1
|
Camps-Vilaró A, Subirana I, Elosua R, Palomo I, Sanchis J, Tizón-Marcos H, Cainzos-Achirica M, Sala J, Masia R, Ramos R, Dégano IR, Marrugat J. Analysis of myocardial infarction incidence and case-fatality in the last three decades in the province of Girona. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:450-458. [PMID: 37981192 DOI: 10.1016/j.rec.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/28/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION AND OBJECTIVES Myocardial infarction (MI) incidence and case fatality trends are highly informative but relatively untested at the population level. The objective of this work was to estimate MI incidence and case fatality in the Girona population aged 35-74 years, and to determine their 30-year trends (1990-2019). METHODS The REGICOR (Girona Heart Registry) monitored MI incidence and case fatality rates from 1990 to 2008. For the period 2008 to 2019, we linked discharges from Girona hospitals (n=4 974 977) and mortality registry (n=70 405) during this period. Our linkage algorithm selected key MI diagnostic codes and removed duplicates. Estimates from the linkage algorithm and the REGICOR registry were compared using chi-square tests for overlapping years (2008-2009). We estimated the annual percent change (APC) of standardized MI incidence and 28-day case fatality, and analyzed their trends using joinpoint regression. RESULTS MI incidence and case fatality estimates were similar in the linkage algorithm and the REGICOR registry. We observed significant decreasing trends in the incidence of MI. The trend was APC, -0.96% (95% confidence interval (95%CI), -1.4 to -0.53) in women from 1990 to 2019 and -4.2% (95%CI, -5.5 to -3.0) in men from 1994 to 2019. The largest decrease in case fatality was -3.8% (95%CI, -5.1 to -2.5) from 1995 to 2003 in women and -2.4% (95%CI, -2.9 to -1.9) from 1995 to 2004 in men, mainly due to prehospital case fatality declines: -1.8% (95%CI, -2.6 to -1.1) in men and -3.2% (95%CI, -4.6 to -1.8) in women. CONCLUSIONS In Girona, MI incidence and case fatality decreased between 1990 and 2019. The incidence showed a slow but continuous decrease while case fatality only stabilized in the last decade, particularly in women.
Collapse
Affiliation(s)
- Anna Camps-Vilaró
- Grup d'Estudi REGICOR, Institut de Recerca Hospital del Mar (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Doctoral College, University of Vic-Central University of Catalonia (Uvic-UCC), Vic, Barcelona, Spain
| | - Isaac Subirana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Grup d'Epidemiologia i Genètica Cardiovascular, Institut de Recerca Hospital del Mar (IMIM), Barcelona, Spain
| | - Roberto Elosua
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Doctoral College, University of Vic-Central University of Catalonia (Uvic-UCC), Vic, Barcelona, Spain; Facultat de Medicina, Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Vic, Barcelona, Spain
| | - Iván Palomo
- Centro de Investigación en Trombosis, Departmento de Bioquímica Clínica e Inmunohematología, Escuela de Ciencias de la Salud, Universidad de Talca, Talca, Chile
| | - Juan Sanchis
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Cardiology Department, Hospital Clínic de Valencia, Valencia, Spain
| | - Helena Tizón-Marcos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servei de Cardiologia, Hospital del Mar, Barcelona, Spain
| | | | - Joan Sala
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servei de Cardiologia, Hospital Universitari Josep Trueta, Girona, Spain
| | - Rafael Masia
- Servei de Cardiologia, Hospital Universitari Josep Trueta, Girona, Spain
| | - Rafel Ramos
- Unitat de Recerca de Medicina Familiar-de Girona, Institut de Recerca en Atenció Primària Jordi Gol, Barcelona, Spain
| | - Irene R Dégano
- Grup d'Estudi REGICOR, Institut de Recerca Hospital del Mar (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Grup d'Epidemiologia i Genètica Cardiovascular, Institut de Recerca Hospital del Mar (IMIM), Barcelona, Spain; Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), Vic, Barcelona, Spain.
| | - Jaume Marrugat
- Grup d'Estudi REGICOR, Institut de Recerca Hospital del Mar (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| |
Collapse
|
2
|
Esmaeili P, Roshanravan N, Ghaffari S, Mesri Alamdari N, Asghari-Jafarabadi M. Unraveling atherosclerotic cardiovascular disease risk factors through conditional probability analysis with Bayesian networks: insights from the AZAR cohort study. Sci Rep 2024; 14:4361. [PMID: 38388574 PMCID: PMC10883955 DOI: 10.1038/s41598-024-55141-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 02/20/2024] [Indexed: 02/24/2024] Open
Abstract
This study aimed at modelling the underlying predictor of ASCVD through the Bayesian network (BN). Data for the AZAR Cohort Study, which evaluated 500 healthcare providers in Iran, was collected through examinations, and blood samples. Two BNs were used to explore a suitable causal model for analysing the underlying predictor of ASCVD; Bayesian search through an algorithmic approach and knowledge-based BNs. Results showed significant differences in ASCVD risk factors across background variables' levels. The diagnostic indices showed better performance for the knowledge-based BN (Area under ROC curve (AUC) = 0.78, Accuracy = 76.6, Sensitivity = 62.5, Negative predictive value (NPV) = 96.0, Negative Likelihood Ratio (LR-) = 0.48) compared to Bayesian search (AUC = 0.76, Accuracy = 72.4, Sensitivity = 17.5, NPV = 93.2, LR- = 0.83). In addition, we decided on knowledge-based BN because of the interpretability of the relationships. Based on this BN, being male (conditional probability = 63.7), age over 45 (36.3), overweight (51.5), Mets (23.8), diabetes (8.3), smoking (10.6), hypertension (12.1), high T-C (28.5), high LDL-C (23.9), FBS (12.1), and TG (25.9) levels were associated with higher ASCVD risk. Low and normal HDL-C levels also had higher ASCVD risk (35.3 and 37.4), while high HDL-C levels had lower risk (27.3). In conclusion, BN demonstrated that ASCVD was significantly associated with certain risk factors including being older and overweight male, having a history of Mets, diabetes, hypertension, having high levels of T-C, LDL-C, FBS, and TG, but Low and normal HDL-C and being a smoker. The study may provide valuable insights for developing effective prevention strategies for ASCVD in Iran.
Collapse
Affiliation(s)
- Parya Esmaeili
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Epidemiology and Biostatistics, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Roshanravan
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samad Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mohammad Asghari-Jafarabadi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
- Cabrini Research, Cabrini Health, Malvern, VIC, 3144, Australia.
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, 3004, Australia.
- Department of Psychiatry, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, 3168, Australia.
| |
Collapse
|
3
|
Schubert CR, Pinto AA, Paulsen AJ, Chappell RJ, Chen Y, Engelman CD, Ferrucci L, Hancock LM, Johnson SC, Merten N. Midlife sensory and motor functions improve long-term predictions of cognitive decline and incidence of cognitive impairment. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12543. [PMID: 38288267 PMCID: PMC10823154 DOI: 10.1002/dad2.12543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/31/2024]
Abstract
INTRODUCTION We aimed to assess whether midlife sensory and motor functions improve risk prediction of 10-year cognitive decline and impairment when added to risk prediction models using the Cardiovascular Risk Factors, Aging, and Incidence of Dementia Score (CAIDE) and Framingham Risk Score (FRS). METHODS Longitudinal data of N = 1529 (mean age 49 years; 54% women) Beaver Dam Offspring Study (BOSS) participants from baseline, 5 and 10-year follow-up were included. We tested whether including baseline sensory (hearing, vision, olfactory) impairment and motor function improves CAIDE or FRS risk predictions of 10-year cognitive decline or cognitive impairment incidence using logistic regressions. RESULTS Adding sensory and motor measures to CAIDE-only and FRS-only models significantly improved areas under the curve for cognitive decline and impairment models. DISCUSSION Including midlife sensory and motor function improved risk predictions of long-term cognitive decline and impairment in middle-aged to older adults. Sensory and motor assessments could contribute to cost-effective and non-invasive screening tools that identify high-risk individuals earlier to target intervention and prevention strategies. Highlights Sensory and motor measures improve risk prediction models of cognitive decline.Sensory and motor measures improve risk prediction models of cognitive impairment.Prediction improvements were strongest in midlife (adults < 55 years of age).Sensory and motor changes may help identify high-risk individuals early.
Collapse
Affiliation(s)
- Carla R. Schubert
- Department of Population Health SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - A. Alex Pinto
- Department of Biostatistics and Medical InformaticsSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Adam J. Paulsen
- Department of Population Health SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Richard J. Chappell
- Department of Biostatistics and Medical InformaticsSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of StatisticsSchool of Computer, Data & Information SciencesUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Yanjun Chen
- Department of Ophthalmology and Visual SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Corinne D. Engelman
- Department of Population Health SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Luigi Ferrucci
- Longitudinal Study Section, Intramural Research ProgramNational Institute on Aging, NIHGaithersburgMarylandUSA
| | - Laura M. Hancock
- Neurological InstituteSection of NeuropsychologyCleveland ClinicClevelandOhioUSA
| | - Sterling C. Johnson
- Division of Geriatrics and GerontologyDepartment of MedicineSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Natascha Merten
- Department of Population Health SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Division of Geriatrics and GerontologyDepartment of MedicineSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| |
Collapse
|
4
|
Cohen GH, Bor J, Keyes KM, Demmer RT, Stellman SD, Puac-Polanco V, Galea S. What was the impact of tobacco taxes on smoking prevalence and coronary heart disease mortality in the United States -2005-2016, and did it vary by race and gender? Prev Med 2023; 175:107653. [PMID: 37532031 DOI: 10.1016/j.ypmed.2023.107653] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/10/2023] [Accepted: 07/29/2023] [Indexed: 08/04/2023]
Abstract
Tobacco taxes have reduced smoking and coronary heart disease (CHD) mortality, yet few studies have examined heterogeneity of these associations by race and gender. We constructed a yearly panel (2005-2016) that included age-adjusted cigarette smoking prevalence and CHD mortality rates across all 50 U.S. States and the District of Columbia using the Behavioral Risk Factor Surveillance System and Wide-ranging Online Data for Epidemiological Research. We examined associations between changes in total cigarette excise taxes (i.e., federal and state) and changes in smoking prevalence and CHD mortality, using linear regression models with state and year fixed effects. Each dollar of tobacco tax was associated with a reduction in age-adjusted smoking prevalence 1 year later of -0.4 [95% CIs: -0.6, -0.2] percentage points; and a relative reduction in the rate of CHD mortality 2 years later of -2.0% [95% CIs: -3.7%, -0.3%], or -5 deaths/100,000 in absolute terms. Associations between tobacco taxes and smoking prevalence were statistically significantly different by race and gender and were strongest among Black non-Hispanic women (-1.2 [95% CIs: -1.6, -0.8] percentage points). Associations between tobacco taxes and CHD mortality were not statistically significantly different by race and gender, but point estimates for percent changes were highest among Black non-Hispanic men (-2.9%) and Black non-Hispanic women (-3.5%) compared to White non-Hispanic men (-1.8%) and White non-Hispanic women (-1.5%). These findings suggest that tobacco taxation is an effective intervention for reducing smoking prevalence and CHD mortality among White and Black non-Hispanic populations in the United States.
Collapse
Affiliation(s)
- Gregory H Cohen
- Boston University School of Public Health, Department of Epidemiology, 715 Albany St., Boston, MA 02118, United States of America.
| | - Jacob Bor
- Boston University School of Public Health, Department of Global Health, 715 Albany St., Boston, MA 02118, United States of America
| | - Katherine M Keyes
- Columbia University, Mailman School of Public Health, Department of Epidemiology, 722 West 168th St., New York, NY 10032, United States of America
| | - Ryan T Demmer
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, 300 West Bank Office Building, 1300 S. 2nd St., Minneapolis, MN 55454, United States of America
| | - Steven D Stellman
- Columbia University, Mailman School of Public Health, Department of Epidemiology, 722 West 168th St., New York, NY 10032, United States of America
| | - Victor Puac-Polanco
- Harvard Medical School, Department of Health Care Policy, 180 Longwood Avenue, Boston, MA 02115, United States of America
| | - Sandro Galea
- Boston University School of Public Health, Office of the Dean, 715 Albany St., Boston, MA 02118, United States of America
| |
Collapse
|
5
|
Bender U, Norris CM, Dreyer RP, Krumholz HM, Raparelli V, Pilote L. Impact of Sex- and Gender-Related Factors on Length of Stay Following Non-ST-Segment-Elevation Myocardial Infarction: A Multicountry Analysis. J Am Heart Assoc 2023; 12:e028553. [PMID: 37489737 PMCID: PMC10492965 DOI: 10.1161/jaha.122.028553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/30/2023] [Indexed: 07/26/2023]
Abstract
Background Gender-related factors are psycho-socio-cultural characteristics and are associated with adverse clinical outcomes in acute myocardial infarction, independent of sex. Whether sex- and gender-related factors contribute to the substantial heterogeneity in hospital length of stay (LOS) among patients with non-ST-segment-elevation myocardial infarction remains unknown. Methods and Results This observational cohort study combined and analyzed data from the GENESIS-PRAXY (Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome study), EVA (Endocrine Vascular Disease Approach study), and VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI [Acute Myocardial Infarction] Patients study) cohorts of adults hospitalized across Canada, the United States, Switzerland, Italy, Spain, and Australia for non-ST-segment-elevation myocardial infarction. In total, 5219 participants were assessed for eligibility. Sixty-three patients were excluded for missing LOS, and 2938 were excluded because of no non-ST-segment-elevation myocardial infarction diagnosis. In total, 2218 participants were analyzed (66% women; mean±SD age, 48.5±7.9 years; 67.8% in the United States). Individuals with longer LOS (51%) were more likely to be White race, were more likely to have diabetes, hypertension, and a lower income, and were less likely to be employed and have completed secondary education. No univariate association between sex and LOS was observed. In the adjusted multivariable model, age (0.62 d/10 y; P<0.001), unemployment (0.63 days; P=0.01), and some of countries included relative to Canada (Italy, 4.1 days; Spain, 1.7 days; and the United States, -1.0 days; all P<0.001) were independently associated with longer LOS. Medical history mediated the effect of employment on LOS. No interaction between sex and employment was observed. Longer LOS was associated with increased 12-month all-cause mortality. Conclusions Older age, unemployment, and country of hospitalization were independent predictors of LOS, regardless of sex. Individuals employed with non-ST-segment-elevation myocardial infarction were more likely to experience shorter LOS. Sociocultural factors represent a potential target for improvement in health care expenditure and resource allocation.
Collapse
Affiliation(s)
- Uri Bender
- Department of Medicine, McGill University and Centre for Outcomes Research and EvaluationResearch Institute, McGill University Health CentreMontrealQuebecCanada
| | - Colleen M. Norris
- Faculties of Nursing, Medicine and School of Public HealthUniversity of AlbertaEdmontonCanada
| | - Rachel P. Dreyer
- Department of Emergency MedicineYale School of MedicineNew HavenCTUSA
- Center for Outcomes Research and EvaluationYale New Haven HospitalNew HavenCTUSA
- Department of BiostatisticsYale School of Public HealthNew HavenCTUSA
- Section of Cardiovascular Medicine, Department of Internal MedicineYale School of MedicineNew HavenCTUSA
- Department of Health Policy and ManagementYale School of Public HealthNew HavenCTUSA
| | - Harlan M. Krumholz
- Section of Cardiovascular Medicine, Department of Internal MedicineYale School of MedicineNew HavenCTUSA
- Department of Health Policy and ManagementYale School of Public HealthNew HavenCTUSA
| | - Valeria Raparelli
- Department of Translational MedicineUniversity of FerraraItaly
- University Center for Studies on Gender MedicineUniversity of FerraraItaly
| | - Louise Pilote
- Department of Medicine, McGill University and Centre for Outcomes Research and EvaluationResearch Institute, McGill University Health CentreMontrealQuebecCanada
| |
Collapse
|
6
|
Merten N, Pinto AA, Paulsen AJ, Chen Y, Schubert CR, Cruickshanks KJ. Better cognitive function in younger generations - Insights from two cohort studies of middle-aged to older adults in Wisconsin. Maturitas 2022; 162:31-36. [PMID: 35526325 PMCID: PMC9233025 DOI: 10.1016/j.maturitas.2022.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Understanding generational trends in dementia and cognitive decline is essential to quantify future healthcare needs and may help identify interventions and preventions. We aimed to determine whether individuals from more recent generations showed better neurocognitive function. METHODS This cross-sectional study combined data from 4439 participants (mean age 64 years (SD = 13); 57% were women) from the Epidemiology of Hearing Loss Study and Beaver Dam Offspring Study. We assessed participants' birth cohort (1901-1924, Greatest Generation; 1925-1945, Silent Generation; 1946-1964, Baby Boom Generation; 1965-1984, Generation X) and neurocognition (Trail-Making Tests A and B, Digit Symbol Substitution Test, Auditory Verbal Learning Test, Verbal Fluency Test). Multivariable linear regression models were utilized. RESULTS Adjusted for age, sex, education, and known risk factors for cognitive decline, more recent generations showed better processing speed, executive function, attention, and verbal fluency than the Greatest Generation. Largest benefits were found in the Baby Boom Generation. Compared with the Greatest Generation, individuals from the Baby Boom Generation performed better on Trail-Making Tests A (-0.21 ln(time in s); 95% confidence interval (CI) -0.29, -0.13) and B (-0.31 ln(time in s); 95% CI -0.40, -0.22), Digit Symbol Substitution Test (6.07 numbers correct; 95% CI 3.61, 8.52) and Verbal Fluency Test (8.75 numbers correct; 95% CI 5.07, 12.42 in women; 5.28 numbers correct; 95% CI 0.79, 9.78 in men), with effect sizes similar to effects of 11-15 years of less aging. CONCLUSIONS This indicates that some benefits of younger generations might be related to yet unknown and potentially modifiable environmental, health-related or lifestyle factors and motivates research of such underlying factors to promote healthy cognitive aging.
Collapse
Affiliation(s)
- Natascha Merten
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA; Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA.
| | - A Alex Pinto
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA
| | - Adam J Paulsen
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA
| | - Yanjun Chen
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA
| | - Carla R Schubert
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA
| | - Karen J Cruickshanks
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA; Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, WI, USA
| |
Collapse
|
7
|
Ding M, Zhou Y, Li C, Li W, Jia N, Dong X. Can the WHO 's recommendations of physical activity volume decrease the risk of heart disease in middle and older aged Chinese People: the evidence from a seven year longitudinal survey. BMC Geriatr 2022; 22:596. [PMID: 35850665 PMCID: PMC9290295 DOI: 10.1186/s12877-022-03276-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 07/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background At present, there is a lack of direct evidence to confirm whether the recommendations of the World Health Organization can play a role in fitness and disease prevention in the Chinese population. Therefore, we aimed to analyse 7-year longitudinal survey data to explore whether the physical activity volume recommended by the World Health Organization can help Chinese middle-aged and elderly people reduce the risk of heart disease. Methods Data for the 8327 participants who were finally included in this study were derived from the 7-year data of the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018. The physical activity volume is expressed by the product of physical frequency and duration, and heart disease is screened according to self-reported diagnosis and related treatment. The relationship between different physical activity volume groups and the incidence rate of heart disease was determined by a multivariate Cox proportional hazards regression model. Results After adjusting for all covariates, participants meeting the WHO’s recommendations had a 20% lower risk of heart disease than those who did not meet the WHO’s recommendations (HR = 0.80, 95% = 0.68–0.96). Subgroup analysis showed that among the participants meeting the WHO’s recommendations, men (HR = 0.71) had a lower risk of heart disease than women (HR = 0.74); in addition, the risk of heart disease was significantly reduced in participants who were middle-aged (26%), had a normal BMI range (49%), did not have hypertension (24%), did not have hyperlipidaemia (21%) and did not have lung disease (21%). It should be noted that the risk of heart disease was reduced by 72 and 67% in participants with untreated hyperlipidaemia and untreated lung disease, respectively. Conclusions This study revealed that meeting the WHO’s recommendations for physical activity volume can reduce the risk of heart disease in middle-aged and older people in China and can also effectively prevent heart disease for people with some common chronic diseases, such as hyperlipidaemia and lung disease. The results showed that physical activity for leisure and exercise had a lower preventive effect on heart disease than physical activity for a job, which may be related to the inappropriate leisure and exercise methods of the participants. Trial registration IRB00001052–11015.
Collapse
Affiliation(s)
- Meng Ding
- College of Physical Education, Shandong Normal University, 17923 Jingshi Road, Jinan, 250014, China
| | - Yanan Zhou
- College of Physical Education, Shandong Normal University, 17923 Jingshi Road, Jinan, 250014, China
| | - Chengxiang Li
- College of Physical Education, Shandong Normal University, 17923 Jingshi Road, Jinan, 250014, China
| | - Weipeng Li
- College of Physical Education, Shandong Normal University, 17923 Jingshi Road, Jinan, 250014, China
| | - Ningxin Jia
- College of Physical Education, Shandong Normal University, 17923 Jingshi Road, Jinan, 250014, China
| | - Xiaosheng Dong
- Department of Sport and Health, School of Physical Education, Shandong University, Jinan, 250061, China.
| |
Collapse
|
8
|
Sex Differences and Temporal Trends in Revascularization and Outcomes of ST-Elevation Myocardial Infarction in Older Adults in the United States. Arch Med Res 2022; 53:441-450. [PMID: 35484020 DOI: 10.1016/j.arcmed.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/30/2021] [Accepted: 03/16/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Previous studies have suggested that in-hospital mortality is higher in younger women with ST-segment elevation myocardial infarction (STEMI) than in men. However, more coronary artery disease diagnoses occurred in patients older than 60 years. AIM OF THE STUDY This study sought to investigate the temporal trends and sex differences in revascularization and in-hospital outcomes in older STEMI patients. METHODS National Inpatient Sample databases from 2005-2014 were utilized to identify all STEMI patients with age greater than 60 years old. We studied the temporal trends and sex differences in revascularization therapies and in-hospital mortality. RESULTS From 2005-2014, there were 192,204 older adults diagnosed with STEMI. Older women with STEMI were less likely to receive reperfusion (percutaneous coronary intervention (PCI) adjusted OR: 0.90; 95% CI: 0.87-0.92) compared to older men. Also, the adjusted odds ratio comparing the likelihood of receiving PCI between women and men decreased by an annual average of 0.9% (p = 0.028). Older women had higher in-hospital mortality than men (adjusted OR: 1.12; 95% CI: 1.08 to 1.17). There was no significant change of adjusted in-hospital mortality in both genders (all p >0.05). CONCLUSIONS Older women were less likely to receive revascularization for STEMI, and this gap was increasing during the study period. Older women had higher in-hospital mortality as compared with older men, but there was no significant temporal change for both genders. These findings present an opportunity to bridge the gender-gap in providing care to older patients with STEMI.
Collapse
|
9
|
Williams BA, Voyce S, Sidney S, Roger VL, Plante TB, Larson S, LaMonte MJ, Labarthe DR, DeBarmore BM, Chang AR, Chamberlain AM, Benziger CP. Establishing a National Cardiovascular Disease Surveillance System in the United States Using Electronic Health Record Data: Key Strengths and Limitations. J Am Heart Assoc 2022; 11:e024409. [PMID: 35411783 PMCID: PMC9238467 DOI: 10.1161/jaha.121.024409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiovascular disease surveillance involves quantifying the evolving population-level burden of cardiovascular outcomes and risk factors as a data-driven initial step followed by the implementation of interventional strategies designed to alleviate this burden in the target population. Despite widespread acknowledgement of its potential value, a national surveillance system dedicated specifically to cardiovascular disease does not currently exist in the United States. Routinely collected health care data such as from electronic health records (EHRs) are a possible means of achieving national surveillance. Accordingly, this article elaborates on some key strengths and limitations of using EHR data for establishing a national cardiovascular disease surveillance system. Key strengths discussed include the: (1) ubiquity of EHRs and consequent ability to create a more "national" surveillance system, (2) existence of a common data infrastructure underlying the health care enterprise with respect to data domains and the nomenclature by which these data are expressed, (3) longitudinal length and detail that define EHR data when individuals repeatedly patronize a health care organization, and (4) breadth of outcomes capable of being surveilled with EHRs. Key limitations discussed include the: (1) incomplete ascertainment of health information related to health care-seeking behavior and the disconnect of health care data generated at separate health care organizations, (2) suspect data quality resulting from the default information-gathering processes within the clinical enterprise, (3) questionable ability to surveil patients through EHRs in the absence of documented interactions, and (4) the challenge in interpreting temporal trends in health metrics, which can be obscured by changing clinical and administrative processes.
Collapse
|
10
|
ST-Elevation Myocardial Infarction Outcomes: A United States Nationwide Emergency Departments Cohort Study. J Emerg Med 2022; 62:306-315. [PMID: 35058097 DOI: 10.1016/j.jemermed.2021.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/18/2021] [Accepted: 10/12/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Literature regarding trends in incidence and mortality of ST-elevation myocardial infarction (STEMI) in emergency departments (EDs) is limited. OBJECTIVE To study the trends of incidence and mortality of STEMI. METHODS Using the National Emergency Department Sample database in the United States, we identified all ED encounters for patients presenting with STEMI using International Classification of Diseases codes. A linear p-trend was used to assess the trends. RESULTS Out of the 973 million ED encounters represented, 641,762 (65/100,000; mean age 69 [59-81] years, 35.8% female) adult patients were recorded with STEMI. Among the major complications associated with STEMI, a total of 49,401 (7.7%) had cardiac complications, which included acute heart failure (n = 9361, 1.6%), ventricular tachycardia or fibrillation (n = 12,267, 1.91%), conduction block (n = 20,165, 3.1%), and cardiogenic shock (n = 7608, 1.2%). There were 5675 (0.9%) patients recorded with cerebrovascular events, which included acute ischemic stroke among 5205 (0.8%) patients and 470 (0.1%) with transient ischemic attack. Acute kidney injury was recorded for 10,082 (1.6%) patients. The trend for incidence of STEMI in the ED had decreased from 7.76/10,000 in 2011 to 4.07/10,000 in 2018 (linear p-trend 0.0006). However, the yearly mortality of STEMI related to ED encounters had remained relatively steady: 7.56% in 2011 to 7.50% in 2018 (linear p-trend 0.2364). CONCLUSION Despite the fact that the number of patients presenting to the ED with STEMI has been decreasing, the mortality trends have remained steady. Further research of in-hospital STEMI may yield opportunities to reduce the risk of complications, improve patient outcomes and decrease health care burden.
Collapse
|
11
|
Mannoh I, Turkson-Ocran RA, Mensah J, Mensah D, Yi SS, Michos ED, Commodore-Mensah Y. Disparities in Awareness of Myocardial Infarction and Stroke Symptoms and Response Among United States- and Foreign-Born Adults in the National Health Interview Survey. J Am Heart Assoc 2021; 10:e020396. [PMID: 34845927 PMCID: PMC9075376 DOI: 10.1161/jaha.121.020396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Atherosclerotic cardiovascular disease, defined as nonfatal myocardial infarction (MI), coronary heart disease death, or fatal or nonfatal stroke, is the leading cause of death in the United States. MI and stroke symptom awareness and response reduce delays in hospitalization and mortality. Methods and Results We analyzed cross‐sectional data from the 2014 and 2017 National Health Interview Surveys on US‐ and foreign‐born adults from 9 regions of birth (Europe, South America, Mexico/Central America/Caribbean, Russia, Africa, Middle East, Indian subcontinent, Asia, and Southeast Asia). The outcomes were recommended MI and stroke knowledge, defined as knowing all 5 symptoms of MI or stroke, respectively, and choosing “call 9‐1‐1” as the best response. We included 63 059 participants, with a mean age 49.4 years; 54.1% were women, and 38.5% had a high school education or less. Recommended MI and stroke knowledge were highest in US‐born people. In both 2014 and 2017, MI knowledge was lowest in individuals born in Asia (23.9%±2.5% and 32.1%±3.3%, respectively), and stroke knowledge lowest for the Indian subcontinent (44.4%±2.4% and 46.0%±3.2%, respectively). Among foreign‐born adults, people from Russia and Europe had the highest prevalence of recommended MI knowledge in 2014 (37.4%±5.4%) and 2017 (43.5%±2.5%), respectively, and recommended stroke knowledge was highest in people from Europe (61.0%±2.6% and 67.2%±2.5%). Improvement in knowledge was not significant in all groups between 2014 and 2017. Conclusions These findings suggest a disparity in MI and stroke symptom awareness and response among immigrants in the United States. Culturally tailored public health education and health literacy initiatives are needed to help reduce these disparities in awareness.
Collapse
Affiliation(s)
- Ivy Mannoh
- School of Medicine Johns Hopkins University Baltimore MD
| | | | | | | | - Stella S Yi
- Grossman School of Medicine New York University New York NY
| | - Erin D Michos
- School of Medicine Johns Hopkins University Baltimore MD
| | | |
Collapse
|
12
|
Paulsen AJ, Fischer ME, Pinto A, Merten N, Dillard LK, Schubert CR, Huang GH, Klein BEK, Tweed TS, Cruickshanks KJ. Incidence of Hearing Impairment and Changes in Pure-Tone Average Across Generations. JAMA Otolaryngol Head Neck Surg 2021; 147:151-158. [PMID: 33211071 DOI: 10.1001/jamaoto.2020.4352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Age-adjusted prevalence of hearing impairment (HI) decreased across generations in the 20th century, suggesting that HI is partially preventable. It is not known whether HI incidence differs by generation. Objectives To examine whether HI incidence and change in pure-tone average (PTA) differ by generation and identify factors underlying these differences. Design, Setting, and Participants This cohort study used data from the Epidemiology of Hearing Loss Study (EHLS) and Beaver Dam Offspring Study (BOSS), a pair of studies of adults in Beaver Dam, Wisconsin. Baseline examinations occurred from 1993 to 1995 in the EHLS and 2005 to 2008 in BOSS, with two 5-year follow-up examinations in each cohort. This longitudinal cohort study assessed 3651 participants without HI at baseline who had follow-up data. Main Outcomes and Measures The primary outcome was incident HI measured by pure-tone audiometry, defined as PTA greater than 25-dB hearing level (dB HL) in either ear. Associations of 5-year incidence were estimated by relative risks (RRs) and 10-year cumulative incidence with generation, as categorized by commonly used sociodemographic descriptors of year of birth, by hazard ratios (HRs). The 10-year change in PTA was investigated using a generation × time interaction term in generalized estimating equation models. Results Among the 3651 participants (mean [SD] age at baseline 53.1 [10.6] years; 2255 [61.8%] female; and 3567 [97.7%] non-Hispanic White), the 5-year HI incidence was 14.1% (95% CI, 13.0%-15.3%) and the 10-year cumulative incidence was 26.0% (95% CI, 24.6%-27.6%). The incidence increased with age. The risk of 5-year incident HI decreased by generation (RR, 0.80; 95% CI, 0.66-0.97) when adjusting for multiple covariates. The decreased risk was similar in the 10-year period (HR, 0.86; 95% CI, 0.73-1.01). The PTA change rate (per 5 years of follow-up) decreased by generation, with the Greatest Generation (born 1901-1924) experiencing the highest rate (7.03 dB HL). The rates were all significantly lower for the other generations (Silent Generation [born 1925-1945], 3.30 dB HL; Baby Boom Generation [born 1946-1964], 3.36 dB HL; and Generation X [born 1965-1984], 2.33 dB HL). Conclusions and Relevance This study suggests that the risk of HI and rate of PTA change is lower for the Silent Generation and Baby Boom Generation compared with the Greatest Generation. Part of this lower risk is likely associated with changes in modifiable factors. A potential continued benefit may exist for Generation X. Combined with the reduced risk of HI for the Silent Generation and Baby Boom Generation, this finding implies that the future HI burden may be lower than current estimates suggest.
