Pub Date : 2025-12-18DOI: 10.1016/j.ijcrp.2025.200565
Jie Tan , Xiaoqing Fu , Xiaoqi Li , Xiaorui Zhao , Wenqi Huang , Jing Huang , Li Xu
Background
This study aimed to explore the most recent trends in NRCAVD burden among adults aged 60 years and older and to further predict trends up to 2041.
Methods
We estimated the age-standardized incidence (ASIR), prevalence (ASPR), disability-adjusted life years (DALYs) (ASDALYsR) and death rates (ASDR) of NRCAVD in adults aged ≥60 years from 1990 to 2021 using data from the 2021 Global Burden of Disease Study. Temporal trends were quantified using average annual percent change and projections to 2041 were made using the Nordpred model.
Results
Globally, in 2021, NRCAVD affected 11.78 million older adults (ASPR: 1122.7/100,000), with 0.84 million new cases (ASIR: 77.3/100,000), resulting in 132,764 deaths (ASDR: 13.7/100,000) and an ASDALYsR of 182 per 100,000. From 1990 to 2021, global ASIR and ASPR increased significantly (22.1 % and 24.8 %, respectively), while ASDALYsR and ASDR declined. High-income regions exhibited the greatest disease burden, notably High-income North America and Western Europe. Marked sex-based differences existed, with males showing higher burden compared to females. Projections indicate that by 2041, the absolute number of cases will rise by 72.1 %.
Conclusions
The global burden of NRCAVD in older adults is substantial and varies by age, gender, socio-demographic index, and region. Despite declining age-standardized rates, the absolute burden of NRCAVD will increase, highlighting the need for early screening and improved treatment access.
{"title":"Global burden of non-rheumatic calcific aortic valve disease in adults aged 60 years and older, with projections to 2041: insights from the Global Burden of Disease Study 2021","authors":"Jie Tan , Xiaoqing Fu , Xiaoqi Li , Xiaorui Zhao , Wenqi Huang , Jing Huang , Li Xu","doi":"10.1016/j.ijcrp.2025.200565","DOIUrl":"10.1016/j.ijcrp.2025.200565","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to explore the most recent trends in NRCAVD burden among adults aged 60 years and older and to further predict trends up to 2041.</div></div><div><h3>Methods</h3><div>We estimated the age-standardized incidence (ASIR), prevalence (ASPR), disability-adjusted life years (DALYs) (ASDALYsR) and death rates (ASDR) of NRCAVD in adults aged ≥60 years from 1990 to 2021 using data from the 2021 Global Burden of Disease Study. Temporal trends were quantified using average annual percent change and projections to 2041 were made using the Nordpred model.</div></div><div><h3>Results</h3><div>Globally, in 2021, NRCAVD affected 11.78 million older adults (ASPR: 1122.7/100,000), with 0.84 million new cases (ASIR: 77.3/100,000), resulting in 132,764 deaths (ASDR: 13.7/100,000) and an ASDALYsR of 182 per 100,000. From 1990 to 2021, global ASIR and ASPR increased significantly (22.1 % and 24.8 %, respectively), while ASDALYsR and ASDR declined. High-income regions exhibited the greatest disease burden, notably High-income North America and Western Europe. Marked sex-based differences existed, with males showing higher burden compared to females. Projections indicate that by 2041, the absolute number of cases will rise by 72.1 %.</div></div><div><h3>Conclusions</h3><div>The global burden of NRCAVD in older adults is substantial and varies by age, gender, socio-demographic index, and region. Despite declining age-standardized rates, the absolute burden of NRCAVD will increase, highlighting the need for early screening and improved treatment access.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"28 ","pages":"Article 200565"},"PeriodicalIF":2.1,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15DOI: 10.1016/j.ijcrp.2025.200561
Mingze Zheng , Chuang Sun , Ming Li , Hongwei Xiang , He Ren , Jin Cheng
Introduction
Alcoholic cardiomyopathy (ACM) remains a significant yet understudied contributor to global cardiovascular disease, with substantial socioeconomic influences on its epidemiology. This study investigates the global burden, temporal trends, and health inequalities of ACM across 204 countries.
Methods
Utilizing the Global Burden of Disease 2021 data (1990–2021), we analyzed age-standardised mortality (ASMR), prevalence (ASPR), and disability-adjusted life years (ASDR) for populations aged ≥15 years. A trend analysis employed the estimated annual percentage change (EAPC), while inequality metrics (Slope Index of Inequality, Concentration Index) assessed socioeconomic disparities using the socio-demographic index (SDI).
Results
Globally, ACM caused 47,073 deaths and 2.19 million DALYs in 2021, with an overall decreasing trend (ASMR EAPC: −1.72 %). High-middle SDI regions bore the highest burden (ASDR: 88.27/100,000), particularly Eastern Europe (ASDR: 510.47). We identified a distinct nonlinear relationship with SDI: burden peaked at SDI≈0.75 (p < 0.001), with Eastern Europe showing the steepest rise/decline. Inequality analysis revealed persistent concentration in high-SDI regions (positive concentration indices: 0.51–0.60), though relative inequalities decreased over time. Kazakhstan exhibited the most rapid burden increase (ASMR EAPC: +11.15 %), while Southern Latin America showed maximal decline (ASMR EAPC: −6.69 %).
Conclusions
ACM disparities are strongly linked to socioeconomic development, highlighting the need for targeted alcohol policies in high-burden regions and equitable healthcare resource allocation.
{"title":"Global burden and cross-country inequalities of alcoholic cardiomyopathy: A 1990–2021 analysis","authors":"Mingze Zheng , Chuang Sun , Ming Li , Hongwei Xiang , He Ren , Jin Cheng","doi":"10.1016/j.ijcrp.2025.200561","DOIUrl":"10.1016/j.ijcrp.2025.200561","url":null,"abstract":"<div><h3>Introduction</h3><div>Alcoholic cardiomyopathy (ACM) remains a significant yet understudied contributor to global cardiovascular disease, with substantial socioeconomic influences on its epidemiology. This study investigates the global burden, temporal trends, and health inequalities of ACM across 204 countries.</div></div><div><h3>Methods</h3><div>Utilizing the Global Burden of Disease 2021 data (1990–2021), we analyzed age-standardised mortality (ASMR), prevalence (ASPR), and disability-adjusted life years (ASDR) for populations aged ≥15 years. A trend analysis employed the estimated annual percentage change (EAPC), while inequality metrics (Slope Index of Inequality, Concentration Index) assessed socioeconomic disparities using the socio-demographic index (SDI).</div></div><div><h3>Results</h3><div>Globally, ACM caused 47,073 deaths and 2.19 million DALYs in 2021, with an overall decreasing trend (ASMR EAPC: −1.72 %). High-middle SDI regions bore the highest burden (ASDR: 88.27/100,000), particularly Eastern Europe (ASDR: 510.47). We identified a distinct nonlinear relationship with SDI: burden peaked at SDI≈0.75 (p < 0.001), with Eastern Europe showing the steepest rise/decline. Inequality analysis revealed persistent concentration in high-SDI regions (positive concentration indices: 0.51–0.60), though relative inequalities decreased over time. Kazakhstan exhibited the most rapid burden increase (ASMR EAPC: +11.15 %), while Southern Latin America showed maximal decline (ASMR EAPC: −6.69 %).</div></div><div><h3>Conclusions</h3><div>ACM disparities are strongly linked to socioeconomic development, highlighting the need for targeted alcohol policies in high-burden regions and equitable healthcare resource allocation.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"28 ","pages":"Article 200561"},"PeriodicalIF":2.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15DOI: 10.1016/j.ijcrp.2025.200564
Pooya Eini , Mohammad Rezayee , Milan Kassulke , Jason Tremblay
Background
Stroke poses a significant health burden among hypertensive patients, where traditional risk models often lack precision. Machine learning (ML) has shown promise in enhancing prediction accuracy by integrating diverse data sources.
Methods
Following PRISMA guidelines, we searched 5 databases from inception to September 2025. Eligible studies reported the performance of ML models in hypertensive cohorts. Data were pooled using random-effects models, with heterogeneity assessed via I2, subgroup analyses, meta-regression, and leave-one-out sensitivity. The risk of bias was evaluated using PROBAST + AI, and the evidence quality was assessed using the GRADE approach.
Results
Ten studies (n = 13,299 stroke cases) were included. Pooled sensitivity was 0.88 (95 % CI: 0.80–0.93), specificity 0.88 (95 % CI: 0.77–0.94), positive likelihood ratio 7.1 (95 % CI: 3.4–15.1), negative likelihood ratio 0.14 (95 % CI: 0.08–0.26), and AUC-ROC 0.94 (95 % CI: 0.91–0.96), indicating good discriminative ability. Heterogeneity was high for both sensitivity (I2 = 79.5 %) and specificity (I2 = 76.8 %), potentially due to variations in study design and populations. Subgroup analyses showed consistent performance in Chinese studies (sensitivity 0.85, specificity 0.84) and those using multimodal features (sensitivity 0.84, specificity 0.83), with higher sensitivity for ischemic/hemorrhagic-specific models (0.90). Meta-regression explained 73.9 % of variance and No publication bias was detected (Deeks' p = 0.654).
Conclusion
ML models demonstrate good performance for stroke prediction in hypertensive patients. However, heterogeneity underscores the need for standardized approaches. This evidence, rated moderate by GRADE, supports ML integration in clinical practice for improved prevention.
{"title":"Efficacy and comparative performance of machine learning models for stroke risk prediction in hypertensive patients: A systematic review and meta-analysis","authors":"Pooya Eini , Mohammad Rezayee , Milan Kassulke , Jason Tremblay","doi":"10.1016/j.ijcrp.2025.200564","DOIUrl":"10.1016/j.ijcrp.2025.200564","url":null,"abstract":"<div><h3>Background</h3><div>Stroke poses a significant health burden among hypertensive patients, where traditional risk models often lack precision. Machine learning (ML) has shown promise in enhancing prediction accuracy by integrating diverse data sources.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, we searched 5 databases from inception to September 2025. Eligible studies reported the performance of ML models in hypertensive cohorts. Data were pooled using random-effects models, with heterogeneity assessed via I<sup>2</sup>, subgroup analyses, meta-regression, and leave-one-out sensitivity. The risk of bias was evaluated using PROBAST + AI, and the evidence quality was assessed using the GRADE approach.</div></div><div><h3>Results</h3><div>Ten studies (n = 13,299 stroke cases) were included. Pooled sensitivity was 0.88 (95 % CI: 0.80–0.93), specificity 0.88 (95 % CI: 0.77–0.94), positive likelihood ratio 7.1 (95 % CI: 3.4–15.1), negative likelihood ratio 0.14 (95 % CI: 0.08–0.26), and AUC-ROC 0.94 (95 % CI: 0.91–0.96), indicating good discriminative ability. Heterogeneity was high for both sensitivity (I<sup>2</sup> = 79.5 %) and specificity (I<sup>2</sup> = 76.8 %), potentially due to variations in study design and populations. Subgroup analyses showed consistent performance in Chinese studies (sensitivity 0.85, specificity 0.84) and those using multimodal features (sensitivity 0.84, specificity 0.83), with higher sensitivity for ischemic/hemorrhagic-specific models (0.90). Meta-regression explained 73.9 % of variance and No publication bias was detected (Deeks' p = 0.654).</div></div><div><h3>Conclusion</h3><div>ML models demonstrate good performance for stroke prediction in hypertensive patients. However, heterogeneity underscores the need for standardized approaches. This evidence, rated moderate by GRADE, supports ML integration in clinical practice for improved prevention.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"28 ","pages":"Article 200564"},"PeriodicalIF":2.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-14DOI: 10.1016/j.ijcrp.2025.200559
Paria Heidari , Negar Heidari , Habibolah Khazaie , Sabra Margaret Abbott , Azad Maroufi , Amir Abdolmaleki , Nader Salari , Masoud Mohammadi , Amir Sharafkhaneh
Background
Cerebrovascular accident (CVA) is a critical medical pathology caused by the interruption of cerebral blood flow and leads to neuronal injury or neurodegeneration. Generally, CVAs are classified into two primary categories of ischemic and hemorrhagic. Investigation of circadian rhythm variation at the time of CVA onset is a critical subject for patient management, clinical treatment, and further scientific research. This systematic review aimed to investigate the relationship between the timing of stroke onset and patient outcomes in both ischemic and hemorrhagic strokes.
Methods
Following searching strategy designation, international databases of Embase, PubMed, Scopus, WoS, ScienceDirect, and Google Scholar were searched using the MeSH-based keywords. No time restrictions were applied in this regard (by December 8, 2024). All English-based observational studies reporting the risk of CVA at various daytimes were enrolled for screenings and quality control. Finally, eligible studies were selected for data extraction and categorization.
Results
According to the reports, ischemic strokes strictly occur in morning hours (06:00 to 12:00) while some studies recorded a bimodal pattern (dual peaks during morning and evening). It was also established that the strokes at night were more severe and yielded more unfavorable results. Scattered reports were found regarding the hemorrhagic strokes; some papers revealed the highest incidence in the early morning hours, while others reported the late evening or nighttime occurrence. In addition, some studies showed that nighttime hemorrhagic strokes are usually associated with greater severity and unfavorable clinical outcomes.
Conclusion
This study clarified the effect of cyclic pattern on the incidence and outcome of stroke. These trends seem greatly accounted for improvement of prevention strategies, management of treatments, and enhancement of patient outcomes.
{"title":"Relationship between stroke onset timing and clinical outcomes in ischemic and hemorrhagic strokes: a systematic review","authors":"Paria Heidari , Negar Heidari , Habibolah Khazaie , Sabra Margaret Abbott , Azad Maroufi , Amir Abdolmaleki , Nader Salari , Masoud Mohammadi , Amir Sharafkhaneh","doi":"10.1016/j.ijcrp.2025.200559","DOIUrl":"10.1016/j.ijcrp.2025.200559","url":null,"abstract":"<div><h3>Background</h3><div>Cerebrovascular accident (CVA) is a critical medical pathology caused by the interruption of cerebral blood flow and leads to neuronal injury or neurodegeneration. Generally, CVAs are classified into two primary categories of ischemic and hemorrhagic. Investigation of circadian rhythm variation at the time of CVA onset is a critical subject for patient management, clinical treatment, and further scientific research. This systematic review aimed to investigate the relationship between the timing of stroke onset and patient outcomes in both ischemic and hemorrhagic strokes.</div></div><div><h3>Methods</h3><div>Following searching strategy designation, international databases of Embase, PubMed, Scopus, WoS, ScienceDirect, and Google Scholar were searched using the MeSH-based keywords. No time restrictions were applied in this regard (by December 8, 2024). All English-based observational studies reporting the risk of CVA at various daytimes were enrolled for screenings and quality control. Finally, eligible studies were selected for data extraction and categorization.</div></div><div><h3>Results</h3><div>According to the reports, ischemic strokes strictly occur in morning hours (06:00 to 12:00) while some studies recorded a bimodal pattern (dual peaks during morning and evening). It was also established that the strokes at night were more severe and yielded more unfavorable results. Scattered reports were found regarding the hemorrhagic strokes; some papers revealed the highest incidence in the early morning hours, while others reported the late evening or nighttime occurrence. In addition, some studies showed that nighttime hemorrhagic strokes are usually associated with greater severity and unfavorable clinical outcomes.</div></div><div><h3>Conclusion</h3><div>This study clarified the effect of cyclic pattern on the incidence and outcome of stroke. These trends seem greatly accounted for improvement of prevention strategies, management of treatments, and enhancement of patient outcomes.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"28 ","pages":"Article 200559"},"PeriodicalIF":2.1,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.ijcrp.2025.200563
Zhenxing Deng , Bin Cao
{"title":"Comment on “phenotype-specific associations of circulating adipokine levels with carotid atherosclerosis: a systematic review and meta-analysis”","authors":"Zhenxing Deng , Bin Cao","doi":"10.1016/j.ijcrp.2025.200563","DOIUrl":"10.1016/j.ijcrp.2025.200563","url":null,"abstract":"","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"28 ","pages":"Article 200563"},"PeriodicalIF":2.1,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.ijcrp.2025.200562
Wenjun Li , Dan Zhou , Yanmei Ji , Meirong Yang , Yunhong Yang , Mengyao Dao , Xianyu He , Xingfang Jin
Background
Hypertension is the most common chronic non-communicable disease and one of the most significant risk factors for cardiovascular and cerebrovascular diseases. Sphingosine (SPH) is a central bioactive lipid metabolite positioned at the crucial intersection of ceramide and sphingosine-1-phosphate (S1P) synthesis is increasingly implicated in cardiometabolic health. However, its precise role in the pathophysiology of hypertension and its interplay with inflammatory pathways remain largely unknown. This study aimed to research the therapeutic effects of SPH in hypertension and to explore its underlying mechanisms, focus on a key driver of sterile inflammation that the NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome pathway.
Methods
An Angiotensin II (Ang II)-induced hypertensive mouse model and an in vitro model using human umbilical vein endothelial cells (HUVECs) were established. The effects of SPH administration on Ang II-induced hypertension, end-organ damage, and the activation status of the NLRP3 inflammasome were systematically evaluated.
Results
In vivo, Ang II infusion triggered significant hypertension, cardiac hypertrophy, and aortic fibrosis, which was accompanied by activation of the NLRP3 inflammasome in cardiovascular tissues. Therapeutic administration of SPH, in a manner comparable to the specific NLRP3 antagonist MCC950, markedly lowered blood pressure and attenuated these pathological changes. In vitro, SPH treatment effectively suppressed Ang II-induced NLRP3 inflammasome activation.
and released of pro-inflammatory cytokines in HUVECs. Furthermore, SPH exhibited direct protective effects on the endothelium by promoting HUVEC proliferation and against Ang II-induced injury. Mechanistically, SPH suppressed the expression and activation of key inflammasome components, including NLRP3, cleaved Caspase-1, and mature IL-1β and IL-18.
Conclusions
This study reveals a novel protective role for Sphingosine in hypertension, acting via the suppression of the NLRP3 inflammasome pathway to decrease inflammation and oxidative stress. These findings explore a new mechanistic link between sphingolipid metabolism and blood pressure regulation and highlight SPH as a potential therapeutic agent for targeting the critical series of metabolic dysregulation and inflammation in hypertensive cardiovascular disease.
{"title":"The sphingolipid metabolite sphingosine protects against hypertension by targeting metabolic-inflammatory crosstalk via the NLRP3 inflammasome","authors":"Wenjun Li , Dan Zhou , Yanmei Ji , Meirong Yang , Yunhong Yang , Mengyao Dao , Xianyu He , Xingfang Jin","doi":"10.1016/j.ijcrp.2025.200562","DOIUrl":"10.1016/j.ijcrp.2025.200562","url":null,"abstract":"<div><h3>Background</h3><div>Hypertension is the most common chronic non-communicable disease and one of the most significant risk factors for cardiovascular and cerebrovascular diseases. Sphingosine (SPH) is a central bioactive lipid metabolite positioned at the crucial intersection of ceramide and sphingosine-1-phosphate (S1P) synthesis is increasingly implicated in cardiometabolic health. However, its precise role in the pathophysiology of hypertension and its interplay with inflammatory pathways remain largely unknown. This study aimed to research the therapeutic effects of SPH in hypertension and to explore its underlying mechanisms, focus on a key driver of sterile inflammation that the NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome pathway.</div></div><div><h3>Methods</h3><div>An Angiotensin II (Ang II)-induced hypertensive mouse model and an in vitro model using human umbilical vein endothelial cells (HUVECs) were established. The effects of SPH administration on Ang II-induced hypertension, end-organ damage, and the activation status of the NLRP3 inflammasome were systematically evaluated.</div></div><div><h3>Results</h3><div>In vivo, Ang II infusion triggered significant hypertension, cardiac hypertrophy, and aortic fibrosis, which was accompanied by activation of the NLRP3 inflammasome in cardiovascular tissues. Therapeutic administration of SPH, in a manner comparable to the specific NLRP3 antagonist MCC950, markedly lowered blood pressure and attenuated these pathological changes. In vitro, SPH treatment effectively suppressed Ang II-induced NLRP3 inflammasome activation.</div><div>and released of pro-inflammatory cytokines in HUVECs. Furthermore, SPH exhibited direct protective effects on the endothelium by promoting HUVEC proliferation and against Ang II-induced injury. Mechanistically, SPH suppressed the expression and activation of key inflammasome components, including NLRP3, cleaved Caspase-1, and mature IL-1β and IL-18.</div></div><div><h3>Conclusions</h3><div>This study reveals a novel protective role for Sphingosine in hypertension, acting via the suppression of the NLRP3 inflammasome pathway to decrease inflammation and oxidative stress. These findings explore a new mechanistic link between sphingolipid metabolism and blood pressure regulation and highlight SPH as a potential therapeutic agent for targeting the critical series of metabolic dysregulation and inflammation in hypertensive cardiovascular disease.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"28 ","pages":"Article 200562"},"PeriodicalIF":2.1,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heart failure with reduced ejection fraction (HFrEF) requires guideline-directed medical therapy (GDMT) to reduce morbidity and mortality. However, adherence to GDMT is often suboptimal in resource-limited settings, such as the Jimma Medical Center, Ethiopia.
