Global Heart最新文献

Objectives: Our objectives were to ascertain: the prevalence and socio-economic distribution of hypertension, as well as the rates of undiagnosed and untreated hypertension; the association between socioeconomic status (SES) and the occurrence of hypertension, as well as the rates of undiagnosed and untreated hypertension; and the factors influencing the poor-non-poor gap in terms of the prevalence, diagnosis, and treatment of hypertension.

Design: Cross-sectional nationally representative study.

Methods: Data from the 2017-18 Bangladesh Demographic Health Survey were used. 11,776 participants who were 18 years of age or older responded to our analysis. We used the wealth index as a proxy for SES. The prevalence of hypertension, both diagnosed and undiagnosed, as well as its untreated states, were the outcome variables.

Results: The age-adjusted prevalence of hypertension, undiagnosed as having hypertension, and untreated cases were 25.1%, 57.2%, and 12.3%, respectively. People in the poor SES groups had a 0.88 times (95% confidence interval [CI] 0.77-0.99) lower likelihood of having hypertension compared to those in the non-poor SES group. Individuals belonging to the poor SES group exhibited a likelihood of 1.68 and 1.53 times greater for having untreated hypertension and being undiagnosed with the condition, respectively, compared to those in the non-poor SES group. The results indicated that BMI played a role in increasing the disparity between the poor and non-poor populations concerning hypertension risk. Additionally, factors such as age, gender, and education were found to exacerbate the gap in the risk of undiagnosed hypertension between these two groups.

Conclusion: The results of this study suggest that appropriate policy measures be developed for ongoing care and early identification, especially for older adults, men, and individuals with low levels of education from low socioeconomic backgrounds. Additionally, efforts must be made to reduce the prevalence of overweight and obesity among people in the non-poor SES category.

Introduction: Hypertension and diabetes are leading causes of adult hospital admissions and mortality across health facilities in Ghana. Timely screening and diagnosis at primary health facilities are crucial to initiate treatment and avert complications. This study explored service availability and readiness of health systems for managing hypertension and diabetes in selected district hospitals in Ghana.

Methods: We adapted the World Health Organization (WHO) Service Availability and Readiness Assessment (SARA) tool to assess hypertension and diabetes management practices between June and July 2022 in four district hospitals in Ghana. Domain scores of service readiness were calculated based on the mean score of tracer item availability, transformed into percentages, and stratified by facility ownership. The mean readiness index was based on basic clinical logistics and equipment, diagnostic capacity, and first-line medications. Service availability was based on the core health workforce and specific service arrangements for the management of hypertension and diabetes. Facilities were considered 'ready' for services at a cut-off readiness score of 70%.

Results: All facilities (n = 4, 100%) provided hypertension and diabetes services, with a median of 118 nurses (IQR 103-140) and 5 physicians (IQR 2-8). Only one facility (n = 1, 25%) had conducted cardiovascular disease training in the past year. All basic equipment (weighing scales, stethoscopes, glucometers, and blood pressure monitors) were available in all 4 facilities. Antihypertensives, including ACE inhibitors (n = 3; 75%), calcium channel blockers (n = 4; 100%), centrally acting agents (n = 4; 100%), and thiazides (n = 4; 100%), were available, as were antidiabetic medications like metformin (n = 4; 100%) and insulin (n = 2; 50%). Only two facilities (n = 2; 50%) could perform the required test (Hemoglobin A1c, full blood count, renal function, serum creatinine, blood urea, electrolytes, and blood lipid tests). Overall readiness score was 75.5%, essential medications (83.5%), basic equipment (78%), clinical guidelines for the management of cardiovascular disease management (75%), and diagnostic capacity (65.5%). Mission facilities had a higher readiness score (96%) and government facilities (55%).

Conclusion: Facilities demonstrated high readiness for basic hypertension and diabetes care, with higher availability of some essential medications and basic clinical logistics and equipment. Limited diagnostic capacity and cardiovascular disease training, highlight areas of improvement to strengthen hypertension and diabetes services in Ghana.

