PMC9346967 DOI: 10.1002/clc.23870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Atherosclerosis-related adverse events are commonly observed even in conditions with low cardiovascular (CV) risk. Longitudinal data regarding the association of normal systolic blood pressure maintenance (SBPmaintain ) with coronary plaque volume changes (PVC) has been limited in adults without traditional CV disease. HYPOTHESIS Normal SBPmaintain is important to attenuate coronary atherosclerosis progression in adults without baseline CV disease. METHODS We analyzed 95 adults (56.7 ± 8.5 years; 40.0% men) without baseline CV disease who underwent serial coronary computed tomographic angiography with mean 3.5 years of follow-up. All participants were divided into two groups of normal SBPmaintain (follow-up SBP < 120 mm Hg) and ≥elevated SBPmaintain (follow-up SBP ≥ 120 mm Hg). Annualized PVC was defined as PVC divided by the interscan period. RESULTS Compared to participants with normal SBPmaintain , those with ≥elevated SBPmaintain had higher annualized total PVC (mm3 /year) (0.0 [0.0-2.2] vs. 4.1 [0.0-13.0]; p < .001). Baseline total plaque volume (β = .10) and the levels of SBPmaintain (β = .23) and follow-up high-density lipoprotein cholesterol (β = -0.28) were associated with annualized total PVC (all p < .05). The optimal cutoff of SBPmaintain for predicting plaque progression was 118.5 mm Hg (sensitivity: 78.2%, specificity: 62.5%; area under curve: 0.700; 95% confidence interval [CI]: 0.59-0.81; p < .05). SBPmaintain ≥ 118.5 mm Hg (odds ratio [OR]: 4.03; 95% CI: 1.51-10.75) and baseline total plaque volume (OR: 1.03; 95% CI: 1.01-1.06) independently influenced coronary plaque progression (all p < .05). CONCLUSION Normal SBPmaintain is substantial to attenuate coronary atherosclerosis progression in conditions without established CV disease.
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Affiliation(s)
- Ki‐Bum Won
- Department of Cardiology, Dongguk University Ilsan HospitalDongguk University College of MedicineGoyangSouth Korea,Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea
| | - Hyung‐Bok Park
- Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Department of CardiologyCatholic Kwandong University International St. Mary's HospitalIncheonSouth Korea
| | - Ran Heo
- Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Department of Cardiology, Hanyang University Seoul HospitalHanyang University College of MedicineSeoulSouth Korea
| | - Byoung Kwon Lee
- Department of Cardiology, Gangnam Severance HospitalYonsei University College of MedicineSeoulKorea
| | - Fay Y. Lin
- Department of RadiologyNew York‐Presbyterian Hospital and Weill Cornell MedicineNew YorkNew YorkUSA
| | - Martin Hadamitzky
- Department of Radiology and Nuclear MedicineGerman Heart Center MunichMunichGermany
| | - Yong‐Jin Kim
- Division of Cardiology, Seoul National University College of Medicine, Cardiovascular CenterSeoul National University HospitalSeoulSouth Korea
| | - Ji Min Sung
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea
| | | | | | | | - Matthew J. Budoff
- Department of MedicineLundquist Institute at Harbor UCLA Medical CenterTorranceCaliforniaUSA
| | - Ilan Gottlieb
- Department of RadiologyCasa de Saude São JoseRio de JaneiroBrazil
| | - Eun Ju Chun
- Seoul National University Bundang HospitalSungnamSouth Korea
| | | | - Erica Maffei
- Department of RadiologyArea Vasta 1/ASUR MarcheUrbinoItaly
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da LuzLisboaPortugal
| | - Pedro de Araújo Gonçalves
- UNICA, Unit of Cardiovascular Imaging, Hospital da LuzLisboaPortugal,Nova Medical SchoolLisbonPortugal
| | - Jonathon A. Leipsic
- Department of Medicine and RadiologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Sang‐Eun Lee
- Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Department of CardiologyEwha Womans University Seoul HospitalSeoulKorea
| | - Sanghoon Shin
- Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Department of CardiologyEwha Womans University Seoul HospitalSeoulKorea
| | - Jung Hyun Choi
- Department of CardiologyPusan University HospitalBusanSouth Korea
| | - Renu Virmani
- Department of PathologyCVPath InstituteGaithersburgMarylandUSA
| | - Habib Samady
- Department of CardiologyEmory University School of MedicineAtlantaGeorgiaUSA
| | | | - Daniel S. Berman
- Department of Imaging and MedicineCedars Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie‐Josée and Henry R. Kravis Center for Cardiovascular HealthNew YorkNew YorkUSA
| | - Jeroen J. Bax
- Department of CardiologyLeiden University Medical CenterLeidenThe Netherlands
| | - James K. Min
- Department of RadiologyNew York‐Presbyterian Hospital and Weill Cornell MedicineNew YorkNew YorkUSA
| | - Hyuk‐Jae Chang
- Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea,Yonsei‐Cedars‐Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of MedicineYonsei University Health SystemSeoulSouth Korea
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Yao H, Ekou A, Brou I, Niamkey T, Koffi F, Tano S, Kouamé I, N'Guetta R. [Evolution of epidemiology and management of acute coronary syndromes in Abidjan : A cross-sectional study of 1011 patients.]. Ann Cardiol Angeiol (Paris) 2022; 71:130-135. [PMID: 35293317 DOI: 10.1016/j.ancard.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 11/29/2020] [Accepted: 02/03/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND To assess the evolution of the epidemiology and management of patients hospitalized to Abidjan Heart Institute for acute coronary syndrome (ACS). METHODS Cross-sectional study comparing two periods: from January 2002 to December 2009 (period 1) and from January 2010 to December 2016 (period 2), including all patients aged 18 years old, admitted to Intensive Care Unit of Abidjan Heart Institute for ACS. RESULTS One thousand eleven (1011) patients were included among the 6784 patients admitted to Intensive Care Unit of Abidjan Heart Institute for a cardiovascular disease. The overall prevalence of ACS was 14.9%. The prevalence in period 2 was significantly higher than in period 1 (22.6% and 7.3% respectively, p < 0.001). Diabetes (33.5%, p < 0.001) significantly, and smoking (30.7%, p = 0.30) had the largest rises from period 1 to period 2. ST-segment Elevation Myocardial Infarction was the main clinical presentation during both periods. The median time to treatment (p = 0.46) and length of hospital stay (p <0.001) decreased during period 2. Percutaneous coronary intervention (PCI) was performed in 173 patients (22.6%) during the period 2 and 42 patients (5.5%) underwent primary PCI. The rate of fibrinolysis increased significantly between the two periods (9.5%, p <0.001). In-hospital death increased during period 2 (10.4%, p = 0.07). CONCLUSION The burden of ACS and its related mortality have risen alarmingly past years in Côte d'Ivoire. Healthcare policies should help improve the management and outcomes of patients.
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Affiliation(s)
- H Yao
- Unité de Soins Intensifs Cardiologiques, Institut de Cardiologie d'Abidjan, 01 BP V 206 Abidjan, Côte d'Ivoire
| | - A Ekou
- Unité de Soins Intensifs Cardiologiques, Institut de Cardiologie d'Abidjan, 01 BP V 206 Abidjan, Côte d'Ivoire
| | - I Brou
- Laboratoire de biostatistique et d'informatique médicale, Centre Hospitalier Universitaire de Cocody, Abidjan, Côte d'Ivoire
| | - T Niamkey
- Service des explorations externes, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
| | - F Koffi
- Service des Urgences, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
| | - S Tano
- Unité de Soins Intensifs Cardiologiques, Institut de Cardiologie d'Abidjan, 01 BP V 206 Abidjan, Côte d'Ivoire
| | - I Kouamé
- Unité de Soins Intensifs Cardiologiques, Institut de Cardiologie d'Abidjan, 01 BP V 206 Abidjan, Côte d'Ivoire
| | - R N'Guetta
- Unité de Soins Intensifs Cardiologiques, Institut de Cardiologie d'Abidjan, 01 BP V 206 Abidjan, Côte d'Ivoire.
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Teng Y, Wang K, Fan X, Yang X. Prevalence and Risk Factors of Abnormal Carotid Artery in Young Adults without Overt Cardiovascular Disease. Int J Gen Med 2022; 15:4595-4601. [PMID: 35535143 PMCID: PMC9078336 DOI: 10.2147/ijgm.s360437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The current study was to evaluate the prevalence of increased carotid artery intimal-medial thickness (IMT) and carotid plaque in young individuals and factors associated with increased IMT and carotid plaque were also assessed. Methods Individuals between 18 and 44 years old who underwent an annual health examination and without cardiovascular disease were included. The value of IMT ≥0.1 cm was defined as increased IMT and IMT ≥0.15 cm was defined as carotid plaque. Based on the IMT, participants were divided into normal and abnormal groups. Results A total of 551 individuals were included and the mean age was 38.9 years old, with women accounting for 32.5% (n=179) and 238 (43.2%) individuals with abnormal IMT. Those with abnormal IMT was older, more likely to be male and smoking, had higher blood pressure (BP) and body mass index (BMI). Individuals with abnormal MIT also had worse lipid profiles, higher serum levels of fasting plasma glucose (FPG), HbA1c, homocysteine, and uric acid. Age, male sex, elevated systolic and diastolic BP, BMI, HbA1c, FPG, triglyceride, total cholesterol, LDL-C, homocysteine, and uric acid were positively correlated with IMT, while HDL-C was negatively correlated with IMT. Factors associated with increased IMT and carotid plaque included age, male sex, BMI, triglyceride, LDL-C, homocysteine, uric acid, and smoking. Conclusion Among apparent healthy young individuals, the prevalence of increased IMT was high and there were several factors associated with increased IMT. Further studies are needed to evaluate how to be better in preventing the development of subclinical atherosclerosis among young individuals.
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Affiliation(s)
- Yunjie Teng
- Center of Health Management, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Kaiyang Wang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Xue Fan
- Center of Health Management, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Xiaoping Yang
- Center of Health Management, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
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The Situation-Specific Theory of Heart Failure Self-care: An Update on the Problem, Person, and Environmental Factors Influencing Heart Failure Self-care. J Cardiovasc Nurs 2022; 37:515-529. [PMID: 35482335 PMCID: PMC9561231 DOI: 10.1097/jcn.0000000000000919] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Many studies of heart failure (HF) self-care have been conducted since the last update of the situation-specific theory of HF self-care.
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Tizón-Marcos H, Vaquerizo B, Ferré JM, Farré N, Lidón RM, Garcia-Picart J, Regueiro A, Ariza A, Carrillo X, Duran X, Poirier P, Cladellas M, Camps-Vilaró A, Ribas N, Cubero-Gallego H, Marrugat J. Socioeconomic Status and Prognosis of Patients With ST-Elevation Myocardial Infarction Managed by the Emergency-Intervention “Codi IAM” Network. Front Cardiovasc Med 2022; 9:847982. [PMID: 35548422 PMCID: PMC9082814 DOI: 10.3389/fcvm.2022.847982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDespite the spread of ST-elevation myocardial infarction (STEMI) emergency intervention networks, inequalities in healthcare access still have a negative impact on cardiovascular prognosis. The Family Income Ratio of Barcelona (FIRB) is a socioeconomic status (SES) indicator that is annually calculated. Our aim was to evaluate whether SES had an effect on mortality and complications in patients managed by the “Codi IAM” network in Barcelona.MethodsThis is a cohort study with 3,322 consecutive patients with STEMI treated in Barcelona from 2010 to 2016. Collected data include treatment delays, clinical and risk factor characteristics, and SES. The patients were assigned to three SES groups according to FIRB score. A logistic regression analysis was conducted to estimate the adjusted effect of SES on 30-day mortality, 30-day composite cardiovascular end point, and 1-year mortality.ResultsThe mean age of the patients was 65 ± 13% years, 25% were women, and 21% had diabetes mellitus. Patients with low SES were younger, more often hypertensive, diabetic, dyslipidemic (p < 0.003), had longer reperfusion delays (p < 0.03) compared to participants with higher SES. Low SES was not independently associated with 30-day mortality (OR: 0.95;9 5% CI: 0.7–1.3), 30-day cardiovascular composite end point (OR: 1.03; 95% CI: 0.84–1.26), or 1-year all-cause mortality (HR: 1.09; 95% CI: 0.76–1.56).ConclusionAlthough the low-SES patients with STEMI in Barcelona city were younger, had worse clinical profiles, and had longer revascularization delays, their 30-day and 1-year outcomes were comparable to those of the higher-SES patients.
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Affiliation(s)
- Helena Tizón-Marcos
- Hospital del Mar, Servicio de Cardiología, Barcelona, Spain
- Grupo de Investigación Biomédica en Enfermedades del Corazón, Barcelona, Spain
- IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- *Correspondence: Helena Tizón-Marcos
| | - Beatriz Vaquerizo
- Hospital del Mar, Servicio de Cardiología, Barcelona, Spain
- Grupo de Investigación Biomédica en Enfermedades del Corazón, Barcelona, Spain
- IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Josepa Mauri Ferré
- Hospital Universitari GermansTrias I. Pujol, Servicio de Cardiología, Badalona, Spain
- Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Núria Farré
- Hospital del Mar, Servicio de Cardiología, Barcelona, Spain
- Grupo de Investigación Biomédica en Enfermedades del Corazón, Barcelona, Spain
- IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Rosa-Maria Lidón
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Hospital Universitari de la Valld'Hebron, Servicio de Cardiología, Barcelona, Spain
| | - Joan Garcia-Picart
- Hospital de la Santa Creu I. Sant Pau, Servicio de Cardiología, Barcelona, Spain
| | - Ander Regueiro
- Hospital Clínic i Provincial, Servicio de Cardiología, Barcelona, Spain
| | - Albert Ariza
- Hospital Universitario de Bellvitge, Servicio de Cardiología, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Carrillo
- Hospital Universitari GermansTrias I. Pujol, Servicio de Cardiología, Badalona, Spain
| | - Xavier Duran
- IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
- AMIB, Assessoria Metodològica i Bioestadística, Barcelona, Spain
| | - Paul Poirier
- Insititut Universitaire de Cardiologie et Pneumologie de Québec, Québec, QC, Canada
| | - Mercè Cladellas
- Hospital del Mar, Servicio de Cardiología, Barcelona, Spain
- Grupo de Investigación Biomédica en Enfermedades del Corazón, Barcelona, Spain
- IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
- Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Anna Camps-Vilaró
- IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Núria Ribas
- Hospital del Mar, Servicio de Cardiología, Barcelona, Spain
- Grupo de Investigación Biomédica en Enfermedades del Corazón, Barcelona, Spain
- IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
- Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Hector Cubero-Gallego
- Hospital del Mar, Servicio de Cardiología, Barcelona, Spain
- Grupo de Investigación Biomédica en Enfermedades del Corazón, Barcelona, Spain
- IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
| | - Jaume Marrugat
- IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Trends in Mortality from Stroke in Latin America and the Caribbean, 1979–2015. Glob Heart 2022; 17:26. [PMID: 35586747 PMCID: PMC8992764 DOI: 10.5334/gh.1114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Stroke is the second largest single cause of death and disability in Latin America and the Caribbean (LAC). There have been large overall declines in stroke mortality rates in most LAC countries in recent decades. Objective: To analyze trends in mortality caused by stroke in LAC countries in the period 1979–2015. Methods: We extracted data for age-standardized stroke mortality rates per 100,000 in LAC for the period 1979–2015 from the World Health Organization Mortality Database. Joinpoint regression was used to analyze the trends and compute the annual percent change (APC) in LAC as a whole and by country. Analyses were conducted by gender, region and World Bank income classification. Results: Mortality from stroke has decreased in LAC over the study period by an average APC of –1.9%. Most countries showed significant downward trends, with the sharpest decreases in Chile, Colombia and Uruguay. We recorded statistically significant decreases of –1.4% and –2.4% in mortality rates in men and women, respectively, in the whole LAC. Southern and high-income countries showed the steepest decreases. Conclusions: Stroke mortality has decreased in LAC, in both sexes, especially in southern and high-income countries. Our results could serve as a reference for the development of primary prevention and acute management of stroke policies focused on countries with higher mortality.
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Bergmark BA, Mathenge N, Merlini PA, Lawrence-Wright MB, Giugliano RP. Acute coronary syndromes. Lancet 2022; 399:1347-1358. [PMID: 35367005 PMCID: PMC8970581 DOI: 10.1016/s0140-6736(21)02391-6] [Citation(s) in RCA: 120] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 12/14/2022]
Abstract
Although substantial progress has been made in the diagnosis and treatment of acute coronary syndromes, cardiovascular disease remains the leading cause of death globally, with nearly half of these deaths due to ischaemic heart disease. The broadening availability of high-sensitivity troponin assays has allowed for rapid rule-out algorithms in patients with suspected non-ST-segment elevated myocardial infarction (NSTEMI). Dual antiplatelet therapy is recommended for 12 months following an acute coronary syndrome in most patients, and additional secondary prevention measures including intensive lipid-lowering therapy (LDL-C <1·4 mmol/L), neurohormonal agents, and lifestyle modification, are crucial. The scientific evidence for diagnosis and management of acute coronary syndromes continues to evolve rapidly, including adapting to the COVID-19 pandemic, which has impacted all aspects of care. This Seminar provides a clinically relevant overview of the pathobiology, diagnosis, and management of acute coronary syndromes, and describes key scientific advances.
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Affiliation(s)
- Brian A Bergmark
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Njambi Mathenge
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Piera A Merlini
- 4th Division of Cardiology, Cardiocenter De Gasperis, ASST GOM Niguarda and Bicocca University, Milan, Italy
| | - Marilyn B Lawrence-Wright
- Division of Cardiology, Department of Medicine, The University of the West Indies at Mona, Kingston, Jamaica
| | - Robert P Giugliano
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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127
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Hampson R, Botrous C, Chahal N, Senior R. Feasibility, efficacy and safety of exercise stress echocardiography during the COVID-19 pandemic. Open Heart 2022; 9:e001894. [PMID: 35444048 PMCID: PMC9021455 DOI: 10.1136/openhrt-2021-001894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/11/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To assess the feasibility, efficacy and safety of performing exercise stress echocardiography (ESE) for the assessment of myocardial ischaemia during the COVID-19 pandemic. METHODS AND RESULTS Baseline data were collected prospectively on 740 consecutive patients (mean age 61.4 years, 56.8% males), referred for a stress echocardiogram (SE), who underwent ESE between July 2020 (immediate post lockdown) and January 2021 according to national safety guidelines, in addition to patients wearing masks during ESE. Retrospective analysis was performed on follow-up data for outcomes. Propensity score matching was used to compare workload achieved during ESE pre-COVID-19, in 768 consecutive patients who underwent ESE between May 2014 and May 2015. Of the 725 (97.9%) diagnostic tests obtained, 69 (9.3%) demonstrated significant inducible ischaemia (≥3 segments) with no serious adverse events. Of the 61 patients who underwent coronary angiography, 51 (83%) demonstrated flow-limiting coronary artery disease. During a mean follow-up period of 4.6 months, one first-cardiac event was recorded.Compliance with mask-wearing throughout ESE was seen in 98.7% of patients. Of the 17 healthcare professionals performing ESE, none contracted COVID-19 during this period. SE service performance increased to 96.8% of prepandemic levels (100%) from 26.6% at the start of July 2020 to the end of December 2020.Propensity-matched data showed no significant difference in exercise workload between patients undergoing ESE during and prepandemic. CONCLUSION Performing ESE during the COVID-19 pandemic, with safety measures in place, is feasible, efficacious and safe. It impacted on the time patients were waiting to undergo a diagnostic test and yielded appropriate outcomes.Service evaluation authorisation of research capability numberSE20/059.
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Affiliation(s)
| | | | - Navtej Chahal
- Department of Cardiology, Northwick Park Hospital, Harrow, UK
| | - Roxy Senior
- Department of Cardiology, Northwick Park Hospital, Harrow, UK
- Cardiology, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
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128
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Onwukwe SC, Ngene NC. Blood pressure control in hypertensive patients attending a rural community health centre in Gauteng Province, South Africa: A cross-sectional study. S Afr Fam Pract (2004) 2022; 64:e1-e9. [PMID: 35384677 PMCID: PMC8991089 DOI: 10.4102/safp.v64i1.5403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Hypertension is a major cause of morbidity and mortality and its control has important clinical and socio-economic benefits to the family and community. Unfortunately, the extent of blood pressure (BP) control and its potential predictors in hypertensive patients in many rural communities in low-resource settings are largely unknown. This study assessed the extent of uncontrolled BP and its predictors amongst hypertensive patients accessing primary health care in a rural community in South Africa. METHODS This cross-sectional study included 422 randomly selected hypertensive patients. Demographic and clinical data were collected using structured face-to-face questionnaire supplemented by respondents' clinical records. RESULTS Obesity plus overweight (n = 286, 67.8%) and diabetes (n = 228, 54.0%) were the most common comorbidities. Treatment adherence was achieved in only 36.3% and BP was controlled to target in 50.2% of the respondents. Significant predictors of uncontrolled BP were poor treatment adherence (odds ratio [OR] = 15.88, 95% confidence interval [CI] = 8.96, 28.14, p 0.001), obesity compared with normal weight and overweight (OR = 3.75, 95% CI = 2.17, 6.46, p 0.001) and being a diabetic (OR = 2.83, 95% CI = 1.74, 4.61, p 0.001). CONCLUSION Poor adherence to treatment was the major predictor of uncontrolled BP. The increase in uncontrolled BP in the presence of diabetes and/or obesity as risk predictors, indicates the need for appropriate behaviour change/interventions and management of these conditions in line with the health belief model (HBM). We also propose the use of Community-Based Physical and Electronic Reminding and Tracking System (CB-PERTS) to address poor treatment adherence.