Objectives
To assess prescriber adherence to guideline-based medical therapy in heart failure at Jimma Medical Center, Ethiopia.
Methods
A convergent mixed-methods study was conducted from December 2023 to April 2024, enrolling 215 adult HFrEF patients. Prescriber adherence was measured using the Guideline Adherence Index (GAI) and QUALIFY scores. Semi-structured interviews with physicians explored the qualitative factors that affect adherence. Multinomial logistic regression identified the factors associated with adherence.
Results
Only 13.5 % of patients were discharged on all four recommended GDMT classes (ACEI/ARB, beta-blockers, MRAs, and SGLT2 inhibitors). Moderate and poor prescriber adherence occurred in 70.1 % and 16.3 % of the cases, respectively. Patient adherence was higher (74.9 % by MARS-5), yet 94 % were physically inactive, and 54.4 % regularly consumed salt. Insurance coverage (AOR: 4.81; p = 0.001), salt restriction (AOR: 6.62; p = 0.003), and shorter hospital stays (AOR: 0.90; p = 0.005) were linked to better adherence, whereas higher ejection fraction (AOR: 1.07; p = 0.005) and more comorbidities (AOR: 2.36; p = 0.037) predicted poorer adherence. The qualitative findings highlighted medication stock-outs, financial barriers, and clinical complexities as key challenges, with institutional support and multidisciplinary care as facilitators.
Conclusions
Prescriber and patient adherence to GDMT for HFrEF at Jimma Medical Center was suboptimal. Interventions targeting prescriber training, expansion of insurance coverage, patient education, and multidisciplinary care are needed to improve outcomes.
背景：心力衰竭伴射血分数降低（HFrEF）需要有指导的药物治疗（GDMT）来降低发病率和死亡率。然而，在资源有限的环境中，如埃塞俄比亚的Jimma医疗中心，坚持GDMT往往不是最佳的。目的评估埃塞俄比亚Jimma医疗中心心衰患者对基于指南的药物治疗的依从性。方法于2023年12月至2024年4月进行一项融合混合方法研究，纳入215例成人HFrEF患者。使用指南依从性指数（GAI）和合格评分来衡量处方依从性。与医生的半结构化访谈探讨了影响依从性的定性因素。多项逻辑回归确定了与依从性相关的因素。结果只有13.5%的患者在所有四种推荐的GDMT类别（ACEI/ARB， β受体阻滞剂，MRAs和SGLT2抑制剂）下出院。中度和不良处方依从性分别占70.1%和16.3%。患者的依从性更高（MARS-5为74.9%），但94%的人不运动，54.4%的人经常食用盐。保险覆盖率（AOR: 4.81; p = 0.001）、限盐（AOR: 6.62; p = 0.003）和较短住院时间（AOR: 0.90; p = 0.005）与较好的依从性相关，而较高的射血分数（AOR: 1.07; p = 0.005）和较多的合共病（AOR: 2.36; p = 0.037）预示较差的依从性。定性调查结果强调，药品缺货、财务障碍和临床复杂性是主要挑战，而机构支持和多学科护理是促进因素。结论吉马医疗中心治疗HFrEF的处方医师和患者对GDMT的依从性不理想。需要针对处方培训、扩大保险覆盖范围、患者教育和多学科护理的干预措施来改善结果。
{"title":"Assessment of prescriber adherence to guideline-directed medical therapy for heart failure at Jimma Medical Center, Ethiopia","authors":"Getachew Yitayew Tarekegn , Legese Chelkeba , Mariam Dubale Deko , Fisseha Nigussie Dagnew , Samuel Berihun Dagnew , Tilaye Arega Moges , Sisay Sitotaw Anberbr , Taklo Simeneh Yazie , Addisu Assfaw Ayen , Behailu Terefe Tesfaye","doi":"10.1016/j.ijcrp.2025.200555","DOIUrl":"10.1016/j.ijcrp.2025.200555","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure with reduced ejection fraction (HFrEF) requires guideline-directed medical therapy (GDMT) to reduce morbidity and mortality. However, adherence to GDMT is often suboptimal in resource-limited settings, such as the Jimma Medical Center, Ethiopia.</div></div><div><h3>Objectives</h3><div>To assess prescriber adherence to guideline-based medical therapy in heart failure at Jimma Medical Center, Ethiopia.</div></div><div><h3>Methods</h3><div>A convergent mixed-methods study was conducted from December 2023 to April 2024, enrolling 215 adult HFrEF patients. Prescriber adherence was measured using the Guideline Adherence Index (GAI) and QUALIFY scores. Semi-structured interviews with physicians explored the qualitative factors that affect adherence. Multinomial logistic regression identified the factors associated with adherence.</div></div><div><h3>Results</h3><div>Only 13.5 % of patients were discharged on all four recommended GDMT classes (ACEI/ARB, beta-blockers, MRAs, and SGLT2 inhibitors). Moderate and poor prescriber adherence occurred in 70.1 % and 16.3 % of the cases, respectively. Patient adherence was higher (74.9 % by MARS-5), yet 94 % were physically inactive, and 54.4 % regularly consumed salt. Insurance coverage (AOR: 4.81; p = 0.001), salt restriction (AOR: 6.62; p = 0.003), and shorter hospital stays (AOR: 0.90; p = 0.005) were linked to better adherence, whereas higher ejection fraction (AOR: 1.07; p = 0.005) and more comorbidities (AOR: 2.36; p = 0.037) predicted poorer adherence. The qualitative findings highlighted medication stock-outs, financial barriers, and clinical complexities as key challenges, with institutional support and multidisciplinary care as facilitators.</div></div><div><h3>Conclusions</h3><div>Prescriber and patient adherence to GDMT for HFrEF at Jimma Medical Center was suboptimal. Interventions targeting prescriber training, expansion of insurance coverage, patient education, and multidisciplinary care are needed to improve outcomes.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"28 ","pages":"Article 200555"},"PeriodicalIF":2.1,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lipoprotein(a) [Lp(a)] and PCSK9 are emerging lipid biomarkers implicated in atherogenesis and residual cardiovascular risk, but their relationship with coronary disease complexity in acute coronary syndrome (ACS) is unclear. This study evaluates their serum levels in first-episode ACS patients versus controls and explores their relationship with SYNTAX score–defined coronary severity.
