Cardiovascular Disease Survivors Research Articles

Report on cardiovascular health and diseases in China 2021: an updated summary.

In 2019, cardiovascular disease (CVD) accounted for 46.74% and 44.26% of all deaths in rural and urban areas, respectively. Two out of every five deaths were attributed to CVD. It is estimated that approximately 330 million individuals in China are affected by CVD. Among them, there are 13 million cases of stroke, 11.4 million cases of coronary heart disease, 5 million cases of pulmonary heart disease, 8.9 million cases of heart failure, 4.9 million cases of atrial fibrillation, 2.5 million cases of rheumatic heart disease, 2 million cases of congenital heart disease, 45.3 million cases of lower extremity artery disease, and 245 million cases of hypertension. With the dual challenges of population aging and a steady increase in the prevalence of metabolic risk factors, the burden of CVD in China is expected to continue rising. Consequently, new demands arise for CVD prevention, treatment, and the allocation of medical resources. Emphasizing primary prevention to reduce disease prevalence, increasing the allocation of medical resources for CVD emergency and critical care, and providing rehabilitation services and secondary prevention to reduce the risk of recurrence, rehospitalization, and disability among CVD survivors are of paramount importance. Hypertension, dyslipidemia, and diabetes affect millions of individuals in China. Since blood pressure, blood lipids, and blood sugar levels often rise insidiously, vascular disease and serious events such as myocardial infarction and stroke occur by the time they are detected in this population. Therefore, it is crucial to implement strategies and measures to prevent risk factors such as hypertension, dyslipidemia, diabetes, obesity, and smoking. Furthermore, greater efforts should be directed towards assessing cardiovascular health status and conducting research on early pathological changes to enhance prevention, treatment, and understanding of CVD.

Activity-to-sedentary ratio provides novel insight into mortality reduction among male survivors of cardiovascular disease in the United States: national health and nutrition examination survey, 2007–2014

BackgroundLower physical activity and sedentary behavior have been identified as modifiable risk factors for cardiovascular disease (CVD). However, the quantitative, dose-response association between activity-to-sedentary ratio (ASR) and mortality is unknown.MethodsProspective cohort studies with participants 50 to 80 years that reported the association between recreational physical activity, sedentary behavior, and all-cause mortality were included from the 2007 to 2014 United States National Health and Nutrition Examination Survey (NHANES) and followed through December 31, 2015. Cox or Weibull regression models and restricted cubic splines were used to determine the association between ASR and all-cause mortality.ResultsSixty deaths occurred among 498 CVD survivors, with a median of 56 months of follow-up. After accounting for all covariates, CVD survivors with an ASR between 0.21 and 0.57 (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.25–0.87) and those with an ASR more than 0.57 (HR, 0.40; 95% CI, 0.20–0.81) were at significantly lower risk for mortality than participants with an ASR < 0.21. Moreover, a nonlinear negative association and an L-shaped association were observed for the level of ASR with risk of mortality among CVD survivors (P for nonlinearity = 0.004). What’s more, adjusting for covariates, a statistically significant interaction (P for interaction = 0.016) between sex and ASR, an increase of ASR more than and equal to 0.18 was associated with a lower risk of mortality among males (HR, 0.23; 95% CI, 0.12–0.46).ConclusionsAn negative correlation between ASR and mortality in CVD survivors, especially in males when ASR is more than 0.18. Our novel findings provide further insights into easing the global burden of deaths.

Report on Cardiovascular Health and Diseases in China 2021: An Updated Summary

In 2019, cardiovascular disease (CVD) accounted for 46.74% and 44.26% of all deaths in rural and urban areas, respectively. Two out of every five deaths were due to CVD. It is estimated that about 330 million patients suffer from CVD in China. The number of patients suffering from stroke, coronary heart disease, heart failure, pulmonary heart disease, atrial fibrillation, rheumatic heart disease, congenital heart disease, lower extremity artery disease and hypertension are 13.00 million, 11.39 million, 8.90 million, 5.00 million, 4.87 million, 2.50 million, 2.00 million, 45.30 million, and 245.00 million, respectively. Given that China is challenged by the dual pressures of population aging and steady rise in the prevalence of metabolic risk factors, the burden caused by CVD will continue to increase, which has set new requirements for CVD prevention and treatment and the allocation of medical resources in China. It is important to reduce the prevalence through primary prevention, increase the allocation of medical resources for CVD emergency and critical care, and provide rehabilitation services and secondary prevention to reduce the risk of recurrence, re-hospitalization and disability in CVD survivors. The number of people suffering from hypertension, dyslipidemia and diabetes in China has reached hundreds of millions. Since blood pressure, blood lipids, and blood glucose levels rise mostly insidiously, vascular disease or even serious events such as myocardial infarction and stroke often already occured at the time of detection in this population. Hence, more strategies and tasks should be taken to prevent risk factors such as hypertension, dyslipidemia, diabetes, obesity, and smoking, and more efforts should be made in the assessment of cardiovascular health status and the prevention, treatment, and research of early pathological changes.

Factors related to under‐treatment of secondary cardiovascular risk, including primary healthcare: Australian National Health Survey linked data analysis

ObjectiveTo inform national evidence gaps on cardiovascular disease (CVD) preventive medication use and factors relating to under‐treatment ‐ including primary healthcare engagement ‐ among CVD survivors in Australia. MethodsData from 884 participants with self‐reported CVD from the 2014–15 National Health Survey were linked to primary care and pharmaceutical dispensing data for 2016 through the Multi‐Agency Data Integration Project. Logistic regression quantified the relation of combined blood pressure‐ and lipid‐lowering medication use to participant characteristics. ResultsOverall, 94.8% had visited a general practitioner (GP) and 40.0% were on both blood pressure‐ and lipid‐lowering medications. Medication use was least likely in: women versus men (OR=0.49[95%CI:0.37‐0.65]), younger participants (e.g. 45–64y versus 65–85y: OR=0.58[0.42–0.79])and current versus never‐smokers (OR=0.73[0.44–1.20]). Treatment was more likely in those with ≥9 versus ≤4 conditions (OR=2.15[1.39–3.31]), with ≥11 versus 0–2 GP visits/year (OR=2.62[1.53–4.48]) and with individual CVD risk factors (e.g. high blood pressure OR=3.13 [2.34–4.19]) versus without); the latter even accounting for GP service‐use frequency. ConclusionsYounger people, smokers, those with infrequent GP visits or without CVD risk factors were the least likely to be on medication. Implications for public healthSubstantial under‐treatment, even among those using GP services, indicates opportunities to prevent further CVD events in primary care.

Effects of telehealth-assisted interventions for secondary prevention of cardiovascular disease: A systematic review and meta-analysis.

Telehealth-assisted interventions have been used as secondary prevention measures in cardiac rehabilitation, especially for the delivery of information between healthcare service providers and patients. However, as the application of this intervention modality broadens, investigation of its effects in secondary prevention of cardiovascular disease (CVD) is necessary. To identify the effectiveness of telehealth-assisted interventions for secondary prevention of CVD. Systematic review and meta-analysis. The PRISMA protocol was used to conduct a systematic review and meta-analysis of randomised controlled trials. The full text of articles was obtained from six databases for the period from database establishment to 25 November 2021. To assess the methodological quality of the studies reviewed, the updated Cochrane risk-of-bias checklist for randomised trials was employed. A meta-analysis was performed using a random-effects model to calculate the pooled effects of telehealth-assisted interventions for secondary CVD prevention. The final analysis included 4012 individuals from 18 different trials. Telehealth-assisted interventions were shown to improve medication adherence (standardised mean difference [SMD]: 0.31; 95% confidence interval [CI]: 0.33-0.59) and reduce depression (SMD: -0.28; 95% CI: -0.46 to -0.10). Telehealth-assisted interventions appear to improve adherence to medication and reduce depression of individuals with CVD. These intervention strategies could be offered to both healthcare providers and individuals with CVD as an option in delivering and facilitating the use of health services to improve health behaviours and overall outcomes. Furthermore, this study may be used as guidance for future research to provide an appropriate plan of care for this population. The findings imply that the delivery of care remotely via telehealth-assisted interventions for secondary prevention of CVD is beneficial in improving CVD survivors' health and access to healthcare services. The International Prospective Register of Systematic Review: (PROSPERO): CRD 42021290111.

Risk stratification for mortality in cardiovascular disease survivors: A survival conditional inference tree analysis

Background and aimsEfficient analysis strategies for complex network with cardiovascular disease (CVD) risk stratification remain lacking. We sought to identify an optimized model to study CVD prognosis using survival conditional inference tree (SCTREE), a machine-learning method. Methods and resultsWe identified 5379 new onset CVD from 2006 (baseline) to May, 2017 in the Kailuan I study including 101,510 participants (the training dataset). The second cohort composing 1,287 CVD survivors was used to validate the algorithm (the Kailuan II study, n = 57,511). All variables (e.g., age, sex, family history of CVD, metabolic risk factors, renal function indexes, heart rate, atrial fibrillation, and high sensitivity C-reactive protein) were measured at baseline and biennially during the follow-up period. Up to December 2017, we documented 1,104 deaths after CVD in the Kailuan I study and 170 deaths in the Kailuan II study. Older age, hyperglycemia and proteinuria were identified by the SCTREE as main predictors of post-CVD mortality. CVD survivors in the high risk group (presence of 2–3 of these top risk factors), had higher mortality risk in the training dataset (hazard ratio (HR): 5.41; 95% confidence Interval (CI): 4.49–6.52) and in the validation dataset (HR: 6.04; 95%CI: 3.59–10.2), than those in the lowest risk group (presence of 0–1 of these factors). ConclusionOlder age, hyperglycemia and proteinuria were the main predictors of post-CVD mortality. Trial registrationChiCTR-TNRC-11001489.

P3415Will less developed countries be capable of giving high-quality universal coverage to cardiovascular disease survivors? Results from a national health survey, Chile ENS 2016–2017

Abstract Background Chilean Health System has fully implemented Universal Health Coverage (UHC) for acute cardiovascular events since 2005. Age-adjusted cardiovascular mortality has decreased, but there is limited information about coverage and quality of chronic health care given to cardiovascular disease (CVD) survivors at the national level. Purpose To assess the prevalence and quality of care in Chilean adult CVD survivors. Methods Chilean National Health Survey 2016–2017 (ENS 2016–2017) is a random stratified multistage sample of non-institutionalized population over 14 years (n=6240). Age, education, gender, rural/urban and geographical area weighted prevalence of CVD survivors (self-reported medical diagnosis of myocardial infarction or cerebrovascular attack) were calculated. High quality of care was defined as meeting six criteria simultaneously: under 70mg% LDL- C level, statin use, aspirin use, blood pressure under 130/80 mmHg, HgA1C&lt;7 or 8 (&gt;74-year-old) and non-smoking. Quality of care was explored using multivariate linear and logistic regression adjusting by age, gender, education and year of diagnosis (before or after UHC). Results Weighted national prevalence of CVD survivors in over 20-year-old population was 6.1%. The sample size for the CVD survivor analyses was n=455. 28.7% of CVS had their first event before the year 2005 (n=141). Overall 27.9% had LDL-C under 70mg%, 37.8% used statins, 41.4% used aspirin, 37.8% had controlled blood pressure, 78.3% were non-smokers and 84.3% had good glycemic control. National “high quality of care” prevalence in CVD survivors was 0.3%, 0.4% and 0.1% for men and women respectively. LDL and Blood pressure control prevalence (meet both criteria simultaneously) was 4,4%. In the adjusted multivariate model age was associated to a higher number of quality criteria achievement. Conclusion The number of CVD survivors in Chile is a huge challenge for the health care system. Universal coverage does not guarantee the quality of chronic life long care. Specific surveillance in high-risk population is needed to assess the system's effectiveness and accountability. Acknowledgement/Funding ENS 2016-2017 was funded by the chilean Ministry of Health (MINSAL)

B Vitamin and/or n-3 Fatty Acid Supplementation and Health-Related Quality of Life: Ancillary Findings from the SU.FOL.OM3 Randomized Trial

BackgroundDespite growing attention to nutrition and quality of life in cardiovascular disease survivors, the impact of dietary factors according to disease type or to quality of life domain is poorly understood. We investigated the effects of B vitamin and/or n-3 fatty acid supplementation on health-related quality of life among survivors of stroke, myocardial infarction, or unstable angina.MethodsWe performed ancillary analyses of the SU.FOL.OM3 trial (2003–2009; France). In total, 2,501 men (mean age = 61 y) and women (mean age = 63 y) were randomized in a 2×2 factorial design to: 1) 0.56 mg 5-methyl-tetrahydrofolate, 3 mg vitamin B6, 0.02 mg vitamin B12; 2) 600 mg eicosapentaenoic and docosahexaenoic acids in a 2∶1 ratio; 3) B vitamins and n-3 fatty acids combined; or 4) placebo. Health-related quality of life was evaluated at follow-up with the Medical Outcomes Study 36-Item Short Form Health Survey. Data from 2,029 individuals were used in this analysis.ResultsAfter 3.1±0.4 y, no effects of supplementation with either B vitamins or n-3 fatty acids on quality of life (physical or mental health domains) were found. However, participants receiving B vitamins had slightly more activity limitations due to emotional problems compared with those not receiving B vitamins (mean difference = 3.8; 95% CI: 0.4, 7.1). A significant interaction of treatment by prior disease revealed an inverse association between n-3 fatty acids and vitality among myocardial infarction survivors (mean difference = 2.9; 95% CI: 0.5, 5.2).ConclusionsThere were no beneficial effects of supplementation with relatively low doses of B vitamins or n-3 fatty acids on health-related quality of life in cardiovascular disease survivors. The adverse effects of B vitamins on activity limitations and of n-3 fatty acids on vitality among individuals with prior myocardial infarction merit confirmation.

Gaps in Health-Related Quality of Life Among Survivors of Cancer and Cardiovascular Disease

Few studies performed so far have weighed the health-related quality of life (HRQoL) of cancer survivors against that of cardiovascular disease (CVD) survivors. This study was based on data obtained from the Third Korean National Health and Nutrition Examination Survey. Of adults with available EuroQoL (EQ) information, a total 23 370 individuals (658 CVD survivors, 389 cancer survivors, and 22 323 controls) remained in the final analysis. Cancer survivors have the lowest HRQoL scales among the 3 groups, independent of age. The HRQoL of young cancer survivors was as impaired as that of older cancer survivors, whereas the HRQoL of CVD survivors and controls decreased with increasing age. Cancer survivors also have more problems in all domains of EQ-5D, especially domains of pain/discomfort and anxiety/depression. The study suggests that cancer survivors should receive more intensive attention to develop means of identifying them and to improve their quality of life.

Supplementation with B vitamins or n−3 fatty acids and depressive symptoms in cardiovascular disease survivors: ancillary findings from the SUpplementation with FOLate, vitamins B-6 and B-12 and/or OMega-3 fatty acids (SU.FOL.OM3) randomized trial

Dietary factors might affect depressive symptoms. In secondary data analyses, we examined effects of supplementation with B vitamins or n-3 (omega-3) fatty acids on depressive symptoms in cardiovascular disease survivors. The SUpplementation with FOLate, vitamins B-6 and B-12 and/or OMega-3 fatty acids (SU.FOL.OM3) trial was a secondary prevention trial (2003-2009; n = 2501) in which individuals aged 45-80 y were randomly assigned, by using a 2 × 2 factorial design, to receive 0.56 mg 5-methyl-tetrahydrofolate and vitamins B-6 (3 mg) and B-12 (0.02 mg); EPA and DHA (600 mg) in a 2:1 ratio; B vitamins and n-3 fatty acids; or a placebo. Depressive symptoms were evaluated at years 3 and 5 with the 30-item Geriatric Depression Scale (GDS). Overall and sex-specific ORs and 95% CIs were estimated in 2000 participants by using factorial logistic regression. After a median of 4.7 y of supplementation, there was no association between allocation to receive B vitamins and depressive symptoms. However, the allocation to receive n-3 fatty acids was positively associated with depressive symptoms (GDS >10) in men (adjusted OR: 1.28; 95% CI: 1.03, 1.61) but not in women. We showed no beneficial effects of a long-term, low-dose supplementation with B vitamins or n-3 fatty acids on depressive symptoms in cardiovascular disease survivors. The adverse effects of n-3 fatty acids in men merit confirmation.

Physical Activity and Risk of Fatal or Non-Fatal Cardiovascular Disease Among CVD Survivors

Although many population-based studies have reported an association between physical activity and cardiovascular disease (CVD) among healthy populations, the association among CVD survivors has been less reported. We examined the relationship between physical activity and CVD risk among survivors. This was a prospective cohort study of 12,490 Japanese participants, including 754 individual CVD survivors. Between April 1992 and July 1995, a baseline survey was conducted in 12 communities in Japan. The mean follow-up period was 11.9 years, during which time 74 individuals had non-fatal CVD and 51 cases were fatal CVD. Among CVD survivors, analysis was performed after exclusion of participants with a history of cancer and those who died within the first 2 years of follow-up. Physical activity was analyzed in tertiles (low, moderate and heavy), and the hazard ratios (HRs) were calculated for non-fatal or fatal CVD among CVD survivors. After setting the low group as the reference, the HRs for non-fatal CVD in the moderate and heavy groups were 0.61 (95% confidence interval: 0.30-1.24) and 0.50 (0.20-1.25) (P for trend = 0.059), respectively, and the HRs for fatal CVD were 0.75 (0.33-1.69) and 0.18 (0.04-0.83) (P for trend = 0.026), respectively. Physical activity reduced the risk of CVD, both fatal and non-fatal events, among CVD survivors.

Psychological distress, use of rehabilitation services, and disability status among noninstitutionalized US adults aged 35 years and older, who have cardiovascular conditions, 2007

To investigate whether psychological distress is associated with disability status and use of rehabilitation services among adults aged 35 years and older with cardiovascular conditions. Using 2007 data from the Behavioral Risk Factor Surveillance System (BRFSS), we assessed the association between serious psychological distress (SPD) and the prevalence of disability and use of outpatient rehabilitation services among cardiovascular disease (CVD) survivors aged 35 years or older. Respondents' SPD status was ascertained by the Kessler 6 questionnaire; their CVD survivor status was based on self-reports of physician-diagnosed coronary heart disease (CHD) or stroke; and their disability status was based on self reports of activity limitation and use of special equipment. The prevalence of SPD was higher among respondents with a CVD history than those without. Among CVD survivors, those with SPD had worse disability status than those without SPD; the rate of having used any outpatient rehabilitation services following a heart attack or stroke was not significantly different by SPD status. Further studies are needed to confirm whether higher rate of disability among CVD survivors with SPD is attributable to conditions that can be corrected or improved by rehabilitation services; whether alleviating psychological distress among CVD survivors may lead to more frequent use of rehabilitation services and thus to a reduction in their rate of disability.

Depression and anxiety associated with cardiovascular disease among persons aged 45 years and older in 38 states of the United States, 2006

Objective To highlight the close association of cardiovascular disease (CVD) with depression and anxiety in US non-institutionalized adults and examine the sociodemographic correlates of depression and anxiety among CVD survivors. Method The data were obtained from 38 states which administered an Anxiety and Depression Module as part of the 2006 Behavioral Risk Factor Surveillance System. CVD was assessed with three questions on coronary heart disease and stroke. Adjusted prevalence ratios (APRs) were obtained after adjustment for demographic characteristics using SUDAAN 9.0. Results The prevalence of a CVD history was 15.3% among studied population (sample size n = 129,499). Persons with a CVD history were more likely than those without to experience current depression (15.8% versus 7.1%, APR [95% CI] = 1.69 [1.54–1.85]), to have a lifetime diagnosis of depressive disorders (22.3% versus 15.1%, APR [95% CI] = 1.56 [1.45–1.67]) or anxiety disorders (16.6% versus 10.0%, APR [95% CI] = 1.46 [1.37–1.54]). CVD survivors with low education attainment or minority background were less likely to receive a diagnosis of depression though their experience of depression was comparable with or higher than their counterparts. Conclusion CVD is associated significantly with depression and anxiety. Disparities exist among CVD survivors on the diagnosis of depression and anxiety.