European Heart Journal - Quality of Care and Clinical Outcomes最新文献

Aims: The impact of sex-related differences on outcomes following transcatheter aortic valve replacement (TAVR) remains inconclusive. This study investigates sex-related differences in survival and safety outcomes in patients with aortic stenosis undergoing TAVR.

Methods and results: We systematically searched PubMed, Embase, Scopus, and Cochrane Library until November 2024. Individual patient data (IPD) were reconstructed from published Kaplan-Meier curves and compared using Cox-proportional hazards model for overall survival and cardiovascular mortality. Pooled risk ratios (RR) for safety outcomes at 30-days and 1 year were estimated using a random-effects model. A total of 48 studies (69 355 women and 65 580 men) were included. Meta-analysis of reconstructed IPD showed that men were at higher risk of all-cause mortality at 5 years [hazard ratio (HR): 1.24, 95% confidence interval (CI): 1.20-1.28, P < 0.001] and cardiovascular mortality at 4 years (HR: 1.34, 95% CI: 1.21-1.49, P < 0.001) compared with women. In random-effects meta-analysis, men faced a higher risk of permanent pacemaker implantation (RR: 1.29, 95% CI: 1.16-1.44, P < 0.001) during the first year. Men experienced a lower risk of stroke (RR: 0.75, 95% CI: 0.64-0.87, P < 0.001) and major vascular complications (RR: 0.58, 95% CI: 0.49-0.69, P < 0.001) at 30 days, and a lower risk of major bleeding (RR: 0.77, 95% CI: 0.70-0.84, P < 0.001) as well as major vascular complications (RR: 0.54, 95% CI: 0.43-0.68, P < 0.001) within the first year.

Conclusion: Men demonstrated poorer 5-year overall survival and 4-year cardiovascular survival following TAVR compared with women. Future research with extended follow-up is needed to understand the mechanism underlying sex-specific TAVR outcomes.

Background: Recent evidence indicates that degenerative valvular heart disease (VHD) and psoriasis share overlapping risk factors and simultaneous presence of inflammation, yet this relationship has not been thoroughly explored.

Methods and results: Drawing on the prospective cohort data from the UK Biobank, baseline information on psoriasis and the incidence of eight specific types of degenerative VHD-aortic stenosis (AS), aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid stenosis, tricuspid regurgitation, pulmonary stenosis, and pulmonary regurgitation-during the follow-up period were recorded. Cox proportional hazards models were conducted to estimate the association between psoriasis and the risk of degenerative VHD, adjusted for demographic indicators, lifestyle factors, comorbidities, and medication. A total of 494 510 participants were included in the study. Among the participants without psoriasis, 13 672 events of degenerative VHD were observed during a median follow-up of 13.78 years, yielding an incidence rate of 2.14 per 1000 person-years. In contrast, in the psoriasis group (n = 10 917), 422 events of degenerative VHD were reported during a median follow-up of 13.70 years, corresponding to an incidence rate of 2.93 per 1000 person-years. After fully adjusting, participants with psoriasis had a significantly increased risk of AS (hazard ratio, 1.24; 95% confidence interval, 1.07-1.43), yet no significant associations were observed between psoriasis and the risk of other degenerative valve diseases. In sex subgroup analyses, there was an interaction between sex and psoriasis in the occurrence of AS (P for interaction = 0.039), suggesting a high risk in women.

Conclusions: Psoriasis was significantly associated with the risk of new-onset AS and may be more distinct in females, while no significant associations were observed between psoriasis and the risk of developing other degenerative valve diseases.

Background: Antithrombotic therapy post-transcatheter aortic valve implantation (TAVI) has been widely debated in the past two decades. Data describing practice patterns of antithrombotic therapy are warranted. This study examined the trends in use of antithrombotic therapy post-TAVI in Denmark.

Methods: Danish patients with aortic stenosis who underwent first-time TAVI from 2008 to 2021 were identified from Danish registries. Patients were categorized according to atrial fibrillation (AF) status and antithrombotic therapy post-TAVI based on prescription fillings: no antithrombotic therapy, single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), oral anticoagulant therapy (OAC), and oral anticoagulant therapy with antiplatelet therapy (OAC+). Use of antithrombotic therapy among survivors at 15 months was examined to assess persistence and possible changes in treatment.

Results: This study included 6447 patients undergoing TAVI. Among patients without AF (n = 3975), most patients received SAPT or DAPT. In AF patients (n = 2472), most patients received OAC or OAC+ . During the first 14 years of TAVI, there was a shift in the antithrombotic treatment pattern. For patients without AF, SAPT increased from 15.6% to 69.5%, with a concomitant decrease in DAPT from 56.3% to 9.1%. For AF patients, OAC increased from 13.0% to 77.9% and OAC+ decreased to 9.1%. Most patients without AF either remained with or shifted to SAPT. AF patients either remained in or shifted to the OAC group.

