Burden Of Cardiovascular Disease Research Articles

Patient-Centric Outcomes: A Longitudinal Study on the Impact of Multifaceted Interventions in Diabetes and Cardiovascular Health

This longitudinal study investigates the effectiveness of multifaceted interventions in improving patient outcomes in diabetes and cardiovascular health. With an increasing prevalence of these conditions worldwide, there is a pressing need for holistic approaches that address multiple facets of patient care. Our study follows a cohort of individuals diagnosed with diabetes and cardiovascular diseases over five years, examining the impact of comprehensive interventions on various patient-centric outcomes. These interventions encompassed a combination of lifestyle modifications, medication adherence programs, dietary counseling, physical activity promotion, and psychological support. Through rigorous data collection and analysis, we assessed changes in key clinical indicators such as HbA1c levels, lipid profiles, blood pressure, and body mass index, alongside patient-reported outcomes including quality of life, self-efficacy, and satisfaction with care. Additionally, we explored healthcare utilization patterns and economic implications associated with the interventions. Our findings reveal significant improvements in both clinical and patient-reported outcomes among participants engaged in multifaceted interventions compared to those receiving standard care. The interventions demonstrated sustained benefits over the follow-up period, suggesting their long-term efficacy in managing chronic conditions and enhancing overall well-being. Furthermore, our study highlights the importance of personalized, patient-centered approaches in chronic disease management, emphasizing the need for integrated care models that prioritize individual needs and preferences. These insights have profound implications for healthcare policymakers, providers, and stakeholders seeking to optimize outcomes and reduce the burden of diabetes and cardiovascular diseases on patients and healthcare systems.

Understanding the Role of Oxidative Stress in Platelet Alterations and Thrombosis Risk among Frail Older Adults.

Frailty and cardiovascular diseases are increasingly prevalent in aging populations, sharing common pathological mechanisms, such as oxidative stress. The evidence shows that these factors predispose frail individuals to cardiovascular diseases but also increase the risk of thrombosis. Considering this background, this review aims to explore advances regarding the relationship between oxidative stress, platelet alterations, and cardiovascular diseases in frailty, examining the role of reactive oxygen species overproduction in platelet activation and thrombosis. The current evidence shows a bidirectional relationship between frailty and cardiovascular diseases, emphasizing how frailty not only predisposes individuals to cardiovascular diseases but also accelerates disease progression through oxidative damage and increased platelet function. Thus, oxidative stress is the central axis in the increase in platelet activation and secretion and the inadequate response to acetylsalicylic acid observed in frail people by mitochondrial mechanisms. Also, key biomarkers of oxidative stress, such as isoprostanes and derivate reactive oxygen metabolites, can be optimal predictors of cardiovascular risk and potential targets for therapeutic intervention. The potential of antioxidant therapies in mitigating oxidative stress and improving cardiovascular clinical outcomes such as platelet function is promising in frailty, although further research is necessary to establish the efficacy of these therapies. Understanding these mechanisms could prove essential in improving the health and quality of life of an aging population faced with the dual burden of frailty and cardiovascular diseases.

Contribution of laboratory medicine and emerging technologies to cardiovascular risk reduction via exposome analysis: an opinion of the IFCC Division on Emerging Technologies.

This opinion article highlights the critical role of laboratory medicine and emerging technologies in cardiovascular risk reduction through exposome analysis. The exposome encompasses all external and internal exposures an individual faces throughout their life, influencing the onset and progression of cardiovascular diseases(CVD). Integrating exposome data with genetic informationallows for a comprehensive understanding of the multifactorial causes of CVD, facilitating targeted preventive interventions. Laboratory medicine, enhanced by advanced technologies such as metabolomics and artificial intelligence (AI), plays a pivotal role in identifying and mitigating these exposures. Metabolomics provides detailed insights into metabolic changes triggered by environmental factors, while AI efficiently processes complex datasets to uncover patterns and associations. This integration fosters a proactive approach in public health andpersonalized medicine, enabling earlier detection and intervention. The article calls for global implementation of exposome technologies to improve population health, emphasizing the need for robust technological platforms and policy-driven initiatives to seamlessly integrate environmental data with clinical diagnostics. By harnessing these innovative technologies, laboratory medicine can significantly contribute to reducing the global burden of cardiovascular diseases through precise and personalized risk mitigation strategies.

