Global Heart最新文献

Background: Cardiovascular diseases (CVDs) are the leading global cause of mortality and disability, with prevalence increasing due to aging and risk factors like obesity and hypertension. The retina, rich in microvasculature, provides a unique opportunity to investigate microvascular dysfunction linked to CVDs and other systemic vascular diseases.

Method: This study used a multifaceted approach to assess the genetic correlation and causal relationship between retinal characteristics and CVDs. Linkage disequilibrium score regression (LDSC) and Mendelian randomization (MR) analyses were conducted using genome-wide association study (GWAS) data from the UK Biobank and FinnGen datasets. A cross-sectional study was also conducted to validate the findings, collecting optical coherence tomography (OCT) images from 124 eyes (89 with CVDs and 35 healthy controls). A prediction model is based on least absolute shrinkage and selection operator (LASSO) regression to assess the risk of CVD.

Result: Using LDSC and two-sample MR, we found genetic evidence consistent with a causal effect whereby genetically proxied thinner retinal nerve fiber layer (RNFL) was associated with higher risks of hypertension and myocardial infarction (MI), while genetically proxied thicker photoreceptor inner segment/outer segment (PR-IS/OS) was associated with coronary heart disease and MI (false discovery rate [FDR] thresholds as reported). Genetically proxied thinner retinal pigment epithelium (RPE) showed an inverse association with stroke risk. Several circulating biomarkers-including lipoprotein(a) [Lp(a)], low-density lipoprotein cholesterol (LDL-C), and ApoB-exhibited MR evidence of association with multiple CVDs. In a cross-sectional cohort, retinal layer differences and their relationships with lipids were directionally consistent with the genetic findings.

Conclusion: Retinal structural traits measured by OCT-particularly RNFL, PR-IS/OS, and RPE thickness-are best interpreted as non-invasive markers that reflect systemic vascular biology. Our MR analyses support shared etiologic pathways between retinal microstructure and CVDs rather than implying that retinal damage clinically causes cardiovascular events. Findings warrant validation in larger and more diverse populations and should not be considered definitive proof of causality.

Cardiovascular diseases (CVDs) remain a leading global cause of mortality and disability, with significant disparities observed across countries. This is particularly true in Central and Eastern Europe (CEE), where populations are primarily at high and very high CVD risk. Highlighting modifiable risk factors underscores the urgent need for effective prevention programs. This paper introduces the European Program for Prevention (EPP), an initiative by the International Lipid Expert Panel (ILEP), designed to address these challenges. The EPP aims to enhance awareness and knowledge of validated preventive healthcare solutions implemented in CEE countries, showcase the region's potential for innovative strategies, and evaluate the adaptability of successful programs for broader implementation. The EPP strongly supports the EU Cardiovascular Health Plan, as well as initiatives by the World Heart Federation (WHF) and World Health Organization (WHO), by promoting best practices, early detection, integrated prevention frameworks, training, cross-border cooperation, and policy development. It advocates shifting healthcare priorities towards pre-disease prevention, thus reducing reliance on resource-intensive treatments. The program proposes an optimal CVD prevention system that includes mandatory health education, screening programs for familial hypercholesterolemia and universal Lp(a) screening, and comprehensive check-ups, notably integrated, comprehensive care programs. By leveraging existing validated programs and fostering collaboration, the EPP seeks to reduce the burden of CVD, improve outcomes, and promote cardiovascular health across Europe and beyond.

Background: A novel low-dose triple single-pill combination of antihypertensive drugs (GMRx2) has demonstrated superior blood pressure (BP)-lowering efficacy compared to placebo and dual combinations in short-term randomized double-blind trials.

Objectives: To evaluate the long-term BP-lowering efficacy and safety of GMRx2-based treatment when used in normal clinical care.

Methods: After completing a four-week double-blind randomised phase, participants from Sri Lanka and Nigeria were enrolled into an open-label extension phase (OLE) with follow-up to one year. The OLE involved treatment and uptitration with GMRx2, of ¼, ½ and standard doses of telmisartan/amlodipine/indapamide (i.e., 10/1.25/0.625 mg, 20/2.5/1.25 mg and 40/5/2.5 mg), and add-on antihypertensive drugs if needed to target a home BP goal of <130/80 mm Hg. Home BP monitoring was continued throughout the follow-up and six follow-up clinic visits were conducted. The primary outcome was percentage of participants with home BP control (<130/80 mmHg) at week 52.

Results: From 21 August 2023 to 20 August 2024, 50 participants participated in the OLE, of whom 48 (96%) completed it. The mean age of participants was 49 years and 60% were female. Home and clinic mean BP at enrolment into OLE were 126/79 mmHg and 131/83 mmHg, respectively. At one year, home BP control (<130/80 mmHg) was 60% and clinic BP control (<140/90 mmHg) was 88%. Home mean BP was reduced to 121/78 mmHg after 4 weeks into the OLE and was 120/78 mmHg at one year. For clinic BP, the corresponding values were 126/79 mmHg and 122/77 mmHg. None of the participants discontinued trial treatment due to an adverse event.

Conclusions: In a population with mild-to-moderate hypertension, long-term therapy with GMRx2-based treatment achieved high levels of BP control and was well tolerated.Trial registration: NCT04518306.

Background: Degenerative mitral valve disease (DMVD) is a significant contributor to the global burden of disease. This study aimed to estimate the prevalence, mortality, and disability-adjusted life years (DALYs) rates of DMVD at global, regional, and national levels from 1990 to 2021 and to project its future burden.

Methods: This study extracted three pivotal indicators, including the prevalence, mortality, and DALYs related to DMVD, from the Global Burden of Disease 2021. The average annual percentage change and rate change were utilized to evaluate the changes in the disease burden. Decomposition analyses were conducted to evaluate these changes. In addition, a Bayesian age-period-cohort analysis was performed to forecast the future burden of DMVD.

Results: In 2021, the global age-standardized prevalence rates (ASPRs), age-standardized mortality rates (ASMRs), and age-standardized disability-adjusted life year rates (ASDRs) for DMVD were 182.13 per 100,000 persons [95% uncertainty interval (UI): 169.952, 196.070], 0.456 per 100,000 persons (95% UI: 0.394, 0.514), and 11.362 per 100,000 persons (95% UI: 9.867, 13.611), respectively. Regions with a high sociodemographic index exhibited the most substantial disease burden. Women exhibited lower ASPR than men, but higher ASMR. Decomposition analyses reveal that improvements in DMVD burden were primarily attributable to epidemiological changes; however, it was negatively affected by population growth and aging. Predictive analysis suggests that global projections for DMVD in 2035 estimate approximately 21.41 million (95% UI: 15,718,776, 27,102,848) cases of prevalence, 47,878 (95% UI: 28,449, 67,307) cases of mortality, and 1.20 million (95% UI: 793,487, 1,615,972) cases of DALYs.

Conclusions: The global burden of DMVD, indicated in its age-standardized prevalence, mortality, and DALYs rates, exhibits significant declines. However, significant regional and national variations exist. Findings of our study emphasize the importance of devising targeted public health strategies tailored to different regions, countries, and populations, with the aim of further mitigating DMVD's global impact.

The use of social marketing (SM) interventions for salt/sodium reduction has drawn increased attention worldwide. This systematic review investigates the application of social marketing principles to the design, implementation, and evaluation of salt/sodium reduction interventions globally and provides recommendations for future public health practice. Using PRISMA, searches were conducted on PubMed, Web of Science, CINAHL, and PsychInfo, with 51 final studies identified, abstracted, and synthesized using the matrix method. Studies conducted more recently contained a greater number of social marketing benchmark criteria (behavioral focus, formative research, segmentation, exchange, competition, marketing mix, community involvement, and integration). Studies reporting greater success used more benchmark criteria. Community-based initiatives using personalized/localized tactics combined with upstream policy-supported structural measures and management-supported place-based initiatives implemented in hospitals, workplaces, and schools were the most self-reported effective interventions. Future salt/sodium reduction initiatives should apply the full social marketing framework to multilevel interventions designed with culturally responsive community-based processes.

[This corrects the article DOI: 10.5334/gh.1450.].

