Global Heart最新文献

Background: Cooking with polluting fuels is common in low- and middle-income countries and may impact blood pressure, yet data on this association in urban Haiti is limited. This study describes the prevalence of polluting fuel use and indoor cooking, evaluates their associations with blood pressure, and evaluates whether effects are heterogeneous by sex in urban Haiti.

Methods: Using cross-sectional data from the Haiti Cardiovascular Disease Cohort study, prevalence of polluting fuel use and indoor cooking was estimated. The associations between polluting fuel use and indoor cooking with systolic blood pressure (SBP), diastolic blood pressure (DBP) and hypertension (HTN) (mean SBP ≥140 mmHg or mean DBP ≥90 mmHg) were estimated using generalized estimating equations. The interaction between polluting fuel use and sex was also evaluated.

Results: Among 2,931 participants, 58.2% were female and the mean age was 42.0 (SD = 15.9) years. The majority (88.2%) primarily cooked with polluting fuels. Polluting vs clean fuel users tended to have less than a high school education (38.0% vs 22.8%), earn ≤ 1 USD/day (70.5% vs 67.4%), and have high food insecurity (85.0% vs 64.3%). Polluting vs clean fuel users had similar HTN prevalence (adjusted prevalence ratio [aPR] = 0.94, 95% CI: 0.80, 1.10). Average SBP was similar for women (0.99 mmHg, 95% CI: -1.46, 3.44) and lower for men (-4.80 mmHg, 95% CI: -8.24, -1.37) who used polluting vs clean fuels. Cooking indoors vs outdoors was associated with higher HTN prevalence (aPR = 1.12, 95% CI: 1.00, 1.25) and higher average SBP (1.67 mmHg, 95% CI: 0.15, 3.20).

Conclusions: This study demonstrates that most Haitians in Port-au-Prince cook with polluting fuels and often indoors. Those with higher poverty are more exposed, with mixed results in their association with blood pressure. Longitudinal studies are needed to clarify causal relationships and inform interventions promoting clean fuel use. (ClinicalTrials.gov Identifier: NCT03892265).

Background: COVID-19 has led to nearly seven million deaths and male sex has been reported as one of the main risk factors for mortality. Few studies have analyzed cohorts of male patients, especially in underrepresented regions in the medical literature, such as low and middle-income nations. To address this gap, we conducted large-scale, male-specific, multinational analyses, to improve understanding of factors associated with mortality in this high-risk population and global variations.

Methods: This is a prospective, multicenter study that includes data from the CARDIO COVID-19-20 registry and the WHF COVID-19 CVD study. A multiple Poisson regression model was performed to evaluate differences in factors associated with in-hospital mortality among male COVID-19 patients across different regions.

Results: We analyzed 4,899 hospitalized male COVID-19 patients from 32 countries: Africa (11.2%), the Americas (44.7%), Asia (33.8%), and Europe (10.2%). Median age was 59 years (IQR: 47-69), with 50.5% aged 40-64. ICU admission was 42.4%, and mortality was 19.2%, with marked regional differences (ranging from 6% in Europe to 26.9% in the Americas). Poisson regression showed age >80 years (aRR = 4.21) and IMV (aRR = 3.80) as the strongest factors associated with mortality. Other factors included diabetes, chronic kidney disease, myocarditis, and decompensated heart failure. Mortality risk was higher in Africa (aRR = 3.86), Asia (aRR = 2.72), and the Americas (aRR = 2.23) compared to Europe (p < 0.001). Anticoagulation/Antiplatelet therapy showed a potential correlation with survival.

Conclusion: This study reflects the complexity of factors influencing COVID-19 mortality among male patients hospitalized with COVID-19, emphasizing global variability. The substantial differences in mortality noted across countries are likely due to differences in disease severity, comorbidities, clinical care, and health system factors. Age remains a primary risk factor, with older populations particularly vulnerable. Our findings underscore the need for targeted and tailored regional approaches to manage male COVID-19 patients.

Background: Little is known about the prospective relationship between visual acuity (VA) and atherosclerotic cardiovascular disease (ASCVD) events and the extent to which this association is mediated via potential mediators. This study aims to investigate the relationship between VA and ASCVD events, including the mediation effects of potential factors.

