The Burden of Cardiovascular Diseases Among US States, 1990-2016

Exploring the Acceptability and Feasibility of a Self-directed Approach to Identifying Health Priorities in a Sample of Southern Older African American Adults with Multiple Chronic Conditions

OBJECTIVES

To evaluate the cultural acceptability and feasibility of the self-directed "My Health Priorities" (MHP) web-based program in older Southern African Americans (AAs) with multiple chronic conditions (MCCs) and their family caregivers (FCGs).

DESIGN

A multi-method formative evaluation study (NIH Stage 1a) to explore patients' and FCGs' experiences with the MHP web-based program, a component of the patient priorities care approach. Interviews were analyzed using the constant comparative method and thematic analysis. Participants rated usability via the system usability scale (SUS) (scores range from 0 to 100). Sample characteristics were analyzed using SAS and SPSS.

SETTING

A primary care clinic in a southeastern U.S. academic medical center.

PARTICIPANTS

Fifteen older AAs with MCCs (≥ 65 years old, diagnosed with ≥ 2 chronic conditions) and their adult AA FCGs (≥ 18 years old).

RESULTS

Participants generally found the program acceptable but difficult to navigate on devices other than computers. Suggestions included redesigning the avatar for cultural relevance, optimizing functionality for mobile devices, and offering strategies to address challenging patient-clinician interactions. Patients rated usability at 75.31 ± 14.63 (good usability), while FCGs rated it at 30.13 ± 4.31 (indicating limited usability). Study measures required 30 min to complete, while the intervention took 60 min. Participants completed 81% of study measures.

CONCLUSIONS

Established web-based programs may be acceptable to AA patients and their caregivers, but specific technical and content aspects may need to be revised to make the programs more suitable for AAs. Design refinements should account for the differing usability experiences reported by AA patients and their caregivers.

TRIAL REGISTRATION

NCT05129709.

Social determinants of cardiovascular disease in women with and without breast cancer

PURPOSE

Social determinants of health (SDOH) may impact cardiovascular (CV) risk in women with and without breast cancer (BC).

METHODS

In 153,401 participants without prevalent CV disease from the Women's Health initiative (WHI), we assessed key SDOH factors: geographic region, rurality, insurance status, and household income. Multivariable Cox proportional hazards models were used to assess associations between SDOH factors and a composite CV outcome, which included incident myocardial infarction, incident stroke, hospitalization for heart failure, or CV death.

RESULTS

In the final cohort, 10,954 (mean ± standard deviation [SD] age 62 ± 7 years) women developed BC, and 142,144 (mean age 63 ± 7 years) women remained free of BC. During a median follow-up time of 13 years, 18,148 women experienced the composite CV outcome. Rurality, low household income, and non-private insurance were associated with an increased risk of the composite CV outcome and CV death, both in women with and without BC.

CONCLUSIONS

SDOH factors are associated with an increased risk of CV events among women, irrespective of BC status. These associations highlight the importance of socioeconomic factors across cardiovascular health outcomes.

Perfluorooctanoic acid increases serum cholesterol in a PPARα-dependent manner in female mice

Per- and polyfluoroalkyl substances (PFAS) are a large group of persistent chemicals that are pervasive in the environment leading to widespread exposure for humans. Perfluorooctanoic acid (PFOA), one of the most commonly measured PFAS in people, disrupts liver and serum lipid homeostasis as shown in animal toxicity and human epidemiological studies. We tested the hypothesis that the effects of PFOA exposure in mice expressing mouse PPARα (mPPARα) are driven largely through PPARα-dependent mechanisms while non-PPARα dependent mechanisms will be more apparent in mice expressing human PPARα (hPPARα). Female and male mPPARα, hPPARα, and PPARα null mice were exposed to PFOA (0.5, 1.4 or 6.2 mg PFOA/L) via drinking water for 14 weeks. Concurrently, mice consumed an American diet containing human diet-relevant amounts of fat and cholesterol. Here, we focused on the effects in female mice, given the dearth of data reported on PFAS-induced effects in females. Increasing the duration of PFOA exposure reduced weight gain in all genotypes of female mice while end-of-study body fat was lower in PFOA exposed hPPARα and PPARα null mice. Serum cholesterol, but not triacylglyceride, concentrations were increased by PFOA exposure in a PPARα-dependent manner. Hepatic triacylglycerides were higher in vehicle-exposed mPPARα and PPARα null mice than hPPARα mice, and PFOA significantly reduced concentrations in mPPARα and PPARα null mice only. In contrast, PFOA increased hepatic cholesterol content in a PPARα-dependent manner. Changes in liver and serum cholesterol may be explained by a strong, PPARα-dependent downregulation of Cyp7a1 expression. PFOA significantly increased PPARα target gene expression in mPPARα mice. Other nuclear receptors were examined: CAR target gene expression was only induced by PFOA in hPPARα and PPARα null mice. PXR target gene expression was induced by PFOA in all genotypes. Results were similar in male mice with two exceptions: (1) vehicle-exposed male mice of all genotypes were equally susceptible to diet-induced hepatic steatosis; (2) male mice drank less water, resulting in lower serum PFOA levels, which may explain the less significant changes in lipid endpoints. Overall, our results show that PFOA modifies triacylglyceride and cholesterol homeostasis independently and that PPARα plays an important role in PFOA-induced increases in liver and serum cholesterol.

Association between brominated flame retardants and heart failure in U.S. adults: A cross-sectional analysis of national health and nutrition examination survey 2005-2016

BACKGROUND

Brominated flame retardants (BFRs) are environmental pollutants widely used in consumer products, which accumulate in human tissues. Despite their prevalence, the potential impact of BFRs on cardiovascular health, particularly heart failure (HF), remains insufficiently explored.

OBJECTIVES

This study aims to investigate the association between BFR exposure and the prevalence of HF in U.S. adults.

METHODS

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2005-2016. To assess the relationship between BFR exposure and HF prevalence, weighted generalized linear regressions (GLMs) were applied. Restricted cubic splines (RCS) were used to examine potential nonlinear associations. Additionally, quantile-weighted quantile sum (WQS) regression and quantile g-computation (QGC) analysis were performed to evaluate the overall effect of BFR mixtures on HF.

RESULTS

A total of 6,931 individuals participated, with 219 diagnosed with HF. In the adjusted Model 3, BFRs including PBDE28, PBDE47, PBDE85, PBDE99, PBDE100, PBDE154, and PBB153 were significantly associated with increased odds of HF (all p < 0.05). RCS analysis revealed a significant nonlinear relationship between serum BFRs and HF. The WQS analysis showed a positive association between combined BFR exposure and HF (OR: 1.694; 95 % CI: 1.264, 2.270; p < 0.001), and QGC analysis similarly showed a significant positive association (OR: 1.365; 95 % CI: 1.094, 1.705; p = 0.006).

CONCLUSION

This study suggests a link between BFR exposure and an increased risk of HF. Further research is needed to explore the causal relationship and underlying mechanisms.

Long-term cardiovascular risk and mortality associated with uric acid to HDL-C ratio: a 20-year cohort study in adults over 40

Cardiovascular diseases (CVD) and mortality remain significant public health challenges, especially among middle-aged and older adults. However, their relationship with Uric Acid to High-Density Lipoprotein Cholesterol Ratio (UHR) has not been extensively studied in the US population. This study aimed to examine these associations in adults aged ≥ 40 based on the National Health and Nutrition Examination Survey (NHANES) 1999-2018. 29,742 participants' data in NHANES between 1999 and 2018 were retrospectively analyzed. Multivariable logistic regression, Cox proportional hazards models, restricted cubic spline (RCS) analyses, and subgroup analyses were used to assess the associations between UHR and various CVD outcomes. Among the participants, 4,505 (15.15%) reported a history of CVD. A positive association was observed between UHR and the risk of total CVD, including coronary heart disease, heart attack, heart failure, angina pectoris, and stroke (P all < 0.05). UHR was associated with increased risks of all-cause mortality (HR = 1.02, 95% CI: 1.02-1.03) and CVD-specific mortality (HR = 1.03, 95% CI: 1.02-1.05). UHR had a linear dose-response relationship with CVD and a nonlinear relationship with all-cause mortality by RCS analyses. Subgroup analyses confirmed that these associations remained stable across different groups. The findings highlight UHR as a significant predictor of CVD risk and mortality in middle- and older-age adults. Given its strong association with adverse health outcomes, UHR can be a valuable indicator in facilitating the early identification of individuals at elevated cardiovascular risk.

Disparities in cardiovascular disease outcomes and economic burdens among minorities in southeastern Virginia

BACKGROUND

Cardiovascular diseases are the leading cause of mortality in the United States, presenting significant public health challenges and financial burdens, particularly in Southeastern Virginia, where African American and Hispanic (AA&H) populations are disproportionately affected.

METHODS

This retrospective observational study analyzed data from 30,855 hospital discharges of AA&H patients across Southeastern Virginia from 2016 to 2020, focusing on individuals aged 18 to 85 with cardiovascular diseases. Utilizing the Virginia Health Information database, we examined demographic information, clinical data, and healthcare utilization patterns through hypothesis tests and regression models to explore associations between these variables and the economic impacts of cardiovascular diseases.

RESULTS

Heart failure and shock (47.2% of discharges) and cardiac arrhythmia and conduction disorders (12.3%) were the most prevalent cardiovascular conditions. Female patients incurred significantly higher charges than males across conditions (7.1% higher in heart failure, p < 0.0001; 8.8% higher in chest pain, p < 0.01). Younger patients (< 65 years) faced 8.5% higher charges for cardiac arrhythmia with procedures (p < 0.0001) and 5.2% higher charges for circulatory disorders (p < 0.05). Year of discharge consistently predicted increasing costs (standardized coefficient 0.816 for acute myocardial infarction, p < 0.0001). The presence of fluid and electrolyte disorders was associated with significantly higher charges across conditions (standardized coefficient 0.042 for heart failure, p < 0.0001; 0.051 for acute myocardial infarction, p < 0.0001).