Methods
This single-centre observational study enrolled 160 patients presenting with their first episode of ACS (aged 18–75) and 40 age-matched healthy controls. All participants were free from lipid-lowering therapy and major comorbidities. Fasting serum samples were collected to measure the standard lipid profile, Lp(a), and PCSK9 levels. The severity of coronary artery disease was quantified using the SYNTAX score after coronary angiography.
Results
The ACS cohort (mean age 55.7 years; 73.1 % male) most frequently presented with STEMI (53.7 %). Traditional risk factors included smoking/tobacco use (48.8 %), diabetes (40.0 %), and hypertension (38.1 %). Median SYNTAX score was 19.4. Compared with controls, ACS patients had significantly lower HDL-C and higher LDL/HDL and cholesterol/HDL ratios. Lp(a) (38.9 vs. 15.9 mg/dL, p < 0.001) and PCSK9 (272.3 vs. 169.6 ng/mL, p < 0.001) were markedly elevated in ACS patients. Neither Lp(a) nor PCSK9 correlated with SYNTAX score. LDL-C showed a modest positive correlation with Lp(a) (r = 0.163, p = 0.040). Higher SYNTAX scores were associated with more extensive multivessel disease.
Conclusion
Patients with ACS exhibited significantly higher Lp(a) and PCSK9 levels compared with healthy controls, but these biomarkers did not reflect angiographic disease complexity. Their role may lie more in underlying cardiovascular risk assessment than in predicting anatomical severity.
脂蛋白(a) [Lp(a)]和PCSK9是新兴的脂质生物标志物，与动脉粥样硬化和残留心血管风险有关，但它们与急性冠状动脉综合征（ACS）中冠状动脉疾病复杂性的关系尚不清楚。本研究评估了首发ACS患者与对照组的血清水平，并探讨了它们与SYNTAX评分定义的冠状动脉严重程度的关系。方法本单中心观察性研究纳入了160例首次出现ACS发作的患者（18-75岁）和40例年龄匹配的健康对照。所有参与者均无降脂治疗和主要合并症。采集空腹血清样本，测量标准血脂、Lp(a)和PCSK9水平。冠状动脉造影后使用SYNTAX评分量化冠状动脉疾病的严重程度。结果ACS队列（平均年龄55.7岁，73.1%为男性）最常表现为STEMI（53.7%）。传统的危险因素包括吸烟/烟草使用（48.8%）、糖尿病（40.0%）和高血压（38.1%）。SYNTAX得分中位数为19.4。与对照组相比，ACS患者的HDL- c显著降低，LDL/HDL和胆固醇/HDL比值显著升高。Lp(a) （38.9 vs. 15.9 mg/dL, p < 0.001）和PCSK9 （272.3 vs. 169.6 ng/mL, p < 0.001）在ACS患者中显著升高。Lp(a)和PCSK9与SYNTAX评分均无相关性。LDL-C与Lp(a)呈正相关（r = 0.163, p = 0.040）。较高的SYNTAX评分与更广泛的多血管疾病相关。结论ACS患者Lp(a)和PCSK9水平明显高于健康对照组，但这些生物标志物不能反映血管造影疾病的复杂性。它们的作用可能更多地在于潜在的心血管风险评估，而不是预测解剖严重程度。
{"title":"A study of extended lipid profile in patients with acute coronary syndrome: Focus on Lipoprotein(a) and PCSK9","authors":"Pradeep Kumar , Sudesh Prajapathi , Abhishek Singh , Akshyaya Pradhan , Ayush Shukla , Monika Bhandari , Akhil Sharma , Pravesh Vishwakarma , Gaurav Chaudhary , Sharad Chandra , Rishi Sethi , Sudhanshu Dwivedi , Raman Puri","doi":"10.1016/j.ijcrp.2025.200558","DOIUrl":"10.1016/j.ijcrp.2025.200558","url":null,"abstract":"<div><h3>Background</h3><div>Lipoprotein(a) [Lp(a)] and PCSK9 are emerging lipid biomarkers implicated in atherogenesis and residual cardiovascular risk, but their relationship with coronary disease complexity in acute coronary syndrome (ACS) is unclear. This study evaluates their serum levels in first-episode ACS patients versus controls and explores their relationship with SYNTAX score–defined coronary severity.</div></div><div><h3>Methods</h3><div>This single-centre observational study enrolled 160 patients presenting with their first episode of ACS (aged 18–75) and 40 age-matched healthy controls. All participants were free from lipid-lowering therapy and major comorbidities. Fasting serum samples were collected to measure the standard lipid profile, Lp(a), and PCSK9 levels. The severity of coronary artery disease was quantified using the SYNTAX score after coronary angiography.</div></div><div><h3>Results</h3><div>The ACS cohort (mean age 55.7 years; 73.1 % male) most frequently presented with STEMI (53.7 %). Traditional risk factors included smoking/tobacco use (48.8 %), diabetes (40.0 %), and hypertension (38.1 %). Median SYNTAX score was 19.4. Compared with controls, ACS patients had significantly lower HDL-C and higher LDL/HDL and cholesterol/HDL ratios. Lp(a) (38.9 vs. 15.9 mg/dL, p < 0.001) and PCSK9 (272.3 vs. 169.6 ng/mL, p < 0.001) were markedly elevated in ACS patients. Neither Lp(a) nor PCSK9 correlated with SYNTAX score. LDL-C showed a modest positive correlation with Lp(a) (r = 0.163, p = 0.040). Higher SYNTAX scores were associated with more extensive multivessel disease.</div></div><div><h3>Conclusion</h3><div>Patients with ACS exhibited significantly higher Lp(a) and PCSK9 levels compared with healthy controls, but these biomarkers did not reflect angiographic disease complexity. Their role may lie more in underlying cardiovascular risk assessment than in predicting anatomical severity.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"28 ","pages":"Article 200558"},"PeriodicalIF":2.1,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-04DOI: 10.1016/j.ijcrp.2025.200549
Alberico L. Catapano , Aldo Pietro Maggioni , Francesco Rossi , Eleonora Consolo , Lucia Notarianni , Giancarlo Agnelli , the OMERO study group
Background
The OMERO study (Observational Multicenter study on Effectiveness and tolerability of aliROcumab in real-world) aimed to evaluate the long-term effectiveness, safety and adherence of alirocumab in a cohort of Italian patients with elevated cholesterol at high- or very-high cardiovascular risk.
Methods
Italian patients with elevated cholesterol received alirocumab for at least six months before the inclusion visit and were monitored for up to five years. The achievement of the recommended LDL-Cholesterol (LDL-C) goal (70 mg/dL in high-risk patients; 100 mg/dL in very-high-risk patients) after one year, regardless of modifications of concurrent lipid-lowering therapy or treatment adherence, was the primary endpoint of the study. The evaluation of the lipid profile, the concomitant use of lipid-lowering therapies, the treatment adherence and the occurrence of adverse events were also investigated.
Results
517 (68.6 %) of the 754 FAS patients met the primary endpoint 12 months after beginning their treatment with alirocumab. Median (mean ± SD) LDL-C reductions at the final visit (median or mean follow-up period) were −60.7 % (−57.4 % ± 19.3 %) compared to baseline. The primary endpoint was achieved by 341(70.7%) of the 482 patients with an LDL-C measurement 3 years after initiating alirocumab. Adherence to the alirocumab regimen was approximately 100 % during the observation period. Eighteen (2.3 %) of the 797 patients included in the safety population experienced at least one adverse drug reaction.
Conclusion
The effectiveness of alirocumab in reducing LDL-C and its favorable safety and tolerability profile have been consistently confirmed in a real-world setting among Italian patients treated for up to 3 years.
