Burden Of Cardiovascular Disease Research Articles

The global burden of cardiovascular disease attributable to diet low in fiber among people aged 60 years and older, 1990–2019: an age–period–cohort analysis of the global burden of disease study

ObjectivesThis study aimed to quantify the global cardiovascular disease (CVD) burden attributable to diet low in fiber among adults aged 60 years and older using data from the Global Burden of Disease (GBD) Study 2019.MethodsWe extracted data on CVD mortality, disability-adjusted life-years (DALYs), and risk-factor exposures from the GBD 2019 study for people aged 60 and older. Age-period-cohort models were used to estimate the overall annual percentage change in mortality and DALY rate (net drift, % per year), mortality and DALY rate for each age group from 1990 to 2019 (local drift, % per year), longitudinal age-specific rate corrected for period bias (age effect), and mortality and Daly rate for each age group from 1990 to 2019 (local drift, % per year). And period/cohort relative risk (period/cohort effect).ResultsFrom 1990 to 2019, global age-standardized cardiovascular disease (CVD) mortality rates attributable to low dietary fiber intake decreased by 2.37% per year, while disability-adjusted life years (DALYs) fell by 2.48% annually. Decreases were observed across all sociodemographic index regions, with fastest declines in high and high-middle SDI areas. CVD mortality and DALY rates attributable to low fiber increased exponentially with age, peaking at 85–89 years, and were higher in men than women. Regarding period effects, mortality and DALY rates declined since 2000, reaching nadirs in 2015–2019. For birth cohort patterns, risks attributable to low fiber intake peaked among early 1900s births and subsequently fell, with more pronounced reductions over time in women.ConclusionsLow dietary fiber intake is a leading contributor to the global cardiovascular disease burden, accounting for substantial mortality and disability specifically among older adults over recent decades.

Unraveling the complex interplay between abnormal hemorheology and shape asymmetry in flow through stenotic arteries

Background and Objective:Stenosis or narrowing of arteries due to the buildup of plaque is a common occurrence in atherosclerosis and coronary artery disease (CAD), limiting blood flow to the heart and posing substantial cardiovascular risk. While the role of geometric irregularities in arterial stenosis is well-documented, the complex interplay between the abnormal hemorheology and asymmetric shape in flow characteristics remains unexplored. Methods:This study investigates the influence of varying hematocrit (Hct) levels, often caused by conditions such as diabetes and anemia, on flow patterns in an idealized eccentric stenotic artery using computational fluid dynamics simulations. We consider three physiological levels of Hct, 25%, 45%, and 65%, representing anemia, healthy, and diabetic conditions, respectively. The numerical simulations are performed for different combinations of shape eccentricity and blood rheological parameters, and hemodynamic indicators such as wall shear stress (WSS), oscillatory shear index (OSI), are relative residence time (RRT) are calculated to assess the arterial health. Results:Our results reveal the significant influence of Hct level on stenosis progression. CAD patients with anemia are exposed to lower WSS and higher OSI, which may increase the propensity for plaque progression and rupture. However, for CAD patients with high Hct level—as is often the case in diabetes—the WSS at the minimal lumen area increases rapidly, which may also lead to plaque rupture and cause adverse events such as heart attacks. These disturbances promote endothelial dysfunction, inflammation, and thrombus formation, thereby intensifying cardiovascular risk. Conclusions:Our findings underscore the significance of incorporating hemorheological parameters, such as Hct, into computational models for accurate assessment of flow dynamics. We envision that insights gained from this study will inform the development of tailored treatment strategies and interventions in CAD patients with common comorbidities such as diabetes and anemia, thus mitigating the adverse effects of abnormal hemorheology and reducing the ever-growing burden of cardiovascular diseases.

The Adverse Impact of Bisphenol A Exposure on Optimal Cardiovascular Health as Measured by Life's Essential 8 in U.S. Adults: Evidence from NHANES 2005 to 2016.