DISCUSSION

The findings highlight the complex interplay between demographic characteristics and healthcare costs among AA&H populations, underscoring the need for targeted interventions. The significant economic impact observed calls for culturally competent healthcare strategies that can mitigate high costs and improve health outcomes. However, the retrospective, administrative nature of the data limits establishing causality, with potential misclassification of some conditions.

CONCLUSION

This study provides crucial insights into cardiovascular disease management's demographic and economic dimensions among AA&H populations in Southeastern Virginia. By identifying key factors contributing to healthcare disparities, the research supports the development of tailored interventions aimed at reducing the burden of cardiovascular diseases, thereby improving overall health equity and reducing economic strains on the healthcare system.

Potential impact of the time trend of fried food consumption on the cardiovascular disease burden in China

Background: Cardiovascular disease (CVD) is a leading cause of death in China. Fried foods are a risk factor for increasing CVD and their consumption in China is rapidly rising. Evaluation of the impact of fried foods on the CVD burden has important implications for future public health and policy making. This study aimed to evaluate the impact of fried foods on the CVD burden. Methods: We estimated the temporal trends of fried food consumption from 1997 to 2011 using data from the China Health and Nutrition Survey. We estimated CVD events attributed to fried food consumption using comparative risk assessment methods. We also projected fried food consumption and the related CVD burden from 2011 to 2031. Results: Fried food consumption continued to increase from 1997 to 2011, reaching 110.2 g per week in 2011. It is estimated that high consumption of fried foods is responsible for 3.4%, 2.3%, and 14.3% of the CVD, CHD, and stroke burden, accounting for 0.112 million CVD cases, 0.036 million CHD cases, and 0.243 million stroke cases, respectively. Notably, fried food consumption is projected to increase to 127.6 g per week by 2031. High consumption levels are projected to cause 0.239 million CVD cases, 0.078 million CHD cases, and 0.529 million stroke cases by 2031. Conclusions: The consumption of fried foods has continued to increase over time, which has an important impact on the burden of CVD in China. Dietary guidelines should continue to emphasize on decreasing the consumption of fried foods to reduce the CVD burden in China.

Type 2 diabetes disease and management patterns across a large, diverse healthcare system: Issues and opportunities for guideline-directed therapies

BACKGROUND

The prevalence, chronicity and clinical impact of type 2 diabetes (T2D) defines this disease state as a critical determinant in morbidity and mortality, as encountered by individuals, health care systems, and public health in general. The need to understand and optimize T2D identification and management is now further heightened by the advent of medications with established cardiovascular (CV) and kidney benefits in such patients, namely sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA). Prescription rates for these agents have remained low despite guidelines incorporating and emphasizing their use. Better understanding T2D disease and management patterns, including percentage of patients meeting guideline indications, is necessary to address undertreatment, improve patient management, and enable better strategies. We evaluated such issues, including eligibility for and utilization of SGLT2i and GLP-1 RA, in a large health system caring for over 1.5 million patients annually.

METHODS

The electronic health record (EHR) at a large health network in the Northeastern United States was queried to identify patients 18 years of age or older with T2D and at least 1 hemoglobin A1c (HbA1c) between January 1, 2020 and January 1, 2023, examining those with T2D and 1) atherosclerotic CV disease (ASCVD), 2) an estimated 10-year ASCVD risk score ≥ 10% without known ASCVD, 3) heart failure (HF), and/or 4) chronic kidney disease (CKD) based on EHR listed comorbidities. Demographics, medications, comorbidities, and indications for SGLT2i and/or GLP-1 RA therapy were assessed by 1 or more of the 4 indications above as outlined in society guidelines.

RESULTS

Of the 147,338 patients who met inclusion criteria, 47% were female, 28% were non-white, and 14% with a non-English language preference. Of those, 121,508 (83%) had an indication for either SGLT2i or GLP-1 RA based on guideline recommendations: 17% were prescribed an SGLT2i, 22% were prescribed GLP-1 RA, and 6% of patients were prescribed both medications. Only 33% of all eligible patients were prescribed therapy. Of patients eligible for either an SGLT2i or GLP-1 RA therapy not currently receiving either therapy, 49% had 10-year ASCVD risk ≥ 10% without known ASCVD, 42% had ASCVD, 52% had CKD, and 14% had HF.

CONCLUSIONS

More than 4 out of 5 patients with T2D had a CV or kidney indication for either SGLT2i or GLP-1 RA. However, uptake of SGLT2i/GLP-1 RA in these high-risk populations remains low (just 32%) across this health network. Future studies are needed to identify better strategies to overcome provider, patient, and system-level barriers to the uptake and dissemination of guideline-concordant T2D therapies.

Development and internal validation of a clinical prediction model to predict independence in daily living at discharge for patients with heart failure: analysis using a Japanese national inpatient database real-world dataset

PURPOSE

To develop a clinical prediction model (CPM) to predict independence in activities of daily living (ADLs) in patients with heart failure.

SUBJECTS AND METHODS

We collected the data of the individuals who were admitted and rehabilitated for heart failure from January 2017 to June 2022 from Japan's Diagnosis Procedure Combination database. We assessed the subjects' ADLs at discharge using the Barthel Index and classified them into independence, partial-independence, and total-dependence groups based on their ADLs at discharge. Two CPMs (an independence model and a partial-independence model) were developed by a binomial logistic regression analysis. The predictors included subject characteristics, treatment, and post-hospitalization disease onset. The CPMs' accuracy was validated by the area under the curve (AUC). Internal validation was performed using the bootstrap method. The final CPM is presented in a nomogram.

RESULTS

We included 96,753 patients whose ADLs could be traced at discharge. The independence model had a 0.73 mean AUC and a 1.0 slope at bootstrapping. We thus developed a simplified model using nomograms, which also showed adequate predictive accuracy in the independence model. The partial-independence model had a 0.65 AUC and inadequate predictive accuracy.

CONCLUSIONS

The independence model of ADLs in patients with heart failure is a useful CPM.

Surgeon proclivity for coronary endarterectomy during isolated coronary artery bypass grafting in Medicare beneficiaries†

OBJECTIVES

Coronary endarterectomy (CE) is an adjunct to coronary artery bypass grafting (CABG) in patients with one or more diffusely diseased coronary arteries. Although associated with increased perioperative morbidity and mortality, it remains a therapeutic strategy to potentially improve late outcomes by facilitating the revascularization of an otherwise ungraftable target.

METHODS

Medicare beneficiaries undergoing CABG from 2001 to 2019 were identified. Surgeon proclivity for endarterectomy was determined; surgeons were stratified by quintile of endarterectomy frequency. Overlap propensity score weighting risk-adjusted measured confounding variables. Risk-adjusted survival was compared between surgeons.

RESULTS

1 500 710 Medicare beneficiaries underwent isolated CABG, of whom 32 302 (2.2%) underwent concomitant CE. Surgeons were divided into never-endarterectomizers (0% frequency, 267 245 surgeries by 1839 surgeons), occasional-endarterectomizers (0-4% frequency, 1 001 310 surgeries by 2207 surgeons) and frequent-endarterectomizers (≥4% frequency, 232 155 surgeries by 756 surgeons). Beneficiaries undergoing surgery by a never-endarterectomizer had a risk-adjusted median survival of 10.05 [95% CI: 10.00, 10.09] versus 9.90 [9.86, 9.95] years in those undergoing surgery by a frequent-endarterectomizer, a difference of 1.71 [1.08, 2.37] months, P < 0.001 for risk-adjusted survival comparison. Similarly, beneficiaries undergoing surgery by an occasional-endarterectomizer had a risk-adjusted median survival of 9.94 [9.91, 9.96] versus 9.85 [9.80, 9.90] years for those undergoing surgery by a frequent-endarterectomizer, a difference of 1.05 [0.56, 1.74] months, P < 0.001 for risk-adjusted survival comparison.

CONCLUSIONS

Medicare beneficiaries undergoing CABG by never- or occasional-endarterectomizers had small early risk-adjusted survival advantages and similar late outcomes compared to those undergoing surgery by frequent-endarterectomizers. CE remains a valuable tool in selected cases; however, it may be reasonable for surgeons to adopt a never- or occasional-endarterectomy approach to CABG.

A data harmonization project of 3 large prospective cardiovascular health-focused cohorts

Few prospective studies examine multilevel resilience resources and psychosocial factors in relation to cardiovascular health and disease. Recent research indicates that resilience resources are associated with a reduction in the incidence of cardiovascular disease-related events, but few studies have examined this relationship across different racial/ethnic populations or in large cohorts. Harmonization may address these limitations because it allows data from several cohorts to be analyzed together, potentially increasing sample size and in turn power overall and in minority populations. This article describes the process involved in combining 3 cardiovascular health-focused cohorts: Jackson Heart Study, Multi-Ethnic Study of Atherosclerosis, and Mediators of Atherosclerosis in South Asians Living in America Study. Using a systematic process, we identified appropriate data harmonization techniques to use in harmonizing variables across cohorts. Variables included exposures (eg, resilience resources), outcomes (eg, American Heart Association's Life's Simple 7), and covariates (eg, race and ethnicity). Post-harmonization examinations included psychometric analyses of the harmonized variables. A total of 13 284 participants were included in the final harmonized data set. This project provides opportunities for future research in resilience resources and informs future studies that need to harmonize data. Results based on the harmonized data set could inform interventions and policies.

THRA1/PGC-1α/SIRT3 pathway regulates oxidative stress and is implicated in hypertension of maternal hypothyroid rat offspring

Many epidemiologic and animal studies have shown that maternal hypothyroidism is associated with an increased risk of hypertension in offspring in later life. In this study, we established a maternal hypothyroidism rat model to explore the underlying mechanism that contributes to elevated blood pressure in adult male offspring of hypothyroid mothers. The levels of thyroid hormones (THs) in the offspring were measured using ELISA kits. Blood pressure (BP) and depressor response were recorded in conscious, freely moving rats. Vascular reactivity was conducted in isolated mesenteric arteries (MAs) using a myograph. We used real-time quantitative PCR (RT-qPCR) and Western blots to examine the mRNA and protein expression of relevant molecules in MAs. The A7r5 cells were transfected with small interfering RNA (siRNA) to further investigate the gene functions. The following findings were observed: Basal systolic BP and diastolic BP was significantly increased, accompanied by attenuated depressor response and decreased vascular sensitivity to sodium nitroprusside (SNP). Reactive Oxygen Species (ROS) levels in the MAs were enhanced, along with decreased expression of the THRA1/PGC-1α/SIRT3 pathway. In A7r5 cells, triiodothyronine (T3) pretreatment improved the PGC-1α/SIRT3 pathway and reduced ROS levels after H2O2-induced oxidative stress. In contrast, the knockdown of THRA1 or SIRT3 diminished the above effects of T3. Down-regulation of THRA1 contributed to a decline in the PGC-1α/SIRT3 pathway, which causes an increased production of ROS. This indicates that the T3-THRA1/PGC-1α/SIRT3 pathway plays a protective role in the regulation of BP and may be a potential therapeutic strategy against hypertension.

Trends, gender, and racial disparities in patients with mortality due to paroxysmal tachycardia: A nationwide analysis from 1999-2020

BACKGROUND

Paroxysmal tachycardia encompasses various heart rhythm disorders that cause rapid heart rates. Its episodic occurrence makes it difficult to identify and measure its prevalence and trends in the population. Additionally, there is limited data on disparities and trends in mortality due to paroxysmal tachycardia, which is essential for assessing current medical approaches and identifying at-risk populations.

METHODS

Our study examined death certificates from 1999 to 2020 using the CDC WONDER Database to identify deaths caused by paroxysmal tachycardia in individuals aged 25 and older, using the ICD-10 code I47. Age-adjusted mortality rates (AAMRs) and annual percent changes (APC) were calculated by year, gender, age group, race/ethnicity, geographic location, and urbanization status. Trends in AAMRs were analyzed using the Joinpoint Regression Program to identify significant changes and inflection points in mortality trends throughout the study period.

RESULTS

Between 1999 and 2020, 155,320 deaths were reported in patients with paroxysmal tachycardia. Overall, AAMR decreased from 4.8 to 3.7 per 100,000 population between 1999 and 2020, despite showing a significant increase from 2014 to 2020 (APC: 4.33; 95% CI: 3.53 to 5.56). Men had consistently higher AAMRs than women (4.7 vs. 2.2). Furthermore, we found that AAMRs were highest among Non-Hispanic (NH) Black or African Americans and lowest in NH Asian or Pacific Islanders (4 vs. 1.9). Nonmetropolitan areas had higher AAMRs than metropolitan areas (3.6 vs. 3.2).

CONCLUSIONS

Our analysis showed a significant decrease in mortality from paroxysmal tachycardia since 1999, although there has been a slight increase in recent years. However, disparities remain, with higher AAMRs among men, NH Black or African Americans, and residents of non-metropolitan areas. These findings call for immediate public health actions to curb the rising trends and reduce potential disparities.

A bipartite bacterial virulence factor targets the complement system and neutrophil activation

The complement system and neutrophils constitute the two main pillars of the host innate immune defense against infection by bacterial pathogens. Here, we identify T-Mac, a novel virulence factor of the periodontal pathogen Treponema denticola that allows bacteria to evade both defense systems. We show that T-Mac is expressed as a pre-protein that is cleaved into two functional units. The N-terminal fragment has two immunoglobulin-like domains and binds with high affinity to the major neutrophil chemokine receptors FPR1 and CXCR1, blocking N-formyl-Met-Leu-Phe- and IL-8-induced neutrophil chemotaxis and activation. The C-terminal fragment functions as a cysteine protease with a unique proteolytic activity and structure, which degrades several components of the complement system, such as C3 and C3b. Murine infection studies further reveal a critical T-Mac role in tissue damage and inflammation caused by bacterial infection. Collectively, these results disclose a novel innate immunity-evasion strategy, and open avenues for investigating the role of cysteine proteases and immunoglobulin-like domains of gram-positive and -negative bacterial pathogens.

Sociodemographic index-age differences in the global prevalence of cardiovascular diseases, 1990-2019: a population-based study

BACKGROUND

This study aims to assess the global burden and trends in cardiovascular diseases (CVDs) prevalence, stratified by sociodemographic index (SDI) categories and age groups, across 204 countries and territories.

METHODS

Utilizing data from the Global Burden of Disease Study 2019, this study analyzed trends in the age-standardized prevalence rate of overall and type-specific CVDs, including rheumatic heart disease, ischemic heart disease, stroke, hypertensive heart disease, non-rheumatic valvular heart disease, cardiomyopathy and myocarditis, atrial fibrillation and flutter, peripheral artery disease, endocarditis, and other cardiovascular and circulatory diseases. Age-standardized prevalence rates were stratified by SDI categories (low, low-middle, middle, high-middle, and high) and age groups (0-14, 15-49, 50-69, and ≥ 70 years). The corresponding average annual percentage change was calculated to assess temporal trends.

RESULTS

From 1990 to 2019, the global age-standardized prevalence rate per 100,000 population for CVD decreased from 6728.04 (95% UI 6394.55 to 7059.66) to 6431.57 (95% UI 6109.95 to 6759.8), with an average annual percent change of -0.15% (95% CI -0.17 to -0.13). When stratified by SDI category, the age-standardized prevalence rate of CVD decreased significantly in high-middle and high SDI countries but increased in middle, low-middle, and low SDI countries. By age group, the age-standardized prevalence rate of CVD declined in the 50-69 and ≥ 70 years groups but increased in the 0-14 and 15-49 years groups. SDI levels were negatively associated with faster increases in the age-standardized prevalence rate of CVD across all ages and age groups. Low SDI countries consistently showed the highest age-standardized prevalence rates of CVD in the younger age groups (0-14 and 15-49 years), while high-middle SDI countries had the highest rates in the older age groups (50-69 and ≥ 70 years). The age-standardized prevalence rate of CVD was negatively associated with SDI levels in the 0-14 and 15-49 years groups and positively associated with SDI levels in the 50-69 and ≥ 70 years groups. Type-specific CVDs such as rheumatic heart disease, other cardiovascular and circulatory diseases, non-rheumatic valvular heart disease, and hypertensive heart disease showed increased age-standardized prevalence rates from 1990 to 2019.

CONCLUSIONS

This study highlights significant disparities in CVD prevalence across sociodemographic and age groups. While the global prevalence of CVD has generally decreased, the rise in CVD prevalence in lower SDI countries and younger populations calls for tailored intervention strategies. Addressing these disparities is crucial to mitigating the growing burden of CVD and promoting cardiovascular health on a global scale.

Smart furniture using radar technology for cardiac health monitoring

The integration of radar technology into smart furniture represents a practical approach to health monitoring, circumventing the concerns regarding user convenience and privacy often encountered by conventional smart home systems. Radar technology's inherent non-contact methodology, privacy-preserving features, adaptability to diverse environmental conditions, and high precision characteristics collectively establish it a compelling alternative for comprehensive health monitoring within domestic environments. In this paper, we introduce a millimeter (mm)-wave radar system positioned strategically behind a seat, featuring an algorithm capable of identifying unique cardiac waveform patterns for healthy subjects. These patterns are characterized by two peaks followed by a valley in each cycle, which can be correlated to Electrocardiogram (ECG), enabling effective cardiac waveform monitoring. The provided algorithm excels in discerning variations in heart patterns, particularly in individuals with prolonged corrected QT intervals, by minimizing high frequency breathing interference and ensuring accurate pattern recognition. Additionally, this paper addresses the influence of body movements in seated individuals, conducting a comprehensive study on heart rate variability and estimation. Experiment results demonstrate a maximum interbeat intervals (IBI) error of 30 milliseconds and an average relative error of 4.8% in heart rate estimation, showcasing the efficacy of the proposed method utilizing variational mode decomposition and a multi-bin approach.

Convergences and Divergences in the Burden of Disease in Older People Across The Organisation for Economic Cooperation and Development Countries

BACKGROUND

The Organization for Economic Cooperation and Development (OECD) member states are heterogeneous in their social, economic, and health conditions.

AIMS

a) to analyze age-specific mortality rate (ASMR) and age-specific disability-adjusted life year (DALY) rate among older people in countries by age groups (65-74 years and 75+ years) and sex, and b) to estimate the association between age-specific DALY rate with Socio-Demographic Index (SDI) and with Healthcare Access and Quality Index (HAQI).

METHODS

Secondary analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The ASMR and the age-specific DALY rate were reported for the years 1990, 2005, and 2019. Correlation between age-specific DALY rate with SDI and HAQI was estimated.

RESULTS

There were differences in the level and change in ASMR and the age-specific DALY rates among OECD countries. Overall, men had a higher rate for both age groups in both indicators. Although the rates have been reduced between 1990 and 2019, some countries stand out for continuing to have higher rates than countries with better socioeconomic levels. The disease burden profile also differed between adults aged 65-74 years and those aged 75+ years. In almost all cases, there was a negative and statistically significant correlation between the age-specific DALY rate with SDI and HAQI.

CONCLUSIONS

The burden of mortality and DALY in OECD countries is convergent because they have decreased over time in all countries but diverge in the magnitude and speed of change.

Global Burden of Early-Onset Ischemic Heart Disease, 1990 to 2019

BACKGROUND

Early-onset ischemic heart disease (IHD) is a growing burden associated with high disability and death.