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Affiliation(s)
- Sergius C Onwukwe
- Department of Public Health, Faculty of Health Science, University of Liverpool, Liverpool, United Kingdom; and, Department of Family Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
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129
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Vicent B, Meda J, Ngoma M, Wan L, Yinglan L. Risk factors and early cardiovascular outcomes in cancer patients treated with anthracycline-based chemotherapy in Tanzania: a protocol for a quasi-experimental study. Biol Methods Protoc 2022; 7:bpac006. [PMID: 35291267 PMCID: PMC8917873 DOI: 10.1093/biomethods/bpac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/30/2022] [Indexed: 11/14/2022] Open
Abstract
The objective of this quasi-experimental study is to assess the risk factors and early cardiovascular outcomes in cancer patients treated with anthracycline-based chemotherapy in Tanzania. The study will be conducted at Ocean Road Cancer Institute in Dar es salaam, Tanzania. The study will have three phases: baseline survey, follow-up, and end-line survey. Participants will be newly diagnosed adult cancer patients who are eligible for anthracycline-based chemotherapy. A total of 427 participants will be involved. At baseline, participants will be evaluated for the cardiovascular risk factors before commencing chemotherapy. During follow-up, participants will commence their prescribed anthracycline and the cardiovascular indices monitored throughout until the patient completes the prescribed anthracycline cycles. After completing the prescribed anthracycline cycles, an end line survey will be conducted to evaluate any change in cardiovascular indices. The outcome variable in this study will be the change in biochemical data (high-density lipoprotein, low-density lipoprotein, triglyceride, and troponin I), blood pressure, and electrocardiographic information (heart rate and Bazett QT interval). Independent variables will be demographic characteristics, risk factors for cardiovascular disorders, current dietary practices, and body mass index. Descriptive statistics will be used to describe the participants. Independent and paired t-tests will be performed to make comparisons between and within groups. P-values <0.05 will be considered statistically significant. The results of this study will help clinicians and policymakers to understand the burden of early cardiovascular outcomes and plan for appropriate preventive strategies.
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Affiliation(s)
- Bankanie Vicent
- Xiangya School of Nursing, Central South University, Changsha, China
| | - John Meda
- College of Health Sciences, University of Dodoma, P.O. Box 259, Dodoma, Tanzania
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, P.O. Box 3592, Dar es salaam, Tanzania
| | - Li Wan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Li Yinglan
- Xiangya School of Nursing, Central South University, Changsha, China
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130
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Identifying peripheral arterial disease in the elderly patients using machine-learning algorithms. Aging Clin Exp Res 2022; 34:679-685. [PMID: 34570316 DOI: 10.1007/s40520-021-01985-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/12/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Peripheral artery disease (PAD) is a common syndrome in elderly people. Recently, artificial intelligence (AI) algorithms, in particular machine-learning algorithms, have been increasingly used in disease diagnosis. AIM In this study, we designed an effective diagnostic model of PAD in the elderly patients using artificial intelligence. METHODS The study was performed with 539 participants, all over 80 years in age, who underwent the measurements of Doppler ultrasonography and ankle-brachial pressure index (ABI). Blood samples were collected. ABI and two machine-learning algorithms (MLAs)-logistic regression and a random forest (RF) model-were established to diagnose PAD. The sensitivity and specificity of the models were analyzed. An additional RF model was designed based on the most significant features of the original RF model and a prospective study was conducted to demonstrate its external validity. RESULTS Thirteen of the 28 features introduced to the MLAs differed significantly between PAD and non-PAD participants. The respective sensitivities and specificities of logistic regression, RF, and ABI were as follows: logistic regression (81.5%, 83.8%), RF (89.3%, 91.6%) and ABI (85.1%, 84.5%). In the prospective study, the newly designed RF model based on the most significant seven features exhibited an acceptable performance rate for the diagnosis of PAD with 100.0% sensitivity and 90.3% specificity. CONCLUSIONS An RF model was a more effective method than the logistic regression and ABI for the diagnosis of PAD in an elderly cohort.
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131
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Dev R, Raparelli V, Pilote L, Azizi Z, Kublickiene K, Kautzky-Willer A, Herrero MT, Norris CM. Cardiovascular health through a sex and gender lens in six South Asian countries: Findings from the WHO STEPS surveillance. J Glob Health 2022; 12:04020. [PMID: 35265330 PMCID: PMC8876159 DOI: 10.7189/jogh.12.04020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Sex and gender-based differences in cardiovascular health (CVH) has been explored in the context of high-income countries. However, these relationships have not been examined in low- and middle-income countries. The main aim of this study was to examine how sex and gender-related factors are associated with cardiovascular risk factors of people in South Asian countries. Methods We conducted a retrospective analysis of the World Health Organization’s “STEPwise approach to surveillance of risk factors for non-communicable disease” or “STEPS” from six South Asian countries, surveys conducted between 2014-2019. The main outcomes were CVH as measured by a composite measure of STEPS-HEART health index (smoking, physical activity, fruit and vegetable consumption, overweight/obesity, diabetes and hypertension), values ranging from 0 (worst) to 6 (best or ideal) and self-reported occurrence of cardiovascular disease (ie, heart attack and stroke). Multivariate linear and logistic regression models were performed. Multiple imputation with chained equations was performed. Results The final analytic sample consisted of 33 106 participants (57.5% females). The mean STEPS-HEART index score in the South Asian population was 3.43 [SD: 0.92]. Female sex (β: 0.05, 95% confidence interval (CI) = 0.01-0.08, P < 0.05) was significantly associated with better CVH compared to males. Being married (βmale = -0.30, 95% CI = -0.37, -0.23 vs βfemale = -0.23, 95% CI = -0.29, -0.17; P < 0.001) and having a household size ≥5 (βmale = -0.15, 95% CI = -0.24, -0.06 vs βfemale = -0.11, 95% CI = -0.16, -0.04; P < 0.01) were associated with poorer CVH, more so in males. Being married was also associated with high risk of CVD (ORmale = 2.54, 95% CI = 1.68-3.86, P < 0.001 vs ORfemale = 1.19, 95% CI = 0.84-1.68, P = 0.31), significant in males. Conclusions Among the South Asian population, being female may be advantageous in having an ideal CVH. However, gender-related factors such as marital status and large household size were associated with poorer CVH and greater risk of CVD, regardless of sex.
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Affiliation(s)
- Rubee Dev
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Valeria Raparelli
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- University Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
| | - Louise Pilote
- Research Institute of McGill University Health Centre, Division of Clinical Epidemiology McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC, Canada
| | - Zahra Azizi
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC, Canada
| | - Karolina Kublickiene
- Department of Clinical Science, Intervention & Technology (CLINTEC), Section for Renal Medicine, Karolinska Institute and Karolinska University hospital, Stockholm, Sweden
| | - Alexandra Kautzky-Willer
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Gender Medicine Unit, Medical University of Vienna, Vienna, and Gender Institute, Iapura, Gars am Kamp, Austria
| | - Maria Trinidad Herrero
- Clinical & Experimental Neuroscience (NiCE-IMIB-IUIE), School of Medicine. University of Murcia, Murcia, Spain
| | - Colleen M Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Sebastian SA, Avanthika C, Jhaveri S, Carrera KG, Camacho L GP, Balasubramanian R. The Risk of Cardiovascular Disease Among Immigrants in Canada. Cureus 2022; 14:e22300. [PMID: 35350529 PMCID: PMC8933291 DOI: 10.7759/cureus.22300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/05/2022] Open
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133
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Rahbar MH, Medrano M, Diaz-Garelli F, Gonzalez Villaman C, Saroukhani S, Kim S, Tahanan A, Franco Y, Castro-Tejada G, Diaz SA, Hessabi M, Savitz SI. Younger age of stroke in low-middle income countries is related to healthcare access and quality. Ann Clin Transl Neurol 2022; 9:415-427. [PMID: 35142101 PMCID: PMC8935275 DOI: 10.1002/acn3.51507] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022] Open
Abstract
Stroke is the second leading cause of mortality globally with higher burden and younger age in low‐middle income countries (LMICs) than high‐income countries (HICs). However, it is unclear to what extent differences in healthcare access and quality (HAQ) and prevalence of risk factors between LMICs and HICs contribute to younger age of stroke in LMICs. In this systematic review, we conducted meta‐analysis of 67 articles and compared the mean age of stroke between LMICs and HICs, before and after adjusting for HAQ index. We also compared the prevalence of main stroke risk factors between HICs and LMICs. The unadjusted mean age of stroke in LMICs was significantly lower than HICs (63.1 vs. 68.6), regardless of gender (63.9 vs. 66.6 among men, and 65.6 vs. 70.7 among women) and whether data were collected in population‐ (64.7 vs. 69.5) or hospital‐based (62.6 vs. 65.9) studies (all p < 0.01). However, after adjusting for HAQ index, the difference in the mean age of stroke between LMICs and HICs was not significant (p ≥ 0.10), except among women (p = 0.048). In addition, while the median prevalence of hypertension in LMICs was 23.4% higher than HICs, the prevalence of all other risk factors was lower in LMICs than HICs. Our findings suggest a much larger contribution of HAQ to the younger mean age of stroke in LMICs, as compared with other potential factors. Additional studies on stroke care quality and accessibility are needed in LMICs.
