Global Heart最新文献

Cardiovascular diseases (CVD), including pre-existing cardiac conditions and hypertensive disorders of pregnancy, are among the leading causes of maternal mortality globally and account for a substantial proportion of preventable deaths in low- and middle-income countries (LMICs). In these settings, women are disproportionately affected by conditions such as rheumatic heart disease, peripartum cardiomyopathy, and severe anemia-related heart failure, yet clinical guidance tailored to LMICs contexts remains limited. This paper presents the findings of a scoping review on CVD in pregnancy guidelines in LMICs. The review seeks to identify and map clinical guidelines from LMICs and international organizations with reach in LMICs that addresses the prevention, screening, and management of cardiovascular diseases (CVD) in pregnancy and examine their scope, content, and specific recommendations for pregnant women. The review followed the JBI methodology. Guidelines on CVD care in pregnancy published between 2011 and 2023 by international or national professional organizations and Ministries of Health from LMICs were searched using databases such as PubMed, Scopus, GIN International library, and individual websites. Data were extracted using a custom-designed MS Excel form, capturing details such as guideline title, year, type, publisher, country, target audience and population, clinical focus, timing, and summary of recommendations. Out of the 90 shortlisted guidelines, 17 were included and 73 were excluded. Of the included guidelines, 3 are on CVDS and 14 are on hypertensive disorders of pregnancy (HDP). They varied in scope, with most focusing on preeclampsia or HDP, but only a few provided comprehensive recommendations across the continuum of cardiovascular care in pregnancy, highlighting major gaps in prevention, screening, and long-term follow-up. Existing guidance remains fragmented with limited coverage of high-burden conditions of LMICs such as rheumatic heart disease. Strengthening clinical practice will require not only adapting global recommendations to local realities but also investing in LMIC-led research and inclusive guideline development that reflects regional priorities and health system capacities.

Obesity is a growing global epidemic with significant implications for cardiovascular diseases (CVD). It couples as an independent risk factor and driver for multiple pathways leading to CVDs. Here we examine obesity's impact on CVD and propose actionable strategies. Data from the NCD Risk Factor Collaboration (NCD-RisC), Global Burden of Disease (GBD) survey, and regional health surveys databases were used. We examined trends in obesity prevalence and CVD mortality attributable to high body mass index (BMI), disaggregated by sex, geography, socioeconomic status, and urban-rural residence. Evidence from national policy initiatives and clinical management guidelines was also reviewed. As of 2022, over 1 billion people globally were living with obesity. Since 1990 the age-standardised obesity prevalence has doubled among women (from 8.8% to 18.5%) and tripled among men (from 4.8% to 14%). Globally, the number of annual CVD deaths attributable to high BMI (25 kg/m² or over) more than doubled between 1990 and 2021, reaching 1.9 million in 2021. Reducing global obesity to 2019 levels could save an estimated US$2.2 trillion annually by 2060. Positive steps have been made in recent years, with the implementation of several global, national and local initiatives that show promise in tackling obesity and CVDs, in addition to the emergence of potentially game-changing medical interventions, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs). Yet, to tackle obesity and associated CVD, there is a need for a holistic approach across clinical and public health interventions that accounts for the multiple determinants of obesity. We recommend the implementation of evidence-based, cost-effective public health measures, and the incorporation of obesity-specific recommendations into cardiovascular guidelines. Addressing the global cardiovascular crisis linked to obesity will require coordinated efforts from policymakers, healthcare systems, and global health organisations.

Background: The burden of degenerative valve disease is increasing globally because of population aging. However, data on this condition is scarce in Nigeria and across Africa.

Objective: Our study evaluated the prevalence, pattern, and associations of aortic sclerosis and degenerative valve disease in a Nigerian population.

Methods: Data of a total of 4030 patients were analyzed retrospectively from the Federal Medical Centre Abuja transthoracic echocardiographic registry from January 2020 to December 2024. Patients were 18 years and above. Aortic sclerosis, degenerative mitral valve disease, calcific aortic valve disease, and degenerative valve disease were defined in accordance with the report of the American Heart Association/American College of Cardiology guidelines.

