Cardiovascular Disease Burden in Rural Central Asia: A Systematic Review of Epidemiological Trends and Mortality Patterns

Hypertension curriculum review: epidemiology and the prevention of hypertension.

Apolipoprotein L1 gene variants associate with prevalent kidney but not prevalent cardiovascular disease in the Systolic Blood Pressure Intervention Trial

The burden of Cardiovascular Disease (CVD) in Sub-Saharan Africa is rising amidst a high prevalence of infectious diseases including HIV. While use of certain Antiretroviral Therapy (ART) drugs has been shown to cause dyslipidaemia, little is known about the burden of CVD in the presence of Protease Inhibitors (PIs) in Sub-Saharan Africa. We investigated the incidence and risks associated with the use of PI-containing ART in the development of CVD among HIV seropositive adults at the University Teaching Hospital, Zambia. For this purpose a retrospective cohort study was used to review records of patients on PIs and non PIs between January 2008 and January 2016. The end point of the study was CVD (n=281). Generalized linear models using a log-binomial link were used to assess covariates, while Kaplan Meier method for probability of survival to CVD and time to CVD comorbidity were utilised. The results showed that the incidence of CVD among PIs was 62%, while among the non-PI ART group it was 38%. The risk of CVD was 2.3 times higher (p<0.001; 95% CI: 1.86-2.81) in the PIs ART group than non-PI ART group. Risk factors included; Age, CD4 cell count, Type of ART, Years since HIV diagnosis and BMI, with the CVD attributable risk of 56%. The Kaplan-Meier survival estimates for CVD showed a marked difference in survivorship between the two ART groups (Log-rank P=0.003). Based on this therefore, prolonged use of PI-containing ART was significantly associated with a higher incidence of CVD. Addressing the modifiable risk factors could significantly contribute towards reduction of CVD in the HIV population. This study underscores the importance of new screening strategies to be effectively incorporated in ART program. However, many opportunities exist for developing interventions for optimal screening, treatment and prevention of CVD in patients on ART.

Introduction: Type 2 diabetes (T2D) is a chronic metabolic disorder marked by insulin resistance and poses significant health risks, including cardiovascular diseases, vision impairment, nerve damage, and kidney failure. The disease is linked to a reduced life expectancy and increased risks for complications like dementia and cancer, highlighting the urgent need for effective management strategies tailored to urban and rural populations. Aim of the study: This study aimed to identify the management strategies and outcomes of T2D in urban and rural populations of Bangladesh. Methods: This cross-sectional study was conducted in the Department of Anaesthesia Analgesia and Intensive Care Medicine, National Institute of Cardiovascular Disease and Hospital (NICVD). Dhaka, Bangladesh during the period from July 2023 to Jun 2024. A total of 200 participants were included in the study, with 100 patients from urban areas and 100 from rural areas. The study encompassed both male and female participants, who underwent treatment in both indoor (hospital-based) and outdoor (outpatient) settings. Result: A total of 200 participants were included in the study, with 100 patients from urban areas and 100 from rural regions. Among urban respondents, 35% were aged 20-30, while the rural group had a higher representation in this age group at 45%. The study revealed that individuals with higher education levels in rural areas had a lower prevalence of T2D, while overweight participants had a higher incidence in both urban and rural settings. In rural regions, the risk of T2D was notably higher among those who consumed caffeinated drinks and were less physically active, while these factors did not significantly influence T2D risk in urban populations. Additionally, urban participants exhibited a correlation between T2D and hypertension. Conclusion: Our study presents a comprehensive strategy to tackle the rising prevalence of T2D in urban and rural areas. Key elements include promoting...

Understanding the changing profiles of cardiovascular disease (CVD) and modifiable risk factors is essential for CVD prevention and control. We aimed to report the comprehensive trends in CVD and risk factors in China from 1990 to 2019. Data on the incidence, death, and disability-adjusted life years (DALYs) of total CVD and its 11 subtypes for China were obtained from the Global Burden of Disease Study 2019. The CVD burden attributable to 12 risk factors was also retrieved. A secondary analysis was conducted to summarize the leading causes of CVD burden and attributable risk factors. From 1990 to 2019, the number of CVD incidence, death, and DALYs considerably increased by 132.8%, 89.1%, and 52.6%, respectively. Stroke, ischemic heart disease, and hypertensive heart disease accounted for over 95.0% of CVD deaths in 2019 and remained the top three causes during the past 30 years. Between 1990 and 2019, the age-standardized rate of stroke decreased significantly (percentage of decreased incidence: -9.3%; death: -39.8%; DALYs: -41.6%), while the rate of ischemic heart disease increased (percentage of increased incidence: 11.5%; death: 17.6%; DALYs: 2.2%). High systolic blood pressure, unhealthy diet, tobacco, and air pollution continued to be the major contributors to CVD deaths and DALYs (attributing to over 70% of the CVD burden), and the high body mass index (BMI)-associated CVD burden had the largest increase between 1990 and 2019. The significant increases in the number of CVD incident cases, deaths, and DALYs suggest that the CVD burden is still a concern. Intensified strategies and policies are needed to maintain promising progress in stroke and to reduce the escalating burden of ischemic heart disease. The CVD burden attributable to risk factors has not yet made adequate achievements; even worse, high BMI has contributed to the increasing CVD burden.

