Global Heart最新文献

Background: Cardiometabolic diseases (CMD), including ischemic heart disease, stroke, and type 2 diabetes, have caused an enormous global healthcare burden. Beyond traditional risk factors, female reproductive factors may also be associated with CMD. However, comprehensive evaluations of female reproductive factors related CMD is limited.

Methods: A total of 189,411 women with no prior CMD from the UK Biobank cohort from 2007 to 2010 were included and followed until December 2022. Associations between reproductive factors and CMD were analyzed using Cox proportional hazards models with adjustment for potential confounders based on the directed acyclic graph (DAG).

Results: During a median follow-up of 13.2 years, 17,251 incident CMD events occurred. Compared to menarche at age 12-13 years, <12 years and >13 years had a higher risk of CMD (HR <12 year (y) vs 12-13 y: 1.04 [95% CI, 1.01-1.08]; >13 y vs 12-13 y: 1.08 [1.04-1.13]). Earlier age at menopause was related to a higher risk of CMD (HR <46 y vs 50-51 y: 1.22 [1.15-1.29]; 46-49 y vs 50-51 y: 1.08 [1.03-1.14]), and a short reproductive lifespan (HR <33 y vs 36-38 y: 1.19 [1.13-1.25]; 33-35 y vs 36-38 y: 1.08 [1.03-1.14]). Younger age at first live birth (HR <22 y vs 24-26 y: 1.18 [1.12-1.24]; 22-23 y vs 24-26 y: 1.06 [1.00-1.12]) and last live birth (HR <26 y vs 29-30 y: 1.12 [1.06-1.18]) were associated with higher risk. Women with three or four children (HR 3-4 children: 1.21 [1.15-1.28]) and those with more than four children (HR >4 children: 1.27 [1.07-1.52]) were associated with higher risk of CMD. Recurrent pregnancy loss was associated with a 39% and 14% higher risk of CMD, respectively.

Conclusion: Female reproductive factors are associated with CMD, independent of traditional risk factors. These reproductive factors could inform clinical screening and improve cardiometabolic risk assessment in women.

Peer-reviewed publications using local data are critical for understanding disease burdens, generating evidence, and shaping policies tailored to community needs. Although low- and middle-income countries (LMICs) account for 80% of cardiovascular disease (CVD) deaths, they contribute only 2.8% of CVD publications. To address this gap, the US Centers for Disease Control and Prevention (CDC) and partners launched the Emerging Authors Program for Global Cardiovascular Research (EAP), supporting early- to mid-career LMIC practitioners. EAP coordinated mentorship, provided virtual writing tools, training, technical support, and financial assistance for open access. Between 2019 and 2023, three waves engaged 33 authors from 11 countries, resulting in 31 published manuscripts in six journals, with support from 23 global mentors. The success was driven by committed mentors, motivated authors, local collaboration, accessible resources, and strong communication. Strengthening LMIC authors' writing and publication skills is essential for advancing rigorous research and global health equity in scientific publishing.

Background: Single-pill combination (SPC) therapy improves hypertension control; however, its implementation in primary care settings remains limited. In Nigeria, there is insufficient evidence on factors influencing SPC uptake, particularly from the perspective of healthcare workers (HCWs). This study examined the implementation of SPC medications for hypertension treatment by nonphysician HCWs at primary healthcare facilities (PHCs) in Nigeria.

Methods: An explanatory sequential mixed methods study was conducted, building on a cluster randomized controlled trial embedded within the Hypertension Treatment in Nigeria Program. The trial compared SPC medications with free-equivalent combination therapies across 60 PHCs (January-June 2021). A subsequent qualitative component (September-December 2021) included two focus group discussions from 30 PHCs assigned to the SPC arm of the trial and five key informant interviews. The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was used to assess implementation outcomes and identify facilitators and barriers. Integration of quantitative and qualitative findings was guided by the RE-AIM Qualitative Evaluation for Systematic Translation framework (QuEST).