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Affiliation(s)
- Mohammad H Rahbar
- Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Martin Medrano
- Department of Medicine, School of Medicine, Pontificia Universidad Catalica Madre and Maestra (PUCMM), Santiago, Dominican Republic
| | - Franck Diaz-Garelli
- Department of Public Health Sciences, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | | | - Sepideh Saroukhani
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sori Kim
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Department of Biostatistics & Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Amirali Tahanan
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Yahaira Franco
- Department of Neurology, Clínica Corominas, Santiago, Dominican Republic
| | - Gelanys Castro-Tejada
- Department of Medicine, School of Medicine, Pontificia Universidad Catalica Madre and Maestra (PUCMM), Santiago, Dominican Republic
| | - Sarah A Diaz
- Department of Medicine, School of Medicine, Pontificia Universidad Catalica Madre and Maestra (PUCMM), Santiago, Dominican Republic
| | - Manouchehr Hessabi
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sean I Savitz
- Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Jacob MA, Ekker MS, Allach Y, Cai M, Aarnio K, Arauz A, Arnold M, Bae HJ, Bandeo L, Barboza MA, Bolognese M, Bonardo P, Brouns R, Chuluun B, Chuluunbatar E, Cordonnier C, Dagvajantsan B, Debette S, Don A, Enzinger C, Ekizoglu E, Fandler-Höfler S, Fazekas F, Fromm A, Gattringer T, Hora TF, Jern C, Jood K, Kim YS, Kittner S, Kleinig T, Klijn CJ, Kõrv J, Kumar V, Lee KJ, Lee TH, Maaijwee NA, Martinez-Majander N, Marto JP, Mehndiratta MM, Mifsud V, Montanaro V, Pacio G, Patel VB, Phillips MC, Piechowski-Jozwiak B, Pikula A, Ruiz-Sandoval J, von Sarnowski B, Swartz RH, Tan KS, Tanne D, Tatlisumak T, Thijs V, Viana-Baptista M, Vibo R, Wu TY, Yesilot N, Waje-Andreassen U, Pezzini A, Putaala J, Tuladhar AM, de Leeuw FE. Global Differences in Risk Factors, Etiology, and Outcome of Ischemic Stroke in Young Adults-A Worldwide Meta-analysis: The GOAL Initiative. Neurology 2022; 98:e573-e588. [PMID: 34906974 PMCID: PMC8829964 DOI: 10.1212/wnl.0000000000013195] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 11/16/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is a worldwide increase in the incidence of stroke in young adults, with major regional and ethnic differences. Advancing knowledge of ethnic and regional variation in causes and outcomes will be beneficial in implementation of regional health care services. We studied the global distribution of risk factors, causes, and 3-month mortality of young patients with ischemic stroke, by performing a patient data meta-analysis from different cohorts worldwide. METHODS We performed a pooled analysis of individual patient data from cohort studies that included consecutive patients with ischemic stroke aged 18-50 years. We studied differences in prevalence of risk factors and causes of ischemic stroke between different ethnic and racial groups, geographic regions, and countries with different income levels. We investigated differences in 3-month mortality by mixed-effects multivariable logistic regression. RESULTS We included 17,663 patients from 32 cohorts in 29 countries. Hypertension and diabetes were most prevalent in Black (hypertension, 52.1%; diabetes, 20.7%) and Asian patients (hypertension 46.1%, diabetes, 20.9%). Large vessel atherosclerosis and small vessel disease were more often the cause of stroke in high-income countries (HICs; both p < 0.001), whereas "other determined stroke" and "undetermined stroke" were higher in low and middle-income countries (LMICs; both p < 0.001). Patients in LMICs were younger, had less vascular risk factors, and despite this, more often died within 3 months than those from HICs (odds ratio 2.49; 95% confidence interval 1.42-4.36). DISCUSSION Ethnoracial and regional differences in risk factors and causes of stroke at young age provide an understanding of ethnic and racial and regional differences in incidence of ischemic stroke. Our results also highlight the dissimilarities in outcome after stroke in young adults that exist between LMICs and HICs, which should serve as call to action to improve health care facilities in LMICs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Keon-Joo Lee
- From Donders Institute for Brain, Cognition and Behaviour (M.A.J., M.S.E., Y.A., M.C., C.J.M.K., A.M.T., F.-E.d.L.), Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands; Neurology (K.A., N.M.-M., T.T., J.P.), Helsinki University Hospital and University of Helsinki, Finland; National Institute of Neurology and Neurosurgery of Mexico (A.A.), Manuel Velasco Suárez, Mexico City; Department of Neurology (M.A.), Inselspital, University Hospital, University of Bern, Switzerland; Cerebrovascular Disease Center (H.-J.B., K.-J.L.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea; Neurology Department (L.B., P.B., G.P.), Hospital Británico de Buenos Aires, Argentina; Neurosciences Department (M.A.B.), Hospital Dr. Rafael A. Calderon Guardia, CCSS, San Jose, Costa Rica; Neurocenter (M.B., N.A.M.M.), Department of Neurology and Neurorehabilitation, Lucerne Cantonal Hospital, Luzern, Switzerland; The Faculty of Medicine and Pharmacy (R.B.), Vrije Universiteit Brussel, Jette, Belgium; Department of Neurology (R.B.), ZorgSaam Hospital, Terneuzen, the Netherlands; International School of Traditional Medicine (B.C.) and Department of Neurology, School of Medicine (B.D.), Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; Department of Global Health (E.C.), School of Public Health, Taipei Medical University, Taiwan; U1172-LilNCog-Lille Neuroscience & Cognition (C.C.), Univ Lille, Inserm, CHU Lille; Team VINTAGE (S.D.), Bordeaux Population Health Research Center, Inserm, University of Bordeaux, France; School of Medicine (A.D.) and Department of Epidemiology and Preventive Medicine, School of Public Health (D.T.), Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Neurology (C.E., S.F.-H., F.F., T.G.) and Division of Neuroradiology, Department of Radiology (C.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.E., N.Y.), Istanbul University, Istanbul Faculty of Medicine, Turkey; Center for Neurovascular Diseases, Department of Neurology (A.F., U.W.-A.), Haukeland University Hospital, Bergen, Norway; SARAH Hospital of Rehabilitation (T.F.H., V. Montanaro), Brasilia, Brazil; Department of Laboratory Medicine, Institute of Biomedicine (C.J.), and Institute of Neuroscience and Physiology (K.J.), the Sahlgrenska Academy, University of Gothenburg; Departments of Clinical Genetics and Genomics (C.J.) and Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Neurology (K.Y.S.), College of Medicine, Hanyang University, Seoul, South Korea; Department of Neurology (S.K.), Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore; Department of Neurology (T.K.), Royal Adelaide Hospital, Australia; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; Neurological Institute (V.K., V. Mifsud, B.P.-J.), Cleveland Clinic Abu Dhabi, United Arab Emirates; Department of Neurology (T.-H.L.), Chang Gung Memorial Hospital, Linkou Medical Center; College of Medicine (T.-H.L.), Chang Gung University, Guishan, Taoyuan, Taiwan; Department of Neurology (J.P.M., M.V.-B.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental and CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Department of Neurology (M.M.M.), G.B. Pant Institute of Medical Education and Research (GIPMER), New Delhi, India; Department of Neurology (V.B.P.), Nelson R. Mandela School of Medicine, Inkosi Albert Luthuli Central Hospital, Mayville, South Africa; Department of Neurology (M.C.P.), Waikato Hospital, Hamilton, New Zealand; Department of Medicine (Neurology), University Health Network (A. Pikula), and Department of Medicine (Neurology) (R.H.S.), Sunnybrook Health Sciences Center, University of Toronto, Canada; Department of Neurology (J.R.-S.), Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico; Department of Neurology (B.v.S.), University Medicine, Greifswald, Germany; Department of Medicine (K.-S.T.), University of Malaya, Kuala Lumpur; Rambam Healthcare Campus (D.T.), Haifa, Israel; Stroke Theme (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne; Department of Neurology (V.T.), Austin Health, Melbourne, Victoria, Australia; Department of Neurology (T.Y.W.), Christchurch Hospital, New Zealand; and Department of Clinical and Experimental Sciences (A. Pezzini), Neurology Clinic, University of Brescia, Italy.
| | - Tsong-Hai Lee
- From Donders Institute for Brain, Cognition and Behaviour (M.A.J., M.S.E., Y.A., M.C., C.J.M.K., A.M.T., F.-E.d.L.), Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands; Neurology (K.A., N.M.-M., T.T., J.P.), Helsinki University Hospital and University of Helsinki, Finland; National Institute of Neurology and Neurosurgery of Mexico (A.A.), Manuel Velasco Suárez, Mexico City; Department of Neurology (M.A.), Inselspital, University Hospital, University of Bern, Switzerland; Cerebrovascular Disease Center (H.-J.B., K.-J.L.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea; Neurology Department (L.B., P.B., G.P.), Hospital Británico de Buenos Aires, Argentina; Neurosciences Department (M.A.B.), Hospital Dr. Rafael A. Calderon Guardia, CCSS, San Jose, Costa Rica; Neurocenter (M.B., N.A.M.M.), Department of Neurology and Neurorehabilitation, Lucerne Cantonal Hospital, Luzern, Switzerland; The Faculty of Medicine and Pharmacy (R.B.), Vrije Universiteit Brussel, Jette, Belgium; Department of Neurology (R.B.), ZorgSaam Hospital, Terneuzen, the Netherlands; International School of Traditional Medicine (B.C.) and Department of Neurology, School of Medicine (B.D.), Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; Department of Global Health (E.C.), School of Public Health, Taipei Medical University, Taiwan; U1172-LilNCog-Lille Neuroscience & Cognition (C.C.), Univ Lille, Inserm, CHU Lille; Team VINTAGE (S.D.), Bordeaux Population Health Research Center, Inserm, University of Bordeaux, France; School of Medicine (A.D.) and Department of Epidemiology and Preventive Medicine, School of Public Health (D.T.), Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Neurology (C.E., S.F.-H., F.F., T.G.) and Division of Neuroradiology, Department of Radiology (C.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.E., N.Y.), Istanbul University, Istanbul Faculty of Medicine, Turkey; Center for Neurovascular Diseases, Department of Neurology (A.F., U.W.-A.), Haukeland University Hospital, Bergen, Norway; SARAH Hospital of Rehabilitation (T.F.H., V. Montanaro), Brasilia, Brazil; Department of Laboratory Medicine, Institute of Biomedicine (C.J.), and Institute of Neuroscience and Physiology (K.J.), the Sahlgrenska Academy, University of Gothenburg; Departments of Clinical Genetics and Genomics (C.J.) and Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Neurology (K.Y.S.), College of Medicine, Hanyang University, Seoul, South Korea; Department of Neurology (S.K.), Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore; Department of Neurology (T.K.), Royal Adelaide Hospital, Australia; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; Neurological Institute (V.K., V. Mifsud, B.P.-J.), Cleveland Clinic Abu Dhabi, United Arab Emirates; Department of Neurology (T.-H.L.), Chang Gung Memorial Hospital, Linkou Medical Center; College of Medicine (T.-H.L.), Chang Gung University, Guishan, Taoyuan, Taiwan; Department of Neurology (J.P.M., M.V.-B.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental and CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Department of Neurology (M.M.M.), G.B. Pant Institute of Medical Education and Research (GIPMER), New Delhi, India; Department of Neurology (V.B.P.), Nelson R. Mandela School of Medicine, Inkosi Albert Luthuli Central Hospital, Mayville, South Africa; Department of Neurology (M.C.P.), Waikato Hospital, Hamilton, New Zealand; Department of Medicine (Neurology), University Health Network (A. Pikula), and Department of Medicine (Neurology) (R.H.S.), Sunnybrook Health Sciences Center, University of Toronto, Canada; Department of Neurology (J.R.-S.), Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico; Department of Neurology (B.v.S.), University Medicine, Greifswald, Germany; Department of Medicine (K.-S.T.), University of Malaya, Kuala Lumpur; Rambam Healthcare Campus (D.T.), Haifa, Israel; Stroke Theme (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne; Department of Neurology (V.T.), Austin Health, Melbourne, Victoria, Australia; Department of Neurology (T.Y.W.), Christchurch Hospital, New Zealand; and Department of Clinical and Experimental Sciences (A. Pezzini), Neurology Clinic, University of Brescia, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Frank-Erik de Leeuw