O27 DEVELOPMENT OF A CONCEPTUAL EVALUATION MODEL AND TESTING ITS PERFORMANCE IN HYPOTHETICAL PAY-FOR-PERFORMANCE INTERVENTIONS TO IMPROVE HYPERTENSION CONTROL

Background and Objective: Hypertension is a growing concern, particularly in low- and middle-income countries. Financial incentives, such as pay-for-performance, have shown promise in improving non-hypertension outcomes. However, their efficacy and cost-effectiveness in hypertension management, especially in low-resource contexts, remain uncertain. Our objectives were to 1) document studies exploring health financial interventions for hypertension management 2) develop a conceptual model which can facilitate future research on health financing approaches for hypertension management, and 3) assess the model's performance in hypothetical pay-for-performance interventions. Methods: Our literature review identified few studies evaluating finance interventions on hypertension management with somewhat more evidence for pay-for-performance strategies. Thus, we developed a conceptual model and assessed its performance in hypothetical scenarios of pay-for-performance schemes to enhance public hypertension care in Bangladesh. Using a state-transition modeling framework, we estimated the incentive costs and impact on cardiovascular disease burden in 18 scenarios with varying intervention coverage, blood pressure effects, and incentive rates (Figure 1). Key model inputs were derived from the 2019 Global Burden of Disease Study, the 2018 WHO STEPS survey, and WHO-CHOICE. Our primary outcome was incentive costs per health-adjusted life year (HALY) gained. Results: Based on our model, the incentive costs per HALY gained depended on the intervention coverage, intervention effect and incentive rate (Figure). If only currently treated patients were included, the most optimistic scenario (i.e., the largest blood pressure reduction with the lowest incentive rate) was estimated to cost 11,043 USD in incentives per HALY gained (Figure). If the intervention also included new, previously untreated patients while maintaining the same total incentives, the estimated incentive costs per HALY gained was 5,515 USD. Conclusions: Our model suggests that pay-for-performance interventions for hypertension care may demand substantial financial resources, but that the intervention could become more favorable with increased treatment coverage. While more studies on the impact of financial interventions in hypertension care are necessary, our model can guide planning and designing such a study.

Low-Density Lipoprotein Cholesterol, Cardiovascular Risk Factors, and Predicted Risk in Young Adults.

Young adults with elevated LDL-C may experience increased burden of additional cardiovascular disease (CVD) risk factors. It is unclear how much LDL-C levels, a modifiable factor, correlate with non-LDL-C CVD risk factors among young adults or how strongly these CVD risk factors are associated with long-term predicted CVD risk. We quantified clustering of non-LDL-C CVD risk factors by LDL-C among young adults to assess the association between non-LDL-C and LDL-C risk factors with predicted CVD risk in young adults. The current analysis is a cross-sectional study of adults < 40 years with an LDL-C< 190 mg/dL participating in the National Health and Nutrition Examination Survey (NHANES) between January 2015 and March 2020. We measured the prevalence of non-LDL-C risk factors by LDL-C and association between LDL-C and non-LDL-C risk factors with predicted risk of CVD by the Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations. Among 2108 young adults, the prevalence of LDL-C ≥ 130 mg/dL was 15.5%. Compared with young adults with LDL-C < 100 mg/dL, those with LDL-C 100-< 130, 130-< 160, and 160-< 190 mg/dL had greater non-LDL-C risk factors. Both LDL-C and non-LDL-C risk factors were independently associated with a 30-year risk of CVD (OR 1.05, 95% CI 1.03-1.07 and OR 1.17, 95% CI 1.12-1.23, respectively). The association of LDL-C and 30-year risk did not vary by non-LDL-C risk factor burden (pinteraction = 0.43). Non-LDL-C risk factors cluster among increasing levels of LDL-C in young adults. Greater guidance on how to manage cardiovascular risk factors in young adults is needed.

The Impact of Clinical Pharmacists on Cardiovascular Disease Management in Spain: A Community Pharmacy-Based Intervention Study

Background: Cardiovascular Disease (CVD) is a significant global health concern, causing 17.3 million deaths annually. In Spain, CVD accounts for 14.6% of mortality, necessitating effective management strategies. Clinical Pharmacists (CPs) have emerged as crucial players in early CVD identification and management, particularly through community pharmacies. Methods: This study enrolled 900 individuals across 55 pharmacies, with 820 meeting inclusion criteria based on existing CVD risk factors. Participants were randomly assigned to either a control group receiving standard treatment (n = 353) or an intervention group receiving enhanced guidance from CPs (n = 375). Outcomes measured included changes in CVD risk factors, blood pressure, lipid profiles, and smoking cessation over a three-month period. Results: The intervention group exhibited a statistically significant reduction in projected CVD risk, with a mean decrease of 6.42% (p &lt; 0.001). Improvements were noted in LDL cholesterol, blood pressure, and body mass index in both groups, underscoring the effectiveness of CP-led interventions. No adverse events were reported. Conclusion: CPs play a vital role in managing CVD risk factors through education, counseling, and medication management. This study highlights the effectiveness of CP interventions in community pharmacy settings, emphasizing the need for further research to evaluate long-term clinical and humanistic outcomes. Expanding the role of CPs in the healthcare system could significantly alleviate the burden of CVD in Spain.

Unlocking the Potential: Amylin-Based Therapies as Novel Interventions for Addressing the Nexus of Obesity and Cardiovascular Health

The rising prevalence of obesity and cardiovascular diseases demands innovative therapeutic strategies. This paper explores the potential of amylin-based therapies in addressing the intricate interplay between obesity and cardiovascular health. Amylin, a hormone co-secreted with insulin, regulates glucose metabolism, appetite, and gastric emptying. Despite its established role in diabetes management, recent research highlights its promise in addressing obesity. Pramlintide, a synthetic amylin analog, emerges as a promising intervention for obesity, overcoming limitations of current treatments. Cardiovascular diseases, closely linked to obesity, prompt exploration of amylin's potential cardiovascular benefits. The study examines vasodilatory effects, anti-inflammatory properties, and anti-atherosclerotic effects associated with amylin. Amylin-based therapies, including pramlintide and the investigational drug AM833 (cagrilintide), are scrutinized for their impact on blood pressure, lipid profiles, and cardiovascular markers. Beyond weight loss, the study explores changes in body composition, insulin sensitivity, and lipid metabolism. The safety profile of amylin analogs, particularly pramlintide, is discussed, emphasizing their generally well-tolerated nature with manageable gastrointestinal side effects. In conclusion, amylin-based therapies present a novel approach to address the complex connections between obesity and cardiovascular diseases. The study highlights their potential in modifying body composition, improving metabolic parameters, and influencing cardiovascular outcomes. As research progresses, amylin-based strategies may offer innovative approaches to enhance metabolic and cardiovascular health, potentially reducing the global burden of cardiovascular diseases.

LIpid Response to Statins ± Ezetimibe In Mumbai (LIRIM): A Cross-sectional Observational Study.

India has the highest burden of cardiovascular disease (CVD) among developing nations. Data from international studies show significant underimplementation of recommended aggressive lipid-lowering strategies for achieving low-density lipoprotein cholesterol (LDL-C) goals, especially after percutaneous coronary intervention (PCI), a pattern also observed in India. Moreover, ethnic variation in response to statin therapy has prompted clinicians to adopt lower doses of statin therapy in Asians to achieve comparable LDL-C lowering. To document the dose of statin ± ezetimibe required to achieve the European Society of Cardiology (ESC) goals of LDL-C <55 mg/dL in Indian patients with established atherosclerotic cardiovascular disease (ASCVD). This retrospective single-center, cross-sectional, observational, all-comers study in Mumbai evaluated the dose of atorvastatin (A)/rosuvastatin (R) ± ezetimibe (E) treatment at which patients with established ASCVD (n = 542), irrespective of their baseline level, achieved LDL-C goals (<55 mg/dL). Those with LDL-C levels >55 mg/dL on current therapy were switched to R 40 mg ± E 10 mg daily. The final data set (n = 340) included those who achieved LDL-C goals at the initial visit and those at follow-up. The primary and secondary outcomes assessed the impact of R 40 mg ± E 10 mg (R40 ± E10) on LDL-C (<55 mg/dL) and non-high-density lipoprotein cholesterol [non-HDL-C (<85 mg/dL)] goal achievement, respectively. At the end of follow-up, LDL-C <55 mg/dL was observed in 42.16% of patients (n = 113) with R40 and in another 43.28% (n = 116) with R40 + E10. A few patients (n = 39; 14.6%) achieved this goal with other dosages. Similarly, non-HDL-C <85 mg/dL was observed in 39.3% of patients (n = 107) with R40 and in another 47.4% of patients (n = 129) with R40 + E10. Overall, around 20% of patients were unable to achieve their LDL-C and non-HDL-C goals despite being on high-intensity statin ± E therapy. In the first report of its kind in India, this study showed that suboptimal LDL-C goal achievement occurred in around 20% of high-risk ASCVD patients on dual therapy. This indicates that clinicians should consider the addition of other therapies [e.g., bempedoic acid, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, and inclisiran] to mitigate the residual risk. Several more trials are needed to determine the most suitable treatment regimen for this population.

