25 by 25: Achieving Global Reduction in Cardiovascular Mortality

Ten Recommendations for Accelerating Hypertension and Diabetes Control to Reduce Stroke, Heart, and Renal Disease with the Aim to Save Lives in Cameroon Through Partnerships and Collaborations

Hypertension and diabetes are currently the most common, treatable, and controllable cardiovascular and metabolic risk factors for stroke, heart, and renal diseases in Cameroon. Hypertension affects 30% of adults aged ≥ 20 years with 90% as uncontrolled cases, while type 2 diabetes affects 6% of the same population, with 70% remaining underdiagnosed. Despite publication of the first Roadmap on raised blood pressure by the World Heart Federation in 2015, the Pan African Society of Cardiology Roadmap in 2017, and the technical package for cardiovascular disease management in primary health care (WHO-HEARTS) in 2020, very little progress has been made in improving the diagnosis, treatment, and control of cardiovascular risk factors and diseases in Cameroon. The Cameroon Cardiac Society and a dozen Cameroon non-communicable diseases societies, national organizations from the community and the civil society, along with researchers and members of academia and the health sector, came together under the patronage of representatives of the government to propose new strategies to improve hypertension and diabetes control and save lives in Cameroon. Two simple and practical algorithms for the management of hypertension and diabetes were developed. The ten recommendations tailored to be efficiently implemented in our country were summarized under the acronym 'A SMART VIEW' (Awareness, Screening, Manufacture, Activity, Research, Task-shifting, HIV/AIDS, Insurance, Education, and WHO-HEARTS). It is our hope that all stakeholders will further collaborate to remove barriers and enhance facilitators to deploy the proposed actions and reduce the burden of uncontrolled hypertension and untreated diabetes in Cameroon.

The midlife health of only children: chronic disease indicators and biomarkers by sibship size in three nationally representative UK cohorts

BACKGROUND

Despite persistent concerns about only children's disadvantage relative to individuals with siblings, existing health-related evidence is inconsistent. Recent evidence from Nordic countries about only children having poorer health outcomes may not apply elsewhere because selection processes differ across contexts. We investigate the midlife health of only children in the UK where one-child families tend to be socio-economically advantaged relative to large families.

METHODS

Using the 1946, 1958 and 1970 British birth cohort studies, we examine various biomarkers and self-reported measures of chronic disease by sibship size when respondents are aged in their mid-40s, mid-50s and mid-60s. We estimate separate linear probability models for each cohort, age and outcome, adjusting for childhood and early adulthood circumstances.

RESULTS

We found no evidence of only children differing from those with one, two or three or more siblings, at any age, in any of the cohorts, on: heart problems, hypertension, high triglycerides, high glycated haemoglobin or high C-reactive protein. However, compared with only children, the probability for cancer (0.019, 95% confidence interval [CI]: 0.002, 0.035; age 46/1970) and poor general health (0.060, CI: 0.015, 0.127; age 55/1958; and 0.110, CI: 0.052, 0.168; age 63/1946) was higher among those with three or more siblings.

CONCLUSIONS

There is no consistent pattern of only child health disadvantage for midlife chronic disease outcomes across ages or cohorts in the UK. Research should focus on better understanding how sibship size differentials are contingent on context.

Chronic respiratory disease observatory for Africa (CHEST-Africa): study protocol for the prevalence, determinants and economic impacts of asthma and COPD in Africa

INTRODUCTION

Contemporary data on the burden of chronic respiratory diseases in sub-Saharan Africa is limited. More so, their economic burden is not well described. This study aims to establish a chronic respiratory disease observatory for Africa. Specific study aims are (1) to describe the prevalence and determinants of asthma with a target to screen up to 4000 children and adolescents across four African cities; (2) to determine the prevalence and determinants of chronic obstructive pulmonary disease (COPD) with a target to screen up to 3000 adults (≥18 years) across five African cities; (3) to describe the disease burden by assessing the frequency and severity of symptoms and exacerbations, medication use, emergency healthcare utilisation and hospitalisation; and (4) to assess the economic burden and affordability of the medicines for these diseases.

METHODS AND ANALYSIS

Surveys will be conducted in schools to identify children and adolescents with asthma using the Global Asthma Network screening questionnaire in Ghana, Nigeria, the Democratic Republic of Congo, and Uganda. Community surveys will be conducted among adults using an adapted version of the Burden of Obstructive Lung Disease Questionnaire to identify persons with COPD symptoms in Nigeria, Burkina Faso, Mozambique, Rwanda, and Sierra Leone. Fractional exhaled nitric oxide and pre-bronchodilator and post-bronchodilator spirometry will be done for children with asthma or asthma symptoms and for all adult participants. Children and adults with respiratory symptoms or diagnoses will complete the health economic questionnaires. Statistical analysis will involve descriptive and analytical statistics to determine outcomes.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from participating institutions. This study's results will inform deliberations at the United Nations General Assembly high-level meeting on non-communicable diseases in 2025. The results will be shared through academic conferences and journals and communicated to the schools and the communities.

Mapping the Common Barriers to Optimal COPD Care in High and Middle-Income Countries: Qualitative Perspectives from Clinicians

Purpose

Chronic obstructive pulmonary disease (COPD) poses a significant global health burden despite being largely preventable and treatable. Despite the availability of guidelines, COPD care remains suboptimal in many settings, including high-income countries (HICs) and upper-middle-income countries (UMICs), with varied approaches to diagnosis and management. This study aimed to identify common and unique barriers to COPD care across six countries (Australia, Spain, Taiwan, Argentina, Mexico, and Russia) to inform global policy initiatives for improved care.

Methods

COPD care pathways were mapped for each country and supplemented with epidemiological, health-economic, and clinical data from a targeted literature review. Semi-structured interviews with 17 respiratory care clinicians were used to further validate the pathways and identify key barriers. Thematic content analysis was used to generate the themes.

Results

Six themes were common in most HICs and UMICs: "Challenges in COPD diagnosis", "Strengthening the role of primary care", "Fragmented healthcare systems and coordination challenges", "Inadequate management of COPD exacerbations", "Limited access to specialized care" and, "Impact of underfinanced and overloaded healthcare systems". One theme, "Insurance coverage and reimbursement challenges", was more relevant for UMICs. HICs and UMICs differ in patient and healthcare provider awareness, primary care involvement, spirometry access, and availability of specialized care. Both face issues with healthcare fragmentation, guideline adherence, and COPD exacerbation management. In addition, UMICs also grapple with resource limitations and healthcare infrastructure challenges.

Conclusion

Many challenges to COPD care are the same in both HICs and UMICs, underscoring the pervasive nature of these issues. While country-specific issues require customized solutions, there are untapped possibilities for implementing global respiratory strategies that support countries to manage COPD effectively. In addition to healthcare system-level initiatives, there is a crucial need for political prioritization of COPD to allocate the essential resources it requires.

Management of Hypertension in the Asia-Pacific Region: A Structured Review

This article reviews available evidence regarding hypertension management in the Asia-Pacific region, focussing on five research questions that deal with specific aspects: blood pressure (BP) control, guideline recommendations, role of renin-angiotensin-aldosterone system (RAAS) inhibitors in clinical practice, pharmacological management and real-world adherence to guideline recommendations. A PubMed search identified 2537 articles, of which 94 were considered relevant. Compared with Europeans, Asians have higher systolic/diastolic/mean arterial BP, with a stronger association between BP and stroke. Calcium channel blockers are the most-commonly prescribed monotherapy in Asia, with significant variability between countries in the rates of angiotensin-converting enzyme inhibitors (ACEis)/angiotensin-receptor blockers (ARBs) and single-pill combination (SPC) use. In clinical practice, ARBs are used more commonly than ACEis, despite the absence of recommendation from guidelines and clinical evidence supporting the use of one class of drug over the other. Ideally, antihypertensive treatment should be tailored to the individual patient, but currently there are limited data on the characteristics of hypertension in Asia-Pacific individuals. Large outcome studies assessing RAAS inhibitor efficacy and safety in multi-national Asian populations are lacking. Among treated patients, BP control rates were ~ 35 to 40%; BP control in Asia-Pacific is suboptimal, and disproportionately so compared with Western nations. Strategies to improve the management of hypertension include wider access/availability of affordable treatments, particularly SPCs (which improve adherence), effective public health screening programs targeting patients to drive health-seeking behaviours, an increase in physician/patient awareness and early implementation of lifestyle changes. A unified Asia-Pacific guideline on hypertension management with pragmatic recommendations, particularly in resource-limited settings, is essential.

A comparison of the disease occurrence of cerebrovascular diseases, diabetes mellitus, hypertensive diseases, and ischaemic heart diseases among hospitalized older adults in Thailand

This observational research analyzed public hospital data from the Thailand Ministry of Public Health website to investigate gender differences in four categories of non-communicable diseases (NCDs) affecting hospitalized senior Thai populations for 12 years. This study aimed to determine the cumulative effects and analyze the odds ratio (OR) according to ICD-10 cause categories for the data from 2010 to 2021, accounting for 1,327,093 cases in 2010 and 2,275,936 cases in 2021. The findings revealed statistically significant gender differences in four categories of NCDs. Men were found to be more likely than women to have two types of NCDs, as measured by the OR (95%CI): cerebrovascular diseases (OR 1.34-1.47, 95%CI 1.32-1.48), and ischaemic heart disease (OR 1.24-1.63, 95%CI 1.23-1.64). Conversely, diabetes mellitus (OR 0.64-0.84, 95%CI 0.63-0.85) and hypertensive disorders (OR 0.82-0.95, 95%CI 0.81-0.97) were discovered to have a lower likelihood of ratios related in men compared to women. However, the trend of all four NCDs in men has significantly increased every year: cerebrovascular diseases = 0.0093 year(s) + 1.3391, (R2 0.82, p-value 0.001); diabetes mellitus = 0.0171 year(s) + 0.6143, (R2 0.97, p-value 0.001); hypertension = 0.0125 year(s) + 0.8091, (R2 0.96, p-value 0.001); and ischaemic heart disease = 0.0345 year(s) + 1.1884, (R2 0.99, p-value 0.001).Gender, a crucial biological factor, contributes to variations in the prevalence of illness. As such, it is essential to prioritize the disease risk occurrence and preventive care for men and women separately, with a focus on implementing more detailed screening and detection strategies, as well as tailored interventions.

Vaccines in cardiology, an underutilized strategy to reduce the residual cardiovascular risk

Cardiovascular diseases stand as the leading cause of mortality among adults globally. For decades, comprehensive evidence has underscored the correlation between infections, particularly those involving the respiratory system, and an elevated risk of cardiovascular and cerebrovascular events, as well as all-cause mortality. The mechanisms through which infections heighten cardiovascular events are intricate, encompassing immune system activation, systemic inflammation, hypercoagulable states, sympathetic system activation, and increased myocardial oxygen demand. Respiratory infections further contribute hypoxemia to this complex interplay. These mechanisms intertwine, giving rise to endothelial dysfunction, plaque ruptures, myocardial depression, and heart failure. They can either instigate de novo cardiovascular events or exacerbate pre-existing conditions. Compelling evidence supports the safety of influenza, pneumococcal, herpes zoster, COVID-19 and respiratory syncytial virus vaccines in individuals with cardiovascular risk factors or established cardiovascular disease. Notably, the influenza vaccine has demonstrated safety even when administered during the acute phase of a myocardial infarction in individuals undergoing angioplasty. Beyond safety, these vaccinations significantly reduce the incidence of cardiovascular events in individuals with an augmented cardiovascular risk. Nevertheless, vaccination rates remain markedly suboptimal. This manuscript delves into the intricate relationship between infections and cardiovascular events. Additionally, we highlight the role of vaccinations as a tool to mitigate these occurrences and reduce residual cardiovascular risk. Finally, we emphasize the imperative need to optimize vaccination rates among individuals with heart diseases.

MK, Essakky S, Singh M, Ghosh S, Mehndiratta A, Kar SS. Cost-effectiveness of implementing risk-based cardiovascular disease (CVD) management using updated WHO CVD risk prediction charts in India

INTRODUCTION

The World Health Organization (WHO) has released the updated cardiovascular disease (CVD) risk prediction charts in 2019 for each of the 21 Global Burden of Disease regions. The WHO advocates countries to implement population-based CVD risk assessment and management using these updated charts for preventing and controlling CVDs.

OBJECTIVE

To assess the cost-effectiveness of implementing risk-based CVD management using updated WHO CVD risk prediction charts in India.

METHODS

We developed a decision tree combined with Markov Model to simulate implementing two community-based CVD risk screening strategies (interventions) compared with the current no-screening scenario. In the first strategy, the whole population is initially screened using the WHO non-lab-based CVD risk assessment method, and those with ≥10% CVD risk are subjected to WHO lab-based CVD risk assessment (two-stage screening). In the second strategy, the whole population is subjected only to the lab-based CVD risk assessment (single-stage screening). A mathematical cohort of those aged ≥40 years with no history of CVD events was simulated over a lifetime horizon with three months of cycle length. Data for the model were derived from a primary study and secondary sources. Incremental cost-effectiveness ratios (ICERs) were determined for the screening strategies and sensitivity analyses.

RESULTS

The discounted Incremental cost-effectiveness ratio per QALY gained for both the two-stage (US$ 105; ₹ 8,656) and single-stage (US$ 1073; ₹ 88,588) screening strategies were cost-effective at an implementation effect of 40% when compared with no screening scenario. Implementing CVD screening strategies are estimated to cause substantial reduction in the number of CVD events in the population compared to the no screening scenario.