{"title":"Observational, Multicenter study on long-term Effectiveness and tolerability of aliROcumab (OMERO): an Italian real-life experience","authors":"Alberico L. Catapano , Aldo Pietro Maggioni , Francesco Rossi , Eleonora Consolo , Lucia Notarianni , Giancarlo Agnelli , the OMERO study group","doi":"10.1016/j.ijcrp.2025.200549","DOIUrl":"10.1016/j.ijcrp.2025.200549","url":null,"abstract":"<div><h3>Background</h3><div>The OMERO study (Observational Multicenter study on Effectiveness and tolerability of aliROcumab in real-world) aimed to evaluate the long-term effectiveness, safety and adherence of alirocumab in a cohort of Italian patients with elevated cholesterol at high- or very-high cardiovascular risk.</div></div><div><h3>Methods</h3><div>Italian patients with elevated cholesterol received alirocumab for at least six months before the inclusion visit and were monitored for up to five years. The achievement of the recommended LDL-Cholesterol (LDL-C) goal (70 mg/dL in high-risk patients; 100 mg/dL in very-high-risk patients) after one year, regardless of modifications of concurrent lipid-lowering therapy or treatment adherence, was the primary endpoint of the study. The evaluation of the lipid profile, the concomitant use of lipid-lowering therapies, the treatment adherence and the occurrence of adverse events were also investigated.</div></div><div><h3>Results</h3><div>517 (68.6 %) of the 754 FAS patients met the primary endpoint 12 months after beginning their treatment with alirocumab. Median (mean ± SD) LDL-C reductions at the final visit (median or mean follow-up period) were −60.7 % (−57.4 % ± 19.3 %) compared to baseline. The primary endpoint was achieved by 341(70.7%) of the 482 patients with an LDL-C measurement 3 years after initiating alirocumab. Adherence to the alirocumab regimen was approximately 100 % during the observation period. Eighteen (2.3 %) of the 797 patients included in the safety population experienced at least one adverse drug reaction.</div></div><div><h3>Conclusion</h3><div>The effectiveness of alirocumab in reducing LDL-C and its favorable safety and tolerability profile have been consistently confirmed in a real-world setting among Italian patients treated for up to 3 years.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"28 ","pages":"Article 200549"},"PeriodicalIF":2.1,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-03DOI: 10.1016/j.ijcrp.2025.200556
Laixi Zhang , Mi Yan , Chunyu Hu, Yuanling Tao, Zhen Cheng, Yalan Zhang, Jiayang Shi, Bing Zou, Li Sun, Zongtao Chen
Background
Cardiometabolic multimorbidity (CMM) is a growing global public health concern, particularly among aging populations. Body Roundness Index (BRI), a novel anthropometric measure reflecting visceral adiposity, may outperform BMI in predicting cardiometabolic risk. This study aimed to investigate the association between longitudinal BRI trajectories and the risk of CMM in a longitudinal cohort.
Methods
8412 participants were ultimately selected from in the China Health and Retirement Longitudinal Study database. BRI measurements were repeatedly obtained from these participants between 2011 and 2016. Group-based trajectory modeling (GBTM) was applied to identify BRI trajectories from 2011 to 2016, with CMM between 2017 and 2020 designated as the primary outcome. We executed a Cox proportional hazards regression model to assess the association between BRI trajectories and the incidence of CMM. In the sensitivity analysis, we stratified cumulative BRI into quartiles to assess whether the association with CMM remained consistent.
Results
Based on the GBTM, participants were categorized into three distinct BRI trajectory groups. These groups, labeled Low-stable, Moderate-stable, and High-stable, comprised 48.23 %, 42.21 %, and 9.56 % of the study population, respectively. Compared to the Low-stable group, Moderate-stable (HR = 1.99, 95 % CI: 1.69–2.35) and High-stable (HR = 2.88, 95 % CI: 2.28–3.63) groups had significantly increased risks of CMM. Subgroup analyses revealed a significant interaction between BMI level and BRI trajectory on CMM outcomes. Sensitivity results supported these findings.
Conclusion
Persistently high BRI trajectories significantly increase CMM risk. BRI is a simple, noninvasive marker with public health utility for early identification and prevention of cardiometabolic diseases, especially in resource-limited settings.
{"title":"Association between body roundness index trajectories and the risk of cardiometabolic multimorbidity in Chinese middle-aged and older adults: Evidence from the China health and retirement longitudinal study","authors":"Laixi Zhang , Mi Yan , Chunyu Hu, Yuanling Tao, Zhen Cheng, Yalan Zhang, Jiayang Shi, Bing Zou, Li Sun, Zongtao Chen","doi":"10.1016/j.ijcrp.2025.200556","DOIUrl":"10.1016/j.ijcrp.2025.200556","url":null,"abstract":"<div><h3>Background</h3><div>Cardiometabolic multimorbidity (CMM) is a growing global public health concern, particularly among aging populations. Body Roundness Index (BRI), a novel anthropometric measure reflecting visceral adiposity, may outperform BMI in predicting cardiometabolic risk. This study aimed to investigate the association between longitudinal BRI trajectories and the risk of CMM in a longitudinal cohort.</div></div><div><h3>Methods</h3><div>8412 participants were ultimately selected from in the China Health and Retirement Longitudinal Study database. BRI measurements were repeatedly obtained from these participants between 2011 and 2016. Group-based trajectory modeling (GBTM) was applied to identify BRI trajectories from 2011 to 2016, with CMM between 2017 and 2020 designated as the primary outcome. We executed a Cox proportional hazards regression model to assess the association between BRI trajectories and the incidence of CMM. In the sensitivity analysis, we stratified cumulative BRI into quartiles to assess whether the association with CMM remained consistent.</div></div><div><h3>Results</h3><div>Based on the GBTM, participants were categorized into three distinct BRI trajectory groups. These groups, labeled Low-stable, Moderate-stable, and High-stable, comprised 48.23 %, 42.21 %, and 9.56 % of the study population, respectively. Compared to the Low-stable group, Moderate-stable (HR = 1.99, 95 % CI: 1.69–2.35) and High-stable (HR = 2.88, 95 % CI: 2.28–3.63) groups had significantly increased risks of CMM. Subgroup analyses revealed a significant interaction between BMI level and BRI trajectory on CMM outcomes. Sensitivity results supported these findings.</div></div><div><h3>Conclusion</h3><div>Persistently high BRI trajectories significantly increase CMM risk. BRI is a simple, noninvasive marker with public health utility for early identification and prevention of cardiometabolic diseases, especially in resource-limited settings.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"28 ","pages":"Article 200556"},"PeriodicalIF":2.1,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145683592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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