Results: All 30 PHCs assigned to dispense SPCs adopted the medications (Reach/Adoption). Effectiveness: Blood pressure control (<140/90 mm Hg) was 54% (95% CI: 0.52, 0.56) in the SPC arm and 48% (95% CI: 0.46, 0.50) in the free-equivalent arm (cluster-adjusted p = 0.29). Monthly SPC use ranged from 21-37% across sites (Implementation), and 49% of patients remained in care at six months (Maintenance). Facilitators included training on SPC protocols, simplicity of dispensing the regimen, and perceived improvements in patient adherence. Challenges included SPC stockouts and concerns regarding nonphysician HCW capacity to manage complex cases. Policymakers identified the potential role of a Drug Revolving Fund (DRF) to support sustained SPC supply.

Conclusions: The findings indicate favorable implementation outcomes associated with SPC use by nonphysician HCWs in PHCs. Addressing supply challenges, maintaining training, and providing supportive supervision may be important for sustaining SPC-based hypertension treatment.

Objective: Dyslipidaemia is a leading preventable cause of global cardiovascular disease (CVD) burden, responsible for over four million deaths each year (1). A scoping review took a worldwide perspective and assessed recent World Health Organization (WHO) guidance documents, other national or regional guidelines, and randomized controlled trial evidence supporting dyslipidaemia management best practices.

Methods: Review of WHO guidance documents included aspects of dyslipidaemia management, but none provided a detailed and comprehensive approach. Of 11 non-WHO national or regional dyslipidaemia guidelines, nine met pre-defined inclusion criteria and were reviewed in depth. Structured electronic searches of MEDLINE found 27 systematic reviews of randomized clinical trials supporting dyslipidaemia management guideline priority topics.

Findings: This scoping review found overall consistency in the recommendations of regional and national dyslipidaemia guideline recommendations. Guidelines varied in terms of approach to assessing patient CVD risk and recommendations to treat with non-statin lipid-lowering therapy (LLT). Robust randomized trial evidence supports that a dyslipidaemia management guideline focuses on priority areas including approach to patient selection for LLT efficacy and safety, selection of initial LLT drugs and dose intensity, timing of LLT monitoring, and LLT management in specific high-risk groups (familial hypercholesterolemia, diabetes, chronic kidney disease, HIV and other inflammatory diseases, and older adults). Few regional or national guidelines provided practical implementation recommendations or cost-effectiveness assessments; less clinical trial evidence was found for the priority topic of equitable treatment.

Conclusion: Taking a global perspective, this scoping review describes the scope and depth of the current evidence base informing best practice management of dyslipidaemia for the primary and secondary prevention of CVD.

Background: We examined cardiac implantable electronic device (CIED) implantation and outcomes related to geographical remoteness.

Methods: This was a retrospective cohort study of adult cardiovascular hospitalisations in New South Wales, Australia (2008-2018). The primary outcome was CIED implantation in arrhythmia, cardiomyopathy, and syncope groups (and subcategories) among rural and regional residents. Secondary outcomes included CIED subtypes: pacemaker (PPM), implantable defibrillator (ICD) and cardiac resynchronisation therapy (CRT), examination of 10-year implant trends, and 5-year mortality rates adjusted for age and comorbidities.

Results: Of the 1,291,258 cardiovascular admissions, 880,972 patients were from major cities (urban), 304,961 from inner regional (regional), and 105,325 from outer regional, rural, or remote areas (rural). Regional and rural patients received less PPMs (regional: aOR = 0.66; 95% CI 0.64-0.69; rural: aOR = 0.75; 95% CI 0.71-0.79), CRTs (regional: aOR = 0.71; 95% CI 0.65-0.78, rural: aOR = 0.72; 95% CI 0.83-0.94), and ICDs for regional patients (aOR = 0.72; 95% CI 0.67-0.77). Differences persisted in subcategories, including PPMs for complete heart block (regional: aOR = 0.58; 95% CI 0.56-0.60, rural: aOR = 0.66; 95% CI 0.62-0.70) and ICDs for ischaemic (regional: aOR = 0.44; 0.34-0.56, rural: aOR = 0.74; 95% CI 0.54-0.99) and non-ischaemic cardiomyopathy (regional: aOR = 0.64; 95% CI 0.56-0.73, rural: aOR = 0.72; 95% CI 0.59-0.87). Five-year mortality rates were higher in rural patients receiving PPM (urban = 23.7%; 95% CI23.2-24.2, rural = 26.4%; 95% CI 25.8-27.0), ICD (urban = 29.5%; 95% CI 28.2-30.7, rural = 32.5%; 95% CI 31.3-33.8) and CRT (urban = 24.2%; 95% CI 22.9-25.5, rural = 26.9%; 95% CI 25.5-28.3).

Conclusion: Regional and rural patients had less CIED implantation, with higher 5-year rural mortality rates. Our study highlights the geographical disparity that occurs for patients requiring CIED and the need for further examination to determine the underlying causes and address these inequities.

Background: Rheumatic heart disease (RHD) remains a significant public health concern in middle- to low-income countries. Despite advancements in healthcare access and public health measures in Brazil, future projections of RHD burden are essential to guide policy-making. Thus, we projected the national and regional burden of RHD in Brazil through 2050.

Methods: Annual prevalence counts and disability-adjusted life years (DALYs) for RHD from 2000 to 2021 were extracted from the 2021 Global Burden of Disease (GBD) dataset for 10-year age brackets (5-74 years). Age-standardized prevalence (asPR) and DALYs rates (asDALYs) per 100,000 were calculated nationally and regionally. Bayesian age-period-cohort models were used to project trends through 2050, with results reported as medians (25^th, 75^th percentiles) and estimated annual percentage changes (EAPCs).

Results: From 2000 to 2021, Brazil's population grew by 27%. Nationally, the asPR declined slightly from 1,503 to 1,495 per 100,000 [EAPC: -0.04% (95% CI: -0.05, -0.03)], with reductions observed in most regions. However, increases were noted in the North [EAPC: 0.14% (95% CI: 0.13, 0.15)] and Northeast [EAPC: 0.02% (95% CI: 0.01, 0.03)]. Males experienced greater reductions [EAPC: -0.16% (95% CI: -0.19, -0.13)] compared to females, who showed a slight increase [EAPC: 0.05% (95% CI: 0.03, 0.07)]. Projections indicate that asPR will decline nationally to 1,418 per 100,000 by 2050 [EAPC: -0.20% (95% CI: -0.20, -0.19)], with the South and Central West regions reducing the most.The asDALY rates declined from 142 to 104 per 100,000 [EAPC: -1.58% (95% CI: -1.69, -1.46)] during 2000-2021, with all regions showing decreases, particularly the Southeast [EAPC: -1.83% (95% CI: -1.98, -1.69)]. Nationally, projections suggest further reductions to 75 per 100,000 by 2050 [EAPC: -1.17% (95% CI: -1.22, -1.11)].

Conclusion: The burden of RHD in Brazil has decreased nationally and regionally over recent decades. Projections suggest that these trends will continue.

Introduction: Immunization rates against influenza and pneumococcus in Latin America remain lower than expected, particularly in Andean region, Central America, Mexico, and Caribbean region. An incremental correlation between economic strata and educational level and vaccines uptake has been observed. This highlights the need for more comprehensive data to accurately characterize the current health landscape and develop strategies for improvement.

Methods and design: The Inter-American Registry of Influenza and Pneumococcal Vaccination (CorVacc Study) is a cross-sectional survey of the general population conducted across 19 Latin American countries. Adults aged 18 years and older completed a 34-question online survey. The pool was validated within the first 1000 responses. Data were grouped into seven categories: demographics, socioeconomic and educational level, cardiometabolic profile, cardiovascular interventions, medical follow-up and treatments, and COVID-19 vaccination status.

Results: A total of 21,389 responses were obtained, distributed as follows: 8915 from the North, Central, and Caribbean region; 7492 from the Andean region; and 4801 from the Southern Cone region. Influenza vaccination rates were lower in the Andean region (OR: 0.62; 95% CI: 0.50-0.78), the Caribbean (OR: 0.30; 95% CI: 0.23-0.39), and Central America (OR: 0.59; 95% CI: 0.46-0.76) compared with the Southern Cone. Residing in Central America (OR: 3.06; 95% CI: 1.62-5.77) was associated with greater pneumococcal vaccination. The probability of being vaccinated against influenza was higher in men (OR: 1.3; 95% CI: 1.1-1.6) and in individuals with obesity (OR: 1.26; 95% CI: 1.13-1.40). COPD was associated with a lower probability of pneumococcal vaccination (OR: 0.51; 95% CI: 0.33-0.79).