Methods: A prospective study was conducted using data from 110,522 participants in the UK Biobank, all of whom had baseline visual acuity (VA) measurements collected between 2006 and 2010. VA was assessed using the logarithm of the minimum angle of resolution (logMAR) chart, with the better-seeing eye selected for analysis. Incident ASCVD events were obtained from hospital admissions and death records up to April 2021. The longitudinal association between VA and ASCVD was examined using Cox proportional hazards models. A four-way decomposition mediation analysis was performed to quantify the indirect effects of hypertension, diabetes, depression, and socioeconomic status in mediating the relationship between VA and ASCVD.

Results: Over an 11.13-year median follow-up, 5,496 ASCVD cases were recorded. A one-line worsening in VA (0.1 logMAR increase) was associated with an increased risk of ASCVD (HR = 1.63; 95%CI = 1.35-1.96, P < 0.001). Mediation analysis showed that hypertension, diabetes, depression, and Townsend deprivation index contributed 3.8%, 3.3%, 5.7%, and 5.9% to this association, respectively (all P < 0.05). Notably, depression was the strongest mediator, accounting for 10.0% of the association in women (P < 0.05).

Conclusions: Our study demonstrates that visual decline is associated with an increased risk of ASCVD. Early intervention through regular eye exams can help mitigate the risk of ASCVD in middle-aged and older adults. Additionally, mental health is a key mediator in the VA-ASCVD relationship, particularly among women.

Objectives: Hypertension is a chronic disease widely prevalent around the world. While previous observational studies have suggested a link between air pollutants and an increased risk of hypertension, causality has not been established. Our study aimed to investigate potential causal relationships between five air pollutants and four blood pressure phenotypes through two-sample Mendelian randomization.

Methods: Two-sample Mendelian randomization (MR) analyses were performed using genome-wide association studies (GWAS) data from the IEU OpenGWAS project. The main analysis method was the inverse variance weighting (IVW) method. Heterogeneity was assessed by Cochran's Q test, while pleiotropy was assessed by MR-Egger regression. Sensitivity analysis was performed by weighted median method, MR-Egger method, simple mode method, weighted mode method, and leave-one-out analysis method.

Results: Mendelian randomization results showed positive causal associations between PM10 with hypertension (OR: 1.49; 95%CI: 1.06, 2.09; P: 2.23 × 10^-2) and systolic blood pressure (β: 1.89; 95%CI: 0.32, 3.47; P: 1.85 × 10^-2), positive causal associations between PM2.5 and hypertension (OR: 1.26; 95%CI: 1.01, 2.58; P: 4.30 × 10^-2), and negative causal associations between NO₂ and systolic blood pressure (β: -1.71; 95%CI: -3.39, -0.02; P: 4.74 × 10^-2). None of the above associations were subject to pleiotropic bias, and all associations were heterogeneous except for PM10 and hypertension. The leave-one-out analysis showed that no single SNP affected the stability of the results.

Conclusion: Elevated levels of PM2.5 and PM10 have been associated with an increased risk of developing hypertension, with PM10 specifically linked to higher systolic blood pressure levels. Interestingly, NO₂ has shown potential as a protective factor in lowering systolic blood pressure. This study clarifies the causal relationship between five air pollutants and elevated blood pressure. Ensuring good ambient air quality is essential in preventing hypertension and reducing the overall disease burden.

Background and aims: Dyslipidemia is the major risk factor for atherosclerotic cardiovascular disease (ASCVD); therefore, its early diagnosis and treatment is necessary. While previous studies in Pakistan focused on general lipid profiles, investigations into gender disparities in lipid testing remain scarce. Therefore, the present study aims to explore the gender disparity in lipid testing and lipid levels among the adult Pakistani population.

Methods: The lipid profile data was obtained from a tertiary care hospital and a diagnostic laboratory with centers across Pakistan. Dyslipidemia was defined based on the criteria provided by the National Cholesterol Education Program (NCEP) guidelines. Gender-based differences in lipid levels were analysed by copula decomposition, breaking down dyslipidemia differences into composition and structure effects.

