Current Problems in Cardiology最新文献

英文中文

The hidden epidemic: Hypertension-related mortality surges amongst younger adults in the United States 隐性流行病：美国年轻成年人中与高血压相关的死亡率激增

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-12 DOI: 10.1016/j.cpcardiol.2024.102842

Background

The prevalence of hypertension (HTN) has significantly increased among younger adults (15-45 yrs) in the U.S. Despite this, there is limited data on trends of HTN-related mortality within this population.

Methods

Data from the CDC WONDER multiple-cause of death database was analyzed from 1999 to 2021, focusing on HTN-related mortality in young adults aged 15 to 45 years. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent changes (APCs) were calculated and stratified by year, sex, race/ethnicity, urbanization status, and census region.

Results

Between 1999 and 2021, there were 201,860 HTN-related deaths among young adults in the U.S. The AAMR increased from 2.8 in 1999 to 5.0 in 2001 (APC 35.3; 95 % CI 20.6 to 44.5) and then to 9.4 in 2019 (APC 3.1; 95 % CI 2.7 to 3.5) before sharply rising to 13.9 in 2021 (APC 22.3; 95 % CI 15.1 to 26.4). Men consistently exhibited higher AAMRs than women from 1999 (AAMR men: 3.6 vs women: 1.9) to 2021 (AAMR men: 18.9 vs women: 8.8). In 2020, the highest AAMR was observed among non-Hispanic (NH) Black or African American young adults (30.2), followed by NH American Indian/Alaska Natives (29.6), NH White (9.9), Hispanics or Latino (9.3) and NH Asian or Pacific Islander (5.0). The Southern region had the highest AAMR (9.3), followed by the Midwest (6.4), West (5.8), and Northeast (5.4). Nonmetropolitan areas consistently had higher AAMR (8.5) than metropolitan areas (7.0). States in the top 90 th percentile for AAMRs included Mississippi, the District of Columbia, Oklahoma, West Virginia, and Arkansas, with these states exhibiting approximately five times the AAMRs of those in the lower 10th percentile.

Conclusion

HTN-related mortality among young adults in the U.S. increased steadily until 2019, followed by a sharp rise in 2020 and 2021. The highest AAMRs were observed among men, NH Black young adults, and individuals residing in the Southern and non-metropolitan areas of the U.S. These findings underscore the need for targeted interventions to reduce the burden and address disparities in HTN-related mortality among young adults in the U.S.

背景美国年轻成年人（15-45 岁）的高血压（HTN）患病率显著增加。尽管如此，有关这一人群中与高血压相关的死亡率趋势的数据却很有限。方法分析了美国疾病预防控制中心 WONDER 多死因数据库中 1999 年至 2021 年的数据，重点关注 15-45 岁年轻成年人中与高血压相关的死亡率。计算了每 10 万人的年龄调整死亡率（AAMRs）和年百分比变化率（APCs），并按年份、性别、种族/民族、城市化状况和人口普查地区进行了分层。AAMR从1999年的2.8升至2001年的5.0（APC 35.3; 95 % CI 20.6至44.5），然后升至2019年的9.4（APC 3.1; 95 % CI 2.7至3.5），之后急剧升至2021年的13.9（APC 22.3; 95 % CI 15.1至26.4）。从 1999 年（男性急性呼吸道感染率：3.6 vs 女性：1.9）到 2021 年（男性急性呼吸道感染率：18.9 vs 女性：8.8），男性的急性呼吸道感染率一直高于女性。2020 年，非西班牙裔（NH）黑人或非裔美国人青壮年的年平均死亡率最高（30.2），其次是 NH 美国印第安人/阿拉斯加原住民（29.6）、NH 白人（9.9）、西班牙裔或拉丁裔（9.3）以及 NH 亚洲人或太平洋岛民（5.0）。南部地区的 AAMR 最高（9.3），其次是中西部（6.4）、西部（5.8）和东北部（5.4）。非大都市地区的 AAMR（8.5）一直高于大都市地区（7.0）。AAMR排名前90%的州包括密西西比州、哥伦比亚特区、俄克拉荷马州、西弗吉尼亚州和阿肯色州，这些州的AAMR约为排名后10%的州的5倍。男性、新罕布什尔州黑人青壮年以及居住在美国南部和非大都会地区的人的急性心肌梗死死亡率最高。这些发现强调了有必要采取有针对性的干预措施，以减轻美国青壮年中与高血压相关的死亡率的负担并解决这方面的差异。

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引用次数: 0

Table of Content 目录

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-10 DOI: 10.1016/S0146-2806(24)00485-7

引用次数: 0

Title Page 标题页

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-10 DOI: 10.1016/S0146-2806(24)00482-1

引用次数: 0

Updated review on pulmonary arterial hypertension: Differences between down syndrome and non-down syndrome populations 肺动脉高压最新综述：唐氏综合征与非唐氏综合征人群的差异

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-10 DOI: 10.1016/j.cpcardiol.2024.102840

Background

Pulmonary arterial hypertension (PAH) is a major concern in patients with Down syndrome (DS) and congenital heart disease (CHD). Understanding the unique characteristics of PAH in these populations is essential for developing tailored management strategies. This review examines differences in PAH between DS and non-DS (nDS) patients with CHD, focusing on pathophysiology, clinical presentation, hemodynamic profiles, and treatment outcomes.

Methods

A retrospective analysis of 93 adults with PAH was conducted, including 18 with DS and 75 with CHD but without DS (nDS). Data on demographics, clinical presentations, comorbidities, and hemodynamic parameters were collected using echocardiography and right heart catheterization. Statistical analyses included Mann–Whitney U tests, Student's t-tests, and Kaplan–Meier survival analysis to compare the DS and nDS groups.

Results

DS patients presented with PAH at a younger age (mean age 25.06 years) compared to nDS patients (mean age 42.4 years; p < 0.001). Hypothyroidism was more prevalent in DS patients (61.1 %) than in nDS patients (29.3 %; p = 0.012). Hemodynamic assessments showed lower mean arterial pressure (MAP) in DS patients (76.24 ± 11.6 mmHg) versus nDS patients (93.95 ± 15 mmHg; p < 0.001), and a higher TAPSE/PASP ratio (0.41 vs. 0.23; p = 0.009), suggesting less severe right ventricular dysfunction. DS patients had a significant survival advantage over nDS patients (p = 0.043).

Conclusions

DS patients have distinct clinical and hemodynamic profiles in PAH, requiring personalized management. Early detection and tailored treatment are crucial for improving outcomes. Further research should refine these strategies and explore new therapies.

背景肺动脉高压（PAH）是唐氏综合征（DS）和先天性心脏病（CHD）患者的一个主要问题。了解这些人群 PAH 的独特特征对于制定有针对性的管理策略至关重要。本综述研究了患有先天性心脏病（CHD）的唐氏综合征患者与非唐氏综合征（nDS）患者在 PAH 方面的差异，重点关注病理生理学、临床表现、血液动力学特征和治疗效果。方法对 93 名患有 PAH 的成人患者进行了回顾性分析，其中包括 18 名患有唐氏综合征的患者和 75 名患有先天性心脏病但不患有唐氏综合征（nDS）的患者。通过超声心动图和右心导管检查收集了有关人口统计学、临床表现、合并症和血液动力学参数的数据。统计分析包括 Mann-Whitney U 检验、学生 t 检验和 Kaplan-Meier 生存分析，以比较 DS 组和 nDS 组。与 nDS 患者（29.3%；P = 0.012）相比，DS 患者中甲状腺功能减退症的发病率更高（61.1%）。血液动力学评估显示，DS 患者的平均动脉压（MAP）较低（76.24 ± 11.6 mmHg），而 nDS 患者的平均动脉压（93.95 ± 15 mmHg; p < 0.001）较高（TAPSE/PASP 比值为 0.41 vs. 0.23; p = 0.009），表明右心室功能障碍的严重程度较轻。与 nDS 患者相比，DS 患者具有明显的生存优势（p = 0.043）。早期发现和针对性治疗对改善预后至关重要。进一步的研究应完善这些策略并探索新的疗法。

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引用次数: 0

Editor’s Message 编辑致辞

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-10 DOI: 10.1016/S0146-2806(24)00483-3

引用次数: 0

Information for Readers 读者信息

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-10 DOI: 10.1016/S0146-2806(24)00486-9

引用次数: 0

Guidelines for Authors 作者指南

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-10 DOI: 10.1016/S0146-2806(24)00484-5

引用次数: 0

Exploring the complex relationships between health behaviors, health outcomes, social vulnerability, regional cultures, and oral health 探索健康行为、健康结果、社会脆弱性、地区文化和口腔健康之间的复杂关系

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-07 DOI: 10.1016/j.cpcardiol.2024.102835

Objectives

Health and social factors show large heterogeneity across regional cultural geographies and influence oral health as well. The purpose of this study is to confirm associations between county-level general health, behaviors, social factors, and oral health indicators and to further analyze the patterns of distribution of oral health indicators across dominant regional cultures in the United States (US) as defined by the American Nations model.

Methods

We calculated a Lifestyle Health Index (LHI) from the 2023 PLACES database using county-level, age-adjusted health data and merged it with (a) 2020 Social Vulnerability Index (SVI) database, (b) dominant regional cultures from Nationhood Lab's American Nations model, (c) dentist visits and teeth lost data from the 2023 PLACES database, and (d) access to dentistry data from the County Health Rankings database.

Results

Correlation coefficients between the LHI (and sub scores), SVI (and sub scores), and dental variables showed strong associations. ANOVA post-hoc test results revealed significant differences for dental visits and teeth lost for LHI, SVI and access to dentists. Prevalence of dental visits and teeth lost showed clear heterogeneity across regional cultures.

Conclusions

Oral health is strongly linked to lifestyle health factors, social vulnerability, access to dentistry, and cultural norms and belief systems. Within the US, significant heterogeneity exists in the distribution of oral health indicators across dominant regional cultural geographies. Oral health communications and policy solutions focused on health-related behaviors (e.g., tobacco, diet), disease-specific considerations (e.g., diabetes), and the social environment (e.g., poverty, housing) should be tailored to regional cultures rather than a single US-based culture to improve dental care and oral health outcomes.

目标健康和社会因素在不同的区域文化地理中表现出很大的异质性，也影响着口腔健康。本研究旨在确认县级总体健康、行为、社会因素和口腔健康指标之间的关联，并进一步分析美国国家模型所定义的口腔健康指标在美国各主要地区文化中的分布模式。方法我们利用县级年龄调整后的健康数据计算了 2023 PLACES 数据库中的生活方式健康指数 (LHI)，并将其与（a）2020 年社会脆弱性指数 (SVI) 数据库、（b）Nationhood Lab 的美国国家模型中的主导地区文化、（c）2023 PLACES 数据库中的牙医就诊和牙齿脱落数据以及（d）县级健康排名数据库中的牙医就诊数据进行了合并。结果LHI（及子得分）、SVI（及子得分）和牙科变量之间的相关系数显示出很强的关联性。方差分析事后检验结果显示，在 LHI、SVI 和牙医就诊率方面，牙科就诊率和牙齿脱落率存在显著差异。结论口腔健康与生活方式健康因素、社会脆弱性、看牙医的机会以及文化规范和信仰体系密切相关。在美国，口腔健康指标在各主要地区文化地域的分布存在明显的异质性。口腔健康宣传和政策解决方案应侧重于与健康相关的行为（如烟草、饮食）、特定疾病（如糖尿病）和社会环境（如贫困、住房），以改善牙科保健和口腔健康结果。

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引用次数: 0

Response to “Racial disparities in trend, clinical characteristics and outcomes in takotsubo syndrome” 对 "Takotsubo 综合征的趋势、临床特征和结果中的种族差异 "的回应。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-04 DOI: 10.1016/j.cpcardiol.2024.102834

引用次数: 0

Effect of exercise training in patients with chronotropic incompetence and heart failure with preserved ejection fraction: Training-HR study protocol 慢动作不全和射血分数保留型心力衰竭患者运动训练的效果：训练-心率研究方案》。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology

Pub Date : 2024-09-04 DOI: 10.1016/j.cpcardiol.2024.102839

Background

Chronotropic incompetence (ChI) is linked with diminished exercise capacity in heart failure with preserved ejection fraction (HFpEF). Although exercise training has shown potential for improving functional capacity, the exercise modality associated with greater functional and chronotropic response (ChR) is not well-known. Additionally, how the ChR from different exercise modalities mediates functional improvement remains to be determined. This study aimed to evaluate the effect of three different exercise programs over current guideline recommendations on peak oxygen consumption (peakVO₂) in patients with ChI HFpEF phenotype.

Methods and results

In this randomized clinical trial, 80 stable symptomatic patients with HFpEF and ChI (NYHA class II-III/IV) are randomized (1:1:1:1) to receive: a) a 12-week program of supervised aerobic training (AT), b) AT and low to moderate-intensity strength training, c)AT and moderate to high-intensity strength training, or d) guideline-based physical activity and exercise recommendations. The primary endpoint is 12-week changes in peakVO₂. The secondary endpoints are 12-week changes in ChR, 12-week changes in quality of life, and how ChR changes mediate changes in peakVO₂. A mixed-effects model for repeated measures will be used to compare endpoint changes. The mean age is 75.1 ± 7.2 years, and most patients are women (57.5 %) in New York Heart Association functional class II (68.7 %). The mean peakVO₂, percent of predicted peakVO₂, and ChR are 11.8 ± 2.6 mL/kg/min, 67.2 ± 14.7 %, and 0.39 ± 0.16, respectively. No significant baseline clinical differences between arms are found.

Conclusions

Training-HR will evaluate the effects of different exercise-based therapies on peakVO₂, ChR, and quality of life in patients with ChI HFpEF phenotype.

Clinical trial registration

ClinicalTrials.gov (NCT05649787).

背景：射血分数保留型心力衰竭（HFpEF）患者的运动能力减弱与嗜铬细胞功能不全（ChI）有关。虽然运动训练已显示出提高功能能力的潜力，但与更大的功能和促时差反应（ChR）相关的运动方式并不为人所知。此外，不同运动模式的ChR如何介导功能改善仍有待确定。本研究旨在评估三种不同的运动项目与现行指南建议相比，对 ChI HFpEF 表型患者峰值耗氧量（peakVO2）的影响：在这项随机临床试验中，80 名症状稳定的 HFpEF 和 ChI（NYHA II-III/IV 级）患者被随机分配（1:1:1:1:1）接受：a）为期 12 周的有氧训练（AT）项目；b）有氧训练和中低强度力量训练；c）有氧训练和中高强度力量训练；或 d）基于指南的体力活动和运动建议。主要终点是峰值血氧量在 12 周内的变化。次要终点是 12 周 ChR 的变化、12 周生活质量的变化以及 ChR 的变化如何介导峰值 VO2 的变化。将采用重复测量的混合效应模型来比较终点变化。平均年龄为 75.1±7.2 岁，大多数患者为女性（57.5%），纽约心脏协会功能分级为 II 级（68.7%）。平均峰值 VO2、预测峰值 VO2 百分比和 ChR 分别为 11.8±2.6 mL/kg/min、67.2±14.7% 和 0.39±0.16。两组之间没有发现明显的基线临床差异：训练-HR将评估不同运动疗法对ChI HFpEF表型患者的峰值VO2、ChR和生活质量的影响：临床试验注册：ClinicalTrials.gov (NCT05649787)。

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