OBJECTIVES

This study aimed to estimate the burden of incidence, prevalence, and disability-adjusted life years (DALY) of early-onset IHD from 1990 to 2019.

METHODS

Data on the burden of early-onset IHD (men<55 years, women<65 years), including prevalence, incidence, DALY, and deaths, were collected from the Global Burden of Disease study for 204 countries and territories from 1990 to 2019.

RESULTS

In 2019, early-onset IHD affected 5.34 million (95% uncertainty interval [UI]: 3.96-6.96) individuals globally. This resulted in 58.48 million (95% UI: 52.65-64.69) DALY and 1.44 million (95% UI: 1.29-1.59) deaths. Countries with a middle sociodemographic index (SDI) had the highest incidence cases (1.79 million, 95% UI: 1.32-2.34) and the low-middle SDI countries had the highest age-standardized incidence rate of 179.34 per 100,000 (95% UI: 134.38-231.94). Low-middle SDI countries exhibited the highest age-standardized death rate (57.13 per 100,000, 95% UI: 48.45-66.53) and age-standardized DALY rate (2,309.67 per 100,000, 95% UI: 1962.31-2,693.93). Globally, female incidence cases (2.77 million, 95% UI: 2.04-3.64) surpassed male (2.57 million, 95% UI: 1.92-3.32). The top 2 attributable risk factors were high low-density lipoprotein cholesterol and high systolic blood pressure.

CONCLUSIONS

The global incidence rate of early-onset IHD decreased from 1990 to 2019. The incidence rate was highest in low-middle SDI countries, and the burden of DALY was highest in low-middle SDI countries. The DALY and death rate were higher in men. High low-density lipoprotein cholesterol and high systolic blood pressure were the primary attributors.

Monitoring long-term cardiac activity with contactless radio frequency signals

Cardiovascular diseases claim over 10 million lives annually, highlighting the critical need for long-term monitoring and early detection of cardiac abnormalities. Existing techniques like electrocardiograms (ECG) and Holter are accurate but suffer from discomfort caused by body-attached electrodes. While wearable devices using photoplethysmography offer more convenience, they sacrifice accuracy and are susceptible to environmental interference. Here we present a radio frequency (RF)-based (60 to 64 GHz) sensing system that monitors long-term heart rate variability (HRV) with clinical-grade accuracy. Our system successfully overcomes the orders-larger interference from respiration motion in far-field conditions without any model training. By identifying previously undiscovered frequency ranges (beyond 10-order heartbeat harmonics) where heartbeat information predominates over other motions, we generate prominent heartbeat patterns with harmonics typically considered detrimental. Extensive evaluations, including a large-scale outpatient setting involving 6,222 eligible participants and a long-term daily life scenario, where sleep data was collected over 5 separate random nights over two months and a continuous 21-night period, demonstrate that our system can monitor HRV and identify abnormalities with comparable performance to clinical-grade ECG-based systems. This RF-based HRV sensing system has the potential to support active self-assessment and revolutionize medical prevention with long-term and precise health monitoring.

Acute Myocardial Infarction in a Young 26 Years Old Patient: A Rare Sequelae of Blunt Chest Trauma

Acute myocardial infarction (AMI) is an important subset of cardiovascular disease, and a medical emergency, where timely reperfusion is needed to reduce short-term and long-term complications from it. AMI following blunt chest trauma is a rare but serious complication of motor vehicle accidents and should be treated promptly. We are presenting a case of 26 years-old male, who presented to ED after a motor vehicle accident, went into cardiac arrest, and was found ST elevated MI (STEMI) on electrocardiography. Subsequently, cardiac catheterization revealed ruptured plaque in the proximal left anterior descending artery, with thrombus extending to mid-LAD, requiring a stent placement.

Socioeconomic status across the early life course predicts gene expression signatures of disease and senescence

BACKGROUND

Socioeconomic status (SES) is associated with many chronic diseases, indicators of senescence and mortality. However, the changing salience of SES in the prediction of adult health is not well understood. Using mRNA-seq abundance data from wave V of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we examine the extent to which SES across the early life course is related to gene expression-based signatures for chronic diseases, senescence and inflammation in the late 30s.

METHODS

We use Bayesian methods to identify the most likely model of life course epidemiology (critical, sensitive and accumulation models) that characterises the changing importance of parental SES and SES during young (ages 27-30) and mid-adulthood (ages 36-39) in the prediction of the signatures.

RESULTS

For most signatures, SES is an important predictor in all periods, although parental SES or SES during young adulthood are often the most predictive. For three signatures (components of diabetes, inflammation and ageing), critical period models involving the exclusive salience of SES in young adulthood (for diabetes) or parental SES (for inflammation and ageing) are most probable. The observed associations are likely mediated by body mass index.

CONCLUSION

Models of life course patterns of SES may inform efforts to identify age-specific mechanisms by which SES is associated with health at different points in life and they also suggest an enhanced approach to prediction models that recognise the changing salience of risk factors.

Epigenetic regulation of cardiovascular diseases induced by behavioral and environmental risk factors: Mechanistic, diagnostic, and therapeutic insights

Behavioral and environmental risk factors are critical in the development and progression of cardiovascular disease (CVD). Understanding the molecular mechanisms underlying these risk factors will offer valuable insights for targeted preventive and therapeutic strategies. Epigenetic modifications, including DNA methylation, histone modifications, chromatin remodeling, noncoding RNA (ncRNA) expression, and epitranscriptomic modifications, have emerged as key mediators connecting behavioral and environmental risk factors to CVD risk and progression. These epigenetic alterations can profoundly impact on cardiovascular health and susceptibility to CVD by influencing cellular processes, development, and disease risk over an individual's lifetime and potentially across generations. This review examines how behavioral and environmental risk factors affect CVD risk and health outcomes through epigenetic regulation. We review the epigenetic effects of major behavioral risk factors (such as smoking, alcohol consumption, physical inactivity, unhealthy diet, and obesity) and environmental risk factors (including air and noise pollution) in the context of CVD pathogenesis. Additionally, we explore epigenetic biomarkers, considering their role as causal or surrogate indicators, and discuss epigenetic therapeutics targeting the mechanisms through which these risk factors contribute to CVD. We also address future research directions and challenges in leveraging epigenetic insights to reduce the burden of CVD related to behavioral and environmental factors and improve public health outcomes. This review aims to provide a comprehensive understanding of behavioral and environmental epigenetics in CVD and offer valuable strategies for therapeutic intervention.

Modifiable risk factors and excess mortality in depression: Data from the UK Biobank

OBJECTIVE

To study the role of modifiable risk factors in explaining the excess mortality associated with depression using data from the UK Biobank, a middle-aged and elderly cohort recruited in 2006-2010.

METHODS

We estimated the prevalence and relative mortality associated with modifiable risk factors and groups of risk factors (socioeconomic factors, diet and exercise, smoking and substance-related disorders, and cardiometabolic diseases) in a subsample of probable cases of lifetime/current depression (n = 51,302) versus non-cases. We also estimated the relative mortality associated with depression and the percentages of excess mortality associated with depression explained by modifiable risk factors in the total sample (499,762).

RESULTS

In our depression subsample, all modifiable risk factors were associated with increased prevalence and mortality. In our total sample, depression was associated with an age and sex-adjusted mortality hazard ratio of 1.63 (95% CI = [1.58-1.68]). Modifiable risk factors explained 70.5% [66.9%-75.0%] of the excess mortality associated with depression.

CONCLUSIONS

In the UK Biobank cohort, depression was associated with a higher prevalence of modifiable risk factors. These risk factors were associated with increased mortality in the depression subsample and explained most of the excess mortality risk associated with depression in the total sample.

Impact of multimorbidity on risk stratification and prognosis in elderly patients after acute myocardial infarction

Background

Elderly patients with first acute myocardial infarction (AMI) often have serious clinical features and worse prognoses. The purpose of the study was to evaluate the burden of comorbidity in predicting prognosis of elderly patients after AMI.

Methods

A total of 479 elderly patients with AMI divided into three groups: group A (with zero or one comorbidity), group B (with two comorbidities), and group C (with three or more comorbidities). The clinical characteristics, medication, in-hospital complications, and one-year prognosis of these patients were collected and compared across the three groups.

Results

Compared to group A, the age, heart rate, creatinine and uric acid, glucose, left atrial diameter (LAd), relative number of multi-vessel and culprit vessels located in left main (LM) artery and thrombolysis in myocardial infarction (TIMI) grade 0-1 were significantly higher in groups B and C. Compared to group A, the incidences of in-hospital death, paroxysmal atrial flutter/atrial fibrillation, and acute heart failure were significantly higher in groups B and C and that of in-hospital cardiac rupture was remarkably higher in group C. Compared group A, the incidence of one-year major adverse cardiovascular events (MACEs), all-cause death, and attacks of acute heart failure were significantly higher in groups B and C. The incidences of one-year non-fatal ischemic stroke in group C and late revascularization in group B were dramatically higher.

Conclusions

A higher comorbidity burden was associated with more serious clinical presentations, more severe in-hospital complications, and worse one-year prognosis of elderly AMI patients. These findings can help clinicians to identify high-risk elderly AMI patients, determine the prognostic impact of comorbidity, and provide better managements.

Improvement Science Increases Routine Lipid Screening in General Pediatric Cardiology

OBJECTIVE

To evaluate the effectiveness of patient education, physician counseling, and point-of-care (POC) testing on improving adherence to lipid screening national guidelines in a general pediatric cardiology practice (2017-2023).

STUDY DESIGN

Regional primary care providers were surveyed regarding lipid screening practices. Key drivers were categorized (physician, patient, and system) with corresponding interventions. Pediatric cardiologists started offering lipid screening during regular visits by providing families with preventive cardiovascular education materials and lab phlebotomy testing. System redesign included educational posters, clinical intake protocol, physician counseling, electronic health record integration, and POC testing. Run charts and statistical process control charts measured screening rates and key processes.

RESULTS

The primary care survey response rate was 32% (95/294); 97% supported pediatric cardiologists conducting routine lipid screening. Pediatric cardiology mean baseline lipid screening rate was 0%, increased to 7% with patient education, and to 61% after system redesign including POC testing. Screening rates among 1467 patients were similar across age groups (P = .98). More patients received lipid screening by POC (91.7%) compared with phlebotomy (8.3%). Lipid abnormalities detected did not differ by screening methodology (P = .49).

CONCLUSION

Patient education, counseling, and POC testing improved adherence to national lipid screening guidelines, providing a possible model for primary care implementation.

Effects of resveratrol on changes in trimethylamine-N-oxide and circulating cardiovascular factors following exercise training among older adults

PURPOSE

Trimethylamine-N-oxide (TMAO) is a gut-derived metabolite associated with cardiovascular disease (CVD). In preclinical and observational studies, resveratrol and exercise training have been suggested as potential strategies to reduce the systemic levels of TMAO. However, evidence from experimental studies in humans remains unknown. This project examined the dose-dependent effects of a combined resveratrol intervention with exercise training on circulating TMAO and other related metabolite signatures in older adults with high CVD risk.

METHODS

Forty-one older adults [mean (±SD) age of 72.1 (6.8) years] participated in a 12-week supervised center-based, multi-component exercise training intervention [2×/week; 80 min/session] and were randomized to one of two resveratrol dosages [Low: 500 vs. High:1000 mg/day] or a cellulose-based placebo. Serum/plasma were collected at baseline and post-intervention and evaluated for TMAO and associated analytes.

RESULTS

After the 12-week intervention, TMAO concentration increased over time, regardless of treatment [mean (±SD) Placebo: 11262 (±3970); Low:13252 (±1193); High: 12661(±3359) AUC; p = 0.04]. Each resveratrol dose produced different changes in metabolite signatures. Low dose resveratrol upregulated metabolites associated with bile acids biosynthesis (i.e., glycochenodeoxycholic acid, glycoursodeoxycholic acid, and glycocholic acid). High dose resveratrol modulated metabolites enriched for glycolysis, and pyruvate, propanoate, β-alanine, and tryptophan metabolism. Different communities tightly correlated to TMAO and resveratrol metabolites were associated with the lipid and vascular inflammatory clinical markers [|r| > 0.4, p < 0.05].

CONCLUSION

These findings suggest a distinct dose-dependent adaptation response to resveratrol supplementation on circulating metabolite signatures but not on TMAO among high-risk CVD older adults when combined with an exercise training intervention.

Uric acid and cardiovascular diseases: a reappraisal

Serum uric acid (SUA) has garnered an increased interest in recent years as an important determinant of cardiovascular disease. Uric acid, a degradation product of purine metabolism, is affected by several inheritable and acquired factors, such as genetic mutation, metabolic syndrome, chronic kidney disease, and medication interactions. Even though elevated SUA have been commonly associated with the development of gout, it has significant impact in the development of hypertension, metabolic syndrome, and cardiovascular disease. Uric acid, in both crystalline and soluble forms, plays a key role in the induction of inflammatory cascade and development of atherosclerotic diseases. This concise reappraisal emphasizes key features about the complex and challenging role of uric acid in the development and progression of atherosclerosis and cardiovascular disease. It explores the pathogenesis and historical significance of uric acid, highlights the complex interplay between uric acid and components of metabolic syndrome, focuses on the pro-inflammatory and pro-atherogenic effects of uric acid, as well as discusses the role of urate lowering therapies in mitigating the risk of cardiovascular disease while providing the latest evidence to the healthcare professionals focusing on the clinical importance of SUA levels with regards to cardiovascular disease.

Cardiovascular disease risk: it is complicated, but race and ethnicity are key, a Bayesian network analysis

Background

Cardiovascular diseases are the leading cause of morbidity and mortality in the United States. Despite the complexity of cardiovascular disease etiology, we do not fully comprehend the interactions between non-modifiable factors (e.g., age, sex, and race) and modifiable risk factors (e.g., health behaviors and occupational exposures).

Objective

We examined proximal and distal drivers of cardiovascular disease and elucidated the interactions between modifiable and non-modifiable risk factors.

Methods

We used a machine learning approach on four cohorts (2005-2012) of the National Health and Nutrition Examination Survey data to examine the effects of risk factors on cardiovascular risk quantified by the Framingham Risk Score (FRS) and the Pooled Cohort Equations (PCE). We estimated a network of risk factors, computed their strength centrality, closeness, and betweenness centrality, and computed a Bayesian network embodied in a directed acyclic graph.

Results

In addition to traditional factors such as body mass index and physical activity, race and ethnicity and exposure to heavy metals are the most adjacent drivers of PCE. In addition to the factors directly affecting PCE, sleep complaints had an immediate adverse effect on FRS. Exposure to heavy metals is the link between race and ethnicity and FRS.

Conclusion

Heavy metal exposures and race/ethnicity have similar proximal effects on cardiovascular disease risk as traditional clinical and lifestyle risk factors, such as physical activity and body mass. Our findings support the inclusion of diverse racial and ethnic groups in all cardiovascular research and the consideration of the social environment in clinical decision-making.

Racial and ethnic differences in plasma biomarker eligibility for a preclinical Alzheimer's disease trial

INTRODUCTION

In trials of amyloid-lowering drugs for Alzheimer's disease (AD), differential eligibility may contribute to under-inclusion of racial and ethnic underrepresented groups. We examined plasma amyloid beta 42/40 and positron emission tomography (PET) amyloid eligibility for the ongoing AHEAD Study preclinical AD program (NCT04468659).

METHODS

Univariate logistic regression models were used to examine group differences in plasma and PET amyloid screening eligibility.

RESULTS

Of 4905 participants screened at time of analysis, 1724 were plasma eligible to continue in screening: 13.3% Hispanic Black, 24.7% Hispanic White, 20.8% non-Hispanic (NH) Asian, 24.7% NH Black, and 38.9% NH White. Plasma eligibility differed across groups in models controlling for covariates (odds ratio from 1.9 to 4.0 compared to the NH White reference group, P < 0.001). Among plasma eligible participants, PET eligibility did not differ by group.

DISCUSSION

These results suggest that prevalence of brain amyloid pathology differed, but that eligibility based on plasma was equally effective across racial and ethnic group members.

HIGHLIGHTS

Plasma amyloid eligibility is lower in underrepresented racial and ethnic groups. In plasma eligible adults, positron emission tomography eligibility rates are similar across race and ethnicity. Plasma biomarker tests may be similarly effective across racial and ethnic groups.

Challenges in Promoting Health Equity and Reducing Disparities in Access Across New and Established Technologies

Medical innovations and novel technologies stand to improve the return on high levels of health spending in developed countries, particularly in cardiovascular care. However, cardiac innovations also disrupt the landscape of accessing care, potentially creating disparities in who has access to novel and extant technologies. These disparities might disproportionately harm vulnerable groups, including those whose nonmedical conditions-including social determinants of health-inhibit timely access to diagnoses, referrals, and interventions. We first document the barriers to access novel and existing technologies in isolation, then proceed to document their interaction. Novel cardiac technologies might affect existing available services, and change the landscape of care for vulnerable patient groups who seek access to cardiology services. There is a clear need to identify and heed lessons learned from the dissemination of past innovations in the development, funding, and dissemination of future medical technologies to promote equitable access to cardiovascular care. We conclude by highlighting and synthesizing several policy implications from recent literature.

Effects of stress management interventions on heart rate variability in adults with cardiovascular disease: a systematic review and meta-analysis

Meta-analysis was used to investigate the potential benefits of stress management interventions (SMIs) on vagally-mediated heart rate variability (HRV) in adults with cardiovascular disease. Electronic bibliographic databases were searched through August 2022. Randomized controlled trials and quasi-experimental studies assessing effects of SMIs on HRV were included. Methodological quality was assessed with a standardized checklist. A pooled effect size was calculated for vagally-mediated HRV indices (standard deviation of normal-to-normal intervals, root mean square of the successive differences, and high frequency power) using random effects models. Fourteen studies (1202 participants, Mage: 59 ± 6.25 years; 25% ± 16% women; 61% ± 22% White) were included. Ten studies (11 effects) reported short-term HRV assessment; a small between-group difference emerged for vagally-mediated HRV (d+ = .27, 95% confidence interval [CI] 0.01-0.52, k = 11). Most interventions examined biofeedback; these studies yielded a small between-group difference on vagally-mediated HRV (d+ = 0.31, 95% CI 0.09-0.53, k = 7, Q [6] = 3.82, p = .70, I2 = 11%). This is the first systematic examination of the effect of SMIs on HRV in adults with CVD. Findings suggest a small effect of SMIs on vagally-mediated HRV, with biofeedback likely driving the effect. More research is required to fully understand whether this benefit on vagally-mediated HRV applies to other SMIs.

The causal effects of intelligence and fluid intelligence on Parkinson's disease: a Mendelian randomization study

Background

Parkinson's disease (PD) is a chronic neurodegenerative disease that affects the central nervous system, primarily the motor nervous system, and occurs most often in older adults. A large number of studies have shown that high intelligence leads to an increased risk of PD. However, whether there is a causal relationship between intelligence on PD has not yet been reported.

Methods

In this study, Mendelian randomization (MR) analysis was performed with intelligence (ebi-a-GCST006250) and fluid intelligence score (ukb-b-5238) as exposure factors and PD (ieu-b-7) as an outcome, which the datasets were mined from the IEU OpenGWAS database. MR analysis was performed through 3 methods [MR Egger, weighted median, inverse variance weighted (IVW)], of which IVW was the primary method. In addition, the reliability of the results of the MR analysis was assessed via the heterogeneity test, the horizontal polytropy test, and Leave-One-Out (LOO). Finally, based on gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) databases, the genes corresponding to intelligence and fluid intelligence score related to SNPs were enriched for functional features and pathways.