- From Donders Institute for Brain, Cognition and Behaviour (M.A.J., M.S.E., Y.A., M.C., C.J.M.K., A.M.T., F.-E.d.L.), Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands; Neurology (K.A., N.M.-M., T.T., J.P.), Helsinki University Hospital and University of Helsinki, Finland; National Institute of Neurology and Neurosurgery of Mexico (A.A.), Manuel Velasco Suárez, Mexico City; Department of Neurology (M.A.), Inselspital, University Hospital, University of Bern, Switzerland; Cerebrovascular Disease Center (H.-J.B., K.-J.L.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea; Neurology Department (L.B., P.B., G.P.), Hospital Británico de Buenos Aires, Argentina; Neurosciences Department (M.A.B.), Hospital Dr. Rafael A. Calderon Guardia, CCSS, San Jose, Costa Rica; Neurocenter (M.B., N.A.M.M.), Department of Neurology and Neurorehabilitation, Lucerne Cantonal Hospital, Luzern, Switzerland; The Faculty of Medicine and Pharmacy (R.B.), Vrije Universiteit Brussel, Jette, Belgium; Department of Neurology (R.B.), ZorgSaam Hospital, Terneuzen, the Netherlands; International School of Traditional Medicine (B.C.) and Department of Neurology, School of Medicine (B.D.), Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; Department of Global Health (E.C.), School of Public Health, Taipei Medical University, Taiwan; U1172-LilNCog-Lille Neuroscience & Cognition (C.C.), Univ Lille, Inserm, CHU Lille; Team VINTAGE (S.D.), Bordeaux Population Health Research Center, Inserm, University of Bordeaux, France; School of Medicine (A.D.) and Department of Epidemiology and Preventive Medicine, School of Public Health (D.T.), Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Neurology (C.E., S.F.-H., F.F., T.G.) and Division of Neuroradiology, Department of Radiology (C.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.E., N.Y.), Istanbul University, Istanbul Faculty of Medicine, Turkey; Center for Neurovascular Diseases, Department of Neurology (A.F., U.W.-A.), Haukeland University Hospital, Bergen, Norway; SARAH Hospital of Rehabilitation (T.F.H., V. Montanaro), Brasilia, Brazil; Department of Laboratory Medicine, Institute of Biomedicine (C.J.), and Institute of Neuroscience and Physiology (K.J.), the Sahlgrenska Academy, University of Gothenburg; Departments of Clinical Genetics and Genomics (C.J.) and Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Neurology (K.Y.S.), College of Medicine, Hanyang University, Seoul, South Korea; Department of Neurology (S.K.), Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore; Department of Neurology (T.K.), Royal Adelaide Hospital, Australia; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; Neurological Institute (V.K., V. Mifsud, B.P.-J.), Cleveland Clinic Abu Dhabi, United Arab Emirates; Department of Neurology (T.-H.L.), Chang Gung Memorial Hospital, Linkou Medical Center; College of Medicine (T.-H.L.), Chang Gung University, Guishan, Taoyuan, Taiwan; Department of Neurology (J.P.M., M.V.-B.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental and CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Department of Neurology (M.M.M.), G.B. Pant Institute of Medical Education and Research (GIPMER), New Delhi, India; Department of Neurology (V.B.P.), Nelson R. Mandela School of Medicine, Inkosi Albert Luthuli Central Hospital, Mayville, South Africa; Department of Neurology (M.C.P.), Waikato Hospital, Hamilton, New Zealand; Department of Medicine (Neurology), University Health Network (A. Pikula), and Department of Medicine (Neurology) (R.H.S.), Sunnybrook Health Sciences Center, University of Toronto, Canada; Department of Neurology (J.R.-S.), Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico; Department of Neurology (B.v.S.), University Medicine, Greifswald, Germany; Department of Medicine (K.-S.T.), University of Malaya, Kuala Lumpur; Rambam Healthcare Campus (D.T.), Haifa, Israel; Stroke Theme (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne; Department of Neurology (V.T.), Austin Health, Melbourne, Victoria, Australia; Department of Neurology (T.Y.W.), Christchurch Hospital, New Zealand; and Department of Clinical and Experimental Sciences (A. Pezzini), Neurology Clinic, University of Brescia, Italy.
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Unbiased plasma proteomics discovery of biomarkers for improved detection of subclinical atherosclerosis. EBioMedicine 2022; 76:103874. [PMID: 35152150 PMCID: PMC8844841 DOI: 10.1016/j.ebiom.2022.103874] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/14/2022] [Accepted: 01/25/2022] [Indexed: 01/21/2023] Open
Abstract
Background Imaging of subclinical atherosclerosis improves cardiovascular risk prediction on top of traditional risk factors. However, cardiovascular imaging is not universally available. This work aims to identify circulating proteins that could predict subclinical atherosclerosis. Methods Hypothesis-free proteomics was used to analyze plasma from 444 subjects from PESA cohort study (222 with extensive atherosclerosis on imaging, and 222 matched controls) at two timepoints (three years apart) for discovery, and from 350 subjects from AWHS cohort study (175 subjects with extensive atherosclerosis on imaging and 175 matched controls) for external validation. A selected three-protein panel was further validated by immunoturbidimetry in the AWHS population and in 2999 subjects from ILERVAS cohort study. Findings PIGR, IGHA2, APOA, HPT and HEP2 were associated with subclinical atherosclerosis independently from traditional risk factors at both timepoints in the discovery and validation cohorts. Multivariate analysis rendered a potential three-protein biomarker panel, including IGHA2, APOA and HPT. Immunoturbidimetry confirmed the independent associations of these three proteins with subclinical atherosclerosis in AWHS and ILERVAS. A machine-learning model with these three proteins was able to predict subclinical atherosclerosis in ILERVAS (AUC [95%CI]:0.73 [0.70–0.74], p < 1 × 10−99), and also in the subpopulation of individuals with low cardiovascular risk according to FHS 10-year score (0.71 [0.69–0.73], p < 1 × 10−69). Interpretation Plasma levels of IGHA2, APOA and HPT are associated with subclinical atherosclerosis independently of traditional risk factors and offers potential to predict this disease. The panel could improve primary prevention strategies in areas where imaging is not available.
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Chong MR, Narula S, Morton R, Judge C, Akhabir L, Cawte N, Pathan N, Lali R, Mohammadi-Shemirani P, Shoamanesh A, O'Donnell M, Yusuf S, Langhorne P, Paré G. Mitochondrial DNA Copy Number as a Marker and Mediator of Stroke Prognosis: Observational and Mendelian Randomization Analyses. Neurology 2022; 98:e470-e482. [PMID: 34880091 PMCID: PMC8826461 DOI: 10.1212/wnl.0000000000013165] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/24/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Low buffy coat mitochondrial DNA copy number (mtDNA-CN) is associated with incident risk of stroke and poststroke mortality; however, its prognostic utility has not been extensively explored. Our goal was to investigate whether low buffy coat mtDNA-CN is a marker and causal determinant of poststroke outcomes using epidemiologic and genetic studies. METHODS First, we performed association testing between baseline buffy coat mtDNA-CN measurements and 1-month poststroke outcomes in 3,498 cases of acute, first stroke from 25 countries from the international, multicenter case-control study Importance of Conventional and Emerging Risk Factors of Stroke in Different Regions and Ethnic Groups of the World (INTERSTROKE). Then, we performed 2-sample mendelian randomization analyses to evaluate potential causative effects of low mtDNA-CN on 3-month modified Rankin Scale (mRS) score. Genetic variants associated with mtDNA-CN levels were derived from the UK Biobank study (N = 383,476), and corresponding effects on 3-month mRS score were ascertained from the Genetics of Ischemic Stroke Functional Outcome (GISCOME; N = 6,021) study. RESULTS A 1-SD lower mtDNA-CN at baseline was associated with stroke severity (baseline mRS score: odds ratio [OR] 1.27, 95% confidence interval [CI] 1.19-1.36; p = 4.7 × 10-12). Independently of baseline stroke severity, lower mtDNA-CN was associated with increased odds of greater 1-month disability (ordinal mRS score: OR 1.16, 95% CI 1.08-1.24; p = 4.4 × 10-5), poor functional outcome status (mRS score 3-6 vs 0-2: OR 1.21, 95% CI 1.08-1.34; p = 6.9 × 10-4), and mortality (OR 1.35, 95% CI 1.14-1.59; p = 3.9 × 10-4). Subgroup analyses demonstrated consistent effects across stroke type, sex, age, country income level, and education level. In addition, mtDNA-CN significantly improved reclassification of poor functional outcome status (net reclassification index [NRI] score 0.16, 95% CI 0.08-0.23; p = 3.6 × 10-5) and mortality (NRI score 0.31, 95% CI 0.19-0.43; p = 1.7 × 10-7) beyond known prognosticators. With the use of independent datasets, mendelian randomization revealed that a 1-SD decrease in genetically determined mtDNA-CN was associated with increased odds of greater 3-month disability quantified by ordinal mRS score (OR 2.35, 95% CI 1.13-4.90; p = 0.02) and poor functional outcome status (OR 2.68, 95% CI 1.05-6.86; p = 0.04). DISCUSSION Buffy coat mtDNA-CN is a novel and robust marker of poststroke prognosis that may also be a causal determinant of poststroke outcomes. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that low buffy coat mtDNA-CN (>1 SD) was associated with worse baseline severity and 1-month outcomes in patients with ischemic or hemorrhagic stroke.
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Affiliation(s)
- Michael Robert Chong
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Sukrit Narula
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Robert Morton
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Conor Judge
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Loubna Akhabir
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Nathan Cawte
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Nazia Pathan
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Ricky Lali
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Pedrum Mohammadi-Shemirani
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Ashkan Shoamanesh
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Martin O'Donnell
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Salim Yusuf
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Peter Langhorne
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Guillaume Paré
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK.