Association of Life’s Essential 8 With Incident Cardiovascular Disease Among Individuals With Depression: A Prospective Study

BackgroundDepression is an increasing illness worldwide that severely diminishes the quality of life. In this study we sought to elucidate the association of the American Heart Association’s Life’s Essential 8 (LE8) metrics with the incidence of cardiovascular disease (CVD) among depression participants and further quantify the related theoretical reduction of long-term CVD burden. MethodsWe included 20,832 participants with depression from the UK Biobank. LE8, including diet quality, physical activity, nicotine exposure, sleep duration, body mass index, lipids, glucose, and blood pressure, was calculated at baseline and categorized into low, medium, and high levels. Hazard ratios (HRs) and 95% confidence interval (CI) for major cardiovascular events (MACE) were calculated using Cox models. We further quantified the population-attributable fraction (PAF) for CVD. ResultsDuring a median follow-up of 12.0 years, 658 MACE were recorded. After multi-variable adjustment, compared with participants with low LE8, people with high LE8 had a decreased risk of MACE (HR, 0.32; 95% CI, 0.22-0.47), non-fatal MACE (HR, 0.39, 0.26-0.61), myocardial infarction (HR, 0.23, 0.12-0.44), and ischemic stroke (HR, 0.52, 0.27-0.99). Overall 50.7% (95% CI, 34.5%-66.9%) of MACE and 48.0% (95% CI, 29.5%-66.4%) of nonfatal MACE were attributable to the low and medium adherence to LE8 at the 5-year follow-up, respectively. Suboptimal control of blood pressure ranked as the top contributor to all types of CVD in individuals with depression. ConclusionsOptimal adherence to LE8 was associated with lower burden of CVD in those with depression. Adopting a comprehensive lifestyle intervention might help further reduce CVD burden in those with mental disorders.

Global burden of ADHD medication-associated cardiovascular disease, 1967–2023: A comparative analysis using the WHO pharmacovigilance database

BackgroundDespite the widespread use of attention-deficit hyperactivity disorder (ADHD) medications and their known sympathomimetic effects on the cardiovascular system, cardiovascular risk assessment of these medications using comprehensive global data is limited. This study investigated the association between individual ADHD medications and cardiovascular disease (CVD) using global pharmacovigilance data. MethodsReports from the World Health Organization international pharmacovigilance database were utilized (1967–2023; total reports, n=131,255,418). Reporting odds ratios (ROR), and information components (IC) were calculated to evaluate the association between each medication and specific CVDs. ResultsWe identified 13,344 CVD cases related to ADHD medications out of 146,489 cases of all reports on ADHD medications. Cumulative reports on ADHD medications have shown a steady increase, notably in adults since 2010. ADHD medications were associated with a higher risk of CVD overall (ROR [95 % CI], 1.60 [1.58–1.63]; IC [IC0.25], 0.63 [0.60]), with a higher association observed in females than in males. Among specific CVDs, all drugs were associated with an increased risk of torsade de pointes/QT prolongation, cardiomyopathy, and myocardial infarction. Conversely, heart failure, stroke, and cardiac death/shock were exclusively associated with amphetamines. Lisdexamfetamine showed a weaker association with all CVDs compared to amphetamines, and methylphenidate exhibited the lowest overall association with CVD. Atomoxetine had the second-highest association with torsade de pointes/QT prolongation. ConclusionsThe associations between CVDs and ADHD medications vary, with amphetamines posing a higher risk, while lisdexamfetamine and methylphenidate exhibit better safety profiles.

Gestational diabetes mellitus and development of intergenerational overall and subtypes of cardiovascular diseases: a systematic review and meta-analysis

ObjectiveWe aimed to summarize the association between gestational diabetes mellitus (GDM) and its intergenerational cardiovascular diseases (CVDs) impacts in both mothers and offspring post-delivery in existing literature.MethodsPubMed, Embase, Web of Science, and Scopus were utilized for searching publications between January 1980 and June 2024, with data extraction and meta-analysis continuing until 31 July 2024. Based on a predefined PROSPERO protocol, studies published as full-length, English-language journal articles that reported the presence of GDM during pregnancy and its association with any CVD development post-delivery were selected. All studies were evaluated using the Newcastle-Ottawa Scale. Maximally adjusted risk estimates were pooled using random-effects meta-analysis to assess the risk ratio (RR) of GDM, and overall and subtypes of CVDs in both mothers and offspring post-delivery.ResultsThe meta-analysis was based on 38 studies with a total of 77,678,684 participants. The results showed a 46% increased risk (RR 1.46, 95% CI 1.34–1.59) for mothers and a 23% increased risk (1.23, 1.05–1.45) for offspring of developing overall CVDs after delivery, following a GDM-complicated pregnancy. Our subgroup analysis revealed that mothers with a history of GDM faced various risks (20% to 2-fold) of developing different subtypes of CVDs, including cerebrovascular disease, coronary artery disease, heart failure, and venous thromboembolism.ConclusionsThese findings underscore the heightened risk of developing various CVDs for mothers and offspring affected by GDM, emphasizing the importance of preventive measures even right after birth to mitigate the burden of CVDs in these populations.

European Society of Cardiology: the 2023 Atlas of Cardiovascular Disease Statistics.

This report from the European Society of Cardiology (ESC) Atlas Project updates and expands upon the 2021 report in presenting cardiovascular disease (CVD) statistics for the ESC member countries. This paper examines inequalities in cardiovascular healthcare and outcomes in ESC member countries utilizing mortality and risk factor data from the World Health Organization and the Global Burden of Disease study with additional economic data from the World Bank. Cardiovascular healthcare data were collected by questionnaire circulated to the national cardiac societies of ESC member countries. Statistics pertaining to 2022, or latest available year, are presented. New material in this report includes contemporary estimates of the economic burden of CVD and mortality statistics for a range of CVD phenotypes. CVD accounts for 11% of the EU's total healthcare expenditure. It remains the most common cause of death in ESC member countries with over 3 million deaths per year. Proportionately more deaths from CVD occur in middle-income compared with high-income countries in both females (53% vs. 34%) and males (46% vs. 30%). Between 1990 and 2021, median age-standardized mortality rates (ASMRs) for CVD decreased by median >50% in high-income ESC member countries but in middle-income countries the median decrease was <12%. These inequalities between middle- and high-income ESC member countries likely reflect heterogeneous exposures to a range of environmental, socioeconomic, and clinical risk factors. The 2023 survey suggests that treatment factors may also contribute with middle-income countries reporting lower rates per million of percutaneous coronary intervention (1355 vs. 2330), transcatheter aortic valve implantation (4.0 vs. 153.4) and pacemaker implantation (147.0 vs. 831.9) compared with high-income countries. The ESC Atlas 2023 report shows continuing inequalities in the epidemiology and management of CVD between middle-income and high-income ESC member countries. These inequalities are exemplified by the changes in CVD ASMRs during the last 30 years. In the high-income ESC member countries, ASMRs have been in steep decline during this period but in the middle-income countries declines have been very small. There is now an important need for targeted action to reduce the burden of CVD, particularly in those countries where the burden is greatest.

