Changes In Cardiovascular Mortality Research Articles

The impact of exposure assessment on associations between air pollution and cardiovascular mortality risks in the city of Rio de Janeiro, Brazil

Despite a growing literature for complex air quality models, scientific evidence lacks of the influences of varying exposure assessments and air quality data sources on the estimated mortality risks. This case-crossover study estimated cardiovascular mortality risks from fine particulate matter (PM2.5) and ozone (O3) exposures, using varying exposure methods, to aid understanding of the impact of exposure methods in the health risk estimation. We used individual-level cardiovascular mortality data in the city of Rio de Janeiro, 2012–2016. PM2.5 and O3 exposure levels (from the date of death to seven prior days [lag0–7]) were estimated at the individual level or district level using either the WRF-Chem modeling data or monitoring data, resulting in a total of 10 exposure methods. The exposure-response relationships were estimated using multiple logistic regressions. The changes in cardiovascular mortality were represented as an odds ratio (OR) and 95% confidence intervals (CIs) for an interquartile range (IQR) increase in the exposures. Results showed that socioeconomically more advantaged populations had lower access to the stationary monitoring networks. Higher variance in the estimated exposure levels across the 10 exposure methods was found for PM2.5 than O3. PM2.5 exposure was not associated with mortality risk in any exposure methods. WRF-Chem-based O3 exposure estimated for each individual of the entire population found a significant mortality risk (OR = 1.06, 95% CI: 1.01, 1.11), but not the other exposure methods. Higher risks for females and older populations were suggested for O3 estimates estimated for each individual using the WRF-Chem data. Findings indicate that decisions on exposure methods and data sources can lead to substantially varying implications for air pollution risks and highlight the need for comprehensive exposure and health impact assessments to aid local decision-making for air pollution and public health.

Vitamin-D Deficiency and Supplementation Altered the Network of the Coronary Arteries in a Rodent Model-In Situ Video Microscopic Technique.

The aim of our study was to identify whether vitamin-D deficiency (VDD) can alter the geometry of the coronary-resistance-artery system. Male Wistar rats were divided into vitamin-D-deficient (VD−, n = 10) and vitamin-D-supplemented (VD+, n = 8) groups. After eight weeks, branches and segments of the left-anterior-descending-coronary-artery (LAD) network were analyzed by a video-microscopy technique. Segments were divided into 50 μm-long cylindrical ring units. VDD did not increase the number of morphological abnormalities. The number of segments did not differ between the groups (VD−: 210 and VD+: 224; pooled data of 8 networks). A larger lumen area of branches was found in VD+ group, while 1–4-order branches were lengthier in the VD− group. VD− rats had less rich coronary-resistance-artery networks in terms of 50 µm-long units. (VD−: 6365 vs. VD+: 6602; pooled data of 8 networks). VD+ animals were richer in the 100–350 µm outer diameter range, and VD− animals were richer in the 400–550 µm-diameter units. In VD− rats, 150–200 and 300 µm units were almost missing at higher flow distances from the orifice. Serum vitamin-D alterations caused by dietary changes can affect the geometry of the coronary-artery network, which may contribute to vitamin-D-dependent changes in cardiovascular mortality.

Changes in cardiovascular mortality in Chile during the COVID-19 pandemic

ObjectivesThe COVID-19 pandemic has impacted regular cardiovascular healthcare access and delivery. Service utilisation has declined, and excess cardiovascular mortality has been reported in several countries. We aim to estimate excess...