Background: Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis that can result in limb pain, disability, or mortality. Notably, diabetes mellitus (DM) stands out as one of the most significant risk factors for the development of PAD. Compared to individuals with PAD but no DM, those with concurrent DM and PAD (DM-PAD, diabetes mellitus-peripheral artery disease) face a seven-fold higher risk of critical limb ischemia and a five-fold higher risk of amputation. However, the pathogenic factors and effective therapeutic targets for DM-PAD still remain elusive.

Method: To identify candidate hub genes and develop insights into the pathogenesis of DM-PAD, we employed a comprehensive approach encompassing two-sample Mendelian Randomization (two-sample MR), summary data-based Mendelian randomization (SMR), and Bayesian colocalization (COLOC) methods. These methodologies facilitated the integration of summary-level data derived from genome-wide association studies of DM-PAD with expression quantitative trait locus (eQTLs) studies conducted on blood samples.

Result: DENND5B, C4A, and CYP21A2 were found to have passed two-sample MR and SMR analyses, indicating their status as hub genes associated with DM-PAD through mechanisms involving not linkage but rather causality. The COLOC analysis provided strong evidence suggesting that DENND5B and the DM-PAD trait were influenced by the common causal variant rs1150948.

Conclusion: Our study has pinpointed several crucial genes (DENND5B, C4A, and CYP21A2), notably the DENND5B gene, as potential regulators in the pathogenesis of DM-PAD. These discoveries hold promises for shedding light on the underlying mechanisms and novel targets of the disease in future research.

Background: Mortality due to ischemic heart disease (IHD) is heterogeneously distributed globally, and identifying the sites most affected by it is essential in developing strategies to mitigate the impact of the disease, despite the complexity resulting from the great diversity of variables involved.

Objective: To analyze the predictability of IHD mortality using machine learning (ML) techniques in combination with geospatial analysis in southern Brazil.

Methods: Ecological study using secondary and retrospective data on mortality due to ischemic heart disease (IHD) obtained from the Mortality Information Systems (SIM-DATASUS) de 2018 a 2022, covering 1,191 municipalities in the states of Paraná (399), Santa Catarina (295), and Rio Grande do Sul (497). Ordinary Least Squares Regression (OLS), Geographically Weighted Regression (GWR), Random Forest (RF), and Geographically Weighted Random Forest (GWRF) analyses were performed to verify the model with the best performance capable of identifying the most affected sites by the disease based on a set of predictors composed by variables of procedures and access to health.

Results: In the analyzed period, there were 59,093 deaths, 65% of which were men, 82.7% were white, and 72.8% occurred between 60 and 70 years of age. Ischemic heart disease presented the highest mortality rates in the northwest and north regions of the state of Paraná, and in the central-east, southwest and southeast regions of Rio Grande do Sul, the latter state accounting for 41% of total deaths. The GWRF presented the best performance with R² = 0.983 and AICc = 2298.4, RMSE: 3.494 and the most important variables of the model in descending order were electrocardiograph rate, cardiac catheterization rate, access index to hemodynamics, access index of pre-hospital mobile units, cardiologists rate, myocardial scintigraphy rate, stress test rate, and stress echocardiogram rate.

Conclusion: The GWRF identified spatial heterogeneity in the variation of geographic predictors, contrasting the limitation of linear regression models. The findings showed patterns of vulnerability in southern Brazil, suggesting the formulation of health policies to improve access to diagnostic and therapeutic resources, with the potential to reduce IHD mortality.

Background: Epidemiological and clinical studies have shown that there is a co-morbidity between nonalcoholic fatty liver disease (NAFLD) and coronary artery disease (CAD).

Methods: In this study, we utilized linkage disequilibrium score regression (LDSC) to evaluate the genetic correlation between non-alcoholic fatty liver disease (NAFLD) and coronary artery disease (CAD). We identified pleiotropic loci and genes using SNP-Level PLACO analysis. Following this, MAGMA gene set enrichment analysis was conducted to assess the biological significance of these pleiotropic genes. Finally, a two-sample two-way Mendelian randomization (MR) analysis was performed to evaluate causal relationships between NAFLD and CAD.

