Global Heart最新文献

Background: Previous studies have demonstrated a correlation between mental disorders and hypertension. However, the direction of this association and the specific risk factors that mediate the causal effects remain unknown. The present study aimed to investigate the causal relationship between mental disorders and hypertension, as well as identify the risk factors that mediate it.

Methods: We used univariate Mendelian randomization (UVMR) and multivariate Mendelian randomization (MVMR) to evaluate the causal relationship between depression, anxiety, or panic attacks and hypertension using the summarized statistics from eleven extensive genome-wide association studies in European populations. Furthermore, MVMR was used to evaluate seven potential mediators of this association and calculate their mediated proportions. The robustness of our findings was evaluated using sensitivity analyses.

Results: UVMR analysis revealed that genetically predicted higher risk of depression (OR: 1.140, 95%CI: [1.075, 1.210], p < 0.001), anxiety (OR: 2.679, 95%CI: [1.328, 5.408], p < 0.01), and panic attacks (OR: 1.054, 95%CI: [1.016, 1.092], p < 0.01) were associated with increased risk of hypertension. Higher risk of hypertension was also associated with higher risk of depression (OR: 1.101, 95%CI: [1.009, 1.202], p < 0.05). Of seven candidate mediators, two met the screening criteria and were included in the mediation MR analyses. The MVMR analysis revealed that even after adjusting for depression, there was a persistent causal relationship between type 2 diabetes and hypertension (OR: 1.010, 95%CI: [1.005, 1.015], p < 0.001). Similarly, the causal relationship between smoking and hypertension remained significant after accounting for depression (OR: 1.037, 95%CI: [1.015, 1.060], p < 0.001). Mediation analyses indicated that diabetes and smoking have mediation effects of 8.71% and 5.79% between depression and hypertension, with mediation proportions of 41.7% and 27.7%, respectively.

Conclusion: This study provided compelling evidence supporting a bidirectional phenotypic association between depression and hypertension, while highlighting diabetes and smoking as significant mediators in the association's pathway to hypertension development.

Introduction: Observational studies have shown that smoking is more strongly associated with cardiovascular disease (CVD) in females than in males. It remains unclear whether these observed sex differences reflect differences in the causal effects of smoking between the sexes.

Methods: This study investigated sex-specific associations between ever smoking, smoking continuation, and the number of cigarettes smoked per day and CVD outcomes by conducting sex-stratified observational and Mendelian randomisation (MR) analyses in the UK Biobank.

Results: In observational analyses, we found a greater excess risk of ever smoking, smoking continuation, and number of cigarettes smoked per day for CVD in females than in males with female-to-male ratios of hazard ratios (HRs) of 1.08 (95% confidence interval [CI] 1.04, 1.12), 1.15 (1.07, 1.22), 1.05 (1.02, 1.08), respectively. Results were similar for CHD, and we found no sex differences for stroke. Results from MR analyses were directionally similar; however, we were not able to detect statistically significant sex differences in the effect of smoking exposures on any CVD outcome. For subarachnoid haemorrhage (SAH), we found indications for a stronger causal effect of ever smoking in females as compared to males (female-to-male ratio of ORs 2.61 [95%CI 1.06, 6.42]).

Conclusion: This study shows that both smoking initiation and higher smoking intensity are observationally and causally related to a higher CVD risk in both females and males. Observed sex differences in the association between smoking and CVD were directionally similar to sex differences in the causal effects of smoking on CVD. In general, MR estimates were more uncertain, and the causal effects of smoking on CVD may be similar in females and males.

Background: Heart failure (HF) impacts over 56 million people worldwide, with significantly higher mortality rates in low and low-middle-income countries (LIC/LMICs). Despite the effectiveness of guideline-directed medical therapy (GDMT) for HF with reduced ejection fraction (HFrEF), its use remains limited in LIC/LMICs due to limited availability and affordability. These barriers are particularly pressing in Venezuela's context, as the country faces an ongoing crisis.

Objective: Describe price and affordability of HF Guideline Directed Medical Therapy at optimal dosages in Venezuela.

Methods: We conducted a cross-sectional analysis from December 2023 to January 2024, surveying prices of HF GDMT medications across 13 major pharmacy networks in Venezuela. Medications analyzed included ACE inhibitors (ACEi), angiotensin receptor blockers (ARB), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), angiotensin receptor-neprilysin inhibitors (ARNI), and sodium-glucose co-transporter 2 inhibitors (SGLT2i). Affordability was defined and calculated using the World Health Organization/Health Action International (WHO/HAI) methodology, comparing the median costs of one month of HF GDMT at optimal dosages to the lowest-paid government worker's (LPGW) daily wages. Other comparisons of price affordability were made against the mean daily salary of managers, professional and non-professional workers in the country.

Results: The most expensive medication regime for HF in Venezuela was ARNI-based GDMT with a median monthly cost of 393.81USD, followed by ARB-based GDMT and ACEi-based GDMT costing $100.88USD and $82.23USD respectively. meaning LPGW and elderly receiving retirement stipends would need between 506 to 2421 paid work days to cover one month of treatment at optimal dosages.

Conclusion: Based on the WHO/HAI methodology all HF GDMT regimens were deemed unaffordable in Venezuela. Similar affordability challenges exist in other LIC/LMICs countries highlighting the need for global advocacy and policy action to address financial barriers to access guideline-based heart failure care.

Background: Air pollution has emerged as a known risk factor for cardiovascular diseases (CVDs) globally. Raising public knowledge of the importance of air pollution exposure is crucial for implementing future interventions to improve cardiovascular health. This study aimed to explore the knowledge, attitude and behaviour (KAB) of vulnerable women and men towards the cardiovascular benefits of reducing air pollution exposure.

Methods: A cross-sectional study was conducted among 602 vulnerable men and women in Ibadan, Nigeria, using a multi-stage sampling technique. Using the KAB framework, emphasis was placed on the link between air pollution exposure reduction and the burden of CVDs such as stroke, heart failure, heart attack, congenital heart disease, cardiac arrest and atherosclerosis. Data were collected using a digitalised validated semi-structured questionnaire that included questions on knowledge of the link between air pollution and CVD, attitude towards reducing air pollution and behaviours related to reducing air pollution exposure. The median (interquartile range [IQR]) KAB scores were calculated and dichotomised using the median score. Data were analysed using descriptive statistics, chi-square, Spearman's correlation analysis and regression models at p < 0.05.

Results: Respondents' mean age was 44.1 ± 14.0 years, and 54.2% were females. The participants' median (IQR) knowledge score was 7.0 (2.0-8.0), with the majority, 66.9%, having poor knowledge. The median (IQR) pollution-reduction attitude score was 10.0 (3.0-16.0), with a majority (58.5%) having a negative attitude. Respondents' median preventive behaviour score was 6.0 (1.0-11.0), and 58.6% had unsatisfactory behaviour. Awareness about air pollution was found to be associated with knowledge (aOR [adjusted odds ratio] 0.82; 95%CI: 0.57-0.97) and behaviour (aOR 0.44; 95%CI: 0.31-0.64) towards air pollution reduction.

Conclusion: The poor knowledge of the link between exposure to air pollution and CVD underscores the need for targeted educational initiatives, supported by regulatory interventions, to harness the cardiovascular health benefits of reduced exposure to air pollution in Africa.

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide, with a particular burden in middle-income countries (MICs). Cardiac rehabilitation (CR) is a secondary prevention model resulting in reduced CV mortality, morbidity, cost-effectively. However, CR is under-utilized globally, especially in MICs due to structural, social, and economic barriers. The International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) is a World Heart Federation-affiliated umbrella association founded ~15 years ago, now comprised of 50 Associations and 30 champions in countries without CR societies. ICCPR addresses delivery challenges through: CR guidelines tailored for MICs, the Global CR Audit to support advocacy, the International CR Registry (ICRR), Program Certification to support service quality, multi-disciplinary provider training (CR Foundations Certification; CRFC), women-focused CR initiatives, and partnerships with the World Health Organization. ICCPR continues to foster global CR accessibility through collaboration, communication, as well as research and advocacy with their upcoming Global CR Audit Update.

The clinical impact of diabetes medications including sodium-glucose cotransporter-2 (SGLT2) inhibitors, non-steroidal mineralocorticoid receptor antagonists (MRAs) and glucagon-like peptide 1 receptor agonists (GLP-1 RAs) on cardiovascular (CV) and kidney disease outcomes has focused attention on the inter-relatedness of kidney and heart health, both within and outside the context of diabetes. These conditions often co-exist in one individual resulting in frequent hospitalisations and premature deaths. Herein, we provide an updated comprehensive state-of-the-art review, summarising the linkages between heart disease and kidney disease, the mechanisms connecting these conditions, common risk factors, management, implications for health systems, and the impact on patients, particularly in low-resource settings. As experts representing the World Heart Federation (WHF) and International Society of Nephrology (ISN), we highlight areas of opportunity and provide recommendations on improving access to care for the growing numbers of patients with heart and kidney diseases with a focus on low-income and middle-income countries (LMICs).

Background: The diagnosis of coronary artery disease (CAD) has traditionally relied on invasive coronary angiography (ICA), a method with inherent risks. As a noninvasive technique, computed tomography-derived fractional flow reserve (CT-FFR) can integrate both anatomical and functional assessments of the coronary arteries, identifying hemodynamically significant stenosis and thereby reducing unnecessary invasive procedures. Although its clinical value has been demonstrated, its widespread clinical adoption is constrained by physician perception.

Objective: To quantify the professional attitudes and willingness to adopt CT-FFR for clinical application among cardiologists and radiologists, and to identify the key determinants influencing their positivity.

Methods: A cross-sectional survey was conducted from May to June 2023 across five provinces and cities in China. Data were collected from 265 cardiothoracic physicians using a validated, structured questionnaire (Cronbach's α = 0.884). The questionnaire assessed two core dimensions using a five-point Likert scale: "Attitude" (15 questions) and "Willingness" (eight questions). Higher scores indicated more positive attitudes or willingness.

Results: The survey was completed by 265 physicians, with overall attitudes being positive. The median scores for the attitude and willingness dimensions were 51 (interquartile range: 48, 55) and 31 (interquartile range: 29, 32), respectively, with a significant positive correlation between them (r = 0.571, p < 0.001). While over 60% of physicians acknowledged that CT-FFR could prevent unnecessary invasive procedures, 38.1% still expressed concerns about its diagnostic accuracy. Logistic regression analysis showed that physicians working in specialized cardiovascular hospitals held more positive attitudes (OR = 3.085, p = 0.017). Multivariable analysis further confirmed that a positive attitude was the strongest independent predictor driving willingness to adopt (OR = 6.280, p < 0.001).

Conclusion: Participants' belief in the development potential of CT-FFR was positively associated with their willingness to learn, receive training, consider improvements, and participate in clinical research involving CT-FFR.

Background: Brazil has one of the highest stroke rates in Latin America. It is important to understand the impact of other causes of death and sociodemographic factors, as this may contribute to a better comprehension of the stroke mortality process. Machine learning provides a means to explain this process.

Objective: To investigate the stroke deaths profile and its subtype in Brazil using machine learning.

Methods: This is a time series analysis where deaths mentioning stroke and other conditions were identified using individual death records from the country's mortality information system (SIM) between 2000 and 2019. Strokes were grouped into the following subtypes: ischemic stroke (IS), hemorrhagic stroke (HS), and unspecified stroke (US). A decision tree model was built to identify the strongest factors distinguishing IS from HS.

Results: There were 2,459,742 deaths mentioning stroke. There was a progressive increase in the number of deaths mentioning stroke over the study period. The most common type of stroke was US, accounting for more than 62% of deaths. Among HS deaths, hypertensive diseases were the most frequent group of associated causes (40.6%), while the most frequent group in subtypes IS and US was diseases of the respiratory system (48.30% and 42.30%, respectively). The decision tree analysis revealed that IS was more likely to occur in patients aged 60 years and over and in cases where respiratory diseases, endocrine diseases, arrhythmias, ischemic heart disease and heart failure were present. However, HS was more frequent in younger patients without these conditions but with nervous system diseases.

Conclusions: The decision tree analysis identified the strongest factors distinguishing IS from HS, highlighting variables involved in each subtype of stroke-related death that can be recognized in clinical practice. These variables may also support the redistribution of deaths initially classified as unspecified stroke.

Cardiac rehabilitation (CR) is a cornerstone of secondary prevention in coronary heart disease, supported by robust evidence and classified as a Class I recommendation in international guidelines. Despite its proven benefits in reducing morbidity, mortality, and improving quality of life, CR remains strikingly underutilized worldwide, revealing a paradox of high-level evidence with low-level implementation. The INTERASPIRE study highlights this global gap, showing that many patients are neither referred nor adhere to CR programs, and that profound inequities persist across regions and socioeconomic groups. These findings underscore systemic failures in translating guideline recommendations into practice, driven not only by structural limitations but also by physician referral patterns, patient awareness, and health system priorities. Addressing this gap requires investment in infrastructure, equitable referral strategies, standardization of program content, and innovative delivery models such as telehealth. Ensuring universal access to CR is both a clinical imperative and a matter of health equity, with the potential to transform outcomes for patients with cardiovascular disease worldwide.