Global Heart最新文献

Background: The primary objective of this study is to develop and validate a predictive model assessing the likelihood of disease progression in individuals with aortic valve calcification (AVC).

Methods: For the second and third visits, 2,533 patients were followed up. They were randomly assigned to a train set and a validation set at a ratio of 7:3. After employing the Least Absolute Shrinkage and Selection Operator (LASSO) and multiple Cox regression to filter predictors, the selected variables were input into the Cox proportional risk model for model construction. Calibration curve, Consistency Index (C-index), Receiver Operating Characteristic (ROC) curve, and Decision Curve Analysis (DCA) were employed to validate the model. Patients were categorized into low- and high-risk groups based on the model's predicted risk score, and survival analysis was conducted using Kaplan-Meier (K-M) plots. An online platform was used to enhance the clinical utility.

Results: The incidence of AVC progression was 9.63%. LASSO-Cox regression analysis identified seven variables significantly correlated with AVC progression. In both the training and validation sets, the Area Under the Curve (AUC) and C-index of the prediction model exceeded 0.8. The calibration curve aligned closely with the diagonal line. Decision Curve Analysis (DCA) underscored the clinical application value of the model. Survival analysis demonstrated a significantly higher progression rate in the high-risk group compared to the low-risk group. The online platform visualized the probability of progression.

Conclusion: The developed predictive model has proven reliability and accuracy in forecasting the 2-, 3-, and 4-year progression rates of patients with AVC. It offers a dependable framework for estimating progression and facilitating individualized comprehensive prevention strategies for individuals with AVC.

Background: The SECURE trial demonstrated that the cardiovascular (CV)-polypill (acetylsalicylic acid [ASA] + atorvastatin + ramipril) reduces CV mortality by 33% in patients with acute myocardial infarction compared to standard care. The 2023 ACS ESC Guidelines recommend the polypill to improve outcomes and adherence.

Objective: This study aims to establish a global consensus on the optimal use of the CV-polypill in secondary prevention.

Methods: A two-round, modified Delphi method was used, featuring a 30-statement evidence-based questionnaire validated by eight renowned cardiologists. Fifty clinicians from 19 countries in Europe, Latin America, and Asia were invited to join the Delphi panel. Panelists ranked responses using a three-point Likert scale for agreement and importance. Consensus was defined as ≥80% agreement or rating statements 'very important' or 'important'. Statements without consensus after the first round were refined with evidence and feedback in the second round. Remaining disagreements were resolved in a face-to-face meeting. Descriptive statistics were applied.

Results: Response rate was 76% (round 1) and 74% (round 2); 82% were cardiologists, with 74% frequently recommending the CV-polypill. Consensus was achieved on 93.3% of statements. Research showing a 24% relative risk reduction in major adverse CV events over a median of 3 years with the CV-polypill post-acute myocardial infarction, compared to usual care, reached 97.4% agreement for clinical implementation, and a 100% consensus supported polypill use at hospital discharge or first follow-up visits; 81.1% agreed on a prompt initiation after patient stabilization. There was agreement on algorithms for initiating (97.3%), considering patient preferences (97.4%) to the polypill and its cost savings over usual care (89.5%).

Conclusion: The Delphi consensus on real-world use of a CV polypill (ASA, atorvastatin, and ramipril) for secondary prevention post-acute coronary syndrome supports early initiation (within 8 days or at discharge). The findings provide a foundation to inform practice and policy, identifying priorities for further research.

Introduction: Long-term hypertensive heart disease (HHD) trends in East Asia offer insights for heart disease prevention. We analyzed HHD burden trends in East Asia (1990-2021).

Methods: We analyzed trends in age-standardized prevalence (ASPR), death, and disability-adjusted life-years (DALYs) rates of HHD in East Asia from 1990 to 2021 using data from the Global Burden of Disease Study 2021. Annual average percent changes (AAPC) were calculated via Joinpoint regression. Relative risks were estimated via population attributable fraction (PAF).

Results: In 2021, East Asia reported 4,354,899 prevalent cases of HHD, 361,483 deaths and 6,079,780 DALYs. East Asia has seen a decrease in the overall prevalence of hypertensive heart disease (HHD) from 1990 to 2021, yet the ASPR for HHD has increased in the last decade, from 2012 to 2021. During this period, developed areas such as Japan have observed a growing trend of HHD among younger demographics. In contrast, developing regions like North Korea continue to face challenges in managing the condition effectively. The burden of HHD is particularly pronounced among females over 75 years of age, while males exhibit higher risk due to poor lifestyle factors. From 1990 to 2021, the PAF due to high body mass index (BMI) consistently increased across East Asia, with the following AAPC and 95% confidence interval (95% CI): China (1.55, 95%CI: 1.54, 1.56), Japan (0.79, 95%CI: 0.78-0.81), South Korea (0.86, 95%CI: 0.85, 0.86), China-Taiwan (1.3, 95%CI: 1.28, 1.33), North Korea (1.55, 95%CI:1.54, 1.55), and Mongolia (0.24, 95%CI: 0.23, 0.25).

Conclusions: East Asia faces a significant HHD prevalence, with elderly females needing particular focus. High BMI is a notable risk factor. Given the differing HHD impacts across regions, targeted strategies that consider regional and national differences are essential for reducing the burden.

Although the COVID-19 pandemic crisis has come to an end, Long COVID continues to pose a profound challenge to global health. Based on findings from the World Heart Federation (WHF) Global COVID-19 Study, an international prospective cohort study, this editorial reflects on the enduring burden of symptoms and complications among 2,535 previously hospitalized patients across 16 countries during the Omicron era. Beyond a mortality rate of 15% and clinical manifestations such as fatigue, dyspnea, and adverse cardiovascular events, the study highlighted substantial psychosocial and socioeconomic impacts, with reduced work capacity and functional limitations particularly affecting populations in low- and middle-income countries captured through EuroQol 5-dimension scale and employment data. These findings emphasize that the burden of Long COVID extends beyond individual health, with significant implications for healthcare systems and economic stability. Addressing this challenge requires ongoing multidisciplinary research, validated diagnostic criteria, novel biomarkers, and effective preventive and therapeutic strategies. Furthermore, decentralized monitoring models-exemplified by telephone-based data collection in the WHF study-may offer scalable approaches to improve surveillance and inform global health policies for current and future public health crises.

Background: Cardiogenic shock (CS) carries a high in-hospital mortality, with limited data on sex-related disparities in Latin America. Women remain underrepresented in CS studies.

Objectives: To evaluate sex-specific differences in characteristics, management, and mortality in acute myocardial infarction-related (AMI-CS) and non-AMI-CS in a large Latin-American cohort.

Methods: We retrospectively analyzed 9430 patients (5016 AMI-CS and 4414 non-AMI-CS) with SCAI-CSWG stages B-E in a reference center in Mexico City from 2005 to 2023. The primary outcome was in-hospital mortality. Analyses included multivariable Cox models and propensity score matching (PSM).

Results: Women with AMI-CS were older (67 vs. 60 years), had more hypertension (66% vs. 52%) and diabetes (53% vs. 38%), and received less primary reperfusion (62% vs. 71%) and mechanical circulatory support (11.6% vs. 14.7%) than men (all P < 0.05). In non-AMI-CS, women were older (66 vs. 60 years), had more prior heart failure (33% vs. 24%), while men had more chronic obstructive pulmonary disease (COPD) and prior MI (all P < 0.05). Unadjusted mortality was higher in women in AMI-CS (24.6% vs. 16.3%, HR 1.48, 95% CI 1.28-1.72) and non-AMI-CS (HR 1.18, 95% CI 1.05-1.32). After PSM, mortality differences were not significant in AMI-CS (HR 1.22, 95% CI 1.00-1.48) or non-AMI-CS (HR 1.07, 95% CI 0.92-1.24).

Conclusions: Women with CS in Latin America present with greater comorbidity and less aggressive/invasive management. While unadjusted mortality was higher in women, these differences were no longer significant after PSM, indicating that baseline factors and treatment disparities largely explain excess risk.

Recent global estimates indicate that more than one billion people live with obesity, a figure that has doubled since 1990. When overweight individuals are included, nearly 2.5 billion adults are affected, with high body mass index contributing to an estimated 1.9 million cardiovascular disease (CVD) deaths annually. Obesity and its close association with CVD remain pressing public health challenges that require sustained, coordinated action. Recent global policy discussions, including the UN General Assembly's Zero Draft Political Declaration, highlight the importance of improving food labelling, taxing sugary drinks, limiting the marketing of unhealthy foods, and encouraging active living through supportive urban planning. Countries are encouraged to align national obesity strategies with the WHO's 2022 Acceleration Plan to STOP Obesity, with clear goals and mechanisms for accountability and monitoring. Preventive measures are most effective when introduced early, such as encouraging breastfeeding and creating supportive school environments that offer balanced meals, limit access to unhealthy foods, and incorporate regular physical activity into daily schedules. Fiscal measures, including taxes, subsidies, and mandatory nutrition labels, can help guide consumer choices towards healthier options. Supportive built environments with safe access to parks, pedestrian routes, and cycling paths further encourage active lifestyles. Health systems are central in ensuring equitable access to prevention and treatment, delivered through stigma-free and evidence-based care. Community-based and family-oriented programs have shown promise, while pharmacological options may complement lifestyle approaches where appropriate. Long-term progress depends on sustained commitment, cross-sectoral collaboration, and integration of obesity prevention into broader public health frameworks.

Background: INTERASPIRE was an observational study of patients with coronary heart disease (CHD) from 88 hospitals in 14 countries across all six WHO regions. The objective was to describe the proportions of patients referred to and attending cardiac rehabilitation (CR) programmes and to compare lifestyle and risk factor target achievement according to participation in a CR programme.

Methods: Patients 18-80 years of age, with a first or recurrent coronary hospitalisation (acute coronary syndrome and/or revascularisation procedure) were identified and invited to an interview and examination, between six months and two years after the index hospitalisation.

Results: Overall, 4,548 (21.1% female) patients were interviewed a median of 1.05 (interquartile range 0.76-1.45) years after hospitalization. Of those patients, 34.4% reported having been advised to participate in a CR programme, though the percentage varied widely by country, from 4.0% in Kenya to 69.6% in Poland. Among patients advised to participate in CR, 57.1% participated in ≥50% of all sessions, 15.4% participated in <50% of the sessions, and 27.4% did not participate at all. Only 19.6% of all patients recruited to the study attended ≥50% of sessions. Content of programmes reported by patients also varied enormously between countries. Low education level, elective PCI, or unstable angina as recruiting events were associated with lower attendance rates. Attendance at ≥50% of all CR sessions was associated with a lower prevalence of persistent smoking and physical inactivity, better control of blood pressure and LDL-cholesterol, and a higher use of cardioprotective medications.

Conclusions: INTERASPIRE provides a standardised international picture of CR provision and attendance in patients with CHD. Despite CR being a Class 1 recommendation in all international guidelines, only one third of CHD patients reported being advised to attend any form of CR and just one in five patients attended 50% of the sessions, with striking heterogeneity between regions and countries. National cardiology societies should advocate to their governments for urgent investment in standardised CR services.