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de Eston Armond R, de Eston Armond J, Konstantyner T, Rodrigues CL. Spiritual Well-Being and Its Association with Coronary Artery Disease. JOURNAL OF RELIGION AND HEALTH 2022; 61:467-478. [PMID: 33226573 DOI: 10.1007/s10943-020-01115-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/16/2020] [Indexed: 06/11/2023]
Abstract
Cardiovascular diseases are the main cause of mortality in the world, generating important socioeconomic and cultural impacts. Spirituality has been associated with the main risk factors for acute myocardial infarction, influencing lifestyle, and drug treatment compliance. Estimate the level of spiritual well-being and its association with coronary artery disease. We conducted a case-control study with 88 adults (42 cases and 46 controls) individually interviewed. Using a spiritual well-being scale and collecting socioeconomic and demographic information. We compared groups by Chi-square and Mann-Whitney tests. Friedman's analysis of variance was used to evaluate the differences between the values assigned to the scale items in each group. Statistically, there was no significant difference between categories and levels of spiritual well-being in any of the groups. Both had high rates, driven by the high level of religious well-being. There was no difference between the rates attributed to the items on the subscale of religious well-being, in the case or control groups (p = 0.959 and p = 0.817). However, the existential well-being subscale revealed variability between the scores attributed to each item in both groups (p < 0.001). The results revealed a high level of spiritual well-being in the analyzed sample. There was no correlation between the levels of spiritual, religious, and existential well-being with coronary artery disease, possibly due to the reduced ability of the religious well-being subscale to discriminate between groups.
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138
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Health System Performance for Multimorbid Cardiometabolic Disease in India: A Population-Based Cross-Sectional Study. Glob Heart 2022; 17:7. [PMID: 35174048 PMCID: PMC8815445 DOI: 10.5334/gh.1056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 12/20/2021] [Indexed: 11/21/2022] Open
Abstract
Background: The prevalence of multimorbidity in low- and middle-income countries (LMICs) is thought to be rising rapidly. Research on the state of healthcare for multimorbidity in LMICs is needed to provide an impetus for integration of care across conditions, a baseline to monitor progress, and information for targeting of interventions to those most in need. Focusing on multimorbid cardiometabolic disease in India, this study thus aimed to determine 1) the proportion of adults with co-morbid diabetes and hypertension who successfully completed each step of the chronic disease care continuum from diagnosis to control for both conditions, and 2) how having additional cardiovascular disease (CVD) risk factors is associated with health system performance along the care continuum for diabetes, hypertension, and co-morbid diabetes and hypertension. Methods: Using a nationally representative household survey carried out in 2015 and 2016 among women aged 15–49 years and men aged 15–54 years, we created a ‘cascade of care’ for diabetes, hypertension, and co-morbid diabetes and hypertension by determining the proportion of those with the condition who had been diagnosed, were on treatment, and achieved control. We used Poisson regression with a robust error structure to estimate how having additional cardiovascular disease (CVD) risk factors (diabetes, hypertension, current smoking, and obesity) was associated with reaching each cascade step for diabetes, hypertension, and co-morbid diabetes and hypertension. Findings: Seven hundred thirty-four thousand seven hundred ninety-four adults were included in the analysis. Among individuals with co-morbid diabetes and hypertension, 28·8% (95% CI, 26·7%–31·0%), 16·1% (95% CI, 14·4%–17·9%), and 3·7% (95% CI, 2·8%–4·9%) – with these proportions varying between states by a factor of 4·8, 7·9, and 56·8 – were aware, treated, and achieved control of both conditions, respectively. Men, adults with lower household wealth, and those living in rural areas were less likely to reach each cascade step. Having additional CVD risk factors generally did not increase the probability of reaching each cascade step for diabetes, hypertension, and co-morbid diabetes and hypertension, except that having concurrent diabetes increased the probability of successfully transitioning through the hypertension care cascade. Interpretation: While varying widely between states and population groups, health system performance for co-morbid diabetes and hypertension is generally low in India, and there appears to be little integration of care across CVD risk factors. Funding: European Research Council.
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Kaviarasan V, Mohammed V, Veerabathiran R. Genetic predisposition study of heart failure and its association with cardiomyopathy. Egypt Heart J 2022; 74:5. [PMID: 35061126 PMCID: PMC8782994 DOI: 10.1186/s43044-022-00240-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/12/2022] [Indexed: 12/12/2022] Open
Abstract
Heart failure (HF) is a clinical condition distinguished by structural and functional defects in the myocardium, which genetic and environmental factors can induce. HF is caused by various genetic factors that are both heterogeneous and complex. The incidence of HF varies depending on the definition and area, but it is calculated to be between 1 and 2% in developed countries. There are several factors associated with the progression of HF, ranging from coronary artery disease to hypertension, of which observed the most common genetic cause to be cardiomyopathy. The main objective of this study is to investigate heart failure and its association with cardiomyopathy with their genetic variants. The selected novel genes that have been linked to human inherited cardiomyopathy play a critical role in the pathogenesis and progression of HF. Research sources collected from the human gene mutation and several databases revealed that numerous genes are linked to cardiomyopathy and thus explained the hereditary influence of such a condition. Our findings support the understanding of the genetics aspect of HF and will provide more accurate evidence of the role of changing disease accuracy. Furthermore, a better knowledge of the molecular pathophysiology of genetically caused HF could contribute to the emergence of personalized therapeutics in future.
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Affiliation(s)
- Vaishak Kaviarasan
- Human Cytogenetics and Genomics Laboratory, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamilnadu, 603103, India
| | - Vajagathali Mohammed
- Human Cytogenetics and Genomics Laboratory, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamilnadu, 603103, India
| | - Ramakrishnan Veerabathiran
- Human Cytogenetics and Genomics Laboratory, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamilnadu, 603103, India.
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Wei W, Liu J, Chen S, Xu X, Guo D, He Y, Huang Z, Wang B, Huang H, Li Q, Chen J, Chen H, Tan N, Liu Y. Sodium Glucose Cotransporter Type 2 Inhibitors Improve Cardiorenal Outcome of Patients With Coronary Artery Disease: A Meta-Analysis. Front Endocrinol (Lausanne) 2022; 13:850836. [PMID: 35330914 PMCID: PMC8940298 DOI: 10.3389/fendo.2022.850836] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/03/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Sodium glucose cotransporter type 2 inhibitors (SGLT-2i) are beneficial for cardiorenal outcomes in patients with type 2 diabetes mellitus (T2DM), heart failure (HF) or chronic kidney disease (CKD). However, whether or not the patients with coronary artery disease (CAD) have prognostic benefit from SGLT-2i treatment has not been fully studied. The purpose of this meta-analysis is to determine the prognostic benefit of SGLT-2i administration in CAD patients. METHODS We searched the PubMed, Embase and Cochrane Library from inception until October 15, 2021. We included randomized controlled trials (RCTs) reporting the effect of SGLT-2i on major adverse cardiovascular event (MACE), hospitalization for heart failure (HHF), cardiovascular (CV) death and cardiorenal parameters in CAD patients. Hazard ratio (HR) with 95% confidence interval (CI) and mean difference (MD) from trials were meta-analyzed using fixed-effects models. RESULTS Nine trials enrolling 15,301 patients with CAD were included in the analyses. Overall, SGLT2i were associated with a reduced risk of MACE (HR: 0.84; 95% CI 0.74-0.95; I2 = 0%), HHF (HR: 0.69; 95% CI 0.58-0.83; I2 = 0%) and a composite of CV death or HHF (HR: 0.78; 95% CI 0.71-0.86; I2 = 37%) in CAD patients. Compared with control group, estimated glomerular filtration rate (eGFR) level decreased less in SGLT-2i group (mean difference [MD] = -3.60, 95% CI, -5.90 to -1.30, p = 0.002; I2 = 0%). CONCLUSIONS SGLT-2i can improve cardiorenal outcomes in CAD patients. Further RCTs and real world studies are need to investigate the effect of SGLT2i on CAD patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021258237.
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Affiliation(s)
- Wen Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Endocrinology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shiqun Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xinghao Xu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Dachuan Guo
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yibo He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhidong Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bo Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Haozhang Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Qiang Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Provincial People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Hong Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Yong Liu, ; Ning Tan, ; Hong Chen,
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Provincial People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- *Correspondence: Yong Liu, ; Ning Tan, ; Hong Chen,
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Provincial People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- *Correspondence: Yong Liu, ; Ning Tan, ; Hong Chen,
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Kundu J, Kundu S. Cardiovascular disease (CVD) and its associated risk factors among older adults in India: Evidence from LASI Wave 1. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2021.100937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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142
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Niu XN, Wen H, Sun N, Zhao R, Wang T, Li Y. Exploring risk factors of short-term readmission in heart failure patients: A cohort study. Front Endocrinol (Lausanne) 2022; 13:1024759. [PMID: 36518258 PMCID: PMC9742544 DOI: 10.3389/fendo.2022.1024759] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/09/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The risk of all-cause mortality in patients with heart failure (HF) has been studied previously. Readmission risk of HF patients was rarely explored. Thus, we aimed to explore early warning factors that may influence short-term readmission of HF patients. METHODS The data of this study came from an HF database in China. It was a retrospective single-center observational study that collected characteristic data on Chinese HF patients by integrating electronic medical records and follow-up outcome data. Eventually, 1,727 patients with HF were finally included in our study. RESULTS In our study, the proportion of HF patients with New York Heart Association (NYHA) class II, III, and IV HF were 17.20%, 52.69%, and 30.11%, respectively. The proportion of patients with readmission within 6 months and readmission within 3 months was 38.33% and 24.20%, respectively. Multivariate logistic regression showed that NYHA class (p III = 0.028, p IV < 0.001), diabetes (p = 0.002), Cr (p = 0.003), and RDW-SD (p = 0.039) were risk factors for readmission within 6 months of HF patients. NYHA class (p III = 0.038, p IV < 0.001), CCI (p = 0.033), Cr (p = 0.012), UA (p = 0.042), and Na (p = 0.026) were risk factors for readmission within 3 months of HF patients. CONCLUSIONS Our study implied risk factors of short-term readmission risk in patients with HF, which may provide policy guidance for the prognosis of patients with HF.