Global, Regional, and National Burden of Cardiovascular Diseases and Risk Factors in 204 Countries and Territories, 1990-2023.

Objective: To evaluate the incidence and case fatality rate of cardiovascular disease (CVD) among populations in urban and rural communities in eastern, central and western regions of China. Methods: The present study was based on the data of the Prospective Urban and Rural Epidemiology (PURE)-China cohort, which enrolled participants who had at least one follow-up visit and complete information on age and sex. Information on baseline demographics, cardiovascular risk factors, and prevention and treatment for CVD were collected. CVD and mortality events were documented using the standardized case report form of the PURE Global Study to assess the incidence and case fatality rate of CVD among populations in urban and rural communities in eastern, central and western China. Results: This study included a total of 47 262 community-dwelling participants (age: (51.1±9.6) years; female, n=27 529, 58.2%) from 115 urban and rural communities in 12 provinces across the eastern, central, and western regions of China. Over a follow-up period of 11.9 (9.5, 12.6) years, 2 686 deaths and 5 873 cardiovascular events were documented. The incidence of CVD was 11.90 (95%CI: 11.60-12.21)/1 000 person-years. A significant difference in CVD incidence was observed across regions (Ptrend<0.001), which was highest in the western provinces (13.99 (95%CI: 13.33-14.65)/1 000 person-years), intermediate in the eastern provinces (11.92 (95%CI: 11.52-12.33)/1 000 person-years), and lowest in the central provinces (8.87 (95%CI: 8.25-9.50)/1 000 person-years). The 1-year case fatality rate of CVD demonstrated an increasing trend from eastern to western regions (eastern: 10.20% (95%CI: 6.95-14.73); central: 13.50% (95%CI: 9.90-18.14); western: 18.62% (95%CI: 14.95-22.94); Ptrend<0.001). Moreover, the incidence of major CVD was consistently higher in rural areas compared with urban areas across eastern (P<0.001), central (P=0.01) and western (P<0.001)_regions, respectively. The 1-year case fatality rate in rural areas was also significantly higher compared with that in urban areas in both eastern (P<0.001) and western regions (P=0.02). Conclusions: The incidence and case fatality rate of CVD were high among middle-aged population in China, especially those in western regions with low socioeconomic levels and in rural areas.

In patients with diabetes, a high priority must be given to modification of the major risk factors for cardiovascular disease (CVD). There is growing evidence that control of these risk factors will reduce the likelihood of developing CVD and its complications in patients with diabetes.1 In clinical management of patients with diabetes, attention must be given to the following risk factors: smoking, hypertension, prothrombotic state, low-density lipoprotein (LDL) cholesterol and diabetic dyslipidemia, hyperglycemia, overweight/obesity, physical inactivity, and adverse nutrition. Specific considerations of Writing Group IV will be reviewed. They will be discussed in light of current recommendations for management of risk factors in diabetes as presented by the American Diabetes Association (ADA), the American Heart Association (AHA), and the national education programs sponsored by the National Heart, Lung, and Blood Institute (NHLBI).2–11⇓⇓⇓⇓⇓⇓⇓⇓⇓ These recommendations are summarized in the Table. View this table: Table 1107395. Goals for Risk Factor Management in Patients With Diabetes In addition to being a cause of many forms of cancer and chronic lung disease, cigarette smoking is a major cardiovascular risk factor. When a smoking patient also has diabetes, this patient is doubly at risk for CVD. Thus, every effort must be made to convince patients with diabetes who smoke to give up the smoking habit. This need is strongly reinforced by a position statement from the ADA.10 Elevated blood pressure is a major independent risk factor for multiple cardiovascular end points: coronary heart disease (CHD), stroke, chronic renal failure, and heart failure.11 Patients with diabetes have an increased prevalence of hypertension.12 Multiple factors undoubtedly contribute to hypertension in patients with diabetes, eg, obesity, insulin resistance, hyperinsulinemia, and renal disease. Systolic hypertension appears to be the main blood pressure–related risk factor in patients with diabetes.13 …

