Global Heart最新文献

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.

Cardiovascular diseases (CVDs) are a leading cause of mortality in low- and middle-income countries (LMICs), yet access to echocardiography remains limited due to workforce shortages. The Kenya Cardiac Society (KCS), in collaboration with the American College of Cardiology (ACC), launched a 16-week transthoracic echocardiography (TTE) training program to address this gap. This blended learning initiative trains non-cardiologist healthcare workers through online modules, hands-on workshops, and expert mentorship. Since 2022, the program has trained 95 participants, enhancing diagnostic capacity and expanding echocardiography services to underserved areas. Early outcomes include reduced patient travel distances, improved early detection of cardiac conditions, and strengthened CVD management at secondary and tertiary levels. Challenges such as limited equipment access and financial constraints persist, but strategic partnerships and innovative training models demonstrate the program's potential for scalability. The KCS-ACC-TTE program highlights the effectiveness of task-sharing and collaboration in strengthening cardiovascular care, offering a replicable framework for LMICs to improve access to essential cardiac diagnostics.

Background and objectives: Abdominal aortic (AA) aneurysms (AAA) are often incidental findings and preceded by a long period of subclinical growth in diameter. Patients may present with life-threatening complications. Therefore, screening programmes for AAA in primary care are proposed in several European countries, and opportunistic AAA screening during echocardiography is also advocated. However, data on the interest of such an approach in the sub-Saharan African population are unknown.

Methods: In 2022, a total of 189 patients with cardiac symptoms visiting the Mnazi Mmoja Referral Hospital (MMH) in Zanzibar underwent standard transthoracic echocardiography (TTE). Demographics and clinical data were recorded. AA diameter was routinely assessed in 137 patients. AA was measured by the leading-edge-to-leading-edge method from a longitudinal plane, and AAA was defined as an AA diameter of ≥3.0 cm. SPSS version 29.0 was used for data analysis. The prevalence of AAA was estimated as the number of AAA cases divided by the number of all screened subjects. Correlates of AA diameter were tested in univariate and multivariate linear regression analyses.

Results: AA could be visualized in 128 (93.4%) patients (43% of men and 57% of women). The mean age was 54.4 ± 15.9 years. The mean AA diameter was 2.1 ± 0.3 cm in the entire study population and was significantly greater in men than women (2.2 ± 0.3 vs 2.1 ± 0.3 cm, p = 0.005) and in individuals aged ≥60 years than those aged <60 years (2.3 ± 0.3 vs 2.1 ± 0.3 cm, p = 0.003). The prevalence of AAA was 1.6%. In a multivariate linear regression analysis, higher age, male gender, atrial fibrillation and left ventricular (LV) mass were independent correlates of greater AA diameter, adjusted for clinic systolic blood pressure, ascending aortic diameter and LV ejection fraction (multiple R² = 0.38, p < 0.001).

Conclusions: Abdominal aorta screening during routine TTE is feasible in Africa. Patients in Zanzibar have relatively smaller abdominal aorta diameters with a 1.6% prevalence of AAA. Abdominal aorta screening by routine echocardiography may be beneficial, provided that access to care and vascular surgery facility/expertise with appropriate follow-up is available for patients with AAA identified during screening.

Introduction: PET/CT has a synergistic value for optimal diagnosis, disease activity monitoring, and evaluation of damage progression in large vessel vasculitis. The use of standardized uptake values (SUV) as a measurement of relative tissue uptake facilitates comparisons between patients, and has been suggested as a basis for diagnosis. The SUVmean and SUVmax reproducibility in vascular structures is not widely studied.

Objective: The objective of this study was to evaluate the inter-observer variability of both qualitative visual grading of aortic ¹⁸F-FDG uptake and the quantitative aortic mean and maximum SUVs in these patients with mild to moderate covid-19 infection who underwent multimodality cardiac imaging within the COSMIC-19 trial.

Study design: This is a sub-study of the COSMIC-19 trial. 30 patients were subjected to a combined Computed Tomography Coronary Angiogram and ¹⁸F-FDG PET/CT, followed by cardiac magnetic resonance. Two independent observers measured the Standardized uptake values in five regions of interest at each aortic segment. These were performed sequentially along the length of the aorta every 5 mm on the axial slices. The maximum and mean standard uptake values were measured.

Results: Qualitative assessment showed excellent agreement between observer x and y for the ascending aorta and aortic arch regions with the kappa coefficients for the inter observer agreement of 0.92 (95% CI:0.78-1.0) and 0.91 (95% CI:0.74-1.0) respectively. Quantitative assessment showed a very high positive correlation between the two observers for each of the regions measured for SUVmean as follows; ascending aorta r = 0.96 (p < 0.001), Aortic arch r = 0.90 (p < 0.001) and descending Aorta r = 0.91 (p < 0.001). The correlation coefficients for the SUVmax were substantially strong.

Conclusion: This study shows an excellent inter-observer reproducibility for both qualitative and quantitative SUVmean vascular ¹⁸F-FDG measurements in patients with COVID-19 large vessel vasculitis. Quantitative SUVmax demonstrated substantially strong interobserver reproducibility.

Background: HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative, aimed at helping countries enhance hypertension and cardiovascular disease (CVD) risk management in primary care settings. Its core implementation tool, the HEARTS Clinical Pathway, has been adopted by 28 countries. To improve the care of hypertension, diabetes, and chronic kidney disease (CKD), HEARTS 2.0 was developed as a three-phase process to integrate evidence-based interventions into a unified care pathway, ensuring consistency across fragmented guidelines. This paper focuses on Phase 1, highlighting targeted interventions to improve and update the HEARTS Clinical Pathway.

Methods: First, the coordinating group defined the project's scope, objectives, principles, methodological framework, and tools. Second, international experts from different disciplines proposed interventions to enhance the HEARTS Clinical Pathway. Third, the coordinating group harmonized these proposals into unique interventions. Fourth, experts appraised the appropriateness of the proposed interventions on a 1-to-9 scale using the adapted RAND/UCLA Appropriateness Method. Finally, interventions with a median score above 6 were deemed appropriate and selected as candidates to enhance the HEARTS Clinical Pathway.

Results: Building on the existing HEARTS Clinical Pathway, 45 unique interventions were selected, including community-based screening, early detection and management of risk factors, lower blood pressure thresholds for diagnosing hypertension in high-CVD-risk patients, reinforcement of single-pill combination therapy, inclusion of sodium-glucose cotransporter-2 inhibitors for patients with diabetes, CKD, or heart failure, expanded roles for non-physician health workers in team-based care, and strengthened clinical documentation, monitoring, and evaluation.

Conclusion: HEARTS 2.0 Phase 1 identifies key interventions to integrate and improve hypertension and cardiovascular-kidney-metabolic care within primary care, enabling their seamless incorporation into a unified and effective clinical pathway. This process will inform an update to the HEARTS Clinical Pathway, optimizing resources, reducing care fragmentation, improving care delivery, and advancing health equity, thereby supporting global efforts to combat the leading causes of death and disability.

Background: A recent position paper of the European Society of Cardiology Council on Stroke proposed an integrated ABC_stroke pathway to optimise post-stroke management. We evaluated the impact of ABC_stroke pathway adherence on post-stroke cardiovascular outcomes.

Methods: Patients with first-ever ischaemic stroke in Hong Kong between 2006 and 2022 were included in this retrospective cohort study. Multivariable Cox regression analysis was performed to evaluate the association between physicians' adherence to the ABC_stroke pathway and the primary outcome, which was a composite of recurrent ischaemic stroke, transient ischaemic attack, haemorrhagic stroke, myocardial infarction, heart failure and all-cause mortality.

Results: Of the 9,669 included patients with ischaemic stroke (mean age 69.6 ± 13.4 years; 57.5% male), 58.1% were optimally managed according to all three ABC_stroke pillars. After 1 year of follow-up, adherence to the ABC_stroke pathway was associated with a lower risk of the primary composite endpoint (hazard ratio (HR): 0.80; 95% confidence interval (CI): 0.72-0.88), as well as a lower risk of haemorrhagic stroke (subdistribution hazard ratio (SHR): 0.50; 95% CI: 0.38-0.67), heart failure (SHR: 0.771; 95% CI: 0.596-0.998), cardiovascular death (SHR: 0.64; 95% CI: 0.45-0.90), and all-cause mortality (HR: 0.72; 95% CI: 0.62-0.85). Risk reductions in the primary endpoint increased progressively with a higher number of ABC_stroke criteria obtained. No significant interaction was observed in the association according to age, sex, or stroke severity.

Conclusions: In this cohort of Asian patients with first-ever ischaemic stroke, optimal management according to the ABC_stroke pathway was associated with a reduction in the risk of adverse outcomes.

Medication adherence among heart failure (HF) patients in the Middle East remains a critical, under-explored issue. This systematic review examines medication adherence rates and their influencing factors in this region. A search of PubMed, Scopus, and Google Scholar identified 12 studies published between 2013 and 2023, revealing an average non-adherence rate of 60%. Influential factors include socioeconomic status, education, psychiatric conditions, and medication-related issues. Significant gaps in research methodologies and reporting were noted. The review highlights the impact of socio-economic determinants on adherence and calls for more robust research and targeted interventions to address these barriers. Improving patient education and healthcare provider communication are crucial to enhancing adherence rates. These findings underscore the importance of addressing regional challenges through tailored approaches and suggest further studies are needed to develop effective strategies for improving adherence among HF patients in the Middle East.