CONCLUSION

In India, both CVD screening strategies would be cost-effective, and implementing the two-staged screening would be more cost-effective. Our findings support implementing population-based CVD screening in India. Future studies shall assess the budget impact of these strategies at different implementation coverage levels.

Effect of Oat (Avena sativa L.) Consumption on Lipid Profile With Focus on Triglycerides and High-density Lipoprotein Cholesterol (HDL-C): An Updated Systematic Review

Hypercholesterolemia is a significant risk factor for heart disease. The soluble fiber in oat (Avena sativa L.), beta-glucan has been shown to significantly lower serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels but not triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) according to previous studies, reviews, and meta-analyses. However, the effect of oat consumption on the TG and HDL-C is controversial and has not been expanded enough. We did this review study to find out about the effect of oat on lipid profile especially TG and HDL-C more specifically and meticulously with their details. After searching PubMed, Web of Science, and Google scholar we included 17 studies in our review. Our results similar to other reviews showed that oat reduced the TC, VLDL, and LDL-C more significantly than TG. Of 17 included studies 6 studies reported reduction of TG level, and only 1 study reported HDL-C improvement followed by oat consumption. A more detailed review of studies that reported positive effects of oat/ beta-glucan consumption on TG showed that in healthy people with normal lipid profile oat intake might reduce TG effectively and also in overweight people/those with diabetes or metabolic syndrome if a higher amount of oat or/and longer duration applied. Consuming oat in conjunction with calorie-reducing diets or using it with DHA can cause a significant TG reduction. It may be concluded that, in addition to lowering TC and LDL-C, a considerable improvement in TG or HDL-C can be accomplished by adjusting factors such as oat consumption dose or consumption duration or utilizing oat in conjunction with a proper diet program. To conclude, more research on this topic is required.

How effective are anthocyanins on healthy modification of cardiometabolic risk factors: a systematic review and meta-analysis

BACKGROUND

In this meta-analysis, findings from recent studies on the preventive properties of anthocyanins (ACN) against cardiovascular disease are summarized.

METHODS

MEDLINE, PubMed, Embase, Cochrane Library, and Google Scholar were searched and 2512 studies were found in a preliminary search. After screening of titles and abstracts, 47 studies met the inclusion criteria (randomized clinical trial design and sufficient data of outcomes). Studies were excluded based on the following criteria: incomplete data; obscurely reported outcomes, or lack of control groups; and animal studies.

RESULTS

The results showed that intervention with ACNs resulted in a significant decrease in body mass index ((MD),- 0.21; 95% CI, - 0.38, - 0.04; P < 0.001) and body fat mass (MD: - 0.3%, 95% CI - 0.42 to - 0.18%, p < 0.001). Pooled data comparing ACN with control showed statistically significant effect on fasting blood sugar and HbA1c. However, the reductions were significantly more in the subjects with type 2 diabetes and in those who used ACN as supplement/extract. The subgroup analysis test showed that there was a significant effect of ACN on triglyceride concentrations, total cholesterol, LDL-C and HDL-C concentrations in all subgroups of participants (with vs. without dyslipidemia at baseline) and intervention type (supplement/extract vs. food). However, we did not observe any significant effect on apo A and apo B concentrations.

CONCLUSIONS

ACN intake in the forms of natural foods and supplements can induce healthy changes in body fat mass, glycemic and lipidemic status and these effects are more prominent in the subjects with above-normal values. This meta-analysis was registered at http://www.crd.york.ac.uk/Prospero (Registration no. CRD42021286466).

Oxidative Stress, Antioxidants and Hypertension

As a major cause of morbidity and mortality globally, hypertension remains a serious threat to global public health. Despite the availability of many antihypertensive medications, several hypertensive individuals are resistant to standard treatments, and are unable to control their blood pressure. Regulation of the renin-angiotensin-aldosterone system (RAAS) controlling blood pressure, activation of the immune system triggering inflammation and production of reactive oxygen species, leading to oxidative stress and redox-sensitive signaling, have been implicated in the pathogenesis of hypertension. Thus, besides standard antihypertensive medications, which lower arterial pressure, antioxidant medications were tested to improve antihypertensive treatment. We review and discuss the role of oxidative stress in the pathophysiology of hypertension and the potential use of antioxidants in the management of hypertension and its associated organ damage.

Increased arterial pressure volume index and cardiovascular risk score in China

BACKGROUND AND OBJECTIVE

The new non-invasive arterial stiffness indices, arterial pressure volume index (API) is explored as a novel marker of residual stress in the wall of the peripheral muscular arteries at zero-stress state in clinical settings. The present study aimed to study the association of API with cardiovascular disease (CVD) risk in China (China-PAR).

METHODS

According to China-PAR score, participants were divided into three groups: low risk (< 5%), medium risk (5-9.9%), and high risk (≥ 10.0%). API ≥ 31 was defined as high API, and the incidences of high API were compared. Logistic regression models were used to analyze the risk factors of high API and high risk China-PAR categories. The association between China-PAR and API was analyzed by restrictive cubic spline.

RESULTS

The study included 4311 participants. After adjustments for confounding factors, high API was independent factor associated with high risk China-PAR categories, and the probability of high API was 1.366 times higher than that in normal API subjects. While, the independent factors associated with high API were BMI, blood pressure and heart rate. Furthermore, API had a significant U-shaped association with China-PAR. CVD risk was lowest with API of 19 units, the fastest increase at 26 units and the flattest starting point at 59 units.

CONCLUSION

API, an indicator of arterial stiffness and residual stress, had a U-shaped association with China-PAR score and might play an important role in predicting CVD risk in Chinese natural populations.

Impact of Chronic Obstructive Pulmonary Disease on Atrial Fibrillation Ablation Outcomes According to the National Readmission Database

Chronic obstructive pulmonary disease (COPD) is a risk factor for the development of atrial fibrillation (AF). There is a paucity of contemporary data studying the association between COPD and outcomes of AF ablation. The objective of this study was to investigate the impact of COPD on AF ablation outcomes using a large nationwide database. This study was a retrospective analysis of the National Readmission Database for the years 2016-2018 and included patients admitted with a diagnosis of AF who underwent catheter ablation. Admissions were stratified according to COPD diagnosis using International Classification of Diseases, 10th Revision, Clinical Modification codes. Multivariate, linear, Cox, and logistic regressions were performed to study the impact of COPD on AF ablation. A total of 18,224 admissions (mean age, 68 years; standard deviation, 10 years) were included, of whom 3,494 (19%) had a diagnosis of COPD. The COPD group was older (72 ± 8 vs. 67 ± 11 years, P < .001) and more likely to have congestive heart failure (73% vs. 44%, P < .001) and renal failure (31% vs. 17%, P < .001). COPD was associated with an increased risk of readmission (adjusted hazard ratio [aHR], 1.40; 95% confidence interval [CI], 1.26-1.56; P < .001) and all-cause in-hospital mortality (adjusted odds ratio, 2.83; 95% CI, 1.74-4.60; P < .001). However, COPD was not associated with an increased risk of readmission due to recurrent AF (aHR, 0.97; 95% CI, 0.75-1.27; P = .844) or the need for re-ablation (aHR, 0.85; 95% CI, 0.44-1.65; P = .639), respectively. In conclusion, COPD was not associated with an increased risk of recurrent AF after ablation despite higher periprocedural risks. The present study contributes to a better understanding of this high-risk subgroup of patients undergoing AF ablation.