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Affiliation(s)
| | | | | | | | - Ting Wang
- *Correspondence: Yan Li, ; Ting Ting Wang,
| | - Yan Li
- *Correspondence: Yan Li, ; Ting Ting Wang,
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143
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Li S, Liu Z, Joseph P, Hu B, Yin L, Tse LA, Rangarajan S, Wang C, Wang Y, Islam S, Liu W, Lu F, Li Y, Hou Y, Qiang D, Zhao Q, Li N, Lei R, Chen D, Han A, Liu G, Zhang P, Zhi Y, Liu C, Yang J, Resalaiti A, Ma H, Ma Y, Liu Y, Xing X, Xiang Q, Liu Z, Sheng Y, Tang J, Liu L, Yusuf S, Li W. OUP accepted manuscript. Eur Heart J 2022; 43:2852-2863. [PMID: 35731140 DOI: 10.1093/eurheartj/ehac268] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/24/2022] [Accepted: 05/10/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sidong Li
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiguang Liu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Philip Joseph
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Bo Hu
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Yin
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lap Ah Tse
- Division of Occupational and Environmental Health, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Chuangshi Wang
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Wang
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shofiqul Islam
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Weida Liu
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fanghong Lu
- Shandong Academy of Medical Sciences, Basic Medical Institute, Jinan, China
| | - Yindong Li
- Shunyi District Center for Disease Control and Prevention, Beijing, China
| | - Yan Hou
- Balingqiao Community Health Service Center, Taiyuan, China
| | - Deren Qiang
- Wujin District Center for Disease Control and Prevention, Changzhou, China
| | - Qian Zhao
- West China Hospital of Sichuan University, Chengdu, China
| | - Ning Li
- Qingshanhu Community Health Service Station, Nanchang, China
| | - Rensheng Lei
- Center for Disease Control and Prevention of Nanchang County, Nanchang, China
| | - Di Chen
- Jishuitan Hospital, Beijing, China
| | - Aiying Han
- Bayannaoer Center for Disease Control and Prevention, Bayannaoer, China
| | - Guoqin Liu
- Jingle People's Hospital, Xinzhou, China
| | - Peng Zhang
- Health Center of Guanshan Town, Xi'an, China
| | - Yahong Zhi
- Hospital of Xi'an University of Electronic Science and Technology, Xi'an, China
| | - Chunmei Liu
- Mengla District Center for Disease Control and Prevention, Xishuangbanna, China
| | - Jinkui Yang
- Central hospitals of Menglong District, Xishuangbanna, China
| | | | - Haibin Ma
- Xining Center for Disease Control and Prevention, Xining, China
| | - Yuanting Ma
- Xining east area of Dongguan Street Community Health Service Center, Xining, China
| | - Yu Liu
- 242 Hospital, Shenyang, China
| | - Xiaojie Xing
- The Red Cross hospital of Shenyang, Shenyang, China
| | - Quanyong Xiang
- Jiangsu Centers for Disease Control and Prevention, Nanjing, China
| | - Zhengrong Liu
- Jiangxinzhou Community Health Service Center, Nanjing, China
| | - Yundong Sheng
- Jiangxinzhou Community Health Service Center, Nanjing, China
| | | | - Lisheng Liu
- Beijing Hypertension League Institute, Beijing, China
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Wei Li
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Amirul Islam FM, Lambert EA, Islam SMS, Islam MA, Maddison R, Thompson B, Lambert GW. Factors associated with antihypertensive medication use and blood pressure control in a rural area in Bangladesh: baseline data from a cluster randomised control trial. BMC Public Health 2021; 21:2316. [PMID: 34949160 PMCID: PMC8705124 DOI: 10.1186/s12889-021-12379-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 12/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of antihypertensive medications is critical for controlling high blood pressure. We aimed to investigate associations between socio-demographic factors and antihypertensive medications use, and antihypertensive medications use with different types of drugs use with levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP). METHODS For the present report we derived data from the baseline measurements of a cluster randomised control trial on 307 participants with previously diagnosed hypertension from the rural district of Narial in Bangladesh. We measured the participant's current blood pressure levels and recorded antihypertensive medications uses. Associated factors included socio-economic status, diabetes, antihypertensive medications use, and types of drugs and doses used for controlling blood pressure. We applied analysis of variance and logistic regression techniques to identify factors associated with blood pressure. RESULTS Of the total participants, 144 (46.9%) were on antihypertensive medications. After multivariate adjustment, binary logistic regression revealed that employees (odds ratio, (95% confidence interval (CI)) (OR 3.58, 95%CI 1.38-9.28) compared to farmers, and people with diabetes (OR 2.43, 95%CI 1.13-5.26) compared to people without diabetes were associated with a higher proportion of antihypertensive medications use. Of 144 participants on antihypertensive medications, 7 (5%) had taken two doses, 114 (79%) had taken one dose per day and the rest were irregular in medication use. The mean (standard deviation) [min, max] SBP and DBP were 149 (19) mmHg [114, 217] and 90 (10) mmHg [75, 126], respectively. Overall, there was no significant difference in SBP (p = 0.10) or DBP (p = 0.67) between participants with or without antihypertensive medications or using any type of medications (p = 0.54 for SBP and 0.76 for DBP). There was no significant association between antihypertensive medications use and elevated BP levels SBP/DBP≥140/90 mmHg (p = 0.42) CONCLUSION: Less than half of the people with hypertension were on medication. Irrespective of the antihypertensive medications use, most of the participant's blood pressure was high. Further study is needed with a large sample to understand the factors and aetiology of unmanaged hypertension in rural areas of Bangladesh where the prevalence of hypertension is very high.
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Affiliation(s)
- Fakir M Amirul Islam
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia. .,Organisation for Rural Community Development (ORCD), Dariapur, Narail, Bangladesh.
| | - Elisabeth A Lambert
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.,Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition (IPAN), Faculty of Health, Deakin University, Burwood, VIC, 3125, Australia
| | - M Ariful Islam
- Organisation for Rural Community Development (ORCD), Dariapur, Narail, Bangladesh
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition (IPAN), Faculty of Health, Deakin University, Burwood, VIC, 3125, Australia
| | - Bruce Thompson
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia
| | - Gavin W Lambert
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.,Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia
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145
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Khetan AK, Leong DP, Gupta R, Zhu Y, Li S, Liu W, Kruger IM, Teo KK, Wielgosz A, Yusuf R, Noor Khan NAM, Khatib R, Alhabib KF, Karsidag K, Chifamba J, Mohammadifard N, Serón P, Lopez-Jaramillo P, Orlandini A, Szuba A, Yusufali A, Nair S, Rosengren A, Yeates K, Dans AM, Iqbal R, Avezum Á, Rangarajan S, Yusuf S. Variations in the association of height with mortality, cardiovascular disease and cancer in low-, middle- and high-income countries. Int J Epidemiol 2021; 51:1304-1316. [PMID: 34939099 DOI: 10.1093/ije/dyab268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/13/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Final adult height is a useful proxy measure of childhood nutrition and disease burden. Tall stature has been previously associated with decreased risk of all-cause mortality, decreased risk of major cardiovascular events and an increased risk of cancer. However, these associations have primarily been derived from people of European and East Asian backgrounds, and there are sparse data from other regions of the world. METHODS The Prospective Urban-Rural Epidemiology study is a large, longitudinal population study done in 21 countries of varying incomes and sociocultural settings. We enrolled an unbiased sample of households, which were eligible if at least one household member was aged 35-70 years. Height was measured in a standardized manner, without shoes, to the nearest 0.1 cm. During a median follow-up of 10.1 years (interquartile range 8.3-12.0), we assessed the risk of all-cause mortality, major cardiovascular events and cancer. RESULTS A total of 154 610 participants, enrolled since January 2003, with known height and vital status, were included in this analysis. Follow-up event data until March 2021 were used; 11 487 (7.4%) participants died, whereas 9291 (6.0%) participants had a major cardiovascular event and 5873 (3.8%) participants had a new diagnosis of cancer. After adjustment, taller individuals had lower hazards of all-cause mortality [hazard ratio (HR) per 10-cm increase in height 0.93, 95% confidence interval (CI) 0.90-0.96] and major cardiovascular events (HR 0.97, 95% CI 0.94-1.00), whereas the hazard of cancer was higher in taller participants (HR 1.23, 95% CI 1.18-1.28). The interaction p-values between height and country-income level for all three outcomes were <0.001, suggesting that the association with height varied by country-income level for these outcomes. In low-income countries, height was inversely associated with all-cause mortality (HR 0.88, 95% CI 0.84-0.92) and major cardiovascular events (HR 0.87, 95% CI 0.82-0.93). There was no association of height with these outcomes in middle- and high-income countries. The respective HRs for cancer in low-, middle- and high-income countries were 1.14 (95% CI 0.99-1.32), 1.12 (95% CI 1.04-1.22) and 1.20 (95% CI 1.14-1.26). CONCLUSIONS Unlike high- and middle-income countries, tall stature has a strong inverse association with all-cause mortality and major cardiovascular events in low-income countries. Improved childhood physical development and advances in population-wide cardiovascular treatments in high- and middle-income countries may contribute to this gap. From a life-course perspective, we hypothesize that optimizing maternal and child health in low-income countries may improve rates of premature mortality and cardiovascular events in these countries, at a population level.
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Affiliation(s)
- Aditya K Khetan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Darryl P Leong
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Rajeev Gupta
- Eternal Heart Care Center and Research Institute, Jaipur, India
| | - Yibing Zhu
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Sidong Li
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Weida Liu
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Iolanthé M Kruger
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom Campus, South Africa
| | - Koon K Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - Rita Yusuf
- Independent University, Dhaka, Bangladesh
| | | | - Rasha Khatib
- Institute for Community and Public Health, Birzeit University, Birzeit, Palestine; Advocate Aurora Health, Downers Grove, IL, USA
| | - Khalid F Alhabib
- King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Kubilay Karsidag
- Department of Internal Medicine, Medical Faculty of Istanbul University, Istanbul, Turkey
| | - Jephat Chifamba
- Department of Biomedical Sciences, Physiology Unit, Faculty of Medicine and Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pamela Serón
- Faculty of Medicine, Universidad de La Frontera, Claro Solar, Temuco, Chile
| | - Patricio Lopez-Jaramillo
- Masira Research Institute, Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia
| | - Andres Orlandini
- ECLA (Estudios Clínicos Latino America), Instituto Cardiovascular de Rosario, Rosario, Argentina
| | - Andrzej Szuba
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Sanjeev Nair
- Health Action by People, Trivandrum and Government Medical College, Thrissur, India
| | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, VGR Region, Gothenburg, Sweden
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Álvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
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146
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Wang Y, Chu Y, Khan Y, Khan Z, Liu Q, Malik M, Abbas S. A Machine learning-based prediction model for the heart diseases from chance factors through two-variable decision tree classifier. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2021. [DOI: 10.3233/jifs-202226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper addressed the prediction of heart sicknesses from hazard elements through a decision-making tree. We introduced the facts mining technique in public fitness to extract high-degree knowledge from raw data, which facilitates predicting heart diseases from risk factors and their prevention. The existing work intends to introduce a new risk element in heart diseases using novel data mining strategies. Latest actual international affected person’s information (e.g., smoking, area of residence, age, weight, blood stress, chest pain, low-density lipoproteins (LDL), high-density lipoproteins (HDL), block arteries became accrued by way of the use of questionnaire through direct interview technique from patients. Novel two-variable decision trees are constructed for coronary heart illness records primarily based on chance factors and ranking of risk elements. The results show a correct prediction of cardiovascular disease (CVD) from the risk factor if records on chance factors are available as direct results of this study, tobacco, loss of physical exercise, and weight-reduction plan play a vital role in predicting heart diseases, which is the most important reason for mortality in developing countries, especially in my country.
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Affiliation(s)
- Y. Wang
- College of Information Sciences and Engineering, Shandong Agricultural University China, P.R. China
| | - Y.M. Chu
- Department of Mathematics, Huzhou University, Huzhou, P.R. China
- Hunan Provincial Key Laboratory of Mathematical Modeling and Analysis in Engineering, Changsha, P.R. China
| | - Y.A. Khan
- Department of Mathematics and Statistics, Hazara University Mansehra, Pakistan
| | - Z.Y. Khan
- Department of Computer Science and Information Technology, University of Azad Jammu and Kashmir, Pakistan
| | - Q. Liu
- School of Statistics, Jiangxi University of Finance and Economics, Nanchang, China
| | - M.Y. Malik
- Department of Mathematics, College of Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - S.Z. Abbas
- Department of Mathematics and Statistics, Hazara University Mansehra, Pakistan
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147
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Ma Z, Hummel SL, Sun N, Chen Y. From salt to hypertension, what is missed? J Clin Hypertens (Greenwich) 2021; 23:2033-2041. [PMID: 34846798 PMCID: PMC8696232 DOI: 10.1111/jch.14402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/20/2021] [Accepted: 11/03/2021] [Indexed: 01/18/2023]
Abstract
Excess salt intake is viewed as a major contributor to hypertension and cardiovascular disease, and dietary salt restriction is broadly recommended by public health guidelines. However, individuals can have widely varying physiological responses to salt intake, and a tailored approach to evaluation and intervention may be needed. The traditional sodium related concepts are challenging to assess clinically for two reasons: (1) spot and 24-hour urine sodium are frequently used to evaluate salt intake, but are more suitable for population study, and (2) some adverse effects of salt may be blood pressure-independent. In recent years, previously unknown mechanisms of sodium absorption and storage have been discovered. This review will outline the limitations of current methods to assess sodium balance and discuss new potential evaluation methods and treatment targets.
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Affiliation(s)
- Zhiyi Ma
- Cardiology DepartmentBeijing Tsinghua Changgung HospitalSchool of Clinical MedicineTsinghua UniversityBeijingChina
| | - Scott L. Hummel
- Ann Arbor Veterans Affairs Health SystemUniversity of Michigan Frankel Cardiovascular CenterAnn ArborMichiganUSA
| | - Ningling Sun
- Cardiology DepartmentHeart CenterPeking University People's HospitalBeijingChina
| | - Yuanyuan Chen
- Cardiology DepartmentHeart CenterPeking University People's HospitalBeijingChina
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148
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Impact of common cardio-metabolic risk factors on fatal and non-fatal cardiovascular disease in Latin America and the Caribbean: an individual-level pooled analysis of 31 cohort studies. LANCET REGIONAL HEALTH. AMERICAS 2021; 4:None. [PMID: 34957436 PMCID: PMC8669782 DOI: 10.1016/j.lana.2021.100068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/14/2021] [Accepted: 08/24/2021] [Indexed: 12/20/2022]
Abstract
Background Estimates of the burden of cardio-metabolic risk factors in Latin America and the Caribbean (LAC) rely on relative risks (RRs) from non-LAC countries. Whether these RRs apply to LAC remains unknown. Methods We pooled LAC cohorts. We estimated RRs per unit of exposure to body mass index (BMI), systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC) and non-HDL cholesterol on fatal (31 cohorts, n=168,287) and non-fatal (13 cohorts, n=27,554) cardiovascular diseases, adjusting for regression dilution bias. We used these RRs and national data on mean risk factor levels to estimate the number of cardiovascular deaths attributable to non-optimal levels of each risk factor. Results Our RRs for SBP, FPG and TC were like those observed in cohorts conducted in high-income countries; however, for BMI, our RRs were consistently smaller in people below 75 years of age. Across risk factors, we observed smaller RRs among older ages. Non-optimal SBP was responsible for the largest number of attributable cardiovascular deaths ranging from 38 per 100,000 women and 54 men in Peru, to 261 (Dominica, women) and 282 (Guyana, men). For non-HDL cholesterol, the lowest attributable rate was for women in Peru (21) and men in Guatemala (25), and the largest in men (158) and women (142) from Guyana. Interpretation RRs for BMI from studies conducted in high-income countries may overestimate disease burden metrics in LAC; conversely, RRs for SBP, FPG and TC from LAC cohorts are similar to those estimated from cohorts in high-income countries. Funding Wellcome Trust (214185/Z/18/Z).
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149
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Mujanovic A, Smajlovic D. Major epidemiological features of first-ever ischemic stroke in Tuzla Canton, Bosnia and Herzegovina. Health Sci Rep 2021; 4:e445. [PMID: 34877411 PMCID: PMC8628780 DOI: 10.1002/hsr2.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND AIMS Opacity of data on stroke for Bosnia and Herzegovina (B&H) is mainly due to the lack of a unified national stroke registry. This article aims to present updated epidemiological data on the etiology and risk factors for first-ever ischemic stroke in Tuzla Canton, B&H. METHODS This retrospective hospital-based study included all first-ever ischemic stroke patients admitted between January 1, 2018 and December 31, 2018 at the Neurology Department, University Clinical Center Tuzla. RESULTS First-ever ischemic stroke was diagnosed in 739 patients. Leading risk factors were hypertension (94%), diabetes mellitus (40.7%), and dyslipidemia (38.8%). The most common stroke subtypes were atherothrombotic (36.8%), cardioembolic (21.9%), and stroke of undetermined etiologies (19.2%). Mean NIHSS score at discharge was 13 (IQR 2-16), and favorable patient outcome (mRs ≤2) was recorded in 26.4% patients. Men (aOR 0.39; 95% CI 0.24-0.64) and younger patients (aOR 0.96; 95% CI 0.93-0.98) had significantly higher probability of having a favorable outcome at discharge. Dyslipidemia could be considered as a predictive factor for patient outcome (aOR 0.66; 95% CI 0.43-1.00). CONCLUSIONS More than 92% of our patients had at least one modifiable risk factor, with hypertension and diabetes being at the forefront. One out of four patients had become functionally independent at discharge, while hospital mortality was lower than in other Eastern European countries. The overarching goal should be steered toward the development of a national stroke registry, which should be used as a reference for all further stroke management activities.
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Affiliation(s)
- Adnan Mujanovic
- Medical FacultyUniversity of TuzlaTuzlaBosnia and Herzegovina
| | - Dzevdet Smajlovic
- Medical FacultyUniversity of TuzlaTuzlaBosnia and Herzegovina
- Department of NeurologyUniversity Clinical Center TuzlaTuzlaBosnia and Herzegovina
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150
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Studziński K, Tomasik T, Windak A, Banach M, Wójtowicz E, Mastej M, Tomaszewski M, Mikhailidis DP, Toth PP, Catapano A, Ray KK, Howard G, Lip GY, Charchar FJ, Sattar N, Williams B, MacDonald TM, Penson PE, Jóźwiak JJ. The Differences in the Prevalence of Cardiovascular Disease, Its Risk Factors, and Achievement of Therapeutic Goals among Urban and Rural Primary Care Patients in Poland: Results from the LIPIDOGRAM 2015 Study. J Clin Med 2021; 10:5656. [PMID: 34884357 PMCID: PMC8658414 DOI: 10.3390/jcm10235656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/16/2021] [Accepted: 11/28/2021] [Indexed: 11/30/2022] Open
Abstract
A nationwide cross-sectional study, LIPIDOGRAM2015, was carried out in Poland in the years 2015 and 2016. A total of 438 primary care physicians enrolled 13,724 adult patients that sought medical care in primary health care practices. The prevalence of hypertension, diabetes mellitus, dyslipidaemia, and CVD were similar in urban and rural areas (49.5 vs. 49.4%; 13.7 vs. 13.1%; 84.2 vs. 85.2%; 14.4 vs. 14.2%, respectively). The prevalence of obesity (32.3 vs. 37.5%, p < 0.01) and excessive waist circumference (77.5 vs. 80.7%, p < 0.01), as well as abdominal obesity (43.2 vs. 46.4%, p < 0.01), were higher in rural areas in both genders. Mean levels of LDL-C (128 vs. 130 mg/dL, p = 0.04) and non-HDL-C (147 vs. 148 mg/dL, p = 0.03) were slightly higher in rural populations. Altogether, 14.3% of patients with CVD from urban areas and 11.3% from rural areas reached LDL <70 mg/dL (p = 0.04). There were no important differences in the prevalence of hypertension, diabetes, dyslipidaemia, and CVD, or in mean levels of blood pressure, cholesterol fractions, glucose, and HbA1c between Polish urban and rural primary care patient populations. A high proportion of patients in cities and an even-higher proportion in rural areas did not reach the recommended targets for blood pressure, LDL-C, and HbA1c, indicating the need for novel CVD-prevention programs.
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Affiliation(s)
- Krzysztof Studziński
- Department of Family Medicine, Jagiellonian University Medical College, Bochenska 4, 31-061 Krakow, Poland; (K.S.); (A.W.); (E.W.)
| | - Tomasz Tomasik
- Department of Family Medicine, Jagiellonian University Medical College, Bochenska 4, 31-061 Krakow, Poland; (K.S.); (A.W.); (E.W.)
| | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, Bochenska 4, 31-061 Krakow, Poland; (K.S.); (A.W.); (E.W.)
| | - Maciej Banach
- Polish Mothers Memorial Hospital Research Institute, 93-338 Lodz, Poland;
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, 90-136 Lodz, Poland
- Cardiovascular Research Centre, University of Zielona Gora, 65-417 Zielona Gora, Poland
| | - Ewa Wójtowicz
- Department of Family Medicine, Jagiellonian University Medical College, Bochenska 4, 31-061 Krakow, Poland; (K.S.); (A.W.); (E.W.)
| | | | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PT, UK;
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital, University College London, London NW3 2QG, UK;
| | - Peter P. Toth
- Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
- CGH Medical Center, Sterling, IL 61081, USA
| | - Alberico Catapano
- Department of Pharmacological Sciences, University of Milano and Multimedica IRCCS, 20099 Milano, Italy;
| | - Kausik K. Ray
- Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, Imperial College, Kensington, London W6 8RP, UK;
| | - George Howard
- Department of Biostatistics, School of Public Health of Alabama at Birmingham, Birmingham B15 2TT, UK;
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L14 3PE, UK;
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - Fadi J. Charchar
- School of Health and Life Sciences, Federation University Australia, Ballarat, VIC 3350, Australia;
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow G12 8TA, UK;
| | - Bryan Williams
- NIHR University College London Biomedical Research Centre, University College London and University, London NW1 2BU, UK;
- College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
| | - Thomas M. MacDonald
- MEMO Research, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK;
| | - Peter E. Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L2 2QP, UK;
- Liverpool Centre for Cardiovascular Science, Liverpool L69 7TX, UK
| | - Jacek J. Jóźwiak
- Department of Family Medicine and Public Health, Institute of Medical Sciences, University of Opole, Oleska 48, 45-052 Opole, Poland;
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