Global Heart最新文献

Introduction: The high burden of blood pressure-related cardiovascular diseases in Bangladesh is potentially caused by excessive dietary sodium and insufficient potassium intake. Our objective is to estimate dietary salt and potassium intake among Bangladesh rural and urban adults from urinary excretion of sodium and potassium.

Methods: We conducted a cross-sectional study between December 2017 and June 2018, including participants aged 30-59 years from three urban and three rural sites in Bangladesh. Data included urinary excretion of sodium and potassium estimated from one 24-hr urine collection and blood pressure measurements.

Results: Among 840 enrolled participants, complete data was available in 509 individuals. Mean age was 43.0 (SD ±7.9) years; 20.9% had hypertension, 50.9% were women, and 50.9% resided in urban areas. Mean systolic and diastolic blood pressure were 118.6 (SD ± 16.6) mmHg and 76.3 (SD ± 11.3) mmHg, respectively. Overall, the mean urinary sodium excretion was 3.9 g/day (95% CI = 3.8 to 4.0), corresponding to a mean salt intake of 9.7 g/day (95% CI = 9.4-10.1). Mean urinary potassium excretion was 1.4 g/day (95% CI = 1.3-1.4), corresponding to an estimated mean dietary potassium intake of 2.0 g/day. Men and urban residents had slightly but non-significantly higher sodium and potassium excretion than women and rural residents.

Conclusion: In Bangladesh, salt intake exceeded WHO's recommended <5g/day limit, while potassium intake was substantially lower than the recommended intake of ≥ 3.5g/day for adults. Promoting low-sodium and potassium-rich diets through nationwide campaigns and policies, including advocating for accessible low-sodium and potassium-enriched salt substitutes, is recommended to mitigate cardiovascular disease risks.

Background: The prevalence of hypertension (HT) and blood pressure (BP) control varies among ethnic-racial groups, but studies on this issue and correlations between BP and body mass index (BMI) in the black Brazilian population are scarce.

Methods: Cross-sectional study in individuals included in the First Brazilian Hypertension Registry. Relationships between variables were analysed by a binary logistic regression analysis.

Results: The study evaluated 2.191 (82.9%) non-Afro-descendant participants and 452 (17.1%) Afro-descendants. The median age was 61.9 years (55.3% women), the BMI was 28.4 kg/m² and the waist circumference (WC) was 93 cm in the former cohort. In the Afro-descendant group, the median age was 62.5 years (57.5% women), the was BMI 29.8 kg/m² and the was WC 98 cm. A significant correlation was identified between BMI and office diastolic BP (DBP) (R = 0.126; p = 0.007) in Afro-descendants. These individuals had 1.40 times the chance of being obese compared to those of other ethnicities (95% CI: 1.14-1.72; p < 0.001). Afro-descendant men had 0.78 times fewer chance of being obese compared to women (95% CI: 0.66-0.90; p = 0.002), and 1.49 times higher chance (95% CI = 1.21-1.82; p < 0.001) of having uncontrolled BP, with no differences with Afro-descendant women (HR 0.91; 95% CI = 0.78-1.07; p < 0.258).

Conclusion: No correlations were found between office BP, BMI and WC, except for a very weak correlation between DBP and BMI in the Brazilian Afro-descendants, although they were 1.40 times more likely to be obese. In contrast, a significant correlation between SBP and BMI was observed in the non-Afro-descendants. Differences in blood pressure control were not identified between the sexes within each group, but only between ethnic groups, with people of African descent having a 1.49 times greater risk of uncontrolled hypertension compared to non-Afro-descendants.

Background: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality. Most people can reduce their CVD risk through lifestyle improvements and medication. Having low health literacy is a barrier to CVD prevention and management and is associated with worse health outcomes. Knowledge is a key component of health literacy, but there is no standard way for clinicians to assess this to tailor education about CVD. The aim of this review was to identify available CVD knowledge tests and evaluate their quality.

Methods: Electronic database searches were conducted using Medline, CINAHL, PsycINFO and PsycTESTS between inception and October 2022. Identified tools were assessed using the Psychometric Grading Framework (PGF) to assess the quality of included tests.

Results: A total of 28 studies were identified, of which 18 were original test development papers and 10 were language translation papers. The five most common domains were CVD risk factors, nutrition, heart physiology, physical activity, and treatment options. Three papers achieved an A grading on the PGF. Only one test provided a guide to classify patients based on the results.

Conclusions: This review identified 15 additional knowledge assessment tools compared to previous research, including some available in multiple languages. Clinicians can access a wide range of CVD knowledge assessment tools to understand and respond to patient knowledge levels, but some are higher quality than others. Alternative tools may be needed to assess specific risk factor and condition knowledge. Further work is needed to tailor CVD knowledge tests for populations lower health literacy, and to validate the tests against health outcomes to improve clinical practice.

Prospero: CRD42022370227.

What is known: Having low health literacy is associated with worse cardiovascular outcomes.Knowledge is a key component of health literacy, but there is no standard way to assess this for CVD.An assessment of the quality and reliability of CVD knowledge tests could support clinicians to tailor patient education to health literacy needs.

What the study adds: We identified 15 additional tests development papers that were not captured in earlier reviews of CVD knowledge tests.There are multiple high quality CVD knowledge tests available to clinicians, and tests available in different languages.These tests may be used to tailor patient education to individual health literacy needs.

Background: Pulmonary arterial hypertension (PAH) is a severe vascular disorder with a multifactorial etiology, including potential genetic predispositions. Understanding the causal relationship between autoimmune diseases and the risk of developing PAH can inform clinical strategies for prevention and treatment.

Methods: We conducted a two-sample Mendelian Randomization (MR) analysis to evaluate the causal effect of genetic predisposition to five autoimmune diseases (systemic lupus erythematosus [SLE], rheumatoid arthritis [RA], inflammatory bowel disease [IBD], multiple sclerosis [MS], and type 1 diabetes [T1D]) on the risk of PAH. This involved employing various MR methods (IVW, MR-Egger, Weighted median, Simple mode, and Weighted mode), as well as conducting tests for heterogeneity and horizontal pleiotropy.

Results: The analysis revealed a significant association between genetic predisposition to RA and IBD with an increased risk of PAH (RA: OR = 1.28, 95% CI [1.01-1.61], p = 0.042; IBD: OR = 1.29, 95% CI [1.01-1.64], p = 0.043). However, no association was observed between genetically determined MS, SLE, and T1D with the risk of PAH (MS: p = 0.876; SLE: p = 0.564; T1D: p = 0.061). Additionally, tests for heterogeneity and pleiotropy provided no evidence of their influence, suggesting the robustness of these associations. Reverse MR analysis also indicated no significant effect of PAH on the genetic susceptibility to these autoimmune diseases.

Conclusion: The findings suggest a possible genetic causative link between RA and IBD and the risk of developing PAH. Conversely, genetic predisposition to MS, SLE, and T1D does not appear to influence PAH risk. Understanding these relationships may offer insights into the pathophysiology of PAH and inform screening strategies within at-risk populations.

Background and aim: Cardiovascular diseases (CVD), including coronary artery disease (CAD), myocardial infarction (MI), atrial fibrillation (AF), and ischemic stroke (IS), are major causes of morbidity and mortality worldwide. Immune cells play crucial roles in CVD, but causal links between immune cell subtypes and CVD risk remain unclear. This study used Mendelian randomization (MR) to investigate these associations.

Methods and results: Exposure data were analyzed with a P < 1 × 10^-5 threshold, excluding linkage disequilibrium SNPs. MR of 731 immune cell types used the inverse variance weighted (IVW) method, with pleiotropy and heterogeneity tests. Lipid profiles (HDL, LDL, VLDL, triglycerides) were assessed as mediators.Increased CD27 on unswitched memory B cells, CD28^- DN T cells, and CX3CR1 on CD14^- CD16⁺ monocytes raised CVD risk, while CD28 on Tregs and HLA DR⁺⁺ monocytes were protective. For CAD, CD24⁺ CD27⁺ %B cells and SSC-A on HLA DR⁺ NK cells were protective, with certain T cells increasing risk. Similar trends were observed for MI, AF, and IS. Reverse MR showed no CVD effects on these positive immune traits. Lipid profiles mediated CVD risk, with HDL protective and LDL, VLDL, and triglycerides increasing risk. Mediation analyses showed LDL and triglycerides partially mediated CX3CR1-monocyte effects on MI risk. Functional enrichment identified cytokine signaling and inflammation in CVD.