Implications of Elevated Serum Alanine Aminotransferase Levels: Think Outside the Liver

The incidence of cardiovascular diseases (CVD) together with their associated risk factors increasingly impact public health. According to the data provided in the 2024 Annual Report on Cardiovascular Health and Diseases in China, the crude incidence of cardiovascular and cerebrovascular diseases among Chinese residents aged ≥18 years, including acute myocardial infarction (AMI), angina pectoris treated by percutaneous transluminal coronary angioplasty/stent implantation and/or coronary artery bypass grafting, stroke, and sudden cardiac death was 620.33 per 100,000 population, with 87.6 for AMI. Stroke had an incidence of 491.0 per 100,000 population. The prevalence of adult coronary heart disease (CHD, aged ≥18 years) was 758 per 100,000 population. The CVD mortality in 2021 remained the highest, exceeding that of cancer and other causes. The crude mortality rate of CVD in 2021 was 364.16 per 100,000 population in rural areas and 305.39 per 100,000 population in urban areas. The crude mortality rates of cerebrovascular diseases and CHD among urban and rural residents in 2021 were 140.02 and 175.58, 135.08 and 148.19 per 100,000 population, respectively. In addition to interpreting the key findings of CVD incidence and mortality in China, we also update the data of associated risk factors, including tobacco use, physical activity, diet and nutrition, overweight and obesity, hypertension, dyslipidemia, diabetes, chronic kidney disease, sleep and psychological factors, environmental factors, and the diagnostic conditions of CVD diseases, aiming to provide a scientific foundation for advancing CVD prevention and control, and to inform relevant public health policy development.

The Impact of APOL1 on Chronic Kidney Disease and Hypertension.

APOL1 renal risk variants are strongly associated with chronic kidney disease in Black adults, but reported associations with cardiovascular disease (CVD) have been conflicting. We examined associations of APOL1 with incident coronary heart disease (n=323), ischemic stroke (n=331), and the composite CVD outcome (n=500) in 10 605 Black participants of the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Primary analyses compared individuals with APOL1 high-risk genotypes to APOL1 low-risk genotypes in Cox proportional hazards models adjusted for CVD risk factors and African ancestry. APOL1 high-risk participants were younger and more likely to have albuminuria at baseline than APOL1 low-risk participants. The risk of incident stroke, coronary heart disease, or composite CVD end point did not significantly differ by APOL1 genotype status in multivariable models. The association of APOL1 genotype with incident composite CVD differed by diabetes mellitus status (Pinteraction=0.004). In those without diabetes mellitus, APOL1 high-risk genotypes associated with greater risk of incident composite CVD (hazard ratio, 1.67; 95% confidence interval, 1.12-2.47) compared with those with APOL1 low-risk genotypes in multivariable adjusted models. This latter association was driven by ischemic strokes (hazard ratio, 2.32; 95% confidence interval, 1.33-4.07), in particular, those related to small vessel disease (hazard ratio, 5.10; 95% confidence interval, 1.55-16.56). There was no statistically significant association of APOL1 genotypes with incident CVD in subjects with diabetes mellitus. The APOL1 high-risk genotype was associated with higher stroke risk in individuals without but not those with chronic kidney disease in fully adjusted models. APOL1 high-risk status is associated with CVD events in community-dwelling Black adults without diabetes mellitus.

Although the inverse association between socioeconomic status (SES) and cardiovascular disease (CVD) is well established, research on the effect of changes in the SES throughout life on CVD risk in populations with different social backgrounds remains scarce. This study aimed to assess the relationship between childhood SES, adulthood SES, and changes in SES over time, and CVD incidence and mortality in a Polish urban population. In addition, the predictive performance of the SES index was compared with education alone. A cohort study with a 10-year follow-up was conducted, in which a random sample of 10,728 residents in Kraków aged 45–69 years were examined. The SES was assessed at baseline using data on education, parents’ education, housing standard at the age of 10 years, professional activity, household amenities, and difficulties in paying bills and buying food. SES categories (low, middle, and high) were extracted using cluster analyses. Information on new CVD cases was obtained from questionnaires in subsequent phases of the study and confirmed by reviewing clinical records. Data on deaths and causes were obtained from the residents’ registry, Central Statistical Office, and the participants’ families. The effect of the SES index on the risk of CVD was assessed using Cox proportional hazard models. In male and female participants, the CVD incidence and mortality were observed to be 27,703 and 32,956 person-years (384 and 175 new CVD cases) and 36,219 and 40,048 person-years (159 and 92 CVD deaths), respectively. Childhood SES was not associated with CVD incidence and mortality. A protective effect of high adulthood SES against CVD mortality was observed in men and women (HR = 0.59, 95% CI = 0.31–0.97; HR = 0.33, 95% CI = 0.14–0.75, respectively). In women, downward social mobility was related to 2.24 and 3.75 times higher CVD incidence and mortality, respectively. In men, a protective effect against mortality was observed in upward mobility (HR = 0.50, 95% CI = 0.29–0.84). Model discrimination was similar for the SES index and education alone for the association with CVD incidence. In women, the SES index was a slightly better predictor of CVD mortality than education alone (C-index = 0.759, SE = 0.0282 vs. C-index = 0.783, SE = 0.0272; p = 0.041). In conclusion, high adulthood SES, but not childhood SES, may be considered to be a protective factor against CVD in urban populations in high-CVD-risk regions. No effects of critical periods in early life were observed on CVD risk. In later life, social mobility was found to affect CVD mortality in both men and women. In men, a protective effect of upward mobility was confirmed, whereas in women, an increased CVD risk was related to downward mobility. It can be concluded that CVD prevention may be beneficial if socioeconomic potentials are strengthened in later life.