Background/Objectives: Cardiovascular diseases are the primary cause of global morbidity and mortality, with cardiovascular health (CVH) remaining well below the ideal level and showing minimal improvement in the U.S. population over recent years. Bisphenol A (BPA), a pervasive environmental contaminant, has emerged as a potential contributor to adverse cardiovascular outcomes. This cross-sectional study delves into the impact of BPA exposure on achieving optimal CVH, as assessed by the Life's Essential 8 metric, among U.S. adults. Methods: Analyzing data from 6635 participants in the National Health and Nutrition Examination Survey (NHANES) collected between 2005 and 2016, BPA exposure was quantified through urinary BPA levels, while optimal CVH was defined using the American Heart Association's Life's Essential 8 criteria, scoring between 80 and 100. Multivariable logistic regression and propensity score matching were employed to evaluate the association between BPA exposure and CVH. Results: This study reveals that individuals in the highest tertile of urinary BPA levels were 27% less likely to attain optimal CVH compared with those in the lowest tertile (OR, 0.73; 95% CI: 0.59-0.92). This negative association persisted across diverse demographics, including age, sex, and race, mirrored in the link between urinary BPA levels and health factor scores. Conclusions: The findings underscore the potential benefits of reducing BPA exposure in enhancing the prevalence of optimal CVH and mitigating the burden of cardiovascular disease. Given the widespread use of BPA, ongoing monitoring of BPA's impact on CVH is essential. Further studies are necessary to elucidate the long-term and causative connections between BPA and CVH. These insights contribute to understanding the complex interplay between environmental factors and CVH outcomes, informing targeted interventions to mitigate cardiovascular disease risk within the population.

Multidisciplinary team approach for CKD-associated osteoporosis.

Chronic kidney disease mineral and bone disorder (CKD-MBD) contributes substantially to the burden of cardiovascular disease and fractures in patients with CKD. An increasing arsenal of diagnostic tools, including bone turnover markers and bone imaging, is available to support clinicians in the management of CKD-associated osteoporosis. Although not mandatory, a bone biopsy remains useful in the diagnostic workup of complex cases. In this special report, the European Renal Osteodystrophy (EUROD) initiative introduces the concept of a kidney-bone multidisciplinary team (MDT) for the diagnosis and clinical management of challenging cases of CKD-associated osteoporosis. In 2021, the EUROD initiative launched virtual clinical-pathological case-conferences to discuss challenging cases of patients with CKD-associated osteoporosis, in whom a bone biopsy was useful in the diagnostic workup. Out of these, we selected 4 representative cases and asked a kidney-bone MDT consisting of a nephrologist, an endocrinologist and a rheumatologist to provide comments on the diagnostic and therapeutic choices. These cases covered a broad spectrum of CKD-associated osteoporosis, including bone fracture in CKDG5D, post-transplant bone disease, disturbed bone mineralization, severely suppressed bone turnover, and severe hyperparathyroidism. Comments from the MDT were, in most cases, complementary to each other and additive to the presented approach in the cases. The MDT approach may thus set the stage for improved diagnostics and tailored therapies in the field of CKD-associated osteoporosis. We demonstrate the clinical utility of a kidney-bone MDT for the management of patients with CKD-MBD and recommend their establishment at local, national, and international levels.

Association of environmental and behavioural factors with cardiovascular disease mortality.

Recognizing the rising concern of environmental impacts on health, the study aims to explore how specific environmental factors such as air pollution, humidity, and temperature variations contribute to the prevalence of cardiovascular disease (CVD) mortality, emphasizing the role of air quality, climate variables, and lifestyle factors in the disease mortality specifically. Analysis of province-level data on CVD mortality in Turkey from 2010 to 2019, assessing the correlations with environmental and lifestyle factors like particulate matter, sulfur dioxide, meteorological variables, and smoking and alcohol consumption. The study employs the SAS TRAJ procedure and Ordinal Logistic Regression for statistical analysis. The multiplicity correction was done through Benjamini-Hoechberg false discovery rate (FDR) approach. As expected, both smoking and alcohol consumption were found to be significantly associated with CVD mortality (odds ratio (OR): 1.10, 95% CI: 1.08, 1.11, P-value<0.0001). While median Air Pressure and Humidity were among the most significant markers with OR of 1.10 indicating an increasing CVD mortality, their variability metrics such as coefficient of variation (CV) showed significant protective effects with OR of 0.37 and 0.89, respectively. Temperature and its variability seemed to be protective overall. Our research highlights the significant influence of environmental factors on cardiovascular health, especially air pressure and humidity, beyond the known factors such as smoking and alcohol consumption. These findings suggest the need for comprehensive public health strategies that address both environmental and lifestyle risk factors to effectively reduce the burden of cardiovascular diseases.