Social, Economic, Technological, and Environmental Factors Affecting Cardiovascular Diseases: A Systematic Review and Thematic Analysis

Background

Today, cardiovascular disease (CVD) is the leading cause of mortality in both sexes. There are several risk factors for heart diseases; some controllable, others not. However, socioeconomic, technological, and environmental factors can impact CVD as well as exclusive risk factors. Accurate identification and assessment of these factors are often difficult. In the present systematic review, we aimed to explore factors affecting CVD.

Methods

Multiple databases (MEDLINE, Scopus, ISI Web of Science, and Cochrane) and gray literature were searched. The included studies described at least one determinant of CVD. The framework method was applied to analyze the qualitative data.

Results

A total of 64 studies from 26 countries were included. The contextual determinants of CVD were categorized into 45 determinants, 15 factors, and 4 main social, economic, technological, and environmental categories. The 15 potentially reversible factors were identified as sociodemographic, violence, smoking, occupation, positive childhood experience, social inequalities, psychological distress, eating habits, neighborhood, family income, rapid technology, environmental pollution, living environments, noise, and disaster.

Conclusions

Devolution and more efficient health policies are required to achieve further sustained reduction in CVD mortality, increase life expectancy, and reduce its associated risk factors. Policymakers should fully address the value of social, economic, technological, and environmental factors. In fact, a prevention agenda should be developed and updated collaboratively in terms of the determinant factors.

Polypills for Primary Prevention of Cardiovascular Disease: A Systematic Review and Meta-Analysis

Purpose

To evaluate the effect of polypills on the primary prevention of cardiovascular (CV) events using data from clinical trials.

Methods

We searched PubMed, Web of Science, EBSCO, and SCOPUS throughout May 2021. Two authors independently screened articles for the fulfillment of inclusion criteria. The RevMan software (version 5.4) was used to calculate the pooled risk ratios (RRs) and mean differences (MDs), along with their associated confidence intervals (95% CI).

Results

Eight trials with a total of 20653 patients were included. There was a significant reduction in the total number of fatal and non-fatal CV events among the polypill group [RR (95% CI) = 0.71 (0.63, 0.80); P-value &lt; 0.001]. This reduction was observed in both the intermediate-risk [RR (95% CI) = 0.76 (0.65, 0.89); P-value &lt; 0.001] and high-risk [RR (95% CI) = 0.63 (0.52, 0.76); P-value &lt; 0.001] groups of patients. Subgroup analysis was performed based on the follow-up duration of each study, and benefits were only evident in the five-year follow-up duration group [RR (95% CI) = 0.70 (0.62, 0.79); P-value &lt; 0.001]. Benefits were absent in the one-year-or-less interval group [RR (95% CI) = 0.77 (0.47, 1.29); P-value = 0.330]. Additionally, there was a significant reduction in the 10-year predicted cardiovascular risk in the polypill group [MD (95% CI) = −3.74 (−5.96, −1.51); P-value &lt; 0.001], as compared to controls.

Conclusion

A polypill regimen decreases the incidence of fatal and non-fatal CV events in patients with intermediate- and high- cardiovascular risk, and therefore may be an effective treatment for these patients.

An update on the global use of risk assessment models and thromboprophylaxis in hospitalized patients with medical illnesses from the World Thrombosis Day steering committee: Systematic review and meta-analysis

INTRODUCTION

Venous thromboembolism (VTE) is a leading cause of cardiovascular morbidity and mortality. The majority of VTE events are hospital-associated. In 2008, the Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting (ENDORSE) multinational cross-sectional study reported that only approximately 40% of medical patients at risk of VTE received adequate thromboprophylaxis.

METHODS

In our systematic review and meta-analysis, we aimed at providing updated figures concerning the use of thromboprophylaxis globally. We focused on: (a) the frequency of patients with an indication to thromboprophylaxis according with individual models; (b) the use of adequate thromboprophylaxis; and (c) reported contraindications to thromboprophylaxis. Observational nonrandomized studies or surveys focusing on medically ill patients were considered eligible.

RESULTS

After screening, we included 27 studies from 20 countries for a total of 137 288 patients. Overall, 50.5% (95% confidence interval [CI]: 41.9-59.1, I2 99%) of patients had an indication to thromboprophylaxis: of these, 54.5% (95% CI: 46.2-62.6, I2 99%) received adequate thromboprophylaxis. The use of adequate thromboprophylaxis was 66.8% in Europe (95% CI: 50.7-81.1, I2 98%), 44.9% in Africa (95% CI: 31.8-58.4, I2 96%), 37.6% in Asia (95% CI: 25.7-50.3, I2 97%), 58.3% in South America (95% CI: 31.1-83.1, I2 99%), and 68.6% in North America (95% CI: 64.9-72.6, I2 96%). No major differences in adequate thromboprophylaxis use were found across risk assessment models. Bleeding, thrombocytopenia, and renal/hepatic failure were the most frequently reported contraindications to thromboprophylaxis.

CONCLUSIONS

The use of anticoagulants for VTE prevention has been proven effective and safe, but thromboprophylaxis prescriptions are still unsatisfactory among hospitalized medically ill patients around the globe with marked geographical differences.

Relationship of visceral obesity and coronary calcinosis in ischemic heart disease

Aim. To assess the relationship between the prevalence of visceral obesity (VO) and the severity of coronary calcification (CC) in patients with verified coronary artery disease (CAD). Materials and methods. 125 patients with CAD were examined. Assessment of the morphometric characteristics of visceral adipose tissue (VAT) and CC was perform using multislice computed tomography (MSCT). The calcium index (CI) of the coronary arteries (CA) was determine by the Agatston method. Statistical analysis was perform using Statistica 10.0. Results. VO was detect in 82 (65.6%) patients with CAD. In the presence of VO, higher CC values were observed in the projection of the envelope (p=0.00014), right coronary (p=0.00002) arteries, total CI (p=0.0003), and the prevalence of massive CC. Correlation analysis showed the relationship between the area of VAT and the CC of all the studied localizations. According to the ROC analysis, VO is a significant predictor of massive CC (area under the ROC curve AUC 0.72, 95% CI 0.560.89), in contrast to body mass index BMI (AUC 0.56, 95% CI 0.310.82). Conclusion. The index of the ratio of VAT to subcutaneous adipose tissue (VAT/SAT), but not BMI, had a direct correlation with CC. Morphology of VAT may be a significant diagnostic sign of massive CC in patients with CAD, as a factor affecting treatment and prognosis.

The Effect of Sex and Wealth on Population Attributable Risk Factors for Dementia in South Africa

Background and Aims: South Africa is a middle-income country with high levels of income inequality and a rapidly aging population and increasing dementia prevalence. Little is known about which risk factors for dementia are important and how they differ by social determinants of health as well as key demographic characteristics such as sex and wealth. We sought to calculate the population attributable risks (PARs) for established potentially modifiable risk factors for dementia among these different groups.

Methods: We obtained risk factor prevalence from population-based surveys for established dementia risk factors (diabetes, midlife hypertension, midlife obesity, physical inactivity, depression, smoking, low educational attainment, social isolation). We used relative risk estimates reported in previous meta-analyses and estimated PARs using Levin's formula and accounting for communality. We tested for one-way and two-way interactions by sex and wealth using Pearson's χ2. In stratified analyses, we performed tests for trend using logistic regression.

Results: The prevalence of established risk factors for dementia ranged from 5% for depression to 64% for low education. After accounting for communality, the risk factors contributing the greatest PAR were low education (weighted PAR 12%, 95% CI 7% to 18%), physical inactivity (9, 5–14%), and midlife hypertension (6, 5–14%). Together, 45% of dementia cases may be attributable to modifiable risk factors (95% CI 25–59%). We found significant interactions (p < 0.005) between sex, wealth, or both (sex ^* wealth) and each risk factor except social isolation and physical activity. Low education was inversely associated with wealth in both male and female. The PAR for midlife hypertension, obesity, and diabetes was associated with increasing wealth, and was higher in female. In contrast, the PAR for smoking was higher in male (8% vs. 2%) and was associated with increasing wealth among female only. We found that either a strategy of large reductions in selected risk factors with the highest PAR (midlife hypertension, smoking, physical inactivity) or small reductions across all risk factors could potentially reduce dementia cases by as many as 250,000 by 2050.

Discussions: The potential impact on dementia risk by decreasing exposure to established dementia risk factors is large and differs by sex and social determinants of health like wealth. Risk factor PAR should inform national and local health policy dementia initiatives in South Africa including which risk factors to target in the whole population and which to target in high-risk groups for maximum public health benefit.

Global Gender Disparities in Premature Death from Cardiovascular Disease, and Their Associations with Country Capacity for Noncommunicable Disease Prevention and Control

This study aimed to describe the prevalence of gender disparity in cardiovascular disease and explore its association with a country’s capacity for controlling noncommunicable diseases. Study data were extracted from the Global Health Estimates, and the Noncommunicable Disease Country Capacity Survey. Age-standardized premature death rates from cardiovascular disease, defined as any death occurring from ages 30 to 70 years, were calculated. Univariate and multivariate general linear regression models were fitted to estimate the correlations between gender disparity and country capacity for noncommunicable disease control. Globally, the premature death rate from cardiovascular diseases was 35.6% higher among men than women in 2000, and the figure hardly changed from 2000 to 2016. The highest gender differences were observed in Europe and high-income countries. The existence of dedicated and multisectoral noncommunicable disease governance bodies and the availability of cardiovascular disease stratification in primary healthcare facilities were positively correlated with gender differences. Conclusively, gender disparities in premature death rates from cardiovascular diseases differed with economic conditions and across geographic regions, with higher relative differences observed in more developed countries. The effects of existing control measures may have plateaued in men but are ongoing among women, especially in more developed countries, widening the gender disparity.

Spatial and temporal analysis of myocardial infarction incidence in Zanjan province, Iran

Background

Myocardial Infarction (MI) is a major important public health concern and has huge burden on health system across the world. This study aimed to explore the spatial and temporal analysis of the incidence of MI to identify potential clusters of the incidence of MI patterns across rural areas in Zanjan province, Iran.

Materials & methods

This was a retrospective and geospatial analysis study of the incidence of MI data from nine hospitals during 2014–2018. Three different spatial analysis methods (Spatial autocorrelation, hot spot analysis and cluster and outlier analysis) were used to identify potential clusters and high-risk areas of the incidence of MI at the study area.

Results

Three thousand eight hundred twenty patients were registered at Zanjan hospitals due to MI during 2014–2018. The overall age-adjusted incidence rate of MI was 343 cases per 100,000 person which was raised from 88 cases in 2014 to 114 cases in 2018 per 100,000 person-year (a 30% increase, P < 0.001). Golabar region had the highest age-adjusted incidence rate of MI (515 cases per 100,000 person). Five hot spots and one high-high cluster were detected using spatial analysis methods.

Conclusion

This study showed that there is a great deal of spatial variations in the pattern of the incidence of MI in Zanjan province. The high incidence rate of MI in the study area compared to the national average, is a warning to local health authorities to determine the possible causes of disease incidence and potential drivers of high-risk areas. The spatial cluster analysis provides new evidence for policy-makers to design tailored interventions to reduce the incidence of MI and allocate health resource to unmet need areas.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11695-8.

Arterial Stiffness: Its Relation with Prediabetes and Metabolic Syndrome and Possible Pathogenesis

Aims: To evaluate arterial stiffness indicators in people with prediabetes (PreD) and its possible pathogenesis. Materials and methods: Pulse wave velocity (PWV) was measured in 208 people with FINDRISC ≥ 13 (57 ± 8 years old, 68.7% women) and thereafter divided into those having either normal glucose tolerance (NGT) or PreD. In each subgroup we also identified those with/out insulin resistance (IR) measured by the triglyceride/HDL-c ratio (normal cut off values previously established in our population). Clinical and metabolic data were collected for all participants. PWV was compared between subgroups using independent t test. Results: Women and men had comparable clinical and metabolic characteristics with obesity (BMI ≥ 30) and antihypertensive-statin treatment, almost half with either NGT or PreD. Whereas 48% of NGT people presented IR (abnormally high TG/HDL-c ratio), 52% had PreD. PWV was significantly higher only in those with a complete picture of metabolic syndrome (MS). Conclusions: Since PWV was significantly impaired in people with a complete picture of MS, clinicians must carefully search for early diagnosis of this condition and prescribe a healthy life-style to prevent development/progression of CVD. This proactive attitude would provide a cost-effective preventive strategy to avoid CVD’s negative impact on patients’ quality of life and on health systems due to their higher care costs.