The rise in prevalence of cardiovascular diseases (CVD) has been associated with urbanization as a result of the environment, lifestyle, and socioeconomic factors. As the urban population grows, it is essential to understand the link between urbanization and CVD for people's health. The proposed study is intended to discuss how urban lifestyle affects cardiovascular health, including risk factors associated with urbanization and comparisons of CVD incidence rates between urban and rural settings. Cross-sectional research was done on urban and rural participants. The data were collected through surveys to evaluate lifestyle factors, cardiovascular health, and environmental factors (air and noise pollution). Descriptive statistics, chi-square tests, t-tests, and regression models were used to analyze the data, determine risk factors, and compare CVD rates. In wildlife, urbanization similarly impacts cardiovascular health, with altered habitats and environmental stressors exacerbating health issues in species. Urban environments, characterized by increased pollution and habitat fragmentation, pose significant threats to wildlife, including cardiovascular strain. Behavioral changes in response to urbanization, such as altered foraging patterns and higher stress levels, contribute to increased cardiovascular risk in wildlife populations. Understanding the intersection of urbanization and wildlife health is crucial for developing conservation strategies that address these emerging threats. The researchers found a higher prevalence of CVD in urban regions (25%) than in rural regions (15%). Among the significant risk factors in urban populations were sedentary behavior, unhealthy diets, constant stress, and pollution. Rural populations, on the contrary, were more likely to smoke and have poor access to healthcare. Urbanization is a significant cause of the increased prevalence of CVD. To alleviate the risk of cardiovascular diseases among urban populations, effective interventions in the field of public health, including the promotion of physical activity, better nutrition, and the elimination of pollution, are necessary.

Evidence on lead and the burden of cardiovascular disease (CVD) derived from National Health and Nutrition Examination Survey (NHANES) data, a general sample of the U.S. population, lacks sufficient representation of American Indians. Moreover, there is limited prospective evidence on lead and incident CVD outcomes. We evaluated if blood lead levels were associated with CVD mortality and incidence in American Indian adults from the Strong Heart Study (SHS). Whole blood samples collected in 1998-1999 among 1,818 participants was analyzed for lead using inductively coupled plasma mass spectrometry. CVD incidence and mortality were available through 2019. We used progressively adjusted multivariable Cox proportional hazards models to estimate the risk of composite CVD and coronary heart disease (CHD) mortality and incidence by baseline blood lead levels. The median (p20, p80) blood lead was 22.5 (14.2, 37.3) µg/L, similar to that of a representative sample of US adults in NHANES 1999-2000. During follow-up, 578 (31.8%) participants had a composite CVD event and 454 (25.0%) participants had a CHD event. After adjustment for demographic, lifestyle, and cardiovascular risk factors, the hazard ratio (95% CI) per change across the 80th to 20th quantiles in blood lead was 1.15 (1.02-1.30) and 1.22 (1.08- 1.37) for CVD and CHD mortality, respectively, and 1.13 (1.02-1.24) and 1.12 (0.99-1.25) for CVD and CHD incidence, respectively. In flexible dose-response models, the associations appeared to be non-linear, with a clear increased risk of CVD and CHD mortality at blood lead concentrations above 35 µg/L. Blood lead levels in American Indian adults, which are comparable to populations in the U.S. and globally, were associated with increased risk of CVD and CHD incidence and mortality. These findings highlight the importance of further reducing lead exposure, including American Indian communities. https://doi.org/10.1289/EHP16309.