Relative Validity and Reproducibility of a Dietary Screening Tool in Nigerian Health Care

BackgroundHypertension and cardiovascular disease burden are rising rapidly in Nigeria. This trend is partly attributed to a transition from healthy to unhealthy dietary patterns. However, health care professionals lack a dietary screening tool to assess patient dietary intake and offer personalized dietary advice. ObjectivesWe aimed to develop and validate a food frequency questionnaire (FFQ) that can quickly and accurately assess regional dietary intake for use by health care professionals in a hospital setting in Port Harcourt, Nigeria. MethodsWe recruited 58 patients from a single hospital in Nigeria. The FFQ was administered at baseline and again after 3 wk. To evaluate the validity of the FFQ, we used 3 repeated and nonconsecutive 24-h dietary recalls (24DR) as a reference method. Spearman rank correlations, Wilcoxon signed-rank tests, cross-classification, intraclass correlation coefficients (ICCs), and Bland–Altman analysis were performed in R software version 4.3.1 to assess the relative validity and reproducibility. ResultsThe mean correlation coefficient (rs) between the FFQ and 24DR was 0.60 (P < 0.05), and ranged from 0.20 to 0.78. The Wilcoxon signed-rank tests indicated no significant differences in the 19 food groups queried (P > 0.05), except for fats and oils (P < 0.05). The exact agreement for classifying individuals into quartiles ranged from 17% for salt to 88% for processed meats and alcoholic drinks, with 90% of individuals classified into the same or neighboring quartile. Additionally, the Bland–Altman analysis demonstrated acceptable agreement, with >96% of observations within the acceptable limits of agreement for all food groups. For reproducibility, the ICC ranged from 0.31 for stew to 0.98 for fruit, with an mean ICC of 0.77 between the FFQs delivered 2 wk apart. ConclusionsOur results support the use of the FFQ as a valid and reliable tool for ranking intakes of certain food groups among patients in a hospital setting in Nigeria.The trial was registered at clinicaltrials.gov as NCT05973760.

Improving Hypertension Outcomes: Assessing Caregivers’ Knowledge, Attitude and Practices in Rural Malawi

Introduction: Hypertension is a major global health issue, significantly contributing to the burden of cardiovascular diseases, particularly in low- and middle-income countries (LMICs) like Malawi. Caregivers play a crucial role in managing hypertension in these settings, yet their knowledge, attitudes, and practices (KAP) are not well-documented. Objectives: This study aimed to assess the knowledge, attitudes, and practices (KAP) of caregivers for hypertensive patients in rural Malawi, as well as to identify any disparities in these areas. Methods: A descriptive cross-sectional study was conducted from November 2023 to February 2024 at Lisungwi Community Hospital and Neno District Hospital in Neno, Malawi. A total of 422 caregivers were conveniently sampled, with 248 from Lisungwi and 174 from Neno. Data were collected using a validated pre-tested questionnaire, assessing KAP on hypertension. Descriptive, one-way ANOVA and linear regression statistical analyses were performed using SPSS version 22.0. Results: In both Lisungwi and Neno hospitals, the majority of participants were female, accounting for 63.7% and 62.6%, respectively. The mean age of participants was 44.7 years (± 10.3) in Lisungwi and 45.3 years (± 9.3) in Neno, with average care durations of 4.1 years (± 3.3) and 4.2 years (± 3.2). Notably, 94.4% of caregivers at Lisungwi and 94.3% at Neno exhibited poor knowledge of hypertension; however, all caregivers maintained a positive attitude toward its prevention and management. Significant differences in practice scores were observed (p &lt; 0.001), with caregivers in Lisungwi performing better. Additionally, factors such as education, age, and occupation influenced Knowledge, Attitude, and Practices (KAP) scores, while gender impacted practices alone. Conclusions: The findings of poor knowledge highlight the urgent need for enhanced educational interventions, gender-specific support, community engagement, and a context-specific approach to improve the knowledge and practices of caregivers, which are critical for effective hypertension prevention and management in rural setting.

The incidence, mortality and disease burden of cardiovascular diseases in China: a comparative study with the United States and Japan based on the GBD 2019 time trend analysis.