Diabetes, frailty and burden of comorbidities among older Malaysians with stroke

Abstract Background Stroke is a global health challenge. The increasing prevalence of diabetes and the ageing population further add to the complexities of stroke care. Objective This study aims to (1) describe the prevalence of diabetes in older patients with stroke and (2) compare the burden of comorbidities among patients with diabetes and frailty compared to those without these conditions. Methods This was a cross-sectional study in older patients aged ≥ 65 years with stroke. Comorbidities were assessed using the Charlson Comorbidity Index (CCI). Frailty assessments were done using the Clinical Frailty Scale. Participants were classified into four groups: Group 1, frail and diabetic; Group 2, non-frail and diabetic; Group 3, frail and non-diabetic; and Group 4, non-frail and non-diabetic. Results There were 384 participants (mean age 81.11 ± 6.37). Diabetes was present in 45.1%. The mean CCI was highest for the frail and diabetic group (6.97 ± 1.97), followed by non-frail and diabetic (6.00 ± 2.02), frail and non-diabetic (5.49 ± 1.79) and non-frail and non-diabetic (4.74 ± 1.68), p &lt; 0.001. The non-frail and diabetic group had a significantly higher prevalence of hypertension (96.9%) and ischaemic heart disease (34.4%) compared to the other three groups. Conclusions There was a high prevalence of diabetes among older patients with stroke. While the frail and diabetic group had the highest overall burden of comorbidities, the non-frail and diabetic group had the most significant cardiovascular disease burden. These findings highlight the urgent need for integrated and personalized management approaches to enhance the overall well-being and quality of life for older stroke survivors with diabetes.

A review of climate change and cardiovascular diseases in the Indian policy context.

There is growing evidence that climate change adversely affects human health. Multiple diseases are sensitive to climate change, including cardiovascular diseases (CVDs), which are also the leading cause of death globally. Countries such as India face a compounded challenge, with a growing burden of CVDs and a high vulnerability to climate change, requiring a co-ordinated, multi-sectoral response. In this framework synthesis, we analysed whether and how CVDs are addressed with respect to climate change in the Indian policy space. We identified 10 relevant national-level policies, which were analysed using the framework method. Our analytical framework consisted of four themes: (i) political commitment; (ii) health information systems; (iii) capacity building; and (iv) cross-sectoral actions. Additionally, we analysed a subset of these policies and 29 state-level climate change and health action plans using content analysis to identify health priorities. Our analyses revealed a political commitment in addressing the health impacts of climate change; however, CVDs were poorly contextualized with most of the efforts focusing on vector-borne and other communicable diseases, despite their recognized burden. Heat-related illnesses and cardiopulmonary diseases were also focused on but failed to encompass the most climate-sensitive aspects. CVDs are insufficiently addressed in the existing surveillance systems, despite being mentioned in several policies and interventions, including emergency preparedness in hospitals and cross-sectoral actions. CVDs are mentioned as a separate section in only a small number of state-level plans, several of which need an impetus to complete and include CVD-specific sections. We also found several climate-health policies for specific diseases, albeit not for CVDs. This study identified important gaps in India's disease-specific climate change response and might aid policy makers in strengthening future versions of these policies and boost research and context-specific interventions on climate change and CVDs.

The mediating role of depression in the association between socioeconomic status and cardiovascular disease: A nationwide cross-sectional study from NHANES 2005–2018

Disparities in socioeconomic status (SES) are associated with an increased risk of cardiovascular disease (CVD). Depression is a highly prevalent cardiovascular risk factor among individuals with low SES. The present study aimed to gain a better understanding of the association between SES and CVD by examining the mediating effects of depression. 30,127 participants, 50.77 % female, with a mean age of 47.37 years from the National Health and Nutrition Examination Survey (NHANES) 2005–2018, were included. Weighted multivariable logistic regression analyses estimated the association between SES and CVD. Mediation analyses tested the mediating effects of depression. The multivariable-adjusted odds ratio (OR) of high SES for CVD was 0.42 (95 % confidence interval (CI): 0.36, 0.50; P < 0.001). In parallel, depression was negatively associated with SES, in which the multivariable-adjusted β was −1.42 (95 % CI: −1.62, −1.22; P < 0.001) in high SES compared to low SES. For the association between depression and CVD, the multivariable-adjusted OR per 1-point increase of PHQ-9 score for CVD was 1.08 (95 % CI: 1.07, 1.09; P < 0.001). The mediation models indicated that depression mediated 10.92 % of the total association between SES and CVD when fully adjusted. Identifying individuals with depression for appropriate treatment is promising for reducing the CVD burden among populations with low SES.