Conclusion: Antithrombotic therapy patterns post-TAVI have changed over the first 14 years of TAVI in Denmark. Use of DAPT and OAC+ decreased with a concomitant increase in SAPT and OAC.

Aims: Ischaemic heart disease (IHD) has been a significant public health issue worldwide. This study aims to predict the global burden of IHD in a timely and comprehensive manner.

Methods and results: Incidence, prevalence, deaths, and disability-adjusted life years (DALYs) for IHD from 1990 to 2021 were derived from the Global Burden of Disease 2021 database, and three models (linear, exponential, and Poisson regression) were used to estimate their trends over time at the global, regional, and national levels by age, sex, and country groups, with the gross domestic product per capita was applied to adjust the model. The model results revealed that the global burden of IHD is expected to increase continuously by 2050. By 2050, global IHD incidence, prevalence, deaths, and DALYs are projected to reach 67.3 million, 510 million, 16 million, and 302 million, respectively, which represents an increase of 116%, 106%, 80%, and 62%, respectively, from 2021. Moreover, the results showed that regions with lower sociodemographic index (SDI) bore a greater burden of IHD than those with higher SDI, with men having a higher burden of IHD than women. People over 70 years old account for a major part of the burden of IHD, and premature death of IHD is also becoming more serious.

Conclusion: The global burden of IHD will increase further by 2050, potentially due to population ageing and economic disparities. Hence, it is necessary to strengthen the prevention of IHD and formulate targeted strategies according to different SDI regions and special populations.

Background: An increased risk of cardiovascular disease (CVD) has been reported in patients with diverticular disease (DD). However, there are knowledge gaps about specific risks of each major adverse cardiovascular event (MACE) component.

Methods and results: This nationwide cohort study included Swedish adults with DD (1987-2017, N = 52 468) without previous CVD. DD was defined through ICD codes in the National Patient Register and colorectal histopathology reports from the ESPRESSO study. DD cases were matched by age, sex, calendar year, and county of residence to ≤5 population reference individuals (N = 194 525). Multivariable-adjusted hazard ratios (aHRs) for MACE up until December 2021 were calculated using stratified Cox proportional hazard models. Median age at DD diagnosis was 62 years, and 61% were females. During a median follow-up of 8.6 years, 16 147 incident MACE occurred in individuals with DD and 48 134 in reference individuals [incidence rates (IRs)= 61.4 vs. 43.8/1000 person-years], corresponding to an aHR of 1.24 (95%CI = 1.22-1.27), equivalent to one extra case of MACE for every 6 DD patients followed for 10 years. The risk was increased for ischaemic heart disease (IR = 27.9 vs. 18.6; aHR = 1.36, 95%CI = 1.32-1.40), congestive heart failure (IR = 23.2 vs. 15.8; aHR = 1.26, 95%CI = 1.22-1.31), and stroke (IR = 18.0 vs. 13.7; aHR = 1.15, 95%CI = 1.11-1.19). DD was not associated with cardiovascular mortality (IR = 18.9 vs. 15.3; aHR = 1.01, 95%CI = 0.98-1.05). Results remained robust in sibling-controlled analyses.

Conclusions: Patients with DD had a 24% increased risk of MACE compared with reference individuals, but no increased cardiovascular mortality. Future research should confirm these data and examine underlying mechanisms and shared risk factors between DD and CVD.

Aims: To evaluate the global cardiovascular disease (CVD) burden attributable to metabolic risks in 204 countries and territories from 1990 to 2021.

Methods and results: Following the methodologies used in the Global Burden of Disease Study 2021, this study analysed CVD deaths and disability-adjusted life-years (DALYs) attributable to metabolic risks by location, age, sex, and Socio-demographic Index (SDI). In 2021, metabolic risks accounted for 13.59 million CVD deaths (95% UI 12.01-15.13) and 287.17 million CVD DALYs (95% UI 254.92-316.32) globally, marking increases of 63.3% and 55.5% since 1990, respectively. Despite these increases, age-standardized mortality and DALY rates have significantly declined. The highest age-standardized rates of metabolic risks-attributable CVD mortality and DALYs were observed in Central Asia and Eastern Europe, while the lowest rates were found in High-income Asia Pacific, Australasia, and Western Europe, all of which are high SDI regions. Among the metabolic risks, high systolic blood pressure emerged as the predominant factor, contributing to the highest numbers of CVD deaths [10.38 million (95% UI 8.78-12.03)] and DALYs [14.52 million (95% UI 180.42-247.57)] in 2021, followed by high LDL cholesterol.

Conclusion: Our study highlights the persistent and significant impact of metabolic risks on the global CVD burden from 1990 to 2021, emphasizing the need of designing public health strategies that align with regional healthcare capacities and demographic differences to effectively reduce these effects through enhanced international collaboration and specific policies.