Results

The results of MR analysis suggested that elevated intelligence indicators can increase the risk of PD [p = 0.015, Odd Ratio (OR) = 1.316]. Meanwhile, fluid intelligence score was causally associated with the PD (p = 0.035), which was a risk factor (OR = 1.142). The reliability of the results of MR analysis was demonstrated by sensitivity analysis. Finally, the results of GO enrichment analysis for 87 genes corresponding to intelligence related SNPs mainly included regulation of synapse organization, developmental cell growth, etc. These genes were enriched in the synaptic vessel cycle, polycomb expressive complex in KEGG. Similarly, 44 genes corresponding to SNPs associated with fluid intelligence score were used for enrichment analysis. Based on the GO database, these genes were mainly enriched in regulation of developmental growth, negative regulation of neuron projection development, etc. In KEGG, 44 genes corresponding to SNPs associated with fluid intelligence score were enriched in signaling pathways including Alzheimer's disease, the cellular senescence, etc.

Conclusion

The causal relationships between intelligence and fluid intelligence scores, and PD were demonstrated through MR analysis, providing an important reference and evidence for the study of PD.

Clinical Validation of a Machine-Learned, Point-of-Care System to IDENTIFY Functionally Significant Coronary Artery Disease

Many clinical studies have shown wide performance variation in tests to identify coronary artery disease (CAD). Coronary computed tomography angiography (CCTA) has been identified as an effective rule-out test but is not widely available in the USA, particularly so in rural areas. Patients in rural areas are underserved in the healthcare system as compared to urban areas, rendering it a priority population to target with highly accessible diagnostics. We previously developed a machine-learned algorithm to identify the presence of CAD (defined by functional significance) in patients with symptoms without the use of radiation or stress. The algorithm requires 215 s temporally synchronized photoplethysmographic and orthogonal voltage gradient signals acquired at rest. The purpose of the present work is to validate the performance of the algorithm in a frozen state (i.e., no retraining) in a large, blinded dataset from the IDENTIFY trial. IDENTIFY is a multicenter, selectively blinded, non-randomized, prospective, repository study to acquire signals with paired metadata from subjects with symptoms indicative of CAD within seven days prior to either left heart catheterization or CCTA. The algorithm's sensitivity and specificity were validated using a set of unseen patient signals (n = 1816). Pre-specified endpoints were chosen to demonstrate a rule-out performance comparable to CCTA. The ROC-AUC in the validation set was 0.80 (95% CI: 0.78-0.82). This performance was maintained in both male and female subgroups. At the pre-specified cut point, the sensitivity was 0.85 (95% CI: 0.82-0.88), and the specificity was 0.58 (95% CI: 0.54-0.62), passing the pre-specified endpoints. Assuming a 4% disease prevalence, the NPV was 0.99. Algorithm performance is comparable to tertiary center testing using CCTA. Selection of a suitable cut-point results in the same sensitivity and specificity performance in females as in males. Therefore, a medical device embedding this algorithm may address an unmet need for a non-invasive, front-line point-of-care test for CAD (without any radiation or stress), thus offering significant benefits to the patient, physician, and healthcare system.

Effectiveness of Applying Green Heart, a Smartphone-Based Self-management Intervention to Control Smoking: A Randomized Clinical Trial

BACKGROUND

Cardiovascular diseases (CVDs) pose a significant global health concern and are the most common cause of death and disability, necessitating preventive interventions targeting modifiable risk factors. Recently, mobile-health technology has been developed to improve the delivery of cardiovascular prevention by risk factor modification. The "Green Heart" mobile application (app) was designed to aid in risk factor control among coronary artery disease (CAD) patients.

METHODS

This parallel-group, single-blinded randomized controlled trial enrolled 1590 CAD patients, including 668 current smokers, randomly assigned to control (paper-based education) and intervention (application-based) groups. The app encompassed three modules targeting smoking cessation, dyslipidemia control, and blood pressure management. This study evaluated the impact of the smoking cessation module on behavioral change among current smokers. Green Heart assesses nicotine dependence, offering personalized quit plans, educational content, motivational messages, and automated progress tracking. The odds of smoking behavior changes during the 24-week follow-up underwent assessment.

RESULTS

The intention-to-treat analysis highlighted significantly elevated rates of smoking cessation and reductions in the intervention group versus the control group. Adherence to the app (per-treatment analysis) also demonstrated significantly more favorable smoking behavior changes among the application users. Logistic regression emphasized higher odds of quitting and reduction in smoking in the application group, showing an odds ratio of 2.14 (95% CI: 1.16-3.97) compared to those not using the app (P=0.015).

CONCLUSION

Our results confirmed that complete adherence to the app for at least 24 weeks was linked to alterations in cigarette smoking behavior among CAD patients. Trial Registration Number: IRCT20221016056204N1.

Lifestyle behaviors and risk of cardiovascular disease and prognosis among individuals with cardiovascular disease: a systematic review and meta-analysis of 71 prospective cohort studies

BACKGROUND

Healthy lifestyle behaviors (LBs) have been widely recommended for the prevention and management of cardiovascular disease (CVD). Despite a large number of studies exploring the association between combined LBs and CVD, a notable gap exists in integration of relevant literatures. We conducted a systematic review and meta-analysis of prospective cohort studies to analyze the correlation between combined LBs and the occurrence of CVD, as well as to estimate the risk of various health complications in individuals already diagnosed with CVD.

METHODS

Articles published up to February 10, 2023 were sourced through PubMed, EMBASE and Web of Science. Eligible prospective cohort studies that reported the relations of combined LBs with pre-determined outcomes were included. Summary relative risks (RRs) and 95% confidence intervals (CIs) were estimated using either a fixed or random-effects model. Subgroup analysis, meta-regression, publication bias, and sensitivity analysis were as well performed.

RESULTS

In the general population, individuals with the healthiest combination of LBs exhibited a significant risk reduction of 58% for CVD and 55% for CVD mortality. For individuals diagnosed with CVD, adherence to the healthiest combination of LBs corresponded to a significant risk reduction of 62% for CVD recurrence and 67% for all-cause mortality, when compared to those with the least-healthy combination of LBs. In the analysis of dose-response relationship, for each increment of 1 healthy LB, there was a corresponding decrease in risk of 17% for CVD and 19% for CVD mortality within the general population. Similarly, among individuals diagnosed with CVD, each additional healthy LB was associated with a risk reduction of 27% for CVD recurrence and 27% for all-cause mortality.

CONCLUSIONS

Adopting healthy LBs is associated with substantial risk reduction in CVD, CVD mortality, and adverse outcomes among individuals diagnosed with CVD. Rather than focusing solely on individual healthy LB, it is advisable to advocate for the adoption of multiple LBs for the prevention and management of CVD.

TRIAL REGISTRATION

PROSPERO: CRD42023431731.

The Efficacy of Traditional Chinese Herbal Medicine Across Multiple Cardiovascular Diseases: An Umbrella Review of Systematic Reviews of Randomized Controlled Trials

ABSTRACT

Traditional Chinese herbal medicine (CHM) has been extensively used in cardiovascular disease (CVD) in modern clinical practice, alone or in combination with conventional treatment. However, its efficacy has not been assessed extensively. From inception until August 2023, we systematically searched 5 public literature databases to conduct the umbrella review. The inclusion criterion is systematic reviews of randomized controlled trials investigating the effect of CHM in the contemporary management of CVDs. The quality of the included systematic reviews, the certainty of the evidence, and the potential risk of bias were assessed. Five hundred and thirty-nine systematic reviews, including 346 studies in Chinese and 193 in English, were selected before the quantitative synthesis. The methodological quality was generally moderate, with a median value of 11. The favorable efficacy of CHM was primarily presented on 5 main conditions: coronary artery disease, hypertension, heart failure, restenosis, and angina pectoris. CHM, with or without conventional treatment, showed a consistent beneficial effect in various CVDs. Nevertheless, the magnitude of the effect requires further investigation as the lack of relevant research and the complexity of the clinical practice of CHM.

Single and combined association between brominated flame retardants and cardiovascular disease: a large-scale cross-sectional study

Introduction

The single and combined association between brominated flame retardants (BFRs) and cardiovascular diseases (CVD) has remained unelucidated. This research aimed at exploring the associations between mixture of BFRs and CVD.

Methods

This research encompassed adult participants from the National Health and Nutrition Examination Survey in 2005-2016. The weighted quantile sum (WQS) model and quantile g-computation (QGC) model were applied to examine the combined effects of BFRs mixture on CVD.

Results

In this research, overall 7,032 individuals were included. In comparison with the lowest quartile, the highest quartile of PBB153 showed a positive association with CVD, with odds ratio (OR) values and 95% confidence intervals (CI) of 19.2 (10.9, 34.0). Furthermore, the acquired data indicated that PBB153 (OR: 1.23; 95% CI: 1.02, 1.49), PBB99 (OR: 1.29; 95% CI: 1.06, 1.58), and PBB154 (OR: 1.29; 95% CI: 1.02, 1.63) were linked to congestive heart failure. PBB153 was also related to coronary heart disease (OR: 1.29; 95% CI: 1.06, 1.56). Additionally, a positive correlation between the BFRs mixture and CVD (positive model: OR: 1.23; 95% CI: 1.03, 1.47) was observed in the weighted quantile sum (WQS) model and the quantile g-computation (QGC) model.

Discussion

Therefore, exposure to BFRs has been observed to heighten the risk of cardiovascular disease in US adults, particularly in the case of PBB153. Further investigation is warranted through a large-scale cohort study to validate and strengthen these findings.

Ceruloplasmin, Vitamin C, and Uric Acid Levels in Patients With Myocardial Infarction: A Comparative Cross-Sectional Study

INTRODUCTION

Global mortality is significantly influenced by myocardial infarction. Scientists have examined the role of the copper-containing protein ceruloplasmin in heart attacks. It helps to regulate oxidative stress, iron metabolism, and inflammation. Vitamin C's antioxidative qualities lend credence to the idea that it could help prevent cardiovascular disease. Several studies have shown that elevated uric acid levels are related to a higher risk of myocardial infarction. With this background, we conducted this study to estimate levels of ceruloplasmin, vitamin C, and uric acid in patients with myocardial infarction.

MATERIALS AND METHODS

A tertiary care hospital in central India carried out this comparative cross-sectional study. The study was conducted between December 2022 and April 2023. Patients of any gender with newly diagnosed myocardial infarction who received admission to the intensive care unit and had ST-segment elevation of at least 2 mm in two or more consecutive electrocardiogram leads were included in the patient group. The control group consisted of individuals who did not exhibit any changes associated with myocardial infarction. Based on sex, age, and body mass index, the 75 control and 75 patients were matched. Ceruloplasmin, vitamin C, and uric acid were analyzed and compared.

RESULTS

The uric acid levels among the patient group were 10.34 ± 3.23 mg/dL, and among the controls, they were 3.45 ± 1.12 mg/dL (p<0.001). The ceruloplasmin levels among the patient group were 64.34 ± 4.21 mg/dL, and among the controls, they were 29.23 ± 3.82 mg/dL (p<0.001). The vitamin C levels among the patient group were 13.80 ± 0.94 μmol/L, and among the controls, they were 45.62 ± 4.34 μmol/L (p<0.001).

CONCLUSION

The patients with myocardial infarction demonstrated significantly elevated levels of ceruloplasmin and uric acid, while their vitamin C levels were lower in comparison. It is crucial to comprehend the underlying mechanisms through which these parameters influence the development of myocardial infarction.

The 30 Years of Shifting in The Indonesian Cardiovascular Burden-Analysis of The Global Burden of Disease Study

IMPORTANCE

Cardiovascular disease (CVD) remains the leading cause of mortality and morbidity. Compared with disease burden rates in 1990, significant reductions in Disability-Adjusted Life Years (DALYs) burden rates for CVD have been recorded. However, general DALYs rates have not changed in Indonesia in the past 30 years. Thus, assessing Indonesian CVD burdens will be an essential first step in determining primary disease interventions.

OBJECTIVE

To determine the national and province-level burden of CVD from 1990 to 2019 in Indonesia.

DESIGN, SETTING, AND PARTICIPANTS

A retrospective observational study was conducted using data from the Global Burden of Disease (GBD) 2019, provided by the Institute of Health Metrics and Evaluation (IHME), to analyze trends in the burden of CVD, including mortality, morbidity, and prevalence characteristics of 12 underlying CVDs.

EXPOSURES

Residence in Indonesia.

MAIN OUTCOMES AND MEASURES

Mortality, incidence, prevalence, death, and DALYs of CVD.

RESULTS

CVD deaths have doubled from 278 million in 1990 to 651 million in 2019. All CVDs recorded increased death rates, except for rheumatic heart disease (RHD) (- 69%) and congenital heart disease (CHD) (- 37%). Based on underlying diseases, stroke and ischemic heart disease (IHD) are still the leading causes of mortality and morbidity in Indonesia, whereas stroke and peripheral artery disease (PAD) are the most prevalent CVDs. Indonesia has the second worst CVD DALYs rates compared to ASEAN countries after Laos. At provincial levels, the highest CVD DALY rates were recorded in Bangka Belitung, South Kalimantan, and Yogyakarta. In terms of DALYs rate changes, they were recorded in West Nusa Tenggara (24%), South Kalimantan (18%), and Central Java (11%). Regarding sex, only RHD, and PAD burdens were dominated by females.

CONCLUSIONS

CVD mortality, morbidity, and prevalence rates increased in Indonesia from 1990 to 2019, especially for stroke and ischemic heart disease. The burden is exceptionally high, even when compared to other Southeast Asian countries and the global downward trend. GBD has many limitations. However, these data could provide policymakers with a broad view of CVD conditions in Indonesia.

Effectiveness and Feasibility of Telehealth-Based Dietary Interventions Targeting Cardiovascular Disease Risk Factors: Systematic Review and Meta-Analysis

BACKGROUND

Telehealth-based dietary interventions were recommended for cardiovascular disease (CVD) management during the COVID-19 pandemic; however, data regarding their effectiveness and feasibility are limited.

OBJECTIVE

We aimed to examine (1) the effectiveness of telehealth-based dietary interventions in improving clinical CVD risk factors and (2) the feasibility of these interventions among individuals with CVD.

METHODS

To conduct this systematic review and meta-analysis of randomized controlled trials (RCTs), 2 investigators searched PubMed, Cochrane Library, Web of Science, and ClinicalTrials.gov databases based on predetermined search terms and included English-language RCTs published between January 2000 and July 2022. The Cochrane Risk of Bias tool was used to assess RCT quality. To evaluate intervention effectiveness, weight, BMI, systolic and diastolic blood pressure, and levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, or blood glucose were compared postintervention in telehealth and usual care (UC) groups. Feasibility was determined through the number of participants retained in intervention and UC groups. Pooled data for each CVD outcome were analyzed using a random effects model. Mean difference (MD), standardized MD, or risk ratio were calculated using R software.

RESULTS

A total of 13 RCTs with 3013 participants were included in the analysis to assess the effectiveness and feasibility of telehealth-based dietary interventions among individuals with CVD. Participants had a mean age of 61.0 (SD 3.7) years, and 18.5% (n=559) were women. Approximately one-third of RCTs were conducted in the United States (n=4, 31%). Included studies used telephone, app, text, audio-visual media, or website-based interventions. Of the 13 included studies, 3 were of high quality, 9 were of moderate quality, and only 1 was of low quality. Pooled estimates showed systolic blood pressure (MD -2.74, 95% CI -4.93 to -0.56) and low-density lipoprotein cholesterol (standardized MD -0.11, 95% CI -0.19 to -0.03) to be significantly improved among individuals with CVD as a result of telehealth-based dietary interventions compared to UC. No significant difference in effectiveness was detected for weight, BMI, and levels of diastolic blood pressure, total cholesterol, high-density lipoprotein, and triglycerides between telehealth-based dietary interventions and UC among those with CVD. There was no significant difference between the feasibility of telehealth-based dietary interventions versus UC. Significant I2 indicated moderate to considerable heterogeneity.

CONCLUSIONS

Telehealth-based dietary interventions show promise in addressing CVD risk factors.

Drug-induced interstitial lung disease: a real-world pharmacovigilance study of the FDA Adverse Event Reporting System from 2004 to 2021

Background

Drug-induced interstitial lung disease (DILD) is an increasingly common cause of morbidity and mortality. However, due to the lack of specificity, DILD detection remains an unsolved public health challenge.

Objectives

For the first time, we aimed to examine DILD reports submitted to the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) to identify demographic characteristics and top drugs associated with DILD at a group level (including age, sex, drug class, and country stratification) and individual drug level.

Design

A retrospective analysis of the FAERS database was examined by disproportionality analysis.

Methods

We reviewed the FAERS database from 2004 to 2021, using search terms 'interstitial lung disease' and sorting cases by generic drug name. The reporting odds ratio, proportional reporting ratio, and Bayesian confidence propagation neural network were calculated as the measure of strength of association.

Results

There were 32,821 DILD reports in the FAERS. After excluding reports without age, sex, or country data according to the specific measurement, the median age of patients was 68 (interquartile range: 59), 54.77% were male, and 46.00% of reports came from Japan. The top drug classes related to DILD in the FAERS were antineoplastic, followed by cardiovascular and antirheumatic agents, in varying order in different sexes. Fam-trastuzumab deruxtecan-nxki, ramucirumab, and eribulin were the top three drugs with the highest strength of association. We also found some drugs without DILD in the labels, such as amiodarone, temsirolimus, and ursodiol. There are significant differences in DILD reports in various countries. For example, the United States and France reported more cardiovascular agents, whereas Canada reported more antirheumatic agents.

Conclusion

We found the top drugs and drug classes that were associated with DILD in the FAERS, which provides a real-world window for different ages, sexes, and countries to formulate precise pharmacovigilance policies.

Lupus-Induced Accelerated Heart Failure in a Young African American Female: Cardiovascular and Systemic Complications of Noncompliance to Maintenance Therapy and the Social Determinants of Cardiovascular Disease

Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disorder characterized by dysregulations of the immune system with intermittent and remitting symptoms. SLE affects multiple organs and systems, including the cardiovascular system. This condition is associated with an increased risk of cardiovascular disease, particularly in younger patients. Our case report describes a patient who rapidly developed structural, functional, and electrophysiological cardiac abnormalities due to lupus-induced cardiomyopathy. The accelerating cardiac events were the result of medication noncompliance. Myocarditis and other potentially fatal cardiac complications associated with SLE have been the subject of numerous studies. This presentation appears to be the first to emphasize the rarity of lupus-induced cardiomyopathy, the importance of treatment adherence, the adverse cardiac effects of targeted therapeutic interventions, and the influence of social determinants of cardiovascular health on a patient's prognosis.

Barriers and Facilitators to Improving Cardiovascular Health in Churches with Predominantly Black Congregations

Objective

Black communities bear a disproportionate burden of cardiovascular disease (CVD). Barriers and facilitators for improving cardiovascular health (CVH) in churches with predominantly black congregations were explored through a qualitative needs assessment.

Methods

Four focus groups with church members (n=21), 1 with wellness coordinators (n=5), and 1 with primary care providers (n=4) and 7 individual interviews with church leaders were completed in New Orleans and Bogalusa, Louisiana. Virtual, semistructured interviews and focus groups were held between October 2021 and April 2022. The Theorical Domains Framework (TDF) guided a framework analysis of transcribed data based on inductive and deductive coding to identify themes related to determinants of CVH.