Does tutors' support contribute to a telehealth program that aims to promote the quality of life of office workers? A cluster randomized controlled trial

The quality of life in the workplace can be achieved by creating a place more humanized and strategies that provide wellness to workers. The aim of this study was to investigate the effectiveness of telehealth education program to promote quality of life of office workers.This is a cluster randomized controlled trial (RCT). The participants were office workers computer users (n = 326). All received 9 audiovisual content (grouped into topics: musculoskeletal health, healthy diet, and mental health) that addresses the real needs identified by them in the focus groups. The intervention group (n = 178) was instructed to seek the tutor support about topics addressed by the audiovisual content. The primary outcome measure was quality of life by WHOQOL-BREF. The secondary outcome measure was level of physical activity of the participants. Data analysis was performed by General Linear Mixed Model. After six months of telehealth education program a general improvement in health and environmental domain, was observed in the intervention group. During that period, a within-group analysis showed that there was a significant improvement in the intervention group, with respect to quality of life in general health (p < 0.05) and in the environmental domain (p < 0.01).In the baseline to the eighth month, there were statistically significant changes within-group for the general health (p < 0.05) and for the physical domain (p < 0.01) in both groups (p < 0.01). Telehealth education program promoted an improvement in the participants' quality of life. There was no benefit in favor of the telehealth education program, with tutor support in relation to the conventional program.

TRIAL REGISTRATION

The trial was prospectively registered at ClinicalTrial.gov (NCT02980237). The date of registration was August 23, 2016.

Provider perceptions of hypertension care in a low-resource setting

AIM

Globally, the rapid increase of hypertension is particularly prevalent in low- and middle-income countries. Hypertension is the most significant modifiable risk factor for stroke and ischaemic heart disease, the leading cause of mortality in Vietnam. The aim of this study was to gain insight into the provision of hypertension care in Vietnam by exploring provider perceptions.

METHODS

A sequential exploratory mixed-method design was selected to allow for the initial qualitative interview findings to be incorporated into the development of the hypertension education workshop. Data were collected through semistructured interviews of 15 Vietnamese clinicians involved in the care of patients with hypertension.

RESULTS

Anxiety related to diagnosis of hypertension and specifically fear of having a stroke was mentioned by half of the participants. Several themes also emerged regarding barriers to implementing lifestyle modification to improve patient hypertension outcomes. There were contradictory opinions on the nurse's role in providing patient education across clinical settings. A lack of systematic structure and evidence-based teaching resources was also noted.

CONCLUSIONS

Gaining the provider's perspective increases understanding of the regional culture and context of hypertension care. The increased understanding can be used to improve provider education and enhance hypertension population outcomes.

The association between road traffic noise and myocardial infarction: A systematic review and meta-analysis

This systematic review and meta-analysis study aimed to investigate the association between exposure to road traffic noise (RTN) and myocardial infarction (MI). Of 681 studies found by searching in databases, including Scopus, Web of Science, Embase, and PubMed on November 29, 2019, the number of 13 studies, including seven cohort, five case-control, and one cross-sectional studies with 1,626,910 participants and 45,713 cases of MI was included. The pooled relative risk (RR) and 95% confidence interval (CI) of MI were calculated using a random-effect model across studies. Heterogeneity measures by reporting the I-square index. Subgroup analysis according to the designs and sensitivity analysis based on the Jackknife approach was performed. We observed in the eight studies the association was investigated in different noise exposure groups and in the 10 studies (including two conference papers) the risk of MI was provided per specific unit increment of RTN. We ran two independent types of meta-analyses involving a categorical analysis (comparing the highest and the lowest category of noise exposure groups) and an exposure-response analysis (the risk of MI per 10-dB increment of RTN). The pooled RR (95% CI) of MI for the categorical and exposure-response meta-analyses was calculated 1.03 (0.93, 1.13) and 1.02 (1.00, 1.05), respectively. For both types of meta-analyses, subgroup analysis indicates a significant association in the studies with case-control and cross-sectional designs but not cohort studies. For the exposure-response meta-analysis, a significantly greater risk of MI was observed after excluding the two conference papers (RR = 1.03 and 95% CI = 1.00, 1.05) and by further excluding the studies provided originally the risk of MI only for the categorical analysis (RR = 1.02 and 95% CI = 1.01, 1.03). We did not show a significant publication bias across studies. In conclusion, our study suggests a significant odds of association between exposure to RTN and the risk of MI.

Ambient air pollution and respiratory mortality in Xi'an, China: a time-series analysis

Background

Although air pollution is a known fundamental problem in China, few studies have investigated the associations between ambient air pollution and respiratory mortality in non-metropolitan cities of China. The study aimed to investigate a potential relationship between short-term exposure to ambient air pollutants and respiratory mortality in Xi’an, China.

Methods

Daily averages of PM_2.5, SO₂, O₃, temperature, relative humidity and daily counts of respiratory mortality were obtained (2014–2016). Using a single and multi-pollutant approach in time-series analysis, the generalized additive model with natural splines was used for analysis. Subgroup analysis stratified by gender and age group (≤ 64 years and ≥ 65 years) was conducted.

Results

Seven thousand nine hundred sixty-five cases of respiratory mortality were assessed, with 62.9, 28.5, and 8.6% of mortality attributed to chronic lower respiratory diseases, influenza and pneumonia, as well as other forms of respiratory diseases, respectively. Observed pollutants were significantly associated with respiratory mortality. In the single pollutant model, 10 μg/m³ increase in a two-day moving average of PM_2.5, and SO₂ concentrations were significantly associated with relative risk 1.313(1.032, 1.708) and 1.4020(0.827, 2.854) of respiratory mortality, respectively. The effects of both air pollutants remained statistically significant after adjusting for collinearity in the multi-pollutant model. Ozone was only statistically associated with respiratory mortality in females at lag 0 [RR: 0.964(0.938, 0.991)].

Conclusion

This study provided evidence that respiratory mortality in Xi’an was significantly associated with exposure to ambient air pollutants from 2014 to 2016.

Development of an e-health education program at the workplace using formative research - Technologies for improving quality of life

BACKGROUND

e-Learning, a means by which to expand people's access to information can be effective in promoting health in the workplace. This study to present steps in the development of an e-health education program at the workplace.

OBJECTIVE

This study aimed to present all steps of develop a telehealth education program for computer users using formative research to identify themes to health education for workers.

METHODS

A team of expert conducted focus groups with administrative workers (n = 36 participants) to identify thematic health to the development of program. Three meetings were audio video recorded, and notes. All data were based on constant analysis, classical content analysis and keywords in-context.

RESULTS

The content of the nine audio videos included four musculoskeletal health topics (Walking Program, Back School, Muscle Relaxation Techniques, and Work-related Musculoskeletal Diseases); three to healthy diet (Eating and Commensality, Ultra-processed Food and Food labeling, and Oil and Fat); two to mental health (Burnout Syndrome and the Meaning of work).

CONCLUSION

The proposed steps in the development of a workplace e-health education program were successfully achieved. The engagement of the workers' staged focus groups was fundamental to the choice of themes relevant to the population in question.