Conclusions: This study highlights the importance of targeted vaccination campaigns to improve coverage, particularly in regions with lower rates. It also underscores the need for enhanced education and awareness of the benefits of vaccination. Tackling barriers such as vaccine hesitancy and misinformation will be essential for raising vaccination rates and, ultimately, for reducing the burden of cardiovascular disease.

Objective: To assess the heart attack (HA) knowledge, awareness, and attitude among adults in Al-Hasa, Saudi Arabia, and to identify gaps in understanding that could hinder prompt medical intervention.

Methods: A descriptive cross-sectional study was conducted using a self-administered questionnaire distributed via Google Forms from January to March 2024. Statistical analysis was performed using IBM SPSS, Version 29, to evaluate associations between demographics and HA awareness.

Results: Participants demonstrated moderate awareness of non-classical HA symptoms such as slurred speech (relative importance index (RII) = 72.88%) and dizziness (66.35%), whereas critical symptoms such as chest pain (47.8%) and shortness of breath (47.25%) were among the least recognized. This suggests a concerning gap in knowledge of the most urgent indicators of HA. Respondents showed higher awareness of non-modifiable risk factors such as family history (RII = 70.99%) and high cholesterol (63.92%) compared to modifiable lifestyle-related risks. Smoking (43.71%) and obesity (43.08%) ranked lowest in awareness, indicating insufficient recognition of preventable contributors to cardiovascular disease. Participants exhibited a high level of hesitation in seeking immediate medical attention during a suspected HA. Social embarrassment (RII = 67.36%) and concerns about healthcare costs (66.08%) were the primary reasons cited for delay. Alarmingly, the belief that one should wait to be 'very sure' before going to the hospital was common (RII = 59.01%), whereas the urgency of symptoms such as persistent chest pain was undervalued (RII = 31.18%). Significant differences in symptom recognition were observed across age groups (e.g., P = 0.001 for jaw/neck/back pain), education levels (e.g., P = 0.028 for pain in arms/shoulders), and marital status (e.g., P = 0.002 for several symptoms). No significant gender-based differences were found.

Conclusion: Al-Hasa population showed good knowledge and awareness of HA symptoms and risk factors; however, significant gaps exist in recognizing less common symptoms and emergency procedures. Poor attitude was shown toward HA seeking medical care. Concerns about cost, embarrassment, and suspicion in the severity of the symptoms appeared to be barriers to seeking timely care.

Background: Myocardial revascularization by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) lowers mortality, yet long-term outcomes may vary by socioeconomic status despite broadly similar access to care.

Objective: To examine the association between income-measured in legal monthly minimum wages (MMW)-and five-year survival after revascularization in formally employed Colombians (2012-2018).

Methods: This was a retrospective cohort study using linked national administrative datasets. Income was grouped into quartiles at cohort entry. The primary outcome was five-year mortality. Analyses were stratified by procedure (CABG, PCI). Multivariable Cox models were used to estimate adjusted hazard ratios (aHRs), controlling for age, sex, region, Charlson Comorbidity Index, recent acute myocardial infarction, valve surgery within 30 days, and pre-procedural cardiac rehabilitation (30 days). Socioeconomic gradients were summarized using the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII; absolute difference per 100,000 patients).

Results: Among 8,128 patients (mean age = 55.0 ± 9.3 years; 11.3% women), 2,131 underwent CABG and 5,997 underwent PCI. After CABG, five-year mortality was 13.2% in Q1 vs 7.8% in Q4 (p < 0.01); aHRs (vs Q1) were 0.60 (95% CI = 0.40-0.90) for Q2, 0.56 (0.38-0.84) for Q3, and 0.58 (0.38-0.88) for Q4 (all p ≤ 0.01). After PCI, mortality declined from 11.7% (Q1) to 6.5% (Q4) (p < 0.01); only Q4 remained significant after adjustment (aHR = 0.64; 95% CI = 0.49-0.82; p < 0.01). Inequality indices confirmed the gradient: for CABG, SII = 4.14 per 100,000 (95% CI = 3.30-4.98; p < 0.01) and RII = 1.97 (1.17-3.31; p = 0.01); for PCI, SII = 3.13 per 100,000 (2.74-3.52; p < 0.01) and RII = 1.81 (1.32-2.48; p < 0.01).

Conclusions: Lower income is associated with worse five-year survival after myocardial revascularization, with larger absolute and relative inequalities after CABG than after PCI.