Results: We found a significant genetic correlation between NAFLD and CAD. Secondly, PLACO multi-effect analysis identified 6 sites (mainly involved in the establishment of chylomicrons, mitochondrial membrane protein localization and herpes simplex virus 1 infection signaling pathway). Then, three pleiotropic genes (APOC1, TOMM40 and PBX4) were identified by MAGMA gene analysis. Finally, a two-sample two-way MR analysis suggested that there was no causal relationship between NAFLD and CAD.

Conclusions: Our results show that there are significant gene overlaps and pleiotropic genes between NAFLD and CAD and point out their common molecular mechanisms. These findings provide evidence for the common etiology between them and also help to better understand the pleiotropic nature between NAFLD and CAD, which may be of guiding significance for future treatment strategies.

Background: Basic life support (BLS) is the recognition of sudden cardiac arrest and activation of emergency response system, followed by cardiopulmonary resuscitation (CPR), and rapid defibrillation.

Aim: Our study aimed to determine the level of awareness of the Lebanese University medical students and trainees on BLS, by assessing the association between knowledge, attitude, and practice on BLS, and between the demographic variables and KAP scores.

Methods: This was a cross-sectional study including 330 medical students enrolled at Lebanese University, from year four of general medicine till year five of residency. An online survey was used to collect data about demographic characteristics, knowledge (K), attitudes (A), and practice (P) about BLS. Data was analyzed using SPSS version 25.

Results: Participants were 52.7% females, 47.3% males, and their mean age was 24 ± 2 years. Of the 330 participants, 38.8% received formal training regarding BLS. Medical students had low knowledge (90%), moderate to good attitudes (71.5%), and low practice (93%) regarding BLS. Multiple linear regression showed that knowledge was positively associated with age (p = 0.001), knowledge and information regarding BLS (p = 0.016), and any formal training/workshop regarding BLS (p = 0.021). Attitude was positively associated with academic year (p = 0.002) and knowledge (p = 0.003). Practice was positively associated with age (p < 0.001) and knowledge (p < 0.001).

Conclusion: Most Lebanese University medical students showed low knowledge, moderate to good attitudes, and low practice regarding BLS. We recommend that CPR/BLS should be a core competency across all health care professional programs.

In sub-Saharan Africa (SSA), a rising burden of noncommunicable diseases (NCDs) coexists with a persistent high burden of human immunodeficiency virus (HIV). Integrating care for chronic conditions is potentially beneficial, but the optimal approach remains unclear. By use of a narrative review of 14 recent case studies from different SSA countries, examples of NCD and HIV healthcare integration were described. Case studies were categorized into three models: integrating NCD care into existing HIV care (n = 8), integrating HIV care into existing NCD care (n = 2), and simultaneous implementation of HIV and NCD services (n = 4). Facilitators include staff and patient education, while barriers encompass the lack of guidelines and inadequate infrastructure. Providers, patients, and policymakers support integrated care but note several challenges. Available health economics data suggest cost-effectiveness in the long run. Concluding, NCD and HIV healthcare integration in SSA was deemed feasible with models of service integration related to the implementation context.

Background: Pulmonary tuberculosis (PTB) is associated with increased cardiovascular disease (CVD) mortality. However, underlying pathophysiological mechanisms are poorly understood. This systematic review aims to synthesise the evidence on the prevalence of cardiac pathology based on cardiac imaging and circulating biomarkers in patients with PTB.

Methods: We systematically searched databases for studies in patients with PTB evaluating cardiac pathology (pericardial effusion or left ventricular dysfunction) on echocardiography; late gadolinium enhancement on cardiac magnetic resonance imaging (CMR); myocardial inflammation on positron-emission tomography (PET); coronary artery stenosis on CT coronary angiography (CTCA); and cardiac troponin (cTn) and/or B-type natriuretic peptides (BNP) assessment.