Results: A total of 577,489 adults were included in this study. The highest number of tests (n = 86,709, 14.6%) were conducted in individuals aged between 50 to 54 years. Greater number of males (n = 203,415, 64.3%) were tested before the age of 50 years compared to females (n = 113,030, 35.7%). Conversely, after the age of 50 years, number of tests increased notably among females (n = 137,541, 52.7%) compared to males (n = 123,503, 47.3%; p < 0.001). For all comparisons, significant differences were observed for low density lipoprotein cholesterol (LDL-C), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) levels between males and females (p < 0.001), where average levels of LDL-C, TC and HDL-C were higher in females while average TG levels were higher in males.

Conclusion: This study highlights the gender disparity in lipid testing in Pakistan, where females undergo lipid testing later in life, despite higher lipid levels compared to males.

The global burden of rheumatic heart disease (RHD) remains substantial, particularly in low-income countries, despite advancements in prevention and management strategies. This article emphasizes the strategies related to primordial prevention, primary prevention, and secondary prevention, including recent advancements in vaccine development, and discusses current challenges in management and future research directions. For treatment, it evaluates percutaneous mitral commissurotomy, mitral valve repair, and replacement, noting the advantages of individualized approaches based on patient conditions. Addressing RHD's global burden requires equitable access to surgical treatments, robust healthcare systems, and sustainable strategies for prevention and care.

Smoking is a significant risk factor for both acute and chronic cardiovascular diseases. These diseases contribute to approximately twenty percent of all-cause mortality. Research indicates that quitting smoking can substantially reduce or even reverse the harmful effects associated with smoking on cardiovascular health. Notably, these benefits can be observed in a relatively short period compared to the duration of smoking history. This article aims to provide data to understand the effects of smoking on the cardiovascular system locally as well as its effects as a pandemic globally and hence provide comprehensive strategies in the management of cardiovascular patients for smoking cessation.

Aim: To evaluate the achievement of metabolic risk factor targets and influencing factors in ACS patients with diabetes during the 12 months after discharge.

Methods: We retrospectively analyzed data from the Chinese Cardiovascular Association database-iHeart Project. Patients who were hospitalized with a diagnosis of ACS between 2014 and 2021 and who had at least one measurement record of LDL-C, BP, or HbA_1c within 12 months after discharge were included. We further stratified patients by diabetes status and analyzed the correlation between clinical characteristics, measurement strategy, and achievement of targets.

Results: Diabetes was identified in 1,027 (27.5%) of the eligible patients. The proportions of patients with diabetes achieving targets of LDL-C, BP, and HbA_1c levels were 42.4%, 61.5%, and 43.7%, respectively. However, combined achievement rate was significantly lower in patients with diabetes than patients without diabetes (16.6% vs. 26.6%). Patients with diabetes who underwent the first measurement within three months or had ≥3 measurements within 12 months were positively associated with achieving combined targets.

Conclusions: The achievement of multifactorial targets among patients with ACS is suboptimal, particularly among patients with concomitant diabetes. The optimal measurement strategy post-discharge is essential for improving the comprehensive management of metabolic risk factors in ACS patients.

Background: Africa has a disproportionate burden of HIV-related cardiovascular disease. We aimed to describe physical activity in people living with HIV (PLHIV) and people without HIV (PWOH) in Uganda and characterize its relationship with the presence of computed tomography angiography-detected (CCTA) coronary artery disease (CAD).

Methods: We performed a cross-sectional analysis of the Ugandan Study of HIV Effects on the Myocardium and Atherosclerosis using Computed Tomography (mUTIMA-CT) cohort. From 2017-2019, physical activity in PLHIV and PWOH was assessed by accelerometry over seven days. Participants additionally underwent CCTA. Univariable and multivariable modified Poisson regression was used to analyze the relationship between physical activity and CAD presence.

Results: 168 participants were analyzed. The median (IQR) age was 57 (53-58) years old and 64% were female. Males had more moderate-to-vigorous physical activity per week [68 minutes (12-144) vs. 15 minutes (0-50), P < 0.001] and less light physical activity [788 minutes (497-1,202) vs. [1,059 (730-1490), P = 0.001] compared to females, but there was no difference by HIV status. After adjusting for age, which accounted for 10% of the variation in steps taken, and sex, no significant associations were found between physical activity and coronary plaque.

Conclusion: Objectively measured physical activity was low compared to guideline recommendations, with males being somewhat more active than females and without significant differences by HIV status. Physical activity was not associated with the presence of CAD independently of age and sex.