Results: The mean age of patients was 52 ± 15 years and 53.2% were female. The prevalence rates were 4.2% for aortic sclerosis, 0.2% for degenerative mitral valve disease, 1.2% for calcific aortic valve disease, and 1.3% for degenerative valve disease. Among patients aged 65 years and older, the prevalences rates were higher for aortic sclerosis (13.2%), degenerative mitral valve disease (1.0%), calcific aortic valve disease (3.4%), and degenerative valve disease (3.9%) [P < 0.001]. Only 1.7% and 0.6% of those <65 years had aortic sclerosis and calcific aortic valve disease, respectively. Patients aged 65 years and older, and hypertension had odds ratio (OR) of 7.99 and 3.98 for developing aortic sclerosis, respectively. For calcific aortic valve disease, the OR was higher for patients aged 65 years and older (OR: 4.25), hypertension (OR: 2.48), and left ventricular hypertrophy (OR: 5.35) [P < 0.001].

Conclusion: In this Nigerian echocardiographic registry, age above 65 years and hypertension were associated with aortic sclerosis and calcific aortic valve disease.

Background: Long-term adverse consequences of the COVID-19 infection affect many organ systems, which requires comprehensive understanding of the disease burden and determinants of persistent long COVID-19 symptoms in diverse population. However, data on long COVID complications are sparse, particularly from low- and middle-income countries (LMICs). The World Heart Federation (WHF) global study assessed the incidence of vascular complications, persistent long COVID symptoms and factors associated with mortality and major adverse cardiovascular events (MACE) among patients with COVID-19 up to one year after hospitalization.

Methods: We recruited a total of 2535 patients hospitalized with COVID-19 and followed up to one-year post-hospital discharge. We collected data on long COVID symptoms, quality of life, and clinical outcomes, including new onset diseases, MACE, and mortality at 1-, 3-, 6-, and 9-12 months post-discharge. Descriptive and generalized estimating equation (GEE) regression analysis was performed to assess the factors associated with mortality and MACE.

Findings: The majority of participants were recruited from LMICs (64%) and male (56%) with a mean (SD) age of 59.5 (20.0) years. Among those tested for COVID-19 strain (52%), Omicron strain was the most prevalent (98%). The follow-up rate at one year was 90%. Over half of the participants (56%) reported experiencing at least one major long COVID symptom (fatigue, breathlessness, anxiety, chest pain, and palpitations) at 1-month, and one-quarter participants reported persistent long COVID symptoms at 9-12 months. On the EQ-5D scale, 49% reported difficulties in usual activities, 33% reported anxiety/depression, and 23% reported problems in mobility within the first 6 months. The most frequent new-onset illnesses were pulmonary embolism (8%), kidney disease (4%), and hypertension (3%). The cumulative all-cause mortality rate was 15% (n = 382) at one-year post-discharge. Long COVID symptoms were more common among females, individuals with pre-existing comorbidities, and those with more severe acute illness. Age, obesity, ICU admission, and underlying cardiovascular or pulmonary disease were associated with increased risk of mortality and MACE.

Conclusion: The study showed a substantial burden of mortality and morbidity, and a quarter of patients reported at least one persistent long COVID symptom after one year. Our findings underscore the need for early identification and management of long COVID symptoms in LMICs.

Objective: We performed a within-trial cost-effectiveness analysis of a targeted family-based structured lifestyle modification intervention for cardiovascular risk reduction.

Research design and methods: The PROLIFIC study was an open-label, cluster randomised controlled trial in the families (first-degree relatives and spouses older than age 18 years) of individuals with premature coronary heart disease. Families in the intervention group received a comprehensive package of interventions facilitated by non-physician health workers: screening for cardiovascular risk factors, structured lifestyle interventions, linkage to a primary healthcare facility for individuals with established chronic disease risk factors or conditions, and active follow-up for adherence. The usual care group received one-time counselling and annual screening for risk factors. The cost was estimated from a health system perspective, including intervention and treatment costs. Effectiveness was measured as changes in risk factors and quality-adjusted life years (QALYs) elicited using the EQ-5D-5 L instrument. The time horizon was two years, and we performed one-way and probabilistic sensitivity analyses.

Results: Over two years, the incremental cost for the intervention compared to usual care was Int$ 157.5 per person (intervention group: Int$ 381.6, usual care group: Int$ 224.1), and the incremental QALY gain was 0.014 (0.0166 Vs 0.0027). The within-trial ICER was 11,352 Int$/QALY. Incremental cost per unit reduction in systolic blood pressure, fasting plasma glucose, HbA1c, total cholesterol, and waist circumference were Int$ 28.5, 26.9, 130.8, 178.7, and 39.8, respectively.

Conclusions: A family-based structured lifestyle modification program yields a net gain in quality of life and is cost-effective at a three times gross domestic product per capita threshold. The intervention is expected to be relatively more cost-effective when scaled up to larger populations over longer time horizons. The intervention has the potential for a substantial public health impact if adopted as a strategy at the state or national level.Trial Registration Number: Clinicaltrials.gov, NCT02771873.

Background: Heart failure (HF) affects approximately 64.3 million people worldwide. Despite notable progress over the past two decades in advancing the understanding of heart failure in Africa-a condition often more lethal than many cancers-important knowledge gaps persist. These include outdated data on access to care and a lack of information regarding the incidence, aetiology, availability, and affordability of HF medications.

Objectives: To prospectively characterise the contemporary incidence, epidemiology, clinical presentation, and health outcomes of acute HF among a large, representative cohort of patients presenting to hospitals across diverse communities in Africa.

Methods: The Sub-Saharan Africa Survey of Heart Failure (THESUS-HF II) is a pragmatic, multicentre, observational cohort study coordinated by the Pan-African Society of Cardiology (PASCAR). All 27 PASCAR member countries were invited to participate, along with over 5,000 clinicians from the PASCAR database. The survey comprises two components. First, a platform collecting data on each hospital's catchment population, human resources, presence of specialised cardiology services, availability of diagnostic tools, and access to essential heart failure treatments. Second, a prospective observational study capturing all acute heart failure presentations to participating hospitals over seven weekdays within an 8-week period (from the start of surveillance). Data were collected on clinical characteristics and outcomes to discharge, 30 days, and six months. The study commenced in mid-2024 and includes approximately 50 hospitals across 16 countries spanning all major regions of the African continent.

Conclusions: When completed, THESUS-HF II will be the largest and most comprehensive study of acute HF to date in Africa. It will provide invaluable insights into the contemporary characteristics and burden of acute HF in Africa, whilst indicating what is needed to improve health care planning and, ultimately, patient outcomes.

Background: Elevated low-density lipoprotein cholesterol (LDL-C) levels are a leading risk factor for atherosclerotic cardiovascular disease (ASCVD), a major global cause of illness and death. Patients' qualitative insights about experiences, priorities, and needs are essential for creating more targeted, patient-centered quality improvement interventions.

Objectives: To document the experiences of people with high levels of low-density LDL-C in three countries.

Methods: Qualitative study of 60-min in-depth interviews with 50 adult patients from Australia, Brazil, and the United States. The study was overseen by a Steering Committee comprising patients, patient advocates, researchers, and cardiologists. The interviews explored pathways and barriers to high LDL-C diagnosis; the burden of managing high LDL-C and the awareness of the association between high LDL-C and cardiovascular risks. The data were analyzed by applying a structured, team-based approach to coding qualitative data.

Results: There were three main pathways to diagnosing high cholesterol: routine physical exams conducted by primary care providers; symptomatic presentations or incidental findings during emergency visits and through a healthcare visit for another condition, frequently diabetes. Healthcare providers' communication styles influenced patients' perceptions of their conditions. Two-thirds of participants (n = 33) attempted lifestyle changes after their high cholesterol diagnosis, but work schedules and daily routines posed barriers to maintaining healthy habits. Some participants who experienced ASCVD events waited hours or days before seeking care, assuming their symptoms were not serious. After diagnosis of an ASCVD event, many patients feared death and worried about their families' futures. When asked about potential improvements to their current therapy, 21 patients mentioned reduced administration frequency.

Conclusions: This pilot study provides insights into patients' experiences living with and managing elevated LDL-C. It describes opportunities for policymakers and healthcare providers to improve the detection of elevated LDL-C and support patients in understanding risks and strategies for reducing the risk of ASCVD events.

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.