Basic Aspects of Seasonal Cardiovascular Mortality

The review demonstrates the main aspects of seasonal cardiovascular mortality. Climatic factors, including seasonal weather changes, have a significant impact on the biosphere. People are also characterized by the seasonal dynamics of the activity of many organs and systems, biochemical parameters, and mortality. Cardiovascular mortality is also characterized by seasonal fluctuations: in winter it is maximum, in summer it is minimal. The same patterns are characteristic of mortality from cardiovascular diseases (myocardial infarction, stroke, cardiac arrhythmias, etc.). The article presents the basic patterns of seasonal cardiovascular mortality in various climatic zones, the cardiovascular mortality of countries located in the equatorial and subequatorial climatic region. In addition, the mortality displacement phenomenon, the paradox of winter mortality. The main trends in changes in cardiovascular mortality over a long period of time are demonstrated. The paper discusses some of the mechanisms that underlie the dynamics of cardiovascular mortality during the year: seasonal fluctuations in the level of vitamin D, lipids in the blood plasma, changes in hemodynamic parameters, the effects of microbial and viral infections in the cold season, etc. In addition, data on seasonal the dynamics of risk factors for cardiovascular diseases is considered: an increase in body weight, a physical activity decrease, a change in the nutrition structure in the winter, the seasonal dynamics of depression, anxiety, hostility, the relationship of seasonal cardiovascular mortality with socio-economic, demographic and other factors. In conclusion, the main ways of development and prevention of seasonal CV cardiovascular mortality M, taking into account modern technologies at the international level, for state health departments, for specific patients, are demonstrated.

Association Between County-Level Change in Economic Prosperity and Change in Cardiovascular Mortality Among Middle-aged US Adults

After a decline in cardiovascular mortality for nonelderly US adults, recent stagnation has occurred alongside rising income inequality. Whether this is associated with underlying economic trends is unclear. To assess the association between changes in economic prosperity and trends in cardiovascular mortality in middle-aged US adults. Retrospective analysis of the association between change in 7 markers of economic prosperity in 3123 US counties and county-level cardiovascular mortality among 40- to 64-year-old adults (102 660 852 individuals in 2010). Mean rank for change in 7 markers of economic prosperity between 2 time periods (baseline: 2007-2011 and follow-up: 2012-2016). A higher mean rank indicates a greater relative increase or lower relative decrease in prosperity (range, 5 to 92; mean [SD], 50 [14]). Mean annual percentage change (APC) in age-adjusted cardiovascular mortality rates. Generalized linear mixed-effects models were used to estimate the additional APC associated with a change in prosperity. Among 102 660 852 residents aged 40 to 64 years living in these counties in 2010 (51% women), 979 228 cardiovascular deaths occurred between 2010 and 2017. Age-adjusted cardiovascular mortality rates did not change significantly between 2010 and 2017 in counties in the lowest tertile for change in economic prosperity (mean [SD], 114.1 [47.9] to 116.1 [52.7] deaths per 100 000 individuals; APC, 0.2% [95% CI, -0.3% to 0.7%]). Mortality decreased significantly in the intermediate tertile (mean [SD], 104.7 [38.8] to 101.9 [41.5] deaths per 100 000 individuals; APC, -0.4% [95% CI, -0.8% to -0.1%]) and highest tertile for change in prosperity (100.0 [37.9] to 95.1 [39.1] deaths per 100 000 individuals; APC, -0.5% [95% CI, -0.9% to -0.1%]). After accounting for baseline prosperity and demographic and health care-related variables, a 10-point higher mean rank for change in economic prosperity was associated with 0.4% (95% CI, 0.2% to 0.6%) additional decrease in mortality per year. In this retrospective study of US county-level mortality data from 2010 to 2017, a relative increase in county-level economic prosperity was significantly associated with a small relative decrease in cardiovascular mortality among middle-aged adults. Individual-level inferences are limited by the ecological nature of the study.

Percutaneous mitral valve repair for secondary mitral valve regurgitation: A systematic review and meta-analysis

BackgroundThe first two randomized control trials (RCTs) studying the role of MitraClip in patients with secondary mitral regurgitation (MR) had antagonizing results. We, therefore, performed an updated meta-analysis of RCTs and propensity score-matched observational studies investigating the role of MitraClips in patients with secondary MR. A novel method of Kaplan Meier Curve reconstruction from derived individual patient data will be used to compare the survival probability of control groups in COAPT and MITRA HF trail, and hence, access inter-study heterogeneity. MethodsMedline and Cochrane databases was used for systematic search. We used the Mantel-Haenszel method with a random-effect model to calculate risk ratio (RR) with 95% confidence interval (CI) and inverse variance method with a random-effect model to calculate the mean difference (MD) with 95% confidence interval (CI). We used a fixed-effect approach for meta-regression. ResultsMitraClip reduced the risk of all-cause mortality [RR: 0.72, CI: 0.55–0.95, P value = 0.02, I2 = 55%, χ2P-value = 0.08] and readmission [RR: 0.62, CI: 0.42–0.92, P value = 0.02, I2 = 90%, χ2P-value<0.01] at two years follow-up. There was no effect of MitraClip on change in cardiovascular mortality and 6 m walking distance at 12 months follow-up. Meta-regression indicated left ventricular end diastolic volume and age among the factors affecting outcomes. Reconstructed Kaplan Meier curves confirmed considerable heterogeneity among patients randomized in MITRA HF and COAPT trial. ConclusionThe present meta-analysis confirms the beneficial role of percutaneous mitral valve repair in patients with secondary MR. However, all the results were associated with considerable heterogeneity.

Impact of Reductions in Emissions from Major Source Sectors on Fine Particulate Matter-Related Cardiovascular Mortality.

Background:Reductions in ambient concentrations of fine particulate matter () have contributed to reductions in cardiovascular (CV) mortality.Objectives:We examined changes in CV mortality attributed to reductions in emissions from mobile, point, areal, and nonroad sources through changes in concentrations of and its major components [nitrates, sulfates, elemental carbon (EC), and organic carbon (OC)] in 2,132 U.S. counties between 1990 and 2010.Methods:Using Community Multiscale Air Quality model estimated total and component concentrations, we calculated population-weighted annual averages for each county. We estimated total- and component-related CV mortality, adjusted for county-level population characteristics and baseline concentrations. Using the index of Emission Mitigation Efficiency for primary emission-to-particle pathways, we expressed changes in particle-related mortality in terms of precursor emissions by each sector.Results: reductions represented 5.7% of the overall decline in CV mortality. Large point source emissions of sulfur dioxide accounted for 6.685 [95% confidence interval (CI): 5.703, 7.667] fewer sulfate-related CV deaths per 100,000 people. Mobile source emissions of primary EC and nitrous oxides accounted for 3.396 (95% CI: 2.772, 4.020) and 3.984 (95% CI: 2.472, 5.496) fewer CV deaths per 100,000 people respectively. Increased EC and OC emissions from areal sources increased carbon-related CV mortality by 0.788 (95% CI: , 2.116) and 0.245 (95% CI: , 1.187) CV deaths per 100,000 people.Discussion:In a nationwide epidemiological study of emission sector contribution to –related mortality, we found that reductions in sulfur-dioxide emissions from large point sources and nitrates and EC emissions from mobile sources contributed the largest reduction in particle-related mortality rates respectively. https://doi.org/10.1289/EHP5692

Progress in reducing inequalities in cardiovascular disease mortality in Europe

ObjectiveTo assess whether recent declines in cardiovascular mortality have benefited all socioeconomic groups equally and whether these declines have narrowed or widened inequalities in cardiovascular mortality in Europe.MethodsIn this prospective...

Perspective: interesterified triglycerides, the recent increase in deaths from heart disease, and elevated blood viscosity.

The authors hypothesize that consumption of interesterified fats may be the cause of the continuous increase in cardiovascular deaths in the United States which began in 2011. Interesterification is a method of producing solid fats from vegetable oil and began to supplant partial hydrogenation for this purpose upon recognition of the danger of trans fats to cardiovascular health. Long, straight carbon chains, as are present in saturated and trans fatty acids, decrease the fluidity of the erythrocyte cell membrane, which decreases erythrocyte deformability and increases blood viscosity. This decrease in cell membrane fluidity is caused by increased van der Waals interactions, which also solidify dietary fats. Elevated blood viscosity is favored as the pathogenic mechanism by which trans fats increase cardiovascular mortality because changes in lipoprotein levels do not account for all the mortality attributable to their consumption. The rapid changes in cardiovascular mortality noted with the introduction and withdrawal of trans fats from the food supply are reviewed. The evidence implicating elevated blood viscosity in cardiovascular disease is also reviewed. Data regarding the production and consumption of interesterified fats in the US should be released in order to determine if there is an association with the observed increase in cardiovascular deaths.

Declining exposures to lead and cadmium contribute to explaining the reduction of cardiovascular mortality in the US population, 1988-2004.

Lead and cadmium exposures have markedly declined in the USA following the implementation of large-scale public health policies and could have contributed to the unexplained decline in cardiovascular mortality in US adults. We evaluated the potential contribution of lead and cadmium exposure reductions to explain decreasing cardiovascular mortality trends occurring in the USA from 1988-94 to 1999-2004. Prospective study in 15 421 adults ≥40 years old who had participated in the National Health and Nutrition Examination Survey 1988-94 or 1999-2004. We estimated the amount of change in cardiovascular mortality over time that can be independently attributed to the intermediate pathway of changes in blood lead and urine cadmium concentrations. There was a 42.0% decrease in blood lead and a 31.0% decrease in urine cadmium concentrations. The cardiovascular mortality rate ratio [95% confidence intervals (CIs)] associated with a doubling of metal levels was 1.19 (1.07, 1.31) for blood lead and 1.20 (1.09, 1.32) for urine cadmium. The absolute reduction in cardiovascular deaths comparing 1999-2004 to 1988-94 was 230.7 deaths/100 000 person-years, in models adjusted for traditional cardiovascular risk factors. Among these avoided deaths, 52.0 (95% CI 8.4, 96.7) and 19.4 (4.3, 36.4) deaths/100 000 person-years were attributable to changes in lead and cadmium, respectively. Environmental declines in lead and cadmium exposures were associated with reductions in cardiovascular mortality in US adults. Given the fact that lead and cadmium remain associated with cardiovascular disease at relatively low levels of exposure, prevention strategies that further minimize exposure to lead and cadmium may be needed.

Declining Exposures to Lead and Cadmium Contribute to Explain the Reduction of Cardiovascular Mortality in the United States Population, 1988-2004

Background. Lead and cadmium exposures have markedly declined in the US following the implementation of large-scale public health policies and could have contributed to the unexplained decline in cardiovascular mortality in US adults. We evaluated if population changes in the distribution of blood lead and urine cadmium levels explain changes in cardiovascular mortality over time in a representative sample of the US general population. Methods. Prospective study in 15,421 adults ≥40 years old who had participated in the National Health and Nutrition Examination Survey 1988-1994 or 1999-2004 and had baseline measures of urine cadmium, blood lead, and cardiovascular risk factors, and mortality follow-up for up to 8 years. We estimated the amount of change in cardiovascular mortality rates comparing 1999-2004 to 1988-1994 that can be independently attributed to changes in blood lead and urine cadmium concentrations. Results. During the study period there was a 43.7% decrease in blood lead and a 23.5% decreas...

Cardiovascular mortality associated with low and high temperatures: determinants of inter-region vulnerability in China.

The objectives of this study were to estimate the effects of temperature on cardiovascular mortality in 26 regions in the south and west of China from 2008 to 2011, and to identify socioeconomic and demographic factors contributing to such inter-region variation in the temperature effect. A separate Poisson generalized additive model (GAM) was fitted to estimate percent changes in cardiovascular mortality at low and high temperatures on a daily basis for each region. The model used the smooth functions to model the nonlinear effects of temperature and humidity and to control for the seasonal factor using the calendar time variable. Given variation in the magnitude of the temperature effect on cardiovascular mortality, we employed a Bayesian network (BN) to identify potential region-specific socioeconomic and demographic factors that may explain the variation. In most regions, an increasing trend in high or low temperature was associated with an increase in cardiovascular mortality, with variation in the magnitude of the temperature effects across regions. Three factors, including per capita years of education (as an indicator of economic status), percentage of the population over 65 years of age and percentage of women had direct impact on cold-related cardiovascular mortality. Number of hospital beds (as an indicator of the availability of medical resources), percentage of population engaged in industrial occupations, and percentage of women showed direct impact on heat-related cardiovascular mortality. Due to the socioeconomic and demographic inequalities between regions, the development of customized prevention and adaptation programs to address the low/high temperatures in vulnerable regions should be prioritized.

