Progress in cardiovascular diseases最新文献

Background: Neighborhood median household income (NMHI), a key social determinant of health, is being recognized as a major source of inequity in healthcare. Its impact on patients with hypertrophic cardiomyopathy (HCM) is uncertain.

Objective: We sought to study the association between NMHI and long-term outcomes of HCM patients.

Methods: This was an observation registry of 6368 HCM patients (median age 56 years, 58 % men, 83 % white, 32 % with ≥1 sudden death risk factor) who underwent a clinical evaluation at a tertiary care center between 2002 and 18. NMHI (US$) was calculated from each patient's zip code, using data from the US Census Bureau and Department of Housing & Urban Development. The primary outcome was death, appropriate internal cardioverter defibrillator (ICD) discharge or heart transplant in follow up.

Results: Patients were categorized as obstructive (oHCM, n = 3827 or 60 %, 65 % symptomatic, median NMHI $51,600) and nonobstructive (nHCM, n = 2541 or 40 %, 73 % asymptomatic, median NMHI $53,700) using echocardiography. At a median of 6 years (interquartile range or IQR 2.91, 9.74), there were 998 (16 %) primary events (deaths = 939), with breakdown as follows: 599/3827 (16 %) in oHCM and 399/2541 (16 %) in nHCM, respectively. On multivariable Cox survival analysis, a higher NMHI was independently associated with improved long-term freedom from primary events (oHCM [Hazard ratio or HR 0.84 95 % Confidence Interval or CI 0.80-0.88] and nHCM [HR 0.95 95 % CI 0.91-9.97]), both p < 0.01. On penalized spline analysis, the NMHI at which the hazard for primary events crossed 1 was ~$52,000 for both oHCM and nHCM. In nHCM patients, NMHI greater than $52,000 was associated with improved longer-term freedom from primary events vs. those whose NMHI was lower than $52,000 (196/1398 [14 %] vs. 203/1143 [18 %], log-rank p-value<0.01). Similarly, oHCM patients with NMHI greater than $52,000 had significantly improved longer-term freedom from primary events vs. those whose NMHI was lower than $52,000 (186/2067 [9 %] vs. 413/1760 [23 %] vs., log-rank p-value<0.001).

Conclusions: NMHI, a marker of socioeconomic status, is independently associated with outcomes in patients with HCM. oHCM patients below the NMHI cutoff had significantly worse long-term outcomes vs. the nHCM patients similarly below the NMHI cutoff.

Aims: To assess if adiposity measures such as waist-to-hip ratio (WHR) modify the relationship of lipoprotein (a) [Lp(a)] with atherosclerotic cardiovascular disease (ASCVD).

Methods: 4652 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) were grouped as follows: Lp(a) < 50 mg/dl and WHR <90th percentile(pct) (reference); Lp(a) < 50 mg/dl and WHR ≥90th pct; Lp(a) ≥ 50 mg/dl and WHR <90th pct; and Lp(a) ≥50 mg/dl and WHR ≥90th pct. Cox proportional hazard models assessed the relationship of Lp(a) and WHR with time to ASCVD events.

Results: Compared to the reference group, isolated elevated Lp(a) ≥ 50 mg/dl or WHR ≥90th pct were not significantly associated with risk of ASCVD (hazard ratio (HR), 1.15, 95 % confidence interval (CI): 0.94-1.39) and (HR, 1.14, 95 % CI: 0.92-1.41), respectively. In contrast, the combination of elevated Lp(a) ≥50 mg/dl and WHR ≥90th pct was associated with ASCVD risk (HR, 2.34, 95 % CI: 1.61-3.40). Lp(a) ≥50 mg/dl was not significantly associated with ASCVD risk in the 1st and 2nd tertile of WHR (HR, 1.06, 95 % CI: 0.72-1.48and HR, 1.08, 95 % CI: 0.79-1.48, respectively). However, Lp(a) ≥50 mg/dl was significantly associated with ASCVD risk in the highest tertile of WHR (HR, 1.60, 95 % CI: 1.23-2.09). (Interaction p = 0.01). Body mass index (BMI) and Lp(a) combinations resulted in similar greater risks of ASCVD in the highest risk category (HR, 1.33, 95 % CI: 1.00-1.77), without a significant interaction (p = 0.99).

Conclusions: In MESA, WHR significantly modifies the risk of ASCVD associated with Lp(a). Measures of abdominal adiposity may further refine the cardiovascular risk in individuals with elevated Lp(a).

While there is ongoing debate about the role of the 12‑lead Electrocardiogram (ECG) in the routine screening of young athletes during pre-participation evaluations, studies continue to support the use of ECG within properly organized settings. This paper aims to offer considerations for enhancing the International ECG recommendations for the interpretation of the ECGs of young athletes through an emphasis on 1) percentile outliers, 2) computerized ECG technology and 3) clarification of terminology. We specifically highlight criteria for early repolarization, left atrial abnormality, right bundle branch block, ST shifts, and high and low voltage QRS.

With chronic diseases increasingly prevalent in the United States (U.S.), healthcare providers are in a unique position to promote healthy living behaviors, such as physical activity (PA) and nutrition, to patients. However, many healthcare providers struggle with maintaining their own health, which negatively affects their ability to counsel patients effectively on these behaviors. This paper highlights the barriers healthcare providers face in adopting and promoting healthy behaviors, including individual habits, lack of training, and environmental factors within healthcare institutions. It also examines how these barriers, such as insufficient educational opportunities, inadequate work environments, and systemic obstacles like time constraints and reimbursement issues, hinder effective PA and nutritional counseling. The authors propose that improving the health of healthcare providers will enhance the quality of counseling they provide, ultimately benefiting patient care and population health.

Workplace settings, including hybrid, remote, and home-based environments, are key places to support employees and their families to live healthfully since so many adults spend significant amounts of time at work. Employers can create a culture of healthy living at their workplaces and do so intentionally through process and practice. They can establish organizational policies, systems, work processes, architectural design practices, and employment benefits designs to support healthy behaviors for their employees and their families. Employers also can ensure health insurance approaches that provide equitable access to quality health care. They can ensure livable wages for all staff and provide a host of other important healthy living support mechanisms, using incentives and communications. Organizational executives and upper managers play a critical role in modeling these shared values at the workplace and participatory approaches need to be implemented to give all workers opportunity to meaningfully engage. Corporate leaders can reinforce a healthy living culture with role modeling and by ensuring resources are available and accessible-to do so, a set of workplace factors should be implemented that, cumulatively, reach a tipping point toward the creation of a healthy workplace culture. Employers can both influence and be influenced by the communities in which they are located. Recognizing regional culture, participating in strategic relationships, investing in the community, and providing volunteer and civic engagement opportunities all contribute to the support of healthy living strategies in the workplace. When employers pursue a workplace culture of health, they not only do good by their employees, but they also increase the likelihood that their company may outperform their market competition.