Results

The following four domains according to the TDF were identified as the most relevant for improving CVH: knowledge, professional role, environmental context, and emotions. Within these domains, barriers expressed by church leadership and members were a lack of knowledge of CVD, provider distrust, and little time and resources for lifestyle changes; facilitators included existing church wellness programs and social support, community resources, and willingness to improve patient-provider relationships. Primary care providers recognized a lack of effective communication and busy schedules as obstacles and the need to strengthen communication through increased patient autonomy and trust. Potential strategies to improve CVH informed by the Expert Recommendation for Implementing Change compilation of implementation strategies include education and training, task shifting, dissemination of information, culturally tailored counselling, and linkage to existing resources.

Conclusions

These findings can inform the implementation of interventions for improving cardiovascular health and reducing disparities in black church communities.

Recent Advances of Nanogenerator Technology for Cardiovascular Sensing and Monitoring

Cardiovascular sensing and monitoring is a widely used function in cardiovascular devices. Nowadays, achieving desired flexibility, wearability and implantability becomes a major design goal for the advancement of this family of devices. As an emerging technology, nanogenerator (NG) offers an intriguing promise for replacing the battery, an essential obstacle toward tissue-like soft electronics. This article reviews most recent advancements in NG technology for advanced cardiovascular sensing and monitoring. Based on the application targets, the discuss covers implantable NGs on hearts, implantable NGs for blood vessel grafts and patches, and wearable NGs with various sensing functions. The applications of NGs as a power source and as an electromechanical sensing element are both discussed. At the end, current challenges in this direction and future research perspectives are elaborated. This emerging and impactful application direction reviewed in this article is expected to inspire many new research and commercialization opportunities in the field of NG technology.

Association of frailty with postoperative outcomes following thoracic transplantation: A national analysis

Objective

Frailty has been repeatedly associated with inferior outcomes after surgical hospitalizations. However, a thorough evaluation of the impact of frailty on the clinical and financial outcomes of patients undergoing solid-organ thoracic transplantation is sparse in the literature. We evaluated the association of frailty, as determined by an administrative tool, with postoperative outcomes and healthcare resource use after heart or lung transplantation.

Methods

The Nationwide Readmissions Database was used to identify all adult hospitalizations for heart or lung transplant from 2014 to 2020. Patients were grouped as frail or nonfrail using International Classification of Diseases codes associated with conditions in the Johns Hopkins Adjusted Clinical Groups cluster. Multivariable regression models were developed to evaluate the association of frailty status on in-hospital mortality, complications, length of stay, costs, and unplanned readmissions.

Results

Of an estimated 35,862 heart or lung transplant recipients, 7316 (20.4%) were considered frail. After multivariable adjustment, frailty in heart transplantation was associated with greater odds of in-hospital mortality (adjusted odds ratio, 1.54; 95% CI, 1.19-1.99) and infectious complications (adjusted odds ratio, 1.77; 95% CI, 1.45-2.15; P < .001). Frailty in lung transplantation was also associated with higher odds of in-hospital mortality (adjusted odds ratio, 1.38; 95% CI, 1.11-1.69) and infectious complications (adjusted odds ratio, 1.93; 95% CI, 1.60-2.31). In addition, frailty in both heart transplantation and lung transplantation was associated with increased postoperative length of stay and greater costs.

Conclusions

Among transplant recipients, those classified as frail were associated with increased in-hospital mortality, perioperative complications, and resource use.

Association between pharmacist-led telehealth services and improvements in cardiovascular outcomes among patients with cardiovascular risk factors: A scoping review

Background

Cardiovascular disease is the leading cause of death globally. Despite the effectiveness of lifestyle changes and recommended therapeutics, access to primary care and treatments to improve cardiovascular risk-factors (CRFs) remains challenging. Pharmacists and telehealth services have been proposed as potential solutions to overcome these barriers.

Methods

PubMed, OVID, and CINAHL databases were searched from January 2006 to March 2023. The primary outcomes were changes from baseline in systolic/diastolic blood pressure, glycated hemoglobin (A1c), cholesterol levels, and adherence to any patient counseling. Only studies conducted in the United States and Canada were included in the review.

Results

Of 110 screened bibliographic records, 14 studies were included in the review. The pharmacist-led telehealth interventions included medication therapy management, medication reviews, and counseling on lifestyle changes. Nine studies reported significant improvements with intervention, 7 studies on CRFs and 2 studies on medication adherence at the 12-month follow-up, when pharmacist-led telehealth services were compared to usual care or historical data (p < 0.05).

Conclusion

This scoping review provides evidence for continued support to the development and implementation of pharmacist-led telehealth services in primary cardiovascular care. The findings suggest that pharmacist-led telehealth interventions can improve cardiovascular outcomes and adherence to drug and non-drug therapy among patients with CRFs. However, because of lack of published randomized clinical studies on patients with CRFs residing in underserved communities, future directions in research should focus on exploring the implementation of pharmacist-led telehealth services in rural or underserved communities, utilizing various payment models to enhance accessibility and feasibility.

Polygenic Risk Score for Cardiovascular Diseases in Artificial Intelligence Paradigm: A Review

Cardiovascular disease (CVD) related mortality and morbidity heavily strain society. The relationship between external risk factors and our genetics have not been well established. It is widely acknowledged that environmental influence and individual behaviours play a significant role in CVD vulnerability, leading to the development of polygenic risk scores (PRS). We employed the PRISMA search method to locate pertinent research and literature to extensively review artificial intelligence (AI)-based PRS models for CVD risk prediction. Furthermore, we analyzed and compared conventional vs. AI-based solutions for PRS. We summarized the recent advances in our understanding of the use of AI-based PRS for risk prediction of CVD. Our study proposes three hypotheses: i) Multiple genetic variations and risk factors can be incorporated into AI-based PRS to improve the accuracy of CVD risk predicting. ii) AI-based PRS for CVD circumvents the drawbacks of conventional PRS calculators by incorporating a larger variety of genetic and non-genetic components, allowing for more precise and individualised risk estimations. iii) Using AI approaches, it is possible to significantly reduce the dimensionality of huge genomic datasets, resulting in more accurate and effective disease risk prediction models. Our study highlighted that the AI-PRS model outperformed traditional PRS calculators in predicting CVD risk. Furthermore, using AI-based methods to calculate PRS may increase the precision of risk predictions for CVD and have significant ramifications for individualized prevention and treatment plans.

Clinical competence, communication ability and adherence to choosing wisely recommendations for lipid reducing drug use in older adults

BACKGROUND

Although lipid-lowering drugs are not recommended for primary prevention in patients 75+, prevalence of use is high and there is unexplained variation in prescribing between physicians. The objective of this study was to determine if physician communication ability and clinical competence are associated with prescribing lipid-lowering drugs for primary and secondary prevention.

METHODS

We used a cohort of 4,501 international medical graduates, 161,214 U.S. Medicare patients with hyperlipidemia (primary prevention) and 49,780 patients with a history of cardiovascular disease (secondary prevention) not treated with lipid-lowering therapy who were seen by study physicians in ambulatory care. Clinical competence and communication ability were measured by the ECFMG clinical assessment examination. Physician citizenship, age, gender, specialty and patient characteristics were also measured. The outcome was an incident prescription of lipid-lowering drug, evaluated using multivariable GEE logistic regression models for primary and secondary prevention for patients 75+ and 65-74.

RESULTS

Patients 75+ were less likely than those 65-74 to receive lipid-lowering drugs for primary (OR 0.62, 95% CI 0.59-0.66) and secondary (OR 0.70, 95% CI 0.63-0.78) prevention. For every 20% increase in clinical competence score, the odds of prescribing therapy for primary prevention to patients 75+ increased by 24% (95% CI 1.02-1.5). Communication ability had the opposite effect, reducing the odds of prescribing for primary prevention by 11% per 20% score increase (95% CI 0.8-0.99) for both age groups. Physicians who were citizens of countries with higher proportions of Hispanic (South/Central America) or Asian (Asia/Oceania) people were more likely to prescribe treatment for primary prevention, and internal medicine specialists were more likely to treat for secondary prevention than primary care physicians.

CONCLUSION

Clinical competence, communication ability and physician citizenship are associated with lipid-lowering drug prescribing for primary prevention in patients aged 75+.

Divergences and gaps in life expectancy and health-adjusted life expectancy in Mexico: Contribution analysis of the Global Burden of Disease Study 2019

INTRODUCTION

Life expectancy (LE) and Health-adjusted life expectancy (HALE) are summary indicators that reflect a population's general life conditions and measure inequities in health outcomes. The objective of this study was to identify the differences in LE and HALE by sex, age group, and state in Mexico from 1990 to 2019. Also, to evaluate whether the changes in HALE are related to sociodemographic indicators and indicators of access to and quality of health services.

METHODS

A secondary analysis was performed based on the Global Burden of Disease, Injuries, and Risk Factors Study (GBD). Data were obtained for LE (by sex and state) and HALE (by sex, age group, and state) for the years 1990, 2010, and 2019. The correlations between HALE with the Socio-Demographic Index (SDI) and with the Healthcare Access and Quality (HAQ) Index were estimated for 1990 and 2019 (by total population and sex).

RESULTS

LE and HALE had an absolute increase of 6.7% and 6.4% from 1990 to 2019, mainly among women, although they spent more years in poor health (11.8 years) than men. The patterns of LE and HALE were heterogeneous and divergent by state. In 2019, the difference in HALE (for both sex) between the states with the highest (Hidalgo) and the lowest (Chiapas) value was 4.6 years.

CONCLUSIONS

Progress in LE and HALE has slowed in recent years; HALE has even had setbacks in some states. Gaps between men and women, as well as between states, are persistent. Public and population policymaking should seek to lengthen LE and focus on ensuring that such years are spent in good health and with good quality of life.