Collapse
Affiliation(s)
- Adam J Paulsen
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Mary E Fischer
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Alex Pinto
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Natascha Merten
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Lauren K Dillard
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison.,Department of Communication Sciences and Disorders, University of Wisconsin, Madison (Dillard)
| | - Carla R Schubert
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Guan-Hua Huang
- Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan
| | - Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Ted S Tweed
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Karen J Cruickshanks
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison.,Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison
| |
Collapse
|
13
|
Kim J, Byun SJ, Woo SJ, Park KH, Park SJ. Assessment of Trends in the Incidence Rates of Central Retinal Artery Occlusion in Korea From 2002 to 2015. JAMA Ophthalmol 2021; 139:399-405. [PMID: 33570556 DOI: 10.1001/jamaophthalmol.2020.6860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Central retinal artery occlusion (CRAO) is associated with and shares common risk factors with cardiovascular diseases. Over the past several decades, the incidence rates of stroke and ischemic heart disease have substantially decreased in high-income industrialized countries. However, little is known regarding current trends in CRAO incidence rates. Objective To estimate trends in the incidence rates of CRAO in Korea. Design, Setting, and Participants This nationwide population-based cohort study was designed on September 7, 2017, and used data from the Korean National Health Insurance Service from January 1, 2002, to December 31, 2015. Individuals with incident CRAO between 2002 and 2015 were identified using the CRAO diagnostic code (H34.1) from the International Classification of Diseases, Tenth Revision. Unadjusted CRAO incidence rates were calculated using the number of CRAO cases identified and the corresponding midyear population, which was obtained from resident registration data. Standardized incidence rates were calculated based on the 2015 census population, and weighted mean annual incidence rates with 95% CIs were computed based on the Poisson distribution. To identify trends in incidence rates, joinpoint regression analysis was performed using standardized incidence rates, and annual percentage changes (APCs) were calculated across the 12-year study period. Data were analyzed from May 1, 2019, to April 30, 2020. Main Outcomes and Measures Temporal trends in CRAO incidence rates (measured as cases per 100 000 person-years) and age-standardized APCs in CRAO incidence rates using joinpoint and birth cohort analyses. Results Among 50 million residents of Korea, 9892 individuals (5884 men [59.5%]) with incident CRAO between 2002 and 2015 were identified. The mean age of Korean individuals diagnosed with CRAO was 62.4 years (range, 0-97 years); among men and women, the mean age was 61.5 years (range, 0-96 years) and 63.6 years (range, 0-97 years), respectively. The mean standardized incidence rate of CRAO was 2.00 cases per 100 000 person-years (95% CI, 1.97-2.04 cases per 100 000 person-years) among the entire population, 2.43 cases per 100 000 person-years (95% CI, 2.37-2.49 cases per 100 000 person-years) among men, and 1.61 cases per 100 000 person-years (95% CI, 1.57-1.66 cases per 100 000 person-years) among women. The highest incidence rate (9.85 cases per 100 000 person-years; 95% CI, 9.10-10.60 cases per 100 000 person-years) was observed among those aged 80 to 84 years (13.74 cases per 100 000 person-years [95% CI, 12.16-15.32 cases per 100 000 person-years] for men and 8.04 cases per 100 000 person-years [95% CI, 7.21-8.86 cases per 100 000 person-years] for women). The incidence rate in the overall study population decreased over time (APC, -3.46%; 95% CI, -4.3% to -2.6%), and this decreasing trend was more evident in women (APC, -4.56%; 95% CI, -5.7% to -3.4%) than in men (APC, -2.90%; 95% CI, -3.9% to -1.9%). The decrease in the incidence rate was more evident among participants younger than 65 years (APC, -6.80%; 95% CI, -8.3% to -5.2%) than among those 65 years and older (APC, -0.57%; 95% CI, -1.5% to -0.4%). Among participants born after 1930, a decrease in the CRAO incidence rate over time was observed in every age group, while the same decreasing trend was not present among those born before 1930. Conclusions and Relevance This study found that the CRAO incidence rate has been decreasing among residents of Korea, especially among women, individuals younger than 65 years, and individuals born after 1930. This observed decrease may be associated with the development of a national health care system and the general improvement in chronic disease management.
Collapse
Affiliation(s)
- Jongshin Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Seong Jun Byun
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| |
Collapse
|
14
|
Affiliation(s)
- Christy L Avery
- Departments of Epidemiology (C.L.A., H.B.N.), University of North Carolina at Chapel Hill.,the Carolina Population Center (C.L.A., A.G.H.), University of North Carolina at Chapel Hill
| | - Annie Green Howard
- Biostatistics (A.G.H.), University of North Carolina at Chapel Hill.,the Carolina Population Center (C.L.A., A.G.H.), University of North Carolina at Chapel Hill
| | - Hazel B Nichols
- Departments of Epidemiology (C.L.A., H.B.N.), University of North Carolina at Chapel Hill
| |
Collapse
|
15
|
Trends in Incidence and Case Fatality Rates of Heart Disease and Its Subtypes in Korea, 2006-2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228451. [PMID: 33203087 PMCID: PMC7696411 DOI: 10.3390/ijerph17228451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 12/25/2022]
Abstract
Heart disease (HD) is the second leading cause of death in Korea. Several studies in Korea have analyzed the trends of incidence and mortality of myocardial infarction (MI) and ischemic heart disease (IHD), but few have investigated incidence and mortality trends of HD and its subtypes. The aim of this study was to assess the national trends in incidence and case fatality rates of overall HD and its subtypes (including IHD, heart failure (HF), arrhythmia, hypertensive HD (HHD), valvular HD, pulmonary HD, and others) in Korea between 2006 and 2015. Using records from the National Health Insurance Service (NHIS) claims database (2003–2015) and by obtaining the causes of death (Korean Statistical Information Service, 2006–2017), we analyzed the crude and age-standardized incidence rates from 2006 to 2015 and the case fatality rates from 2006 to 2017 of HD and its subtypes. Between 2006 and 2015, the incidence of overall HD changed minimally, but the age-standardized incidence of HD decreased from 210.0 persons per 100,000 populations in 2006 to 161.3 persons in 2015. However, incidence rates have increased in arrhythmia, HD other, pulmonary HD, and the case fatality rates have increased in HF, valvular HD, and HD other. Therefore, it is essential to continuously monitor the incidence and case fatality rates of HD and its subtypes and expand the focus onto prevention and treatment strategies from MI or IHD to various HD subtypes. Active prevention and management are needed to alleviate the burden of HD due to an aging population in Korea.
Collapse
|
16
|
Paulsen AJ, Pinto A, Fischer ME, Chen Y, Huang GH, Klein BEK, Klein R, Cruickshanks KJ. Generational Differences in the 10-year Incidence of Impaired Contrast Sensitivity. Ophthalmic Epidemiol 2020; 28:175-182. [PMID: 32693658 DOI: 10.1080/09286586.2020.1791909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine if incidence of contrast sensitivity (CS) impairment differs by generation and identify factors to explain these differences. METHODS The Beaver Dam Eye Study (BDES) and Beaver Dam Offspring Study (BOSS) are cohort studies of aging adults in Beaver Dam, Wisconsin. Baseline examinations occurred from 1993 to 1995 (BDES) and 2005-2008 (BOSS). Follow-up examinations occurred in five-year intervals. CS testing was conducted with Pelli-Robson letter sensitivity charts; Incident impairment was a log CS score <1.55 in either eye at follow-up. Associations of incidence with generation were investigated using estimated hazard ratios (HR) with 95% confidence intervals (CI). RESULTS Participants (N = 3185) had a mean age of 51.9 years at baseline (standard deviation = 9.9) and 51.9% were female. Ten-year cumulative incidence of CS impairment was 40.1%, was higher among women (41.7%) than men (38.8%), and increased by age group. The risk of incident CS impairment decreased by 39% per generation. In multivariable models, the Baby Boom Generation (HR = 0.42, 95%CI = 0.31, 0.58) and Generation X (HR = 0.56, 95%CI = 0.34, 0.91) had a significantly decreased risk of CS impairment compared to the Greatest Generation. Results were similar in sensitivity analyses excluding those with cataract, age-related macular degeneration, or visual acuity impairment. CONCLUSION The risk of incident CS impairment decreased by birth cohort, with the greatest reduction in the Baby Boom Generation. The difference in risk suggests that there are unknown modifiable risk factors that may help to further explain the etiology of CS impairment and provide potential pathways for prevention in the future.
Collapse
Affiliation(s)
- Adam J Paulsen
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Alex Pinto
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Mary E Fischer
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Yanjun Chen
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Guan-Hua Huang
- Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan
| | - Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Karen J Cruickshanks
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.,Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| |
Collapse
|
17
|
Deng Q, Li XX, Fang Y, Chen X, Xue J. Therapeutic Potential of Quercetin as an Antiatherosclerotic Agent in Atherosclerotic Cardiovascular Disease: A Review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:5926381. [PMID: 32565865 PMCID: PMC7292974 DOI: 10.1155/2020/5926381] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/31/2020] [Accepted: 05/02/2020] [Indexed: 12/11/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is one of the diseases with the highest morbidity and mortality globally. It causes a huge burden on families and caregivers and high costs for medicine and surgical interventions. Given expensive surgeries and failures of most conventional treatments, medical community tries to find a more cost-effective cure. Thus, attentions have been primarily focused on food or herbs. Quercetin (Qu) extracted from food, a flavonoid component, develops potentials of alternative or complementary medicine in atherosclerosis. Due to the wide range of health benefits, researchers have considered to apply Qu as a natural compound in therapy. This review is aimed to identify the antiatherosclerosis functions of Qu in treating ASCVD such as anti-inflammatory, antioxidant properties, effects on endothelium-dependent vasodilation, and blood lipid-lowering.
Collapse
Affiliation(s)
- Qian Deng
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao Xue Li
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yanting Fang
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xin Chen
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jingui Xue
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
18
|
Abstract
After decades of improvement in the outlook for cardiovascular disease (CVD), we are now seeing a plateau. Statins, once believed to be the most important advance in the fight against heart disease, have not mitigated the incidence or prevalence of CVD. AIM New research into lipid-lowering drugs is not only questioning their usefulness in primary care, but identifying them as harmful, resulting in the development of other diseases. When the original research is critically analyzed, the data do not reveal drugs that significantly reduce the incidence or prevalence for primary prevention of CVD in the United States. METHODS The current article sheds light on our current beliefs into lipid-lowering to treat potential CVD. Through a discussion of the difference between relative risk reduction and absolute risk reduction, the author suggests lifestyle modifications have been and always will be the best way to fight against this deadly chronic disease. RESULTS There is over 60 years-worth of scientific research that has been desperately trying to identify sugar as the culprit and driver of CVD disease; however, the medical system continues to fight against fat and cholesterol. This article makes the reader question what the US government, in association with the Medical Establishment (American Heart Association, American Diabetes Association and the American College of Cardiology) have been eschewing for the last 60-70 years as it has NOT been working. CONCLUSION The time for a culture-wide paradigm change has come. The author suggests this will only happen if Big Pharma and Big Food industries will change their marketing habits from 'purely taste' to 'best for your health'.
Collapse
|
19
|
Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4741] [Impact Index Per Article: 1185.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Collapse
|
20
|
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5236] [Impact Index Per Article: 1047.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
21
|
Hu XM, Chen X, Pang HY, Liu HH, Chen PP, Shi JL, Tang S, Wu ZH, Zhang SY. Plasma levels of receptor interacting protein kinase-3 correlated with coronary artery disease. Chin Med J (Engl) 2019; 132:1400-1405. [PMID: 31205096 PMCID: PMC6629337 DOI: 10.1097/cm9.0000000000000225] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Necroptosis plays an important role in human atherosclerosis and atheroma development. Since receptor interacting protein kinase-3 (RIP3) acts as a key mediator of necroptosis, this study aimed to explore its relationship between plasma RIP3 levels and coronary artery disease (CAD) and discover a potential new biomarker for screening CAD subtypes and severity. METHODS A total of 318 patients with CAD who had coronary angiography and 166 controls in Peking Union Medical College Hospital from September 2017 to January 2018 were enrolled in this study. Patients with CAD were divided into three subgroups: patients with stable coronary artery disease (SCAD), patients with unstable angina (UA), and patients with myocardial infarction (MI). The severity of atherosclerosis was determined by Gensini score (GSS). Logistic regression was used to determine the relationship between plasma RIP3 levels and CAD. The correlation between plasma RIP3 and GSS was calculated using multiple linear regression models. RESULTS Overall, plasma RIP3 levels were significantly higher than serum RIP3 levels. Plasma RIP3 levels in patients with CAD were significantly higher than those in controls. Plasma RIP3 levels were strongly associated with CAD (odds ratio: 6.00, 95% confidence interval 3.04-11.81; P < 0.001). Plasma RIP3 levels increased linearly from controls to patients with SCAD, then patients with UA, and finally to patients with MI. We found a significantly positive correlation between proportion of cases of acute coronary syndrome in subjects and their plasma RIP3 level quartile. Plasma RIP3 levels were also associated with GSS (B 0.027; standard error 0.012; P < 0.05). CONCLUSIONS Plasma RIP3 levels were independently associated with CAD. Plasma RIP3 levels could potentially supplement clinical assessment to screen CAD and determine CAD severity.
Collapse
Affiliation(s)
- Xiao-Min Hu
- Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xi Chen
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hai-Yu Pang
- Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hong-Hong Liu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Pei-Pei Chen
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jing-Lin Shi
- Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Si Tang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhi-Hong Wu
- Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Shu-Yang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| |
Collapse
|
22
|
Cruickshanks KJ, Nondahl DM, Johnson LJ, Dalton DS, Fisher ME, Huang GH, Klein BE, Klein R, Schubert CR. Generational Differences in the 5-Year Incidence of Age-Related Macular Degeneration. JAMA Ophthalmol 2019; 135:1417-1423. [PMID: 29145549 DOI: 10.1001/jamaophthalmol.2017.5001] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Whether a reported decline in the risk of developing age-related macular degeneration (AMD) continued for people born during the Baby Boom years (1946-1964) or later is unknown. These data are important to plan for ocular health care needs in the 21st century. Objectives To determine whether the 5-year risk for AMD declined by generation and to identify factors that contributed to improvement in risk. Design, Setting, and Participants Data came from the longitudinal cohort Beaver Dam Eye Study (March 1, 1988, through September 15, 1990, and March 1, 1993, through June 15, 1995) and the Beaver Dam Offspring Study (June 8, 2005, through August 4, 2008, and July 12, 2010, through March 21, 2013). These population-based studies examined residents of Beaver Dam, Wisconsin, aged 43 to 84 years in 1987 through 1988 and their adult offspring aged 21 to 84 years in 2005 through 2008. A total of 4819 participants were at risk for developing AMD based on fundus images obtained at baseline visits. Data were analyzed from February 18, 2016, through June 22, 2017, with additional analyses ending September 22, 2017. Main Outcomes and Measures Fundus images were graded for AMD using the Wisconsin Age-related Maculopathy Grading System. The incidence of AMD was defined as the presence at the 5-year follow-up examination of pure geographic atrophy or exudative macular degeneration, any type of drusen with pigmentary abnormalities, or soft indistinct drusen without pigmentary abnormalities. Results Among the 4819 participants, the mean (SD) baseline age of the cohort was 54 (11) years; 2117 were men (43.9%) and 2702 were women (56.1%). The 5-year age- and sex-adjusted incidence of AMD was 8.8% in the Greatest Generation (born during 1901-1924), 3.0% in the Silent Generation (born during 1925-1945), 1.0% in the Baby Boom Generation (born during 1946-1964), and 0.3% in Generation X (born during 1965-1984). Adjusting for age and sex, each generation was more than 60% less likely to develop AMD than the previous generation (relative risk, 0.34; 95% CI, 0.24-0.46). The generational association (relative risk, 0.40; 95% CI, 0.28 to 0.57) remained significant after adjusting for age, sex, smoking, educational attainment, exercise, levels of non–high-density lipoprotein cholesterol and high-sensitivity C-reactive protein, and use of nonsteroidal anti-inflammatory drugs, statins, and multivitamins. Conclusions and Relevance The 5-year risk for AMD declined by birth cohorts throughout the 20th century. Factors that explain this decline in risk are not known. However, this pattern is consistent with reported declines in risks for cardiovascular disease and dementia, suggesting that aging Baby Boomers may experience better retinal health at older ages than did previous generations.
Collapse
Affiliation(s)
- Karen J Cruickshanks
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin–Madison,Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
| | - David M Nondahl
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Lauren J Johnson
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Dayna S Dalton
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Mary E Fisher
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Guan-Hua Huang
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison,Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan
| | - Barbara E Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Carla R Schubert
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
| |
Collapse
|
23
|
Gatzke N, Güc N, Hillmeister P, Dülsner A, Le Noble F, Buschmann EE, Ingwersen M, Bramlage P, Buschmann IR. Cardiovascular drugs attenuated myocardial resistance against ischaemia-induced and reperfusion-induced injury in a rat model of repetitive occlusion. Open Heart 2019; 5:e000889. [PMID: 30613411 PMCID: PMC6307560 DOI: 10.1136/openhrt-2018-000889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/03/2018] [Accepted: 11/12/2018] [Indexed: 12/26/2022] Open
Abstract
Objective We investigated the impact of cardioprotective drugs on ST-elevation, arrhythmias and infarct size in a rat model of repetitive coronary artery occlusion. Methods Seventy Sprague-Dawley rats were randomised to two control and five treatment groups. Placebo was either implantation of a pneumatic occluder onto the left anterior descending coronary artery (LAD) without starting repetitive occlusion (SHAM) or subsequent RO of the LAD over 10 days without medication (ROP). Treatment groups underwent RO and additionally received nitroglycerin (NTG), metoprolol, verapamil (VER), ranolazine (RAN) or candesartan (CAN). Two weeks after the intervention, rats underwent a single, sustained LAD occlusion followed by reperfusion. To evaluate differences in cardiac resistance against myocardial ischaemia and reperfusion injury, cardiac surrogate parameters including maximal ST-elevation, arrhythmias and infarct size were assessed. Results Compared with sham, RO alone and RO plus nitroglycerin were associated with significantly lower maximal ST-elevation and percentage of infarcted myocardium (SHAM 0.12 mV, ROP 0.06 mV (p=0.004), NTG 0.05 mV (p=0.005); SHAM 16.2%, ROP 6.6% (p=0.008), NTG 5.9% (p=0.006). Compared with RO alone, RO plus RAN was accompanied by increased ST-elevation (0.13 mV, p=0.018) and RO plusVER or CAN by more infarcted myocardium (14.2%, p=0.004% and 15.5%, p=0.003, respectively). Rats treated with VER, RAN or CAN tended to severe arrhythmias more frequently than those of the control groups. Conclusions RO led to an increased myocardial resistance against ischaemia and reperfusion injury. Concomitant administration of nitroglycerin did not affect the efficacy of RO. Cardiovascular channel or receptor blockers reduced the efficacy of RO.