Survival and incidence of cardiovascular diseases in participants in a long-distance ski race (Vasaloppet, Sweden) compared with the background population

Aims

We studied the relationship between taking part in a long-distance ski race and incidence of cardiovascular diseases (CVDs) to address the hypothesis that lifestyle lowers the incidence.

Methods and results

A cohort of 399 630 subjects in Sweden, half were skiers in the world's largest ski race, and half were non-skiers. Non-skiers were frequency matched for sex, age, and year of race. Individuals with severe diseases were excluded. The endpoints were death, myocardial infarction, or stroke. The subjects were followed up for a maximum of 21.8 years and median of 9.8 years. We identified 9399 death, myocardial infarction, or stroke events among non-skiers and 4784 among the Vasaloppet skiers. The adjusted hazard ratios (HRs) comparing skiers and non-skiers were 0.52 [95% confidence interval (CI) 0.49-0.54] for all-cause mortality, 0.56 (95% CI 0.52-0.60) for myocardial infarction and 0.63 (95% CI 0.58-0.67) for stroke and for all three outcomes 0.56 (95% CI 0.54-0.58). The results were consistent across subgroups: age, sex, family status, education, and race year. For skiers, a doubling of race time was associated with a higher age-adjusted risk of 19%, and male skiers had a doubled risk than female skiers, with a HR 2.06 (95% CI 1.89-2.41). The outcome analyses revealed no differences in risk of atrial fibrillation between skiers and non-skiers.

Conclusion

This large cohort study provides additional support for the hypothesis that individuals with high level of physical activity representing a healthy lifestyle, as evident by their participation in a long-distance ski race, have a lower risk of CVD or death.

Dose-response association of dietary sodium intake with all-cause and cardiovascular mortality: a systematic review and meta-analysis of prospective studies

OBJECTIVE

High Na intake has been associated with different health problems. However, serious controversies exist over studies investigating associations of Na intake with mortality from all-causes and CVD. The present systematic review and meta-analysis was done to investigate, for the first time, the dose-response association of dietary Na intake with all-cause and CVD mortality among prospective studies.

DESIGN

Relevant papers published up to August 2017 were searched in MEDLINE, EMBASE and Google Scholar databases. Prospective cohort studies on the association of dietary Na intake with all-cause or/and CVD mortality were included. Linear and non-linear dose-response associations between Na intake and CVD and all-cause mortality were examined.

RESULTS

Overall, twenty publications met inclusion criteria. A significant non-linear association (P&lt;0·001) was found between Na intake and CVD mortality risk among studies assessing urinary Na excretion, with a relatively steep slope at Na intakes above 2400mg/d. However, the association was not significant in studies using dietary Na intake (P=0·61). Additionally, the non-linear association of Na intake with all-cause mortality was also non-significant. No linear association (effect size; 95 % CI; I 2) was seen between 100mg/d increment in Na intake and CVD mortality (1·01; 0·97, 1·05; 98·4 %) or all-cause mortality (1·01; 1·00, 1·02; 89·2 %). Following subgroup analyses, the association between Na intake and CVD mortality was observed only among studies conducted in the USA (0·99; 0·99, 1·00; 20·0 %).

CONCLUSIONS

The study showed a direct association between urinary Na excretion and CVD mortality which was more considerable at intakes above 2400mg/d. In contrast, no significant association was found between Na intake and all-cause mortality. Further long-term prospective studies on different populations are required to confirm these findings.

Pharmacist-Led Intervention to Enhance Medication Adherence in Patients With Acute Coronary Syndrome in Vietnam: A Randomized Controlled Trial

Background: Patient adherence to cardioprotective medications improves outcomes of acute coronary syndrome (ACS), but few adherence-enhancing interventions have been tested in low-income and middle-income countries.

Objectives: We aimed to assess whether a pharmacist-led intervention enhances medication adherence in patients with ACS and reduces mortality and hospital readmission.

Methods: We conducted a randomized controlled trial in Vietnam. Patients with ACS were recruited, randomized to the intervention or usual care prior to discharge, and followed 3 months after discharge. Intervention patients received educational and behavioral interventions by a pharmacist. Primary outcome was the proportion of adherent patients 1 month after discharge. Adherence was a combined measure of self-reported adherence (the 8–item Morisky Medication Adherence Scale) and obtaining repeat prescriptions on time. Secondary outcomes were (1) the proportion of patients adherent to medication; (2) rates of mortality and hospital readmission; and (3) change in quality of life from baseline assessed with the European Quality of Life Questionnaire – 5 Dimensions – 3 Levels at 3 months after discharge. Logistic regression was used to analyze data. Registration: ClinicalTrials.gov (NCT02787941).

Results: Overall, 166 patients (87 control, 79 intervention) were included (mean age 61.2 years, 73% male). In the analysis excluding patients from the intervention group who did not receive the intervention and excluding all patients who withdrew, were lost to follow-up, died or were readmitted to hospital, a greater proportion of patients were adherent in the intervention compared with the control at 1 month (90.0% vs. 76.5%; adjusted OR = 2.77; 95% CI, 1.01–7.62) and at 3 months after discharge (90.2% vs. 77.0%; adjusted OR = 3.68; 95% CI, 1.14–11.88). There was no significant difference in median change of EQ-5D-3L index values between intervention and control [0.000 (0.000; 0.275) vs. 0.234 (0.000; 0.379); p = 0.081]. Rates of mortality, readmission, or both were 0.8, 10.3, or 11.1%, respectively; with no significant differences between the 2 groups.

Conclusion: Pharmacist-led interventions increased patient adherence to medication regimens by over 13% in the first 3 months after ACS hospital discharge, but not quality of life, mortality and readmission. These results are promising but should be tested in other settings prior to broader dissemination.

Hypertension, overweight/obesity, and diabetes among immigrants in the United States: an analysis of the 2010-2016 National Health Interview Survey

BACKGROUND

Ethnic minority populations in the United States (US) are disproportionately affected by cardiovascular disease (CVD) risk factors, including hypertension, overweight/obesity, and diabetes. The size and diversity of ethnic minority immigrant populations in the US have increased substantially over the past three decades. However, most studies on immigrants in the US are limited to Asians and Hispanics; only a few have examined the prevalence of CVD risk factors across diverse immigrant populations. The prevalence of diagnosed hypertension, overweight/obesity, and diagnosed diabetes was examined and contrasted among a socioeconomically diverse sample of immigrants. It was hypothesized that considerable variability would exist in the prevalence of hypertension, overweight and diabetes.

METHODS

A cross-sectional analysis of the 2010-2016 National Health Interview Survey (NHIS) was conducted among 41,717 immigrants born in Europe, South America, Mexico/Central America/Caribbean, Russia, Africa, Middle East, Indian subcontinent, Asia and Southeast Asia. The outcomes were the prevalence of diagnosed hypertension, overweight/obesity, and diagnosed diabetes.