Anti-ageing interventions for the treatment of cardiovascular disease.

As the global demographic landscape continues to shift towards an aged population, so does the medical and socioeconomic burden of cardiovascular diseases. Indeed, ageing is one of, if not the, key risk factor for the development of cardiovascular diseases. However, there are currently no approved cardiovascular therapeutics that primarily target the molecular and cellular mechanisms underlying the ageing process itself. In this review, we present the potential of emerging anti-ageing strategies, including epigenetic rejuvenation, metabolic reprogramming, autophagy activation, as well as senolytic and anti-inflammatory therapies, in delaying or reversing the development of age-related cardiovascular disorders, while considering potential sex differences. In doing so, we implicate cellular ageing processes in the pathogenesis of several prevalent cardiovascular diseases, such as atherosclerosis, hypertension, various types of cardiomyopathies (including its hypertrophic, ischemic, dilated, diabetic, and arrhythmogenic forms) and heart failure, particularly that with preserved ejection fraction. Finally, we outline future challenges and steps needed for the implementation of these novel anti-ageing strategies in the clinical setting, with the aim of challenging the long-held notion of ageing as a 'nonmodifiable' risk factor for cardiovascular diseases.

Awareness and knowledge of cardiovascular disease and their associations with the lifestyles of 8-16-year-old girls: a perspective from Saudi Arabia

BackgroundThere has been an increased focus on children as a target for primordial prevention of cardiovascular disease (CVD). In particular, girls should receive attention to combat the burden of CVD in women, because women have higher CVD mortality and morbidity rates than men do. As health literacy is paramount, the evaluation of awareness, and knowledge of CVD and its risk factors and their associations with the lifestyles of girls forms the basis for planning cardiovascular health promotion programs aiming to improve girls’ immediate health and reduce the future burden of CVD among women.MethodsA prospective cross-sectional study was conducted on a random sample of girls attending elementary and intermediate schools in Riyadh, Saudi Arabia. The girls completed a newly validated 24-item questionnaire that assessed their demographic data, lifestyles, and awareness and knowledge of CVD and its risk factors. Anthropometric and blood pressure measurements were obtained. Knowledge scores were calculated on the basis of correct responses and compared between subgroups via analysis of variance to determine associated factors.ResultsIn total, 469 girls (mean age of 12.5 years) were included. Approximately 41.4% of them did not exercise or only exercised once a week. The dietary intake of important food groups was below or just at the minimal recommended servings for most. Overall, 44.1% were overweight/obese, and almost half were identified as hypertensive on the basis of a single resting measurement. Awareness of CVD as a dangerous disease in adults was 50.3%, whereas, cancer was identified by 61% of participants. Individual risk factors were identified by ≈ 25%, and 16.6% were not aware of any risk factors. The overall knowledge score of the participants was 2.6 (± 1.6) out of a total possible score of 8 representing 32.5% (± 20%). Knowledge levels were positively influenced by increasing school grade (P = 0.001) and family history of CVD (P < 0.001). There was no significant favorable association between improved knowledge level and lifestyle factors.ConclusionThe awareness and knowledge of CVD among girls aged 8–16 years are poor and are largely dissociated from their lifestyle. Improved knowledge scores with increasing school grade and family history of CVD confirm a role for schools and families in improving girls’ knowledge. Our findings mirror those obtained in older women, showing that misinformation among women starts in childhood and should be targeted early in life.

Dose-Response Relationship Between Physical Activity and the Morbidity and Mortality of Cardiovascular Disease Among Individuals With Diabetes: Meta-Analysis of Prospective Cohort Studies.