Background: Kidney dysfunction (KD) poses a severe threat to human health. The aim of this study is to gain a comprehensive understanding of the trends in cardiovascular disease (CVD) burden attributable to KD, thereby providing a theoretical basis for relevant public health policies.

Methods and results: This study analysed trends in the burden of CVD attributable to KD using the 2021 Global Burden of Disease data. It also examined the differences in mortality rates across various age groups, genders, and subtypes of CVD. Additionally, the age-period-cohort model combined with joinpoint regression analysis was employed to gain further insights into the changing trends and inflection points of CVD-related mortality. In 2021, the global number of deaths from CVD attributable to KD significantly increased compared to 1990. However, the global age-standardized mortality rate (ASMR) decreased in 2021. The burden of CVD due to KD was particularly heavy among the elderly. Analysis using the age-period-cohort model revealed a decline in CVD-related mortality rates, with similar trends observed for both men and women.

Conclusion: This study reveals that although the ASMR for CVD due to KD is on a declining trend globally, the absolute number of deaths has significantly increased. This trend is especially pronounced among individuals aged 80 and older, males, and regions with a middle socio-demographic index. In the context of global aging, the burden of CVD related to KD is becoming increasingly substantial.

Objectives: This study aims to analyse the variation in mortality burden of aortic aneurysms (AAs) and explore the associated risk factors based on Global Burden of Disease (GBD) 2019 data, investigating the mortality burden of AA in China.

Methods and results: Using GBD 2019 data, the mortality burden of AA in China from 1990 to 2019 was analysed. The age-period-cohort model was utilized to analyse time trends, period, and cohort effects of four attributable risk factors of AA by age. In 2019, the total number of AA deaths in China increased by 136.1% compared to 1990, while the age-standardized mortality rate (ASMR) decreased by 6.8%. Male deaths and ASMR were higher than those of females, and ASMR increased with age. Whether viewed overall [average annual percent change (AAPC): -0.261, 95% confidence interval (CI): -0.383 to -0.138] or by sex (female AAPC: -0.812, 95% CI: -0.977 to -0.646; male AAPC: -0.011, 95% CI: -0.183-0.162), the ASMR for AA in China has shown a declining trend since 1990. Attributable risk factors such as high blood pressure, a diet high in sodium, smoking, and lead exposure increase AA mortality with age. Smoking mortality peaks between ages 80 and 85. The cyclical effect of high blood pressure on AA mortality significantly increases, while the cyclical effects of the other three risk factors decrease. For the population born after 1940, the cohort effect of high systolic blood pressure (SBP), a diet high in sodium, and smoking increased, while the cohort effect of lead exposure decreased. The local drift values of high SBP, a diet high in sodium, and smoking decreased, while the local drift value of lead exposure increased. High SBP was identified as the most significant attributable risk factor for AA mortality burden among both males and females, and smoking was another major attributable risk factor, particularly in males.

Conclusion: From 1990 to 2019, fatality due to AA in China increased notably, but the ASMR showed a decreasing trend. The mortality rate of AA was influenced by age, sex, and attributable risk factors, with elderly male smokers carrying a heavy burden of death. Moreover, tobacco control and treatment of hypertension should be strengthened to reduce the burden and its impact on AA.

Background: A lack of consensus exists across guidelines as to which risk model should be used for the primary prevention of cardiovascular disease (CVD). Our objective was to determine potential improvements in the number needed to treat (NNT) and number of events prevented (NEP) using different risk models in patients eligible for risk stratification.

Methods and results: A retrospective observational cohort was assembled from primary care patients in Ontario, Canada, between 1 January 2010 and 31 December 2014 and followed for up to 5 years. Risk estimation was undertaken in patients 40-75 years of age, without CVD, diabetes, or chronic kidney disease using the Framingham Risk Score (FRS), the Pooled Cohort Equations (PCEs), a recalibrated FRS (R-FRS), the Systematic Coronary Risk Evaluation 2 (SCORE2), and the low-risk region recalibrated SCORE2 (LR-SCORE2). The cohort consisted of 47 399 patients (59% women, mean age 54 years). The NNT with statins was lowest for the SCORE2 at 40, followed by the LR-SCORE2 at 41, the R-FRS at 43, the PCEs at 55, and the FRS at 65. Models that selected for individuals with a lower NNT recommended statins to fewer, but higher-risk patients. For instance, the SCORE2 recommended statins to 7.9% of patients (5-year CVD incidence 5.92%). The FRS, however, recommended statins to 34.6% of patients (5-year CVD incidence 4.01%). Accordingly, the NEP was highest for the FRS at 406 and lowest for the SCORE2 at 156.

Conclusions: Newer models such as the SCORE2 may improve statin allocation to higher-risk groups with a lower NNT but prevent fewer events at the population level.