Collapse
Affiliation(s)
- Nora Gatzke
- Department for Angiology, Brandenburg Medical School, Campus Brandenburg/Havel, Brandenburg, Germany
- Department of Cardiology, Charité University Hospital, Campus Virchow, Center for Cardiovascular Research (CCR) Charité University Hospital, Berlin, Germany
| | - Nadija Güc
- Department of Cardiology, Charité University Hospital, Campus Virchow, Center for Cardiovascular Research (CCR) Charité University Hospital, Berlin, Germany
| | - Philipp Hillmeister
- Department for Angiology, Brandenburg Medical School, Campus Brandenburg/Havel, Brandenburg, Germany
- Department of Cardiology, Charité University Hospital, Campus Virchow, Center for Cardiovascular Research (CCR) Charité University Hospital, Berlin, Germany
| | - André Dülsner
- Department of Cardiology, Charité University Hospital, Campus Virchow, Center for Cardiovascular Research (CCR) Charité University Hospital, Berlin, Germany
| | - Ferdinand Le Noble
- Department of Cell and Developmental Biology & Institute for Toxicology and Genetics, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Eva Elina Buschmann
- Department for Angiology, Brandenburg Medical School, Campus Brandenburg/Havel, Brandenburg, Germany
- Department of Cardiology, Charité University Hospital, Campus Virchow, Center for Cardiovascular Research (CCR) Charité University Hospital, Berlin, Germany
| | - Maja Ingwersen
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Department for Angiology, Brandenburg Medical School, Campus Brandenburg/Havel, Brandenburg, Germany
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Ivo R Buschmann
- Department for Angiology, Brandenburg Medical School, Campus Brandenburg/Havel, Brandenburg, Germany
- Department of Cardiology, Charité University Hospital, Campus Virchow, Center for Cardiovascular Research (CCR) Charité University Hospital, Berlin, Germany
| |
Collapse
|
24
|
Harrington DH, Stueben F, Lenahan CM. ST-Elevation Myocardial Infarction and Non-ST-Elevation Myocardial Infarction: Medical and Surgical Interventions. Crit Care Nurs Clin North Am 2018; 31:49-64. [PMID: 30736935 DOI: 10.1016/j.cnc.2018.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Coronary artery disease is the leading cause of death in both men and women in the United States. Annually, 790,000 Americans will experience a myocardial infarction. Early recognition and appropriate management of myocardial infarction are imperative to improving patient outcomes. This article discusses the pathophysiology, presentation, and diagnosis and management of both ST-elevation myocardial infarction (STEMI) and non-STEMI.
Collapse
Affiliation(s)
- Deedra H Harrington
- Department of Nursing, University of Louisiana at Lafayette, College of Nursing and Allied Health Professions, 411 East Street Mary Boulevard, Lafayette, LA 70504, USA.
| | - Frances Stueben
- Department of Nursing, University of Louisiana at Lafayette, College of Nursing and Allied Health Professions, 411 East Street Mary Boulevard, Lafayette, LA 70504, USA
| | - Christy McDonald Lenahan
- Department of Nursing, University of Louisiana at Lafayette, College of Nursing and Allied Health Professions, 411 East Street Mary Boulevard, Lafayette, LA 70504, USA
| |
Collapse
|
25
|
Cruickshanks KJ. Generational Differences in Lifetime Exposure to Lead and the Decreasing Incidence of Age-Related Macular Degeneration-Reply. JAMA Ophthalmol 2018; 136:958-959. [PMID: 29902287 DOI: 10.1001/jamaophthalmol.2018.2175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Karen J Cruickshanks
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Wisconsin, Madison.,Department of Population Health Sciences, School of Public Health, University of Wisconsin, Madison
| |
Collapse
|
26
|
Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4466] [Impact Index Per Article: 744.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
27
|
Alvarez-Alvarez B, Abou Jokh Casas C, Garcia Acuña JM, Cid Alvarez B, Agra Bermejo RM, Cordero Fort A, Rodríguez Mañero M, Gude Sampedro F, González-Juanatey JR. Temporal trends between association of evidence-based treatment and outcomes in patients with non-ST-elevation myocardial infarction. Int J Cardiol 2018; 260:1-6. [PMID: 29506939 DOI: 10.1016/j.ijcard.2018.02.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 02/12/2018] [Accepted: 02/26/2018] [Indexed: 01/22/2023]
Affiliation(s)
- Belén Alvarez-Alvarez
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Charigan Abou Jokh Casas
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Jose María Garcia Acuña
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Belén Cid Alvarez
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Rosa María Agra Bermejo
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Alberto Cordero Fort
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain
| | - Moisés Rodríguez Mañero
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Francisco Gude Sampedro
- Epidemiology Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - José R González-Juanatey
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| |
Collapse
|
28
|
Adingupu DD, Westergren HU, Dahgam S, Jönsson-Rylander AC, Blomster J, Albertsson P, Omerovic E, Svedlund S, Gan LM. Radial artery intima-media thickness regresses after secondary prevention interventions in patients' post-acute coronary syndrome and is associated with cardiac and kidney biomarkers. Oncotarget 2017; 8:53419-53431. [PMID: 28881821 PMCID: PMC5581120 DOI: 10.18632/oncotarget.18511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 05/17/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Radial artery intima-media thickness (rIMT) measured by ultra-high-resolution ultrasound is associated with increased cardiovascular risk and predicts outcomes. We performed non-invasive high-resolution ultrasound of the radial artery to investigate vascular changes in subjects presenting with acute coronary syndrome (ACS) and who had undergone percutaneous coronary intervention (PCI). PURPOSE In the present work, we aimed to follow rIMT change over time post-acute coronary syndrome as a tool to monitor potential response to intensified medical therapy. METHODS We examined 256 subjects who underwent PCI due to ACS and healthy controls (n= 39) and we measured a number of biomarkers, which are known to be associated with cardiovascular disease. Images of radial artery were acquired bilaterally in the longitudinal view using a 50 MHz transducer (Vevo 2100 VisualSonics, Inc, Toronto, Ontario, Canada). Carotid IMT (cIMT) and rIMT were measured at <1 month after index PCI followed by a repeated measurement of rIMT at 4 months from the ACS in a sub-set (n=117). RESULTS rIMT measured within 1 month post ACS was significantly higher than rIMT after 4 months from ACS, (p < 0.0001), mean ± SD (rIMT right 0.35 ± 0.08; rIMT left 0.37 ± 0.08) vs. (rIMT right 0.29 ± 0.08; rIMT left 0.31 ± 0.09) respectively. There was no statistically significant change in cIMT. In healthy controls there were no changes in rIMT or cIMT overtime. High levels of CX3CL1 and myeloperoxidase measured within one month post ACS are associated with increase of rIMT, r=0.38 (p< 0.0001) and r=0.41 (p< 0.0001) respectively. CONCLUSIONS rIMT seem to decrease systemically after ACS and is accompanied with corresponding biomarker change. The cause and clinical implications of the observed decrement in rIMT after ACS need further studies.
Collapse
Affiliation(s)
| | - Helena U Westergren
- AstraZeneca R&D Gothenburg, Mölndal, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | | | | | - Juuso Blomster
- AstraZeneca R&D Gothenburg, Mölndal, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Per Albertsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sara Svedlund
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Li-Ming Gan
- AstraZeneca R&D Gothenburg, Mölndal, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
29
|
Trends in atrial fibrillation hospitalizations in the United States: A report using data from the National Hospital Discharge Survey. Indian Pacing Electrophysiol J 2017; 18:6-12. [PMID: 29477216 PMCID: PMC5840763 DOI: 10.1016/j.ipej.2017.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/08/2017] [Accepted: 07/17/2017] [Indexed: 11/25/2022] Open
Abstract
Aims Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. Patients presenting with AF are often admitted to hospital for rhythm or rate control, symptom management, and/or anticoagulation. We investigated temporal trends in AF hospitalizations in United States from 1996 to 2010. Methods Data were obtained from the National Hospital Discharge Survey (NHDS), a national probability sample survey of discharges conducted annually by National Center for Health Statistics. Because of the survey design, sampling weights were applied to the raw NHDS data to produce national estimates. Hospitalizations with a primary diagnosis of AF were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code of 427.31. Weighted least squares regression was used to test for linear trends in the number of AF admissions, length of stay, and inpatient mortality. We further stratified AF admissions based on patients' age, gender, and race. Results Admissions for a primary diagnosis of AF increased from approximately 286,000 in 1996 to about 410,000 in 2010 with a significant linear trend (β = 9470 additional admissions per year, p < 0.001). The trend of increased AF admissions was uniform across patient sub-groups. Overall, mean length of stay for AF admissions was 3.75 days, and this remained relatively stable over time (β = 0.002 days, p = 0.884). Inpatient mortality was 0.96% and also remained stable over time (β = 0.031%, p = 0.181). Conclusion Our data demonstrate an increase in the number of AF admissions but constant length of stay and mortality over time.
Collapse
|
30
|
Grey C, Jackson R, Wells S, Wu B, Poppe K, White H, Chan WC, Kerr AJ. First and recurrent ischaemic heart disease events continue to decline in New Zealand, 2005-2015. Heart 2017; 104:51-57. [PMID: 28663363 DOI: 10.1136/heartjnl-2017-311613] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/25/2017] [Accepted: 05/30/2017] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To examine recent trends in first and recurrent ischaemic heart disease (IHD) deaths and hospitalisations. METHODS Using anonymous patient-linkage of routinely collected data, all New Zealanders aged 35-84 years who experienced an International Statistical Classification of Diseases and Related Health Problems I(CD)-coded IHD hospitalisation and/or IHD death between 1 January 2005 and 31 December 2015 were identified. A 10-year look-back period was used to differentiate those experiencing first from recurrent events. Age-standardised hospitalisation and mortality rates were calculated for each calendar year and trends compared by sex and age. RESULTS 160 109 people experienced at least one IHD event (259 678 hospitalisations and 35 548 deaths) over the 11-year study period, and there was a steady decline in numbers (from almost 24 000 in 2005 to just over 16 000 in 2015) and in age-standardised rates each year. With the exception of deaths in younger (35-64 years) women with prior IHD, there was a significant decline in IHD events in men and women of all ages, with and without a history of IHD. The decline in IHD mortality was greater for those experiencing a first rather than recurrent IHD event (3.8%-5.2% vs 0%-3.7% annually on average). In contrast, the decline in IHD hospitalisations was greater for those experiencing a recurrent compared with a first IHD event (5.6%-7.3% vs 3.2%-5.7% annually on average). CONCLUSIONS The substantial decline in IHD hospitalisations and mortality observed in New Zealanders with and without prior IHD between 2005 and 2015 suggests that primary and secondary prevention efforts have been effective in reducing the occurrence of IHD events.
Collapse
Affiliation(s)
- Corina Grey
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Rod Jackson
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Susan Wells
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Billy Wu
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Katrina Poppe
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Harvey White
- Greenlane Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand
| | - Wing Cheuk Chan
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Andrew J Kerr
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.,Counties Manukau District Health Board, Auckland, New Zealand
| |
Collapse
|
31
|
Manson JE, Bassuk SS. Invited Commentary: The Framingham Offspring Study-A Pioneering Investigation Into Familial Aggregation of Cardiovascular Risk. Am J Epidemiol 2017; 185:1103-1108. [PMID: 28535172 DOI: 10.1093/aje/kwx068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/20/2017] [Indexed: 12/14/2022] Open
Abstract
Launched in 1948, the Framingham Heart Study was a seminal prospective cohort study of 5,209 adult residents of Framingham, Massachusetts, that was designed to uncover the determinants and natural history of coronary heart disease. Data from this original cohort established the cardiac threat posed by high blood pressure, high cholesterol, smoking, obesity, physical inactivity, diabetes, and other factors. In the late 1960s, investigators conceived the innovative idea of assembling a second cohort that comprised the adult children of the original study population (and these children's spouses). From 1971 to 1975, a total of 5,124 individuals were recruited to form the Offspring Cohort. Studying successive generations in this fashion provided an efficient method for examining secular trends in cardiovascular disease and its risk factors, as well as an opportunity to assess familial aggregation of risk without the threat of recall bias. In a paper published in the September 1979 issue of the Journal, then study director William Kannel et al. (Am J Epidemiol. 1979;110(3):281-290) described the sampling design of the Offspring Study and presented selected baseline characteristics of the cohort. The scientific questions addressed by this research provided the impetus for a decades-long effort-still in full force today both within the Framingham Study itself and in the broader cardiovascular epidemiologic community-to quantify the independent and synergistic effects of genetic, lifestyle, and other environmental factors on cardiovascular outcomes.
Collapse
|
32
|
Abstract
Over the last several decades, the global incidence and prevalence of diabetes mellitus has increased significantly. The raised incidence rate is projected to continue as greater numbers of persons adopt a Western lifestyle and diet. Patients with diabetes mellitus are at heightened risk of both adverse microvascular and cardiovascular events. Moreover, once cardiovascular disease develops, diabetes mellitus exacerbates progression and worsens outcomes. The medical management of patients with diabetes mellitus mandates comprehensive risk factor modification and antiplatelet therapy. Recent clinical trials of new medical therapies continue to inform the care of patients with diabetes mellitus to reduce both cardiovascular morbidity and mortality.
Collapse
Affiliation(s)
- Joshua A Beckman
- From the Department of Medicine, Section of Vascular Medicine, Cardiovascular Division, Vanderbilt University School of Medicine, Nashville, TN (J.A.B.); and Department of Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH (M.A.C.).
| | - Mark A Creager
- From the Department of Medicine, Section of Vascular Medicine, Cardiovascular Division, Vanderbilt University School of Medicine, Nashville, TN (J.A.B.); and Department of Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH (M.A.C.)
| |
Collapse
|
33
|
Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 6032] [Impact Index Per Article: 861.7] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
34
|
Menezes R, Rodriguez-Mateos A, Kaltsatou A, González-Sarrías A, Greyling A, Giannaki C, Andres-Lacueva C, Milenkovic D, Gibney ER, Dumont J, Schär M, Garcia-Aloy M, Palma-Duran SA, Ruskovska T, Maksimova V, Combet E, Pinto P. Impact of Flavonols on Cardiometabolic Biomarkers: A Meta-Analysis of Randomized Controlled Human Trials to Explore the Role of Inter-Individual Variability. Nutrients 2017; 9:E117. [PMID: 28208791 PMCID: PMC5331548 DOI: 10.3390/nu9020117] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 02/03/2017] [Indexed: 02/05/2023] Open
Abstract
Several epidemiological studies have linked flavonols with decreased risk of cardiovascular disease (CVD). However, some heterogeneity in the individual physiological responses to the consumption of these compounds has been identified. This meta-analysis aimed to study the effect of flavonol supplementation on biomarkers of CVD risk such as, blood lipids, blood pressure and plasma glucose, as well as factors affecting their inter-individual variability. Data from 18 human randomized controlled trials were pooled and the effect was estimated using fixed or random effects meta-analysis model and reported as difference in means (DM). Variability in the response of blood lipids to supplementation with flavonols was assessed by stratifying various population subgroups: age, sex, country, and health status. Results showed significant reductions in total cholesterol (DM = -0.10 mmol/L; 95% CI: -0.20, -0.01), LDL cholesterol (DM = -0.14 mmol/L; Nutrients 2017, 9, 117 2 of 21 95% CI: -0.21, 0.07), and triacylglycerol (DM = -0.10 mmol/L; 95% CI: -0.18, 0.03), and a significant increase in HDL cholesterol (DM = 0.05 mmol/L; 95% CI: 0.02, 0.07). A significant reduction was also observed in fasting plasma glucose (DM = -0.18 mmol/L; 95%CI: -0.29, -0.08), and in blood pressure (SBP: DM = -4.84 mmHg; 95% CI: -5.64, -4.04; DBP: DM = -3.32 mmHg; 95% CI: -4.09, -2.55). Subgroup analysis showed a more pronounced effect of flavonol intake in participants from Asian countries and in participants with diagnosed disease or dyslipidemia, compared to healthy and normal baseline values. In conclusion, flavonol consumption improved biomarkers of CVD risk, however, country of origin and health status may influence the effect of flavonol intake on blood lipid levels.
Collapse
Affiliation(s)
- Regina Menezes
- iBET/ITQB, Molecular Nutrition & Health Laboratory, 2780-157 Oeiras, Portugal;
| | - Ana Rodriguez-Mateos
- Division of Diabetes and Nutritional Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE1 9NH, UK;
| | - Antonia Kaltsatou
- FAME Laboratory, School of Exercise Science, University of Thessaly, 42100 Volos, Greece;
| | | | | | | | - Cristina Andres-Lacueva
- Biomarkers and Nutrimetabolomic Laboratory, Department of Nutrition, Food Sciences and Gastronomy, Campus Torribera, Faculty of Pharmacy and Food Sciences, University of Barcelona, CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, 08028 Barcelona, Spain; (C.A.-L.); (M.G.-A.)
| | - Dragan Milenkovic
- INRA, UMR 1019, UNH, CRNH Auvergne, F-63000 Clermont-Ferrand, Clermont Université, Université d’Auvergne, Unité de Nutrition Humaine, BP 10448, F-63000 Clermont-Ferrand, France;
| | | | - Julie Dumont
- Université Lille, INSERM, Institut Pasteur de Lille, U1167—RID-AGE—Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, F-59000 Lille, France;
| | - Manuel Schär
- Department of Food and Nutritional Sciences, University of Reading, Reading RG6 6AP, UK;
| | - Mar Garcia-Aloy
- Biomarkers and Nutrimetabolomic Laboratory, Department of Nutrition, Food Sciences and Gastronomy, Campus Torribera, Faculty of Pharmacy and Food Sciences, University of Barcelona, CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, 08028 Barcelona, Spain; (C.A.-L.); (M.G.-A.)
| | | | | | | | - Emilie Combet
- Human Nutrition, University of Glasgow, Glasgow G31 2ER, UK; (S.A.P.-D.); (E.C.)
| | - Paula Pinto
- iBET/ITQB, Molecular Nutrition & Health Laboratory, 2780-157 Oeiras, Portugal;
- Polytechnic Institute of Santarem, ESA, Department of Food Technology, Biotechnology and Nutrition, 2001-904 Santarém, Portugal
| |
Collapse
|
35
|
Estimating cardiovascular disease incidence from prevalence: a spreadsheet based model. BMC Med Res Methodol 2017; 17:9. [PMID: 28114890 PMCID: PMC5259888 DOI: 10.1186/s12874-016-0288-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/26/2016] [Indexed: 12/02/2022] Open
Abstract
Background Disease incidence and prevalence are both core indicators of population health. Incidence is generally not as readily accessible as prevalence. Cohort studies and electronic health record systems are two major way to estimate disease incidence. The former is time-consuming and expensive; the latter is not available in most developing countries. Alternatively, mathematical models could be used to estimate disease incidence from prevalence. Methods We proposed and validated a method to estimate the age-standardized incidence of cardiovascular disease (CVD), with prevalence data from successive surveys and mortality data from empirical studies. Hallett’s method designed for estimating HIV infections in Africa was modified to estimate the incidence of myocardial infarction (MI) in the U.S. population and incidence of heart disease in the Canadian population. Results Model-derived estimates were in close agreement with observed incidence from cohort studies and population surveillance systems. This method correctly captured the trend in incidence given sufficient waves of cross-sectional surveys. The estimated MI declining rate in the U.S. population was in accordance with the literature. This method was superior to closed cohort, in terms of the estimating trend of population cardiovascular disease incidence. Conclusion It is possible to estimate CVD incidence accurately at the population level from cross-sectional prevalence data. This method has the potential to be used for age- and sex- specific incidence estimates, or to be expanded to other chronic conditions.
Collapse
|
36
|
Waters DD. The Rise and Fall of Tuberculosis and Atherosclerosis: First There Is a Mountain…. Can J Cardiol 2017; 33:295-297. [PMID: 28081868 DOI: 10.1016/j.cjca.2016.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 11/17/2016] [Accepted: 11/17/2016] [Indexed: 01/03/2023] Open
Affiliation(s)
- David D Waters
- Division of Cardiology, San Francisco General Hospital, and the Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
| |
Collapse
|
37
|
Abstract
Although the human germline mutation rate is higher than that in any other well-studied species, the rate is not exceptional once the effective genome size and effective population size are taken into consideration. Human somatic mutation rates are substantially elevated above those in the germline, but this is also seen in other species. What is exceptional about humans is the recent detachment from the challenges of the natural environment and the ability to modify phenotypic traits in ways that mitigate the fitness effects of mutations, e.g., precision and personalized medicine. This results in a relaxation of selection against mildly deleterious mutations, including those magnifying the mutation rate itself. The long-term consequence of such effects is an expected genetic deterioration in the baseline human condition, potentially measurable on the timescale of a few generations in westernized societies, and because the brain is a particularly large mutational target, this is of particular concern. Ultimately, the price will have to be covered by further investment in various forms of medical intervention. Resolving the uncertainties of the magnitude and timescale of these effects will require the establishment of stable, standardized, multigenerational measurement procedures for various human traits.