Cardiovascular diseases (CVDs) are not only the primary cause of mortality in China but also represent a significant financial burden. The World Health Organization highlight that as China undergoes rapid socioeconomic development, its disease spectrum is gradually shifting towards that of developed countries, with increasing prevalence of lifestyle-related diseases such as ischemic heart disease and stroke. We reviewed the rates and trends of CVDs incidence, mortality and disability-adjusted life years (DALYs) burden in China and compared them with those in the United States (US) and Japan for formulating CVDs control policies. Data on CVDs incidence, death and DALYs in China, the US and Japan were obtained from the GBD 2019 database. The Joinpoint regression model was used to analyze the trends in CVDs incidence and mortality in China, the US and Japan, calculate the annual percentage change and determine the best-fitting inflection points. In 2019, there were approximately 12,341,074 new diagnosed cases of CVDs in China, with 4,584,273 CVDs related deaths, causing 91,933,122 DALYs. The CVDs age-standardized incidence rate (ASIR) in China (538.10/100,000) was lower than that in the US and globally, while age-standardized death rate (ASDR) (276.9/100,000) and age-standardized DALY rate (6,463.47/100,000) were higher than those in the two regions. Compared with the US and Japan, from 1990 to 2019, the CVDs incidence rate in China showed an increasing trend, with a lower annual decrease in ASDR and a younger age structure of disease burden. Furthermore, the disease spectrum in China changed minimally, with stroke, ischemic heart disease, and hypertensive heart disease being the top three leading CVDs diseases in terms of incidence and disease burden, also being the major causes of CVDs in the US and Japan. The prevention and control of CVDs is a global issue. The aging population and increasing unhealthy lifestyles will continue to increase the burden in China. Therefore, relevant departments in China should reference the established practices for CVDs control in developed countries while considering the diversity of CVDs in different regions when adjusting national CVDs control programs.

Central Hemodynamics in African American Women: Examining the Role of Superwoman Schema Endorsement.

African American women bear a disproportionate burden of cardiovascular diseases, potentially due to altered central hemodynamics. Racism and sexism often lead to African American women taking on numerous caretaking roles and overall increases their use of the Strong Black Woman (ie, Superwoman) mindset, which may have negative health consequences. We hypothesized that endorsing the Superwoman role and its Obligation to Help Others dimension would be associated with a deleterious central hemodynamics profile in African American women. Using cross-sectional data, we examined central systolic blood pressure (mm Hg; n=408), augmentation index (percentage, adjusted for height and heart rate; n=408), and pulse wave velocity (m/s; n=368) in African American women aged 30 to 46 years. The Giscombe Superwoman Schema (SWS) questionnaire assessed endorsement of Overall SWS (range, 0-105) and SWS-Obligation to Help Others (range, 0-3). Multiple linear regression modeled associations between Overall SWS (10-unit increments) and SWS-Obligation to Help Others (1-unit increments) and central hemodynamics while adjusting for pertinent sociodemographic, clinical, and psychosocial factors. In fully adjusted models, central systolic blood pressure was significantly associated with Overall SWS (β=0.83 [95% CI, 0.19-1.47]) and SWS-Obligation to Help Others (β=2.03 [95% CI, 0.39-3.67]). Augmentation index was associated with Overall SWS (β=0.66 [95% CI, 0.02-1.30]) and SWS-Obligation to Help Others (β=2.21 [95% CI, 0.58-3.84]). Significant associations were not observed between pulse wave velocity and SWS. Greater endorsement of the Superwoman role and prioritizing caregiving over self-care were associated with higher central systolic blood pressure and augmentation index, which may contribute to adverse cardiovascular health among African American women.

Global burden of cardiovascular diseases: projections from 2025 to 2050.

The prediction of future trends in cardiovascular disease (CVD) mortality and their risk factors can assist policy-makers in healthcare planning. This study aims to project geospatial trends in CVDs and their underlying risk factors from 2025 to 2050. Using historical data on mortality and disability-adjusted life years (DALYs) from the Global Burden of Disease (GBD) 2019 study, encompassing the period of 1990 to 2019, Poisson regression was performed to model mortality and DALYs associated with CVD and its associated risk factors from 2025 to 2050. Subgroup analysis was based on GBD super-regions. Between 2025 and 2050, a 90.0% increase in cardiovascular prevalence, 73.4% increase in crude mortality, and 54.7% increase in crude DALYs are projected, with an expected 35.6 million cardiovascular deaths in 2050 (from 20.5 million in 2025). However, age-standardized cardiovascular prevalence will be relatively constant (-3.6%), with decreasing age-standardized mortality (-30.5%) and age-standardized DALYs (-29.6%). In 2050, ischaemic heart disease will remain the leading cause of cardiovascular deaths (20 million deaths) while high systolic blood pressure will be the main cardiovascular risk factor driving mortality (18.9 million deaths). Central Europe, Eastern Europe, and Central Asia super-region is set to incur the highest age-standardized cardiovascular mortality rate in 2050 (305 deaths per 100 000 population). In the coming decades, the relatively constant age-standardized prevalence of global CVD suggests that the net effect of summative preventative efforts will likely continue to be unchanged. The fall in age-standardized cardiovascular mortality reflects the improvement in medical care following diagnosis. However, future healthcare systems can expect a rapid rise in crude cardiovascular mortality, driven by the ageing global populace. The continued rise in CVD burden will largely be attributed to atherosclerotic diseases. Not applicable.

