Global Heart最新文献

Background: Hypertension poses a significant global health challenge, warranting exploration of novel preventive measures. This study aimed to investigate the role of circulating concentrations of various micronutrients in hypertension using a Mendelian randomization (MR) approach.

Methods: Data on hypertension were obtained from FinnGen, comprising 55,917 cases and 162,837 controls of European ancestry. Fifteen micronutrients were evaluated and selected based on genome-wide association studies (GWAS) data. Instrumental single nucleotide polymorphisms (SNPs) were chosen according to strict criteria. Univariable Mendelian randomization (UVMR) analysis was conducted using the inverse variance weighted (IVW) method, supplemented by sensitivity analyses. Multivariate Mendelian randomization (MVMR) analysis was performed to assess interactions between micronutrients.

Results: In UVMR analysis, the IVW method revealed a potential influence of copper (OR = 1.052, 95% CI: 1.006-1.099, P = 0.025) and zinc (OR = 1.083, 95% CI: 1.007-1.165, P = 0.031) on hypertension. Sensitivity analyses supported these findings. MVMR analysis confirmed a direct positive effect of zinc on hypertension (OR = 1.087, 95% CI: 1.026-1.151, P = 0.005), while adjusting for zinc attenuated the effect of copper on hypertension (OR = 1.026, 95% CI: 0.987-1.066, P = 0.193).

Conclusion: Circulating zinc levels may be a potential risk factor for hypertension, while the association with other micronutrients remains inconclusive. These findings suggest that reducing zinc intake within a healthy range may help lower hypertension risk. Future research should further explore the role of zinc and nonlinear associations for a more comprehensive understanding.

Introduction: The absence of CAC in asymptomatic individuals is associated with a very low incidence of cardiovascular events. Of symptomatic patients, 1-2% with zero CAC score have non-calcified coronary artery atherosclerosis, and at least one third of cardiovascular events occur in individuals with zero CAC. South Asians (SA) have proportionally higher case fatality rates for CVD, relatively younger age of presentation, and accelerated rate of atherosclerosis when compared with other ethnic groups.

Methods: All consecutive patients who underwent a CTCA to evaluate angina or angina-equivalent symptoms during the study duration were enrolled retrospectively. Patients with prior myocardial infarction, history of revascularization, and congenital heart disease were excluded. MACE was defined as the total of cardiac death, non-fatal myocardial infarction, and/or non-elective revascularization.

Results: A total of 534 patients were enrolled after final exclusion. The mean age was 53 years ± 11. Males constituted 68.4% of the study population. Dyslipidemia was the most common co-morbid condition identified (50%), followed by diabetes (18.4%) and hypertension (3.6%). At least 28.8% of patients with zero CAC scores had the presence of coronary artery disease (soft plaque) of any degree. Obstructive CAD (>50%) was present in 5.8% of patients. Follow-up was available for 61.4% of patients. On a mean follow-up of 96.6 months ± 49.8 (range 21-194 months), all-cause MACE was observed in 8.8% of patients. The most common MACE was angina (3.96%) and all-cause mortality (3%). The baseline characteristics and MACE did not differ in patients with and without obstructive CAD. The baseline characteristics did not differ significantly between patients with and without MACE.

Conclusion: The incidence of soft plaque in this SA cohort is higher than that reported in international studies. However, in symptomatic SA, a CAC score of zero carries a good long-term prognosis, irrespective of the degree of CAD.

Background: Kenya is experiencing a rising burden of cardiovascular diseases (CVDs) due to epidemiological and demographic shifts, along with increasing risk factors. Ideal cardiovascular health (iCVH), defined by the American Heart Association (AHA), encompasses eight metrics to evaluate cardiovascular well-being. This study assessed the prevalence and determinants of iCVH in Kenya.

Methods: Data from the 2015 Kenya STEPwise survey on non-communicable disease risk factors, including 4,500 adults aged 18-69, were analysed. iCVH was assessed using 2022 AHA criteria based on seven factors: nicotine exposure, physical activity, diet, BMI, blood pressure, glucose, and lipid levels. A cardiovascular health (CVH) CVH score of ≥80% classified individuals as having iCVH. Multivariable binary and ordinal logistic regression identified factors associated with iCVH.

Results: The mean CVH score in Kenya was 78.6% (95% CI: 77.9,79.2%), higher in females (79.3%), rural areas (79.5%), and non-drinkers (79.6%) than in males (77.9%), urban residents (77.0%), and alcohol drinkers (75.4%), respectively. The prevalence of iCVH (CVH score ≥80%) was 45.6%, while 6.4% had poor CVH (CVH score <50%). Only 1.2% achieved the maximum CVH score. iCVH prevalence declined with age and was lower among married individuals (43.7%), alcohol drinkers (32.3%), and urban residents (39.7%). Older adults had 50-80% lower odds of iCVH compared to those under 30 years. Alcohol users (AOR 0.5; p < 0.001) and urban residents (AOR 0.6; p < 0.001) were less likely to have iCVH. Residents of Nairobi and Central regions had 40-60% lower odds of iCVH compared to those in Rift Valley. The Kalenjin (AOR 0.5; p = 0.027) and Turkana (AOR 0.3; p = 0.002) ethnic groups had lower odds of iCVH compared to the Kisii.