Background: Cardiovascular care remains limited in sub-Saharan Africa. Since its establishment in 2015, the Benjamin Mkapa Hospital (BMH) in Dodoma, Tanzania, has gradually strengthened its cardiology and cardiothoracic services through the integration of high-tech diagnostics, interventional procedures, and surgical capabilities, aiming to meet the growing demand for advanced medical care in Tanzania.

Objective: To describe the evolution of cardiology and cardiothoracic services at the BMH, assess performance and challenges, and report on procedures conducted between 2019 to 2024.

Methodology: A retrospective descriptive analysis was conducted on patient document review and the hospital electronic database between February 2019 and August 2024. The study included both pediatric and adult patients who received care in the cardiology and cardiothoracic department.

Results: The transformation of cardiovascular services at the BMH from 2018 resulted in providing advanced cardiovascular care to patients in central Tanzania. A total of 1,313 procedures were performed, including 1,215 adult cardiac catheterization procedures (1,081 diagnostic coronary angiographies, 115 percutaneous coronary interventions, and 19 pacemaker implantations), 55 pediatric cardiac catheterization procedures (16 right heart catheterizations, 10 atrial septal defect device closures, 18 patent ductus arteriosus device closures, and 11 pulmonary valve valvuloplasty), and 43 open-heart surgeries, consisting of 36 congenital heart disease repairs, two valve replacements, and five coronary artery bypass grafts. Among 115 patients who underwent percutaneous coronary intervention, four died, yielding a success rate of 96.5%. Of the 43 patients who underwent open-heart surgery, three deaths were recorded, resulting in a success rate of 93.0%. These deaths were mainly due to advanced disease and surgical complications.

Conclusion: The experience underscores the importance of strategic investment, leadership, and partnerships in advancing health system resilience and equity in low-resource settings. A total of 1,313 patients benefited from minimally invasive procedures and open-heart surgeries in the five years of the cardiology and cardiothoracic department's establishment.

Background: Body mass index (BMI) is closely linked to hypertension and diabetes mellitus (DM). However, the association between BMI and hypertension-diabetes comorbidity in elderly population of China remains uncertain.

Methods: This cohort study was conducted based on a prospective database of Chinese Longitudinal Healthy Longevity Survey (CLHLS). The primary outcome was hypertension-diabetes comorbidity. The secondary outcomes included hypertension and DM. BMI was categorized into four groups according to Chinese guidelines: underweight (BMI < 18.5 kg/m²), normal weight (BMI 18.5-23.9 kg/m²), overweight (BMI 24.0-27.9 kg/m²), and obesity (BMI ≥ 28.0 kg/m²).

Results: The final analysis included 5,342 individuals for hypertension, 6,335 for DM, and 6,414 for hypertension-diabetes comorbidity (all individuals aged 65 years and above). Cox regression analysis of the hypertension-diabetes comorbidity revealed the adjusted hazard ratio (HR) for the underweight group was 0.747 (95% confidence interval [CI], 0.651-0.857), for the overweight group was 1.517 (95% CI, 1.309-1.758), and for the obesity group was 1.620 (95% CI, 1.237-2.121) comparing with normal weight group (reference). When considering BMI as a continuous variable, the adjusted HR was 1.043 (95% CI, 1.029-1.059). Employing a multi-model adjusting strategy based on the directed acyclic graph, the HR for individuals with BMI ≥ 24.0 (versus BMI < 24.0) was 1.486 (95% CI, 1.301-1.698). Restricted cubic splines indicate a positive linear trend between BMI (range in BMI ≥ 24) and the risk of hypertension-diabetes comorbidity. The relationship between BMI and secondary outcomes exhibited results similar to those of the primary outcome.Additionally, compared to the Han ethnic, other ethnic had a significantly lower risk of the primary outcome, with an adjusted HR of 0.334 (95% CI, 0.235-0.475). Similar findings were observed for the secondary outcomes.

Conclusions: Increased BMI is significantly associated with a higher risk of hypertension-diabetes comorbidity, hypertension, and DM in elderly population of China. Additionally, Han participants (versus non-Han) have a notably greater risk of developing hypertension-diabetes comorbidity, hypertension, and DM. Greater attention should be paid to obesity in elderly Han Chinese individuals, given its significant associated disease burden.

Background: The improved survival of patients with congenital heart disease (CHD) mandates a shift in focus towards an understanding of patient perspectives on outcomes, particularly focused on quality of life (QOL). This study represents the first systematic, prospective, comprehensive, patient-reported outcome measure (PROM) based QOL assessment of adult congenital heart disease (ACHD) patients in India.

Methods: PROM data from the Indian cohort of APPROACH-IS (Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study) I (2014) and II (2022)-prospective, cross-sectional international studies conducted at two major centers-were collated. PROMs that were recorded included the determinants of QOL, including physical component summary (PCS) and mental component summary (MCS) of the 12-item health survey, EQ VAS (EuroQoL Visual Analogue Scale), as well as the linear analog scale for assessing QOL (LAS-QOL). The influence of demographic and medical factors on PROMs and various aspects of QOL was assessed with multiple linear regression using the Wilson and Cleary model and generalized estimating equations.

Results: The number of patients studied was 325 (26.71 ± 8.66 years, 56.3% males). More than half had college education, 32.4% had a full-time job, and 26.5% had a partner. Defect complexity was simple in 29.9%, moderate in 37.5%, great in 41.5%, and 77.5% had undergone at least one procedure as part of their treatment. Overall, PROMs from India-particularly the physical domain-fared worse than the global data. Nevertheless, there was improvement from 2014 to 2022. Positive predictors of PROMs included self-reported NYHA (New York Heart Association) class, male sex, younger age, education, and center/year of study. Women reported significantly worse PROMs.

Conclusion: ACHD patients from India report overall excellent PROMs including QOL, despite the majority having complex heart defects. Physical functioning is a key deficiency. Age- and gender-sensitive health policies, systematic early implementation of personalized physical activity training programs, and integration of mental health into cardiac follow-up merit strong consideration.

Background: Remnant cholesterol (RC) has received increasing attention and shown to be associated with bleeding and ischemic events in clinical research; however, the mechanisms remain incompletely understood.

Aim: To investigate the relationship between RC and platelet reactivity in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) who received dual antiplatelet therapy with aspirin and clopidogrel.

Methods: A total of 10,724 consecutive PCI patients in China from January 2013 to December 2013 were enrolled. 6,633 patients had the results of thromborlastogram for analysis. Low on-treatment platelet reactivity (LTPR) and high on-treatment platelet reactivity (HTPR) were defined as adenosine diphosphate-induced platelet maximum amplitude of thromborlastogram <31 mm and >47 mm, respectively.

Results: A total of 6,633 PCI patients (mean age, 58.20 ± 10.2 years; male, 77.5%) were finally enrolled. When RC was used as a continuous variable, the multivariate logistic regression showed that RC concentration was negatively associated with LTPR (OR: 0.761, 95% CI 0.609-0.950) and positively associated with HTPR (OR: 1.461, 95% CI 1.151-1.855). For RC quartiles, compared to the lowest quartile (Q1), quartiles 3 and 4 were negatively associated with LTPR (OR_Q3: 0.853, 95% CI 0.735-0.990; OR_Q4: 0.840, 95% CI 0.707-0.999). Meanwhile, higher quartiles of RC (Q2, Q3, Q4) were positively associated with HTPR (OR_Q2: 1.193, 95% CI 1.015-1.402; OR_Q3: 1.356, 95% CI 1.152-1.596; OR_Q4: 1.404, 95% CI 1.164-1.694).

Conclusions: We reported that RC was associated with clopidogrel-related platelet reactivity in patients undergoing PCI received dual antiplatelet therapy. These results suggest an interaction between lipid and thrombosis, and remind us pay attention to RC levels in PCI patients.

Key findings: In the large-scale (n = 6,633) and real-world study, we revealed that RC may modify the platelet reactivity to influence the risk of bleeding and ischemia in PCI patients. Our study firstly reported the relationship between RC and clopidogrel-related platelet reactivity in patients undergoing PCI received dual antiplatelet therapy. The findings may verify the complex interaction between lipid and thrombosis and suggest that RC may be a potential marker associated with platelet reactivity, which warrants further investigation in future studies.