Collapse
|
38
|
Packard KA, Hilleman DE. Adherence to therapies for secondary prevention of cardiovascular disease: a focus on aspirin. Cardiovasc Ther 2016; 34:415-422. [DOI: 10.1111/1755-5922.12211] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Kathleen A. Packard
- Department of Pharmacy Practice; Creighton University School of Pharmacy and Health Professions; Omaha NE USA
| | - Daniel E. Hilleman
- Department of Pharmacy Practice; Creighton University School of Pharmacy and Health Professions; Omaha NE USA
- The Cardiac Center of Creighton University School of Medicine; Omaha NE USA
| |
Collapse
|
39
|
Tobin K, Gilthorpe MS, Rooney J, Heverin M, Vajda A, Staines A, Hardiman O. Age-period-cohort analysis of trends in amyotrophic lateral sclerosis incidence. J Neurol 2016; 263:1919-26. [PMID: 27372451 DOI: 10.1007/s00415-016-8215-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 12/13/2022]
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease with an unknown cause. Studies have reported that the incidence rate of ALS might be changing. As ALS is an age related disease, crude incidence could increase as population structure changes and overall life expectancy improves. Age-period-cohort (APC) models are frequently used to investigate trends in demographic rates such as incidence. Age-specific incidence rate for ALS from 1996 to 2014 were taken from a population-based ALS register in Ireland. To circumvent the well-known identifiability issue in APC models, we apply the method of Partial Least Squares Regression to separate the effects of Age, Period and Cohort on ALS incidence over time. This APC analysis shows no cohort effect and the initial signs of a period effect; increasing incidence of ALS in the most recently diagnosed group. As further years of data accrue to the Irish register it will become clear if this effect emerges as a strong trend in the incidence of ALS in Ireland and replication of these analyses in other populations will show if our findings on temporal patterns in ALS incidence are shared elsewhere.
Collapse
Affiliation(s)
- Katy Tobin
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, TBSI, 152-160 Pearse Street, Dublin 2, Ireland. .,Centre for Health Policy and Management, Trinity College Dublin, Dublin 2, Ireland.
| | - Mark S Gilthorpe
- Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Leeds, UK
| | - James Rooney
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, TBSI, 152-160 Pearse Street, Dublin 2, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, TBSI, 152-160 Pearse Street, Dublin 2, Ireland
| | - Alice Vajda
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, TBSI, 152-160 Pearse Street, Dublin 2, Ireland
| | - Anthony Staines
- School of Nursing and Health Sciences, Dublin City University, Dublin 9, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, TBSI, 152-160 Pearse Street, Dublin 2, Ireland
| |
Collapse
|
40
|
Gikas A, Lambadiari V, Sotiropoulos A, Panagiotakos D, Pappas S. Prevalence of Major Cardiovascular Risk Factors and Coronary Heart Disease in a Sample of Greek Adults: The Saronikos Study. Open Cardiovasc Med J 2016; 10:69-80. [PMID: 27429668 PMCID: PMC4945772 DOI: 10.2174/1874192401610010069] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/20/2015] [Accepted: 09/22/2015] [Indexed: 11/22/2022] Open
Abstract
Background: Comprehensive data regarding prevalence of coronary heart disease (CHD) and associated factors in different geographical regions are very important to our understanding of global distribution and evolution of CHD. The aim of this study was to assess the current prevalence of self-reported risk factors and CHD in Greek adult population.
Methods: A community-based cross-sectional study was
conducted in May 2014, during an election day, among residents of Saronikos municipality (Attica region). Data were collected from face-to-face
interviews. The study sample included 2636 subjects (men, 49.5%; mean age, 50.5; range 20-95 years), with similar age and sex distribution to the
target population.
Results: The age-standardized prevalence rates of five major risk factors were as follows: type 2 diabetes 11.1%, hypercholesterolemia
(cholesterol>240 mg/dl or using cholesterol-lowering medication) 23.8%, hypertension 27.2%, current smoking 38.9% and physical inactivity 43%. Of the participants,
only 21% were free of any of these factors. Clustering of two to five risk factors was more frequent among persons aged 50 years and older as compared with younger
ones (60% vs 27%, P=0.000). The age-adjusted prevalence of CHD was 6.3% (in men, 8.9%; in women, 3.8%) and that of myocardial infarction was 3.6% (in men, 5.2%; in
women, 2.1%). According to multivariate analysis age, gender, education level, obesity, diabetes, hypercholesterolemia, hypertension and ever smoking were strongly
associated with CHD. Conclusion: Classic risk factors are highly prevalent and frequently clustered, especially in adults aged 50 years and older. These findings
raise concerns about future trends of already increased rates of CHD. Multifactorial and integrated population-based interventions need to be applied to reduce the burden of cardiovascular conditions.
Collapse
Affiliation(s)
| | - Vaia Lambadiari
- Second Department of Internal Medicine, Research Institute and Diabetes Centre, Attikon University General Hospital, Athens University Medical School, Greece
| | - Alexios Sotiropoulos
- Third Department of Internal Medicine and Diabetes Centre, Saint Panteleimon General Hospital, Nikea-Pireaus, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition Science and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Stavros Pappas
- Third Department of Internal Medicine and Diabetes Centre, Saint Panteleimon General Hospital, Nikea-Pireaus, Greece
| |
Collapse
|
41
|
Hardy ST, Loehr LR, Butler KR, Chakladar S, Chang PP, Folsom AR, Heiss G, MacLehose RF, Matsushita K, Avery CL. Reducing the Blood Pressure-Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control. J Am Heart Assoc 2015; 4:e002276. [PMID: 26508742 PMCID: PMC4845128 DOI: 10.1161/jaha.115.002276] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 10/02/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND US blood pressure reduction policies are largely restricted to hypertensive populations and associated benefits are often estimated based on unrealistic interventions. METHODS AND RESULTS We used multivariable linear regression to estimate incidence rate differences contrasting the impact of 2 pragmatic hypothetical interventions to reduce coronary heart disease, stroke, and heart failure (HF) incidence: (1) a population-wide intervention that reduced systolic blood pressure by 1 mm Hg and (2) targeted interventions that reduced the prevalence of unaware, untreated, or uncontrolled blood pressure above goal (per Eighth Joint National Committee treatment thresholds) by 10%. In the Atherosclerosis Risk in Communities Study (n=15 744; 45 to 64 years at baseline, 1987-1989), incident coronary heart disease and stroke were adjudicated by physician panels. Incident HF was defined as the first hospitalization with discharge diagnosis code of "428." A 10% proportional reduction in unaware, untreated, or uncontrolled blood pressure above goal resulted in ≈4.61, 3.55, and 11.01 fewer HF events per 100,000 person-years in African Americans, and 3.77, 1.63, and 4.44 fewer HF events per 100 000 person-years, respectively, in whites. In contrast, a 1 mm Hg population-wide systolic blood pressure reduction was associated with 20.3 and 13.3 fewer HF events per 100 000 person-years in African Americans and whites, respectively. Estimated event reductions for coronary heart disease and stroke were smaller than for HF, but followed a similar pattern for both population-wide and targeted interventions. CONCLUSIONS Modest population-wide shifts in systolic blood pressure could have a substantial impact on cardiovascular disease incidence and should be developed in parallel with interventions targeting populations with blood pressure above goal.
Collapse
Affiliation(s)
- Shakia T. Hardy
- Department of EpidemiologyUniversity of North CarolinaChapel HillNC
| | - Laura R. Loehr
- Department of EpidemiologyUniversity of North CarolinaChapel HillNC
| | - Kenneth R. Butler
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Sujatro Chakladar
- Department of BiostatisticsUniversity of North CarolinaChapel HillNC
| | - Patricia P. Chang
- Department of EpidemiologyUniversity of North CarolinaChapel HillNC
- Department of MedicineUniversity of North CarolinaChapel HillNC
| | - Aaron R. Folsom
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMSMN
| | - Gerardo Heiss
- Department of EpidemiologyUniversity of North CarolinaChapel HillNC
| | - Richard F. MacLehose
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMSMN
| | | | - Christy L. Avery
- Department of EpidemiologyUniversity of North CarolinaChapel HillNC
| |
Collapse
|
42
|
Pandya A, Sy S, Cho S, Weinstein MC, Gaziano TA. Cost-effectiveness of 10-Year Risk Thresholds for Initiation of Statin Therapy for Primary Prevention of Cardiovascular Disease. JAMA 2015; 314:142-50. [PMID: 26172894 PMCID: PMC4797634 DOI: 10.1001/jama.2015.6822] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The American College of Cardiology and the American Heart Association (ACC/AHA) cholesterol treatment guidelines have wide-scale implications for treating adults without history of atherosclerotic cardiovascular disease (ASCVD) with statins. OBJECTIVE To estimate the cost-effectiveness of various 10-year ASCVD risk thresholds that could be used in the ACC/AHA cholesterol treatment guidelines. DESIGN, SETTING, AND PARTICIPANTS Microsimulation model, including lifetime time horizon, US societal perspective, 3% discount rate for costs, and health outcomes. In the model, hypothetical individuals from a representative US population aged 40 to 75 years received statin treatment, experienced ASCVD events, and died from ASCVD-related or non-ASCVD-related causes based on ASCVD natural history and statin treatment parameters. Data sources for model parameters included National Health and Nutrition Examination Surveys, large clinical trials and meta-analyses for statin benefits and treatment, and other published sources. MAIN OUTCOMES AND MEASURES Estimated ASCVD events prevented and incremental costs per quality-adjusted life-year (QALY) gained. RESULTS In the base-case scenario, the current ASCVD threshold of 7.5% or higher, which was estimated to be associated with 48% of adults treated with statins, had an incremental cost-effectiveness ratio (ICER) of $37,000/QALY compared with a 10% or higher threshold. More lenient ASCVD thresholds of 4.0% or higher (61% of adults treated) and 3.0% or higher (67% of adults treated) had ICERs of $81,000/QALY and $140,000/QALY, respectively. Shifting from a 7.5% or higher ASCVD risk threshold to a 3.0% or higher ASCVD risk threshold was estimated to be associated with an additional 161,560 cardiovascular disease events averted. Cost-effectiveness results were sensitive to changes in the disutility associated with taking a pill daily, statin price, and the risk of statin-induced diabetes. In probabilistic sensitivity analysis, there was a higher than 93% chance that the optimal ASCVD threshold was 5.0% or lower using a cost-effectiveness threshold of $100,000/QALY. CONCLUSIONS AND RELEVANCE In this microsimulation model of US adults aged 45 to 75 years [corrected], the current 10-year ASCVD risk threshold (≥7.5% risk threshold) used in the ACC/AHA cholesterol treatment guidelines has an acceptable cost-effectiveness profile (ICER, $37,000/QALY), but more lenient ASCVD thresholds would be optimal using cost-effectiveness thresholds of $100,000/QALY (≥4.0% risk threshold) or $150,000/QALY (≥3.0% risk threshold). The optimal ASCVD threshold was sensitive to patient preferences for taking a pill daily, changes to statin price, and the risk of statin-induced diabetes.
Collapse
Affiliation(s)
- Ankur Pandya
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
| | - Stephen Sy
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
| | - Sylvia Cho
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
| | - Milton C Weinstein
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
| | - Thomas A Gaziano
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts2Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|