Conclusion: Less than half of Kenyan adults have iCVH, with poorer CVH status among older adults, urban residents, and alcohol users. Targeted public health interventions could mitigate the CVD burden and enhance health outcomes in Kenya.

Infections, particularly those involving the respiratory tract, are associated with an increased incidence of cardiovascular events, both de novo and as exacerbations of pre-existing cardiovascular diseases. Influenza vaccination has consistently been shown to reduce the incidence of cardiovascular events. Nonetheless, vaccination rates among adults remain suboptimal, both in the general population and among high-risk individuals. Multiple barriers hinder achieving adequate vaccination rates, with physicians' beliefs and attitudes towards these interventions being crucial. The FLUence project was developed within the framework of the World Heart Federation's Emerging Leaders program, to address this issue. This project has two phases: a global quantitative survey to assess the perceptions, opinions, and attitudes and challenges of physicians worldwide regarding the safety and efficacy of the influenza vaccination use, and a qualitative survey to further investigate the barriers and facilitators of recommending and using this vaccination. The quantitative survey was created and disseminated in five languages (English, Spanish, French, Italian, and Portuguese) to physicians of all specialties who care for adults, with a particular focus on patients with cardiovascular disease. The survey included eight domains with a total of 36 questions with closed options; a Likert scale with five possible answers was used to gauge participants' opinions. To gain deeper insights into the complexities behind the low vaccination rates in adults, the second part of the project comprises a qualitative survey, conducted in the two lower-middle- and upper-middle-income countries: India and Argentina, respectively. These countries were selected because patients with cardiovascular diseases have access to free influenza vaccination in Argentina, whereas patients must pay for the vaccine out of pocket in India. Thus, the FLUence study will provide valuable information to better understand the perceptions and barriers to improving influenza vaccination rates from the perspective of physicians. It is imperative to actively engage all healthcare providers to improve influenza vaccination rates.

Cardiovascular disease (CVD) represents the largest burden of disease globally and despite the availability of strong evidence supporting cost-effective treatments for people with CVD, the implementation of these treatments remains low, especially in low-income settings. Shortages in workforce have led to focus on how to increase clinical capacity. However, a simplistic focus on training clinicians will not fill the gaps in research, policy and implementation, which also need to be addressed at the same time. There are multiple efforts to develop early career capacity across diverse areas at national and international level to address these gaps. To-date, there have been limited efforts to compare or evaluate such programmes, and there are no efforts to harmonise such programmes to take advantage of synergies. We now compare three international programmes on global cardiovascular research to train individuals in their early- and mid-career by aims, experience and outputs.

As the burden of chronic disease and multiple long-term conditions is increasing globally, disproportionally affecting those in low-resourced settings, there is an increasing call to action to scale effective models of care that can assist in mitigating the impact of chronic disease on functioning, activity, societal participation, and health-related quality of life. The aim of this paper is to unpack the contextual factors that have been implicitly and explicitly voiced by researchers reporting on rehabilitation interventions used to manage chronic disease in low-resourced settings. We systematically engaged the literature and applied a reflexive qualitative and systems thinking lens to unpack the contextual factors and their interplay. A total of 40 different contextual factors were derived through an iterative analysis of 144 eligible articles. The identified factors could be packaged into nine system elements or subsystems relevant to the scale-up of rehabilitation for people with chronic disease. The complexity identified encourages a focus on innovative and intersectoral approaches to address the rehabilitation needs in low-resourced settings.

Optimal use of guideline-directed medical therapy (GDMT) can prevent hospitalization and mortality among patients with heart failure (HF). We aimed to assess the prevalence of GDMT use for HF across geographic regions and country-income levels. We systematically reviewed observational studies (published between January 2010 and October 2020) involving patients with HF with reduced ejection fraction. We conducted random-effects meta-analyses to obtain summary estimates. We included 334 studies comprising 1,507,849 patients (31% female). The majority (82%) of studies were from high-income countries, with Europe (45%) and the Americas (33%) being the most represented regions, and Africa (1%) being the least. Overall prevalence of GDMT use was 80% (95% CI 78%-81%) for β-blockers, 82% (80%-83%) for renin-angiotensin-system inhibitors, and 41% (39%-43%) for mineralocorticoid receptor antagonists. We observed an exponential increase in GDMT use over time after adjusting for country-income levels (p < 0.0001), but significant gaps persist in low- and middle-income countries. Multi-level interventions are needed to address health-system, provider, and patient-level barriers to GDMT use.