A mixed-methods, theory-driven assessment of the sustainability of a multi-sectoral preventive intervention for South Asian Americans at risk for cardiovascular disease

BackgroundSouth Asian Americans bear a high burden of atherosclerotic cardiovascular disease (ASCVD), but little is known about the sustainability of evidence-based interventions (EBI) to prevent ASCVD in this population. Using community-based participatory research, we previously developed and implemented the South Asian Healthy Lifestyle Intervention (SAHELI), a culturally-adapted EBI targeting diet, physical activity, and stress management. In this study, we use the Integrated Sustainability Framework to investigate multisectoral partners’ perceptions of organizational factors influencing SAHELI sustainability and strategies for ensuring sustainability.MethodsFrom 2022 to 2023, we conducted a mixed-methods study (quant- > QUAL) with 17 SAHELI partners in the Chicago area. Partners’ settings included: community organization, school district, public health department, and healthcare system. Descriptive statistics summarized quantitative results. Two coders used a hybrid thematic analysis approach to identify qualitative themes. Qualitative and quantitative data were integrated and analyzed using mixed methods.ResultsSurveys (score range 1–5: higher scores indicate facilitators; lower scores indicate barriers) indicated SAHELI sustainability facilitators to be its “responsiveness to community values and needs” (mean = 4.9). Barriers were “financial support” (mean = 3.5), “infrastructure/capacity to support sustainment” (mean = 4.2), and “implementation leadership” (mean = 4.3). Qualitative findings confirmed quantitative findings that SAHELI provided culturally-tailored cardiovascular health education responsive to the needs of the South Asian American community, increased attention to health issues, and transformed perceptions of research among community members. Qualitative findings expanded upon quantitative findings, showing that the organizational fit of SAHELI was a facilitator to sustainability while competing priorities were barriers for partners from the public health department and health system. Partners from the public health department and health system discussed challenges in offering culturally-tailored programming exclusively for one targeted population. Sustainability strategies envisioned by partners included: transitioning SAHELI to a program delivered by community members; integrating components of SAHELI into other programs; and expanding SAHELI to other populations. Modifications made to SAHELI (i.e., virtual instead of in-person delivery) had both positive and negative implications for sustainability.DiscussionThis study identifies common sustainability barriers and facilitators across different sectors, as well as those specific to certain settings. Aligning health equity interventions with community needs and values, organizational activities, and local context and resources is critical for sustainability. Challenges also arise from balancing the needs of specific populations against providing programming for broader audiences.

Hypertension in children and adolescents: perspectives in Japan.

Hypertension in children and adolescents is associated with increased risk of hypertension and cardiovascular disease (CVD) in adulthood. Therefore, preventing hypertension among children and adolescents is an important public health objective worldwide. Although the importance of hypertension in children and adolescents has increasingly been recognized, the field of research is relatively new and evidence for etiologies, prevention and treatment is sparse. This review mainly summarizes the content regarding hypertension in children and adolescents published in Hypertension Research in 2023/24. Highlights include the following: The prevalence of hypertension was higher in female than male Japanese junior high school students (13.7% vs. 4.7%), but there was no significant gender difference among Japanese senior high school students (7.4% vs. 5.4%). Hematological parameters, including red blood cell counts, hemoglobin counts, hematocrit and iron levels, were positively associated with blood pressure (BP) levels in healthy children and adolescents. Higher-risk longitudinal BP trajectories in early life were associated with increased risk of target organ damage (TOD) and higher combined TOD load in midlife. BP phenotypes (e.g., masked hypertension, white-coat hypertension) assessed using office and 24-h ambulatory BP monitoring were not highly reproducible in children. The salt check sheet was a useful tool for evaluating the approximate dietary salt intake in Japanese children and adolescents. It is recommended that healthcare providers screen for hypertension in children and adolescents and recognize the importance of early intervention for those with elevated BP levels. Beginning in childhood, continuous education on hypertension and proper dietary salt intake are key to reducing the risk of hypertension and decreasing the burden of CVD in adulthood.

Identifying the Role of Flow-Mediated Dilatation Assessment in Acute Coronary Syndromes: A Systematic Review.

In the context of the global burden of cardiovascular disease, the development of novel, patient-targeted diagnostic and therapeutic strategies is of paramount importance. Acute coronary syndromes (ACS) comprise a subset of cardiovascular disease, with constantly increasing prevalence requiring urgent attention. Flow-mediated dilatation (FMD), a noninvasive method for the evaluation of endothelial function, has been previously implemented in patients with ACS. A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in order to identify all relevant studies assessing the implementation of FMD among patients with ACS. Our review reflects an effort to present all available data regarding the role of FMD to date, a valuable noninvasive and easy accessible diagnostic tool, in the prognosis of patients with ACS. FMD evaluation in patients with ACS reveals a decline in values, indicative of the presence of endothelial function among this distinct patient group. FMD has also been used to assess the response to various treatments, as well as to predict major adverse cardiovascular events. Dynamic responses to interventions highlights its potential in the evolving field of interventional cardiology.

The Economic Burden of Atherosclerotic Cardiovascular Disease in Italy.

Atherosclerotic cardiovascular diseases remain the primary cause of mortality in Italy. Individuals with a history of acute coronary syndrome, peripheral arterial disease, and ischemic stroke/transient ischemic attack face an elevated risk of recurrent major adverse cardiovascular events, including mortality. The population aging, coupled with increasing risk factors such as diabetes mellitus and obesity, exacerbates the disease's economic impact. This study aims to comprehensively assess the economic burden of atherosclerotic cardiovascular diseases in Italy, specifically focusing on direct healthcare costs. We analyzed real-world data from administrative databases in the Marche region and Local Health Unit Umbria 2. The economic burden of patients discharged with acute coronary syndrome, peripheral arterial disease, and ischemic stroke/transient ischemic attack was evaluated, with a focus on direct costs associated with hospitalizations, drugs, and outpatient visits. Results were stratified by age, sex, comorbidities at baseline, and adherence to lipid-lowering therapy and antihypertensive agents. Annually, nearly 350,000 patients were hospitalized for peripheral arterial disease, acute coronary syndrome, or ischemic stroke/transient ischemic attack. Direct health costs averaged €7190 per patient over a 2-year follow-up, with hospitalizations accounting for nearly 70% of the total. Male patients incurred significantly higher costs (€7467) than female patients (€6625). Costs correlated positively with age and with the number of baseline comorbidities, with a range from €5259 (0-1 comorbidities) to €17,095 (4+ comorbidities). Costs were significantly lower in adherent subjects (€6813) compared with non-adherent subjects (€7757). This study provides valuable insights into the economic implications of atherosclerotic cardiovascular diseases in Italy, emphasizing the necessity of a comprehensive approach to preventive measures, optimal medication adherence, and lifestyle modifications to mitigate its impact.

Unraveling the Nexus Between Ambient Air Pollutants and Cardiovascular Morbidity: Mechanistic Insights and Therapeutic Horizons.

Air pollution poses a significant threat to cardiovascular health, contributing to the development and progression of various heart diseases. This review delves into the intricate relationship between ambient air pollutants and cardiovascular morbidity, elucidating the underlying mechanisms and exploring potential therapeutic approaches. We discuss the major types of air pollutants, including particulate matter (PM), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO), and their respective roles in exacerbating cardiovascular conditions. The review highlights the key mechanisms by which air pollutants adversely impact the cardiovascular system, including systemic inflammation, oxidative stress, endothelial dysfunction, autonomic nervous system imbalance, and dysregulation of blood coagulation and thrombosis. Vulnerable populations, including children, the elderly, and those with pre-existing health conditions, are disproportionately affected. Air quality regulations aim to mitigate these effects by reducing pollutant levels, with the overall goal of lowering cardiovascular morbidity and improving public health outcomes. Specifically, stringent regulations focus on curbing vehicular emissions and industrial pollutants and promoting cleaner energy sources. Recent data underscore the importance of addressing environmental and behavioral risk factorsto prevent the growing global burden of cardiovascular disease. This review synthesizes the mechanistic pathways through which pollutants contribute to cardiovascular damage and highlights the urgent need for early detection strategies and targeted therapies. Improving public health through stricter air quality control measures and raising awareness of the health risks associated with pollution is crucial for mitigating the long-term cardiovascular impacts of air pollution.

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.