Diabetes, a chronic condition affecting various organs, is frequently associated with abnormal lipid metabolism, notably increased cholesterol and triglyceride levels. These lipid abnormalities are closely linked to the development and advancement of cardiovascular disease (CVD). Although regular physical activity (PA) has consistently shown benefits in reducing CVD risk in the general population, its precise influence on CVD risk among patients with diabetes remains uncertain, particularly regarding dose-response relationships. This study aimed to summarize the evidence from prospective studies on the association between PA and CVD morbidity and mortality in individuals with diabetes and explore the optimal levels for public health recommendation. We systematically reviewed prospective cohort studies in PubMed, Embase, and Web of Science up to December 2022, with inclusion criteria specifying the studies published in English and included adult participants diagnosed with diabetes. A random effects model was used to pool the relative risk (RR) with the corresponding 95% CI comparing the highest with the lowest PA categories in each study for qualitative evaluation. In addition, linear and spline regression analyses were used to estimate dose-response associations. The meta-analysis included 12 prospective cohort studies, involving a total of 109,820 participants with diabetes. The combined results revealed that higher levels of PA were associated with a reduced risk of CVD. The RR of CVD for the highest compared with the lowest PA category was 0.62 (95% CI 0.51-0.73). In addition, there were 4 studies describing leisure-time PA, and the pooled RR was 0.68 (95% CI 0.52-0.83) for the highest versus the lowest activity. The linear regression model revealed that each 10 MET (metabolic equivalent of task)-hours per week of incrementally higher PA was associated with a 19% (95% CI 11.6-25.7) and a 6.9% (95% CI 4.5-9.3) reduction in CVD morbidity and mortality. Additionally, spline regression curves showed nonlinear relationships between PA levels and the risk of CVD and CVD mortality (both Pnonlinearity<.001), with a limited reduction in CVD risk and some further reduction in CVD mortality above 20 MET-hours per week of PA levels. For patients with diabetes, especially type 2 diabetes, there was a dose-response relationship between increased PA and reduced risk of CVD morbidity and mortality. The observed PA threshold is consistent with the recommended level for the general population. Gradually moving from inactivity to a guideline-recommended PA level could therefore significantly reduce the burden of CVD in patients with diabetes.

The Prevalence of Different Genotypic Forms of Familial Hypercholesterolemia in Relation to Race and Ethnicity

In the present study, a systematic literature review was conducted to examine the prevalence of homo- and heterozygous forms of Familial hypercholesterolemia among different racial and ethnic groups. Familial hypercholesterolemia (FH) is an inherited disorder characterised by elevated blood levels of cholesterol and low-density lipoprotein (LDL), which increases the risk of cardiovascular disease. Databases PubMed, Web of Science, and Elsiever were searched and only peer-reviewed articles with a large number of contributors and sufficient prevalence and ethnicity data were included. Diagnosis of FH was based on genetic testing or clinical criteria. The results of the study indicate inadequate and untimely diagnosis of FH, resulting in inadequate treatment. To date, only 9% of countries have statistical data on the prevalence of FH in the general population. In order to develop effective prevention strategies for cardiovascular diseases associated with FH, further research is needed to obtain accurate epidemiological data, including the race and ethnicity of patients. This will allow optimisation of strategies to reduce the burden of preventable cardiovascular disease associated with FH.&lt;br /&gt; &amp;nbsp;

Management of dyslipidaemia in patients with comorbidities: facing the challenge.

Dyslipidaemia is a common chronic kidney disease (CKD) and contributes to excessively elevated cardiovascular mortality. The pathophysiology is complex and modified by comorbidities like the presence/absence of proteinuria, diabetes mellitus or drug treatment. This paper provides an overview of currently available treatment options. We focused on individuals with CKD and excluded those on renal replacement therapy (haemodialysis, peritoneal dialysis, or kidney transplantation). The use of statins is safe and recommended in most patients, but guidelines vary with respect to low-density lipoprotein (LDL) cholesterol goals. While no dedicated primary or secondary prevention studies are available for pro-protein convertase subtilisin/kexin type 9 inhibitors, secondary analyses of large outcome trials reveal no effect modification on endpoints by the presence of CKD. Similar data have been shown for bempedoic acid, but no definite conclusion can be drawn with respect to efficacy and safety. No outcome trials are available for inclisiran while the cholesterol lowering effects seem to be unaffected by CKD. Finally, the value of fibrates and icosapent ethyl in CKD is unclear. Lipid abnormalities contribute to the massive cardiovascular disease burden in CKD. Lowering of LDL cholesterol with statins (and most likely PCSK9 inhibitors) reduces the event rate and thus statin therapy should be initiated in almost all individuals. Other interventions (bempedoic acid, inclisiran, fibrates, or icosapent ethyl) currently need a case-by-case decision before prescription.