Results: Seven studies were included across 1,333 participants with PTB. Four studies used echocardiography (n = 1,111). The prevalence of pericardial effusion ranged from 14.1-55.9%; and left ventricular systolic impairment from 0-4.25%. One study used CMR and PET-CT (n = 26); and two studies used PET-CT alone (n = 196). The prevalence of pericardial and/or myocardial inflammation ranged from 0.6-21.8%. One study evaluated cTn, Creatine Kinase-MB (CK-MB), and BNP (n = 800), of whom 246 had raised cTn. No study reported cardiac pathology using CTCA.

Conclusion: Pericardial effusion is the commonest reported cardiac pathology in PTB. To date, only one study has evaluated cardiac biomarkers and studies evaluating myocardial or coronary disease on advanced imaging remain limited. Our study highlights the paucity of evidence on the presence of cardiac pathology in PTB. Studies are required to determine the prevalence of, and disease mechanisms associated with cardiac pathology among patients with PTB.

Background: Chronic kidney disease (CKD) increases the risk of adverse cardiovascular outcomes. However, the causal relationships between renal function and cardiovascular diseases (CVD) remain incompletely understood. This study aimed to determine the causal relationships between genetic susceptibility to impaired renal function and the risk of CVD endpoints, as well as cardiac structure and function detectable by cardiac magnetic resonance imaging (CMR).

Methods: Bidirectional Mendelian randomization (MR) analyses were conducted using summary-level data from genome-wide association studies. The exposures were blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (UACR), and CKD. The outcomes included atrial fibrillation, coronary artery disease (CAD), myocardial infarction, heart failure, stroke, and various CMR parameters. Sensitivity analyses, multivariable MR adjusting for cardiometabolic traits, and replication in the FinnGen cohort were performed.

Results: Elevated BUN levels (OR 1.505; 95% CI 1.077 to 2.103; P = 0.017) were causally associated with increased CAD risk, but this relationship was attenuated after adjusting for cardiometabolic traits. Increased UACR was causally linked to higher risks of CAD (OR 1.260; 95% CI 1.042 to 1.523; P = 0.017), myocardial infarction (OR 1.424; 95% CI 1.137 to 1.783; P = 0.002), and stroke (OR 1.182; 95% CI 1.012 to 1.379; P = 0.035), with the association for stroke remaining significant after multivariable adjustment. Reduced eGFR was causally related to decreases in ascending aorta diameter, proximal pulmonary artery diameter, right atrial size, left ventricular stroke volume, and right ventricular volumes, even after accounting for potential confounders. CKD was causally associated with a reduced pulmonary artery-to-aorta ratio and proximal pulmonary artery diameter.

Conclusions: This comprehensive MR study establishes causal roles of genetic susceptibility to impaired renal function influencing cardiovascular outcomes and cardiac structure.

Air pollution is a critical global health issue that significantly impacts cardiovascular health. The air pollutant PM_2.5 (particulate matter with a diameter of 2.5 micrometres or less) has been positioned as a leading environmental risk factor for morbidity and mortality, especially from cardiovascular diseases (CVDs). Using data from the World Health Organization (WHO), Global Health Observatory, and the United Nations Environment Programme, we explored global trends in air pollution, with a focus on PM_2.5 levels, the implications for cardiovascular health, and the policy measures aimed at reducing their impact. Despite progress in reducing pollution levels in high-income countries, global trends show a limited annual reduction in PM_2.5 concentration. The analysis highlights disparities between regions, with low- and middle-income countries bearing the brunt of air pollution-related CVDs. In 2019 alone, ambient air pollution was responsible for approximately 4.2 million deaths worldwide. Of these, 70% were caused by CVDs, with approximately 1.9 million deaths from ischemic heart disease and 900,000 deaths from stroke. Policy gaps remain a challenge, with many countries lacking adequate legally binding air quality standards. We recommend the adoption of WHO air quality guidelines, enhanced monitoring of air pollution levels, and increased investment in interdisciplinary research to understand the full scope of air pollution's effects on cardiovascular health. Addressing the global cardiovascular crisis linked to air pollution will require coordinated efforts from policymakers, healthcare systems, and global health organisations.