RESULTS

The highest multivariable adjusted prevalence of diagnosed hypertension was observed in Russian (24.2%) and Southeast Asian immigrants (23.5%). Immigrants from Mexico/Central America/Caribbean and the Indian subcontinent had the highest prevalence of overweight/obesity (71.5 and 73.4%, respectively) and diagnosed diabetes (9.6 and 10.1%, respectively). Compared to European immigrants, immigrants from Mexico/Central America/Caribbean and the Indian subcontinent respectively had higher prevalence of overweight/obesity (Prevalence Ratio (PR): 1.19[95% CI, 1.13-1.24]) and (PR: 1.22[95% CI, 1.14-1.29]), and diabetes (PR: 1.70[95% CI, 1.42-2.03]) and (PR: 1.78[95% CI, 1.36-2.32]). African immigrants and Middle Eastern immigrants had a higher prevalence of diabetes (PR: 1.41[95% CI, 1.01-1.96]) and PR: 1.57(95% CI: 1.09-2.25), respectively, than European immigrants -without a corresponding higher prevalence of overweight/obesity.

CONCLUSIONS

Immigrants from Mexico/Central America/Caribbean and the Indian subcontinent bore the highest burden of overweight/obesity and diabetes while those from Southeast Asia and Russia bore the highest burden of hypertension.

Melatonin Efficacy in Obese Leptin-Deficient Mice Heart

Cardiomyocytes are particularly sensitive to oxidative damage due to the link between mitochondria and sarcoplasmic reticulum necessary for calcium flux and contraction. Melatonin, important indoleamine secreted by the pineal gland during darkness, also has important cardioprotective properties. We designed the present study to define morphological and ultrastructural changes in cardiomyocytes and mainly in mitochondria of an animal model of obesity (ob/ob mice), when treated orally or not with melatonin at 100 mg/kg/day for 8 weeks (from 5 up to 13 week of life). We observed that ob/ob mice mitochondria in sub-sarcolemmal and inter-myofibrillar compartments are often devoid of cristae with an abnormally large size, which are called mega-mitochondria. Moreover, in ob/ob mice the hypertrophic cardiomyocytes expressed high level of 4hydroxy-2-nonenal (4HNE), a marker of lipid peroxidation but scarce degree of mitofusin2, indicative of mitochondrial sufferance. Melatonin oral supplementation in ob/ob mice restores mitochondrial cristae, enhances mitofusin2 expression and minimizes 4HNE and p62/SQSTM1, an index of aberrant autophagic flux. At pericardial fat level, adipose tissue depot strictly associated with myocardium infarction, melatonin reduces adipocyte hypertrophy and inversely regulates 4HNE and adiponectin expressions. In summary, melatonin might represent a safe dietary adjuvant to hamper cardiac mitochondria remodeling and the hypoxic status that occur in pre-diabetic obese mice at 13 weeks of life.

Cellular mechanisms underlying obesity-induced arterial stiffness

Obesity is an emerging pandemic driven by consumption of a diet rich in fat and highly refined carbohydrates (a Western diet) and a sedentary lifestyle in both children and adults. There is mounting evidence that arterial stiffness in obesity is an independent and strong predictor of cardiovascular disease (CVD), cognitive functional decline, and chronic kidney disease. Cardiovascular stiffness is a precursor to atherosclerosis, systolic hypertension, cardiac diastolic dysfunction, and impairment of coronary and cerebral flow. Moreover, premenopausal women lose the CVD protection normally afforded to them in the setting of obesity, insulin resistance, and diabetes, and this loss of CVD protection is inextricably linked to an increased propensity for arterial stiffness. Stiffness of endothelial and vascular smooth muscle cells, extracellular matrix remodeling, perivascular adipose tissue inflammation, and immune cell dysfunction contribute to the development of arterial stiffness in obesity. Enhanced endothelial cortical stiffness decreases endothelial generation of nitric oxide, and increased oxidative stress promotes destruction of nitric oxide. Our research over the past 5 years has underscored an important role of increased aldosterone and vascular mineralocorticoid receptor activation in driving development of cardiovascular stiffness, especially in females consuming a Western diet. In this review the cellular mechanisms of obesity-associated arterial stiffness are highlighted.

Gamma-glutamyltransferase and risk of cardiovascular mortality: A dose-response meta-analysis of prospective cohort studies

BACKGROUND

Serum gamma-glutamyltransferase (GGT) elevation likely contributes to cardiovascular (CV) mortality, however it has remained unknown whether a dose-response relationship exists between serum GGT and CV mortality.

METHODS

We searched the PubMed, EMBASE, and Cochrane library databases for prospective cohort studies published up to October 2, 2016. Summary hazard ratios (HRs) with their corresponding 95% confidence intervals (CIs) were calculated using a fixed effects model.

FINDINGS

Nine prospective studies, including 527,589 participants and more than 7,011 cases, were included in this meta-analysis. For the moderate, high, and highest levels of GGT, the pooled HRs of CV mortality were 1.11 (95% CI = 1.04-1.19), 1.29 (95% CI = 1.21-1.38) and 1.59 (95% CI = 1.47-1.72), respectively (all p < 0.05 as compared to the lowest levels of GGT). Additionally, the HR per incremental increase of GGT by 10 U/L was 1.10 (95% CI = 1.08-1.11). Evidence of a positive relationship with nonlinear trend for GGT elevation with CV mortality in females was found (P = 0.04 for nonlinearity). However, a linear model was better fit to illustrate the GGT-CV mortality among males (P = 0.304 for nonlinearity).

CONCLUSIONS

These findings indicate that serum GGT activity within the reference interval is positively associated with increased risk of CV mortality in a dose-response manner.

Cheese Consumption and Risk of All-Cause Mortality: A Meta-Analysis of Prospective Studies

The association between cheese consumption and risk for major health endpoints has been investigated in many epidemiologic studies, but findings are inconsistent. As all-cause mortality can be viewed as the final net health effect of dietary intakes, we conducted a meta-analysis to examine the long-term association of cheese consumption with all-cause mortality. Relevant studies were identified by a search of the PubMed database through May 2016. Reference lists from retrieved articles were also reviewed. Summary relative risks (RR) and 95% confidence intervals (CI) were calculated using a random-effects model. Pre-specified stratified and dose-response analyses were also performed. The final analysis included nine prospective cohort studies involving 21,365 deaths. The summary RR of all-cause mortality for the highest compared with the lowest cheese consumption was 1.02 (95% CI: 0.97, 1.06), and little evidence of heterogeneity was observed. The association between cheese consumption and risk of all-cause mortality did not significantly differ by study location, sex, age, number of events, study quality score or baseline diseases excluded. There was no dose-response relationship between cheese consumption and risk of all-cause mortality (RR per 43 g/day = 1.03, 95% CI: 0.99-1.07). No significant publication bias was observed. Our findings suggest that long-term cheese consumption was not associated with an increased risk of all-cause mortality.