FEATURES OF SEASONAL CARDIOVASCULAR MORTALITY IN WINTER IN RUSSIAN REGIONS WITH DIFFERENT CLIMATIC AND GEOGRAPHICAL CHARACTERISTICS

Aim. To study seasonal changes in cardiovascular mortality in winter in Arkhangelsk, Ivanovo and Saratov regions – Russian regions with different climatic and geographical characteristics. Material and methods. Comparison of mortality in Arkhangelsk, Ivanovo and Saratov regions in 2007-2012 in January-March, December and April-November was performed by multivariate analysis of variance. Significance of differences was assessed by t-test of analysis of variance using programme GLM of SAS system. Results. Significantly higher cardiovascular mortality in population of Arkhangelsk (by 12.0%), Ivanovo (by 13.4%) and Saratov (by 11.5%) regions, as well as higher overall death-rate, during January-March, December, compared with April-November (p 0.05). Conclusion. These findings point out the necessity of elaboration and implementation of the measures to prevent a winter increase in mortality, including the prevention of negative impact on the population of lowtemperature air, seasonal prophylaxis of acute respiratory viral infection, influenza and its complications, pharmacologic and non-pharmacologic prevention of cardio-vascular complications.

P2-273 Trends in cardiovascular mortality among adult population in Russia

Changes in cardiovascular mortality (CVM) among adult population of Russia in 2005–2009 were analysed in order to evaluate the efficiency of government program to reduce CVM adopted in 2008. During...

Explaining structural change in cardiovascular mortality in Ireland 1995-2005: a time series analysis

Deaths from diseases of the circulatory system and the seasonality of deaths from these causes fell sharply between 1995 and 2005 among older age groups in Ireland. We examine whether a structural break occurred in deaths from circulatory causes in Ireland between 1995 and 2005 and test whether this can be statistically accounted for by cardiovascular prescribing during the same period controlling for weather trends. Grouped logit time series models were used to identify if and at which quarter a structural break occurred in Irish circulatory deaths between 1995 and 2005. Data on cardiovascular prescribing and temperature within the quarter were entered into the trend-break model to account for the structural break. Controlling for temperature, β-blocker, ace-inhibitor and aspirin medications rendered the structural break indicator insignificant among all age groups for men. Diuretic, statin and calcium channel blocker medications could not account for the break point for men aged 75-84 years. β-Blocker, aspirin and calcium channel blocker medications account for mortality trends among all age groups among women. Ace inhibitor and statin could not account for trends amongst women aged 65-74 years and nitrates and diuretics did not account for trends for any age group. Cardiovascular prescribing accounts for the trend break in circulatory mortality among men and women aged ≥65 years after 1999 in Ireland but the effect of prescribing is lower for women. β-Blocker, ace inhibitor and aspirin medications were more successful than statin, diuretic and nitrates in accounting for the trends.

Changes in traditional risk factors no longer explain time trends in cardiovascular mortality and its socioeconomic differences

Aim:To investigate to what extent the changes in traditional risk factors (total cholesterol, smoking, hypertension) explain the changes in socioeconomic (defined by occupational class and household income) differences in cardiovascular...

Trends in Life Expectancy by Level of Education and Occupational Social Class in Finland 1981-2000

The study analyses trends in life expectancy by level of education and by occupational social class in Finland from 1981 to 2000 to assess to what extent these trends have been in accordance with the target of reducing socioeconomic differences in life expectancy set in the Government public health programme. The study is based on the census records for the population aged 35 or over, which have been linked to the death records for the years 1981 to 2000. The results show that, contrary to the public health target, the difference in the life expectancy between persons with tertiary and basic education and that between upper non-manual and manual occupational classes increased during the 1990s. Differences in the trends in mortality from alcohol-related causes of death and from other cancers than lung cancer accounted for most the increase in the socioeconomic gap among men. Different from the 1980s changes in cardiovascular mortality did not contribute to the increase in the socioeconomic gap. Among women the increase in the socioeconomic gap was mainly due to the heterogeneous group of other diseases and cancers other than lung and breast cancer

Reduction in diastolic blood pressure and cardiovascular mortality in nondiabetic hypertensive patients. A reanalysis of the HOT study

To use published Hypertension Optimal Treatment (HOT) Study data to evaluate changes in cardiovascular mortality in nondiabetic hypertensive patients according to the degree of reduction in their diastolic blood pressure. In the HOT Study, 18,700 patients from various centers were allocated at random to groups having different objectives of for diastolic blood pressure: </=90 (n=6264); </=85 (n=6264); </=80mmHg (n=6262). Felodipine was the basic drug used. Other antihypertensive drugs were administered in a sequential manner, aiming at the objectives of diastolic blood pressure reduction. The group of nondiabetic hypertensive subjects with diastolic pressure</=80mmHg had a cardiovascular mortality ratio of 4.1/1000 patients/year, 35.5% higher than the group with diastolic pressure </=90mmHg (cardiovascular mortality ratio, 3.1/1000 patients/year). In contrast, diabetic patients allocated to the diastolic pressure objective group of </=80mmHg had a 66.7% reduction in cardiovascular mortality (3.7/1000 patients/year) when compared with the diastolic pressure group of </=90mmHg (cardiovascular mortality ratio, 11.1/1000 patients/year). The results indicate that in hypertensive diabetic patients reduction in diastolic blood pressure to levels </=80mmHg decreases the risk of fatal cardiovascular events. It remains necessary to define the level of diastolic blood pressure </=90mmHg at which maximal reduction in cardiovascular mortality is obtained for nondiabetics.

The world health organization monica project (monitoring trends and determinants in cardiovascular disease): A major international collaboration

A World Health Organization Working Group has developed a major international collaborative study with the objective of measuring over 10 years, and in many different populations, the trends in, and determinants of, cardiovascular disease. Specifically the programme focuses on trends in event rates for validated fatal and non-fatal coronary heart attacks and strokes, and on trends in cardiovascular risk factors (blood pressure, cigarette smoking and serum cholesterol) in men and women aged 25–64 in the same defined communities. By this means it is hoped both to measure changes in cardiovascular mortality and to see how far they are explained; on the one hand by changes in incidence mediated by risk factor levels; and on the other by changes in case-fatality rates, related to medical care. Population centres need to be large and numerous; to reliably establish 10-year trends in event rates within a centre 200 or more fatal events in men per year are needed, while for the collaborative study a multiplicity of internally homogeneous centres showing differing trends will provide the best test of the hypotheses. Forty-one MONICA Collaborating Centres, using a standardized protocol, are studying 118 Reporting Units (sub-populations) with a total population aged 25–64 (both sexes) of about 15 million

Trends in cardiovascular mortality in Spanish-surnamed, other white, and black persons in Texas, 1970--1975.

Certain categories of cardiovascular disease have significantly declined recently as causes of death. In the present investigation we describe the variation in cardiovascular mortality in Texas by ethnicity, age and sex during 1970--1975 using age-standardized proportional mortality ratios. Specifically, the question of whether the three major ethnic groups in Texas have shared equally in any changes in cardiovascular mortality is examined. Several subcategories of cardiovascular mortality are considered. Among the sex-ethnic groups both ischemic heart disease and acute myocardial infarction mortality declined less among Spanish-surnamed males and females than in their other white and black counterparts. Chronic ischemic heart disease increased in relative importance for all groups except Spanish-surnamed females, in whom it decreased. There was no significant decrease in cerebrovascular disease mortality among Spanish-surnamed males or females as there was in the other groups. These results suggest that important differences in cause-structure of mortality are occurring in the ethnic subpopulations of Texas.