Conclusions: Our findings highlight immune cell subtypes and lipid traits in CVD risk. Regulatory T cells and protective phenotypes are therapeutic targets, while LDL and triglycerides mediate immune-disease pathways, emphasizing immune-lipid interactions for targeted therapies.

Background: Available evidence suggests that the epidemiology of heart failure (HF) in sub-Saharan Africa (SSA) might be changing. However, there is a scarcity of contemporary data on the epidemiology and prognosis of hospitalized HF patients in Cameroon despite improvements in the treatment of HF and the changing epidemiology of HF in SSA in the last decade.

Objective: To examine the contemporary characteristics, the in-hospital outcomes, and their predictors in patients hospitalized for decompensated HF in Buea, South West region of Cameroon.

Methods: We conducted an observational prospective cohort study. We included consecutive patients hospitalized for HF from March 2021 to March 2024. Multivariate logistic regression analyses were performed to determine factors associated with in-hospital mortality and prolonged length of hospital stay (LOS). A p-value < 0.05 was considered statistically significant.

Results: Out of the 477 patients included, 254 (53.2%) were females. The mean age was 60.3 ± 16.5 years. The most common co-morbidities were hypertension (55.6%), atrial fibrillation (20.8%), diabetes mellitus (17.6%), and chronic kidney disease (14.1%). The most common causes of heart failure were hypertensive heart disease (41.7%), ischemic heart disease (15%), cor pulmonale (11.9%), and dilated cardiomyopathy (9%). The median length of stay (LOS) was seven days. Factors that increased odds of prolonged LOS were atrial fibrillation (OR = 2.04, CI: 1.26-3.35; p = 0.005). Factors that reduced odds of prolonged LOS were valvular heart disease (VHD) (OR = 0.49, CI: 0.26-0.91; p = 0.023), systolic blood pressure (SBP) (OR = 0.99 per 1 mmHg increment, CI: 0.98-0.99; p = 0.005), and natremia (OR = 0.96 per 1 unit increment, CI: 0.93-0.99; p = 0.010). In-hospital mortality was 11.9%. Factors that increased odds of in-hospital mortality were VHD (OR = 2.40, CI: 1.02-5.64; p = 0.045) and dobutamine administration (OR = 4.37, CI: 1.11-17.16; p = 0.034). Factors that reduced odds of mortality were SBP (OR = 0.99, CI = 0.98-0.99; p = 0.033), natremia (OR = 0.93, CI: 0.89-0.97; p < 0.001), and glomerular filtration rate (OR = 0.98 per 1 unit increment, CI: 0.97-0.99; p = 0.001).

Conclusion: The causes of HF are still predominantly hypertensive, but there is an increasing contribution of ischemic heart disease. There is a need to improve hypertension control and other risk factors for ischemic heart disease in SSA.

Objective: This study aimed to assess the feasibility and cost-effectiveness of hand-held echocardiography-based screening for Stage B or C heart failure among individuals with hypertension and/or diabetes at the High-tech Area Fangcao Community Health Service Center and the Tianfu New Area Huayang Community Health Service Center in Chengdu, China, with the objective of promoting early diagnosis and intensified care.

Methods: Patients with hypertension and/or diabetes registered and cared for at two community health service centers (CHSCs; Chengdu, China) with no history of clinical heart failure were recruited between October 2021 and December 2021. By combining symptom assessment (dyspnea and/or edema) and N-terminal-probrain natriuretic peptide (NT-proBNP ≥ 125 pg/ml as the cut-off) levels with HHE for any indexed abnormality in the dedicated semi-quantitative protocol, patients were categorized into heart failure (HF) Stages A, B, and C. The diagnostic accuracy and cost-effectiveness of several pre-specified screening strategies were compared.

Results: Of the 423 patients (70 ± 9 years; males, 46.6%) enrolled, 166 (39.2%) were symptomatic and 106 (25.1%) exhibited elevated NT-proBNP levels. Hand-held echocardiography (HHE) abnormalities were detected in 286 (67.0%) patients, with interventricular septum thickening (47.0%) being the most common finding, followed by left atrial enlargement (30.0%). Left ventricular systolic dysfunction was identified in 18 (4.3%) patients. A total of 240 (56.7%) patients were reclassified as HF Stage B and 59 (13.9%) as Stage C. The stepwise strategy of using symptoms for initial stratification, followed by the selection of HHE or NT-proBNP in different circumstances, resulted in 100% accuracy and a 31.3% reduction in costs.

Conclusions: HHE-based focused HF screening allows for the early identification of numerous cases of Stage B and mild Stage C HF in high-risk populations. A stepwise screening strategy incorporating symptoms, NT-proBNP, and HHE is feasible and cost-effective and should be adopted in community-based primary care settings.

Mendelian randomisation is an approach in genetic epidemiology that uses genetic variants as instrumental variables to investigate the causal relationship between genetically proxied exposures and health outcomes. During the last years, the number of published Mendelian randomisation studies increased tremendously. There are several opportunities of Mendelian randomisation including obtaining potential causal relationships between both exogenous and endogenous exposures and outcomes and for identifying and prioritising drug-targets to inform clinical trials. However, it is also important to be aware of its challenges. This includes the reliability of results under the assumptions on instrumental variables, being aware of potential biases, the correct and critical interpretation of findings and comparison to the results of randomised controlled trials, as well as the availability of genetic data on specific subgroups. This review provides a comprehensive overview of the opportunities and challenges of Mendelian randomisation and presents key future perspectives.

Background: Chemotherapy-induced cardiotoxicity is the leading cause of non-tumor-related mortality among patients with tumors. Although sodium glucose cotransporter 2 inhibitors (SGLT2is) have been shown to confer cardiovascular benefits, their effects and safety profile in patients with cancer remain uncertain. The objective of this study was to assess the cardiovascular effects of SGLT2is in patients with cancer.

Objective: We conducted a meta-analysis of cohort studies to compare the efficacy and safety of SGLT2is and placebo in patients with cancer.

Results: A total of ten cohort studies, encompassing 85,185 patients, were included in this study. SGLT2is significantly decreased mortality (Risk ratios (RR) 0.52, 95% confidence interval (CI) (0.36, 0.75), I² = 98%), heart failure (HF) (RR 0.43, 95% CI 0.24, 0.77, I² = 75%), and arrhythmia (RR 0.33, 95% CI 0 .23, 0.49, I² = 0%). In addition, SGLT2is decreased the incidence of adverse events. No significant difference was identified in hypoglycemia, ketoacidosis, and acute coronary syndrome (ACS).

Conclusion: The present study suggest that sodium glucose cotransporter 2 inhibitors may be an efficacious and safe means for improving the prognosis of patients with cancer and diabetes. However, future large-scale randomized controlled trials are needed to further validate the results.

Introduction: Cardiovascular disease (CVD) is a leading cause of global mortality with >80% of the burden in low-income countries. We investigate population-based estimates of CVD risk factors among young people ages 18-30 in Haiti and provide insights for CVD prevention.

Methods: This is a cross-sectional study within the Haiti Cardiovascular Cohort Study. CVD risk factors include: high blood pressure (BP), dyslipidemia, kidney disease, overweight and obese, and health behaviors. Multivariate logistic regression assessed associated independent factors.

Results: Among 957 participants ages 18-30 years, 23.5% had high BP (95%CI: 20.9%-26.3%), 34.9% had dyslipidemia (95%CI: 31.8%-38.1%), 6.4% had kidney disease (95%CI: 4.8%-8.4%), 16.5% were overweight (95%CI: 14.2%-19.0%), and 6.8% were obese (95%CI: 5.3%-8.6%). More males had high BP (33.6% vs. 14.0%; p < 0.001) and more females had dyslipidemia (45.1% vs. 23.9% p < 0.001). Overweight and obese participants had higher odds of high BP (aOR: 2.05, 95%CI: [1.31-3.19]; aOR 2.15, 95%CI [1.11-4.04]) and dyslipidemia (aOR: 1.70, 95%CI [1.15-2.50]); aOR 2.82, 95%CI [1.63-4.98]) compared to those with normal BMI. Participants ages 25-30 had higher odds of high BP (aOR: 1.58, 95%CI: [1.14-2.18]) and dyslipidemia (aOR: 1.81, 95%CI: [1.35-2.43]) compared to participants ages 18-24.

Discussion: Prevalence of high BP and dyslipidemia are alarmingly high in Haitian young adults, with higher rates of dyslipidemia in women and elevated BP in men. These data provide evidence for routine CVD screening in young people as early as 18 years and underscore the need to identify modifiable drivers of early-onset CVD.