Circulatory Health Research Articles

Gender differences in grant and personnel award funding rates at the Canadian Institutes of Health Research based on research content area: A retrospective analysis.

BackgroundAlthough women at all career stages are more likely to leave academia than men, early-career women are a particularly high-risk group. Research supports that women are less likely than men to receive research funding; however, whether funding success rates vary based on research content is unknown. We addressed gender differences in funding success rates for applications directed to one or more of 13 institutes, representing research communities, over a 15-year period.Methods and findingsWe retrospectively reviewed 55,700 grant and 4,087 personnel award applications submitted to the Canadian Institutes of Health Research. We analyzed application success rates according to gender and the primary institute selected by applicants, pooled gender differences in success rates using random effects models, and fitted Poisson regression models to assess the effects of gender, time, and institute. We noted variable success rates among grant applications directed to selected institutes and declining success rates over time. Women submitted 31.1% and 44.7% of grant and personnel award applications, respectively. In the pooled estimate, women had significantly lower grant success (risk ratio [RR] 0.89, 95% confidence interval [CI] 0.84–0.94; p < 0.001; absolute difference 3.2%) compared with men, with substantial heterogeneity (I2 = 58%). Compared with men, women who directed grants to the Institutes of Cancer Research (RR 0.86, 95% CI 0.78–0.96), Circulatory and Respiratory Health (RR 0.74, 95% CI 0.66–0.84), Health Services and Policy Research (RR 0.78, 95% CI 0.68–0.90), and Musculoskeletal Health and Arthritis (RR 0.80, 95% CI 0.69–0.93) were significantly less likely to be funded, and those who directed grants to the Institute of Aboriginal People’s Health (RR 1.67, 95% CI 1.0–2.7) were more likely to be funded. Overall, women also had significantly lower personnel award success (RR 0.75, 95% CI 0.65–0.86; p < 0.001; absolute difference 6.6%). Regression modelling identified that the effect of gender on grant success rates differed by institute and not time. Study limitations include use of institutes as a surrogate identifier, variability in designation of primary institute, and lack of access to metrics reflecting applicants, coapplicants, peer reviewers, and the peer-review process.ConclusionsGender disparity existed overall in grant and personnel award success rates, especially for grants directed to selected research communities. Funding agencies should monitor for gender differences in grant success rates overall and by research content.

Third Global Summit on Circulatory Health.

Third Global Summit on Circulatory Health.

Shear Stress Ameliorates Superoxide Impairment to Erythrocyte Deformability With Concurrent Nitric Oxide Synthase Activation.

The cellular deformability of red blood cells (RBC) is exceptional among mammalian cells and facilitates nutrient delivery throughout the microcirculation; however, this physical property is negatively impacted by oxidative stress. It remains unresolved whether the molecular determinants of cellular deformability – which in the contemporary model of RBC are increasingly recognized – are sensitive to free radicals. Moreover, given cellular deformability has recently been demonstrated to increase following exposure to specific doses of mechanical stimulation, the potential for using shear “conditioning” as a novel method to reverse free-radical induced impairment of cell mechanics is of interest. We thus designed a series of experiments that explored the effects of intracellular superoxide (O2-) generation on the deformability of RBC and also activation of pivotal molecular pathways known to regulate cell mechanics – i.e., PI3K/Akt kinase and RBC nitric oxide synthase (NOS). In addition, RBC exposed to O2- were conditioned with specific shear stresses, prior to evaluation of cellular deformability and activation of PI3K/Akt kinase and RBC-NOS. Intracellular generation of O2- decreased phosphorylation of RBC-NOS at its primary activation site (Ser1177) (p < 0.001), while phosphorylation of Akt kinase at its active residue (Ser473) was also diminished (p < 0.001). Inactivation of these enzymes following O2- exposure occurred in tandem with decreased RBC deformability. Shear conditioning significantly improved cellular deformability, even in RBC previously exposed to O2-. The improvement in cellular deformability may have been the result of enhanced molecular signaling, given RBC-NOS phosphorylation in RBC exposed to O2- was restored following shear conditioning. Impaired RBC deformability induced by intracellular O2- may be due, in part, to impaired activation of PI3K/Akt, and downstream signaling with RBC-NOS. These findings may shed light on improved circulatory health with targeted promotion of blood flow (e.g., exercise training), and may prove fruitful in future development of blood-contacting devices.

OP88 Digital Approaches For Randomized Controlled Trial Recruitment Or Retention: A Systematic Map

IntroductionRecruitment and retention of participants in randomized controlled trials (RCTs) is challenging, and is why many RCTs fail or are not completed on time. Digital approaches such as social media, data mining, email or text messaging could improve recruitment and/or retention, but how well they match these purposes is unclear. We used systematic methods to map the digital approaches that have been investigated during the past 10 years.MethodsWe searched Medline, Embase, other databases and relevant web sites in July 2018 to identify comparative studies of digital approaches for recruiting and/or retaining participants in clinical or health RCTs. Two reviewers screened references against protocol-specified eligibility criteria. Studies included were coded by one reviewer (with 20 percent checked by a second reviewer) using pre-defined keywords to describe characteristics of the studies, populations and digital approaches evaluated.ResultsWe identified 9,133 potentially relevant references, of which 100, reporting 101 unique studies, met the criteria for inclusion in the map. Among these, 95 percent of studies investigated recruitment but only 11 percent investigated retention. Study areas included health promotion and public health (36 percent), cancer (17 percent), circulatory system disorders (13 percent) and mental health (10 percent). Most study designs were observational (89 percent). The most frequent digital approaches for recruitment were internet sites (53 percent of recruitment studies), social media (42 percent), television or radio (31 percent) and/or email (31 percent). For retention these were email (63 percent of retention studies) or text messaging (38 percent). Time and costs of recruitment were reported in 17 percent and 30 percent of recruitment studies respectively, whilst costs were reported in 19 percent of retention studies.ConclusionsA wide range of digital approaches has been studied, in many combinations. Evidence gaps include lack of experimental studies; studies on retention; and studies for specific populations (e.g. children or older people) and outcomes (e.g. user satisfaction). More robust experimental studies, perhaps conducted as studies-within-a-trial (SWAT), are needed to address knowledge gaps and ensure that estimates of digital tool effectiveness and efficiency are reliable.

Global Coalition for the Fight Against Heart Disease and Stroke: A Global Coalition for WHF Second Global Summit on Circulatory Health.

Global Coalition for the Fight Against Heart Disease and Stroke: A Global Coalition for WHF Second Global Summit on Circulatory Health.

An African cardiology summit: The World Heart Federation African Summit on Best Practices in Policy and Access to Care in 2017 concluded with the Khartoum Action Plan, to improve cardiovascular on the African continent.

The World Heart Federation (WHF) is the umbrella organization of continental and national cardiac societies and heart foundations globally, reporting to the World Health Organization (WHO). The WHF is dedicated to the global fight against CVD, including heart disease, stroke, and rheumatic heart disease (RHD). Building on the first Global Summit on Circulatory Health, held at the 2016 World Congress of Cardiology and Cardiovascular Health in Mexico City, the second Summit held in Singapore July 2017 focused on building a civil society movement for circulatory health.

Spatial Econometric Approach to Modelling of Selected Western Diseases

For years now, developed countries face an epidemic of high blood pressure, diabetes and high cholesterol, risk factors related to heart and circulatory disease, and a suite of psychological disorders ranging from depression, anxiety, to compulsive behaviours. These health risks have traditionally been associated with affluence, however by 2008 there is no clear link between national income and these diseases. E.g. according to Danaei, there was no relationship between national income and blood pressure in men, and in women blood pressure was even higher in poorer countries. This paper provides an in depth analysis of this correlation, applying spatial econometrics tools. The spatial aspect of the prevalence of western diseases does not seem to be obvious and, to our knowledge, is not widely explored in the literature. In particular, the paper investigates the spatial processes of selected diseases of affluence in regions of the European Union. The research covers 261 NUTS 2 regions for the period 2003–2010. This study provides the spatial analysis of circulatory and mental health disorders. In our opinion, the presented spatial econometric approach may constitute an important contribution to the field of epidemiology.

Long-term exposure to ambient PM2.5 associated with fall-related injury in six low- and middle-income countries.

Exposure to ambient air pollution has been linked with adverse health outcomes of the circulatory and nervous systems. Given that falls are closely related to circulatory and nervous health, we hypothesize that air pollution may adversely affect fall-related injury. We employed Wave 1 data from 36,662 participants aged ≥50 years in WHO's Study on Global AGEing and Adult Health in six low- and middle-income countries. Ambient annual concentration of PM2.5 was estimated using satellite data. A three-level logistic regression model was applied to examine the long-term association between ambient PM2.5 and the prevalence of fall-related injury, and associated disease burden, as well as the potential effect modification of consumption of fruit and vegetables. Ambient PM2.5 was found to be significantly associated with the risk of fall-related injury. Each 10μg/m3 increase corresponded to 18% (OR=1.18, 95% CI: 1.09, 1.28) increase in fall-related injury after adjusting for various covariates. The association was relatively stronger among participants with lower consumption of fruit (OR=1.22, 95% CI: 1.12, 1.33) than higher consumption (OR=1.06, 95% CI: 0.92, 1.23), and among those with lower vegetable consumption (OR=1.18, 95% CI: 1.08, 1.28) than higher consumption (OR=1.08, 95% CI: 0.91, 1.27). Our study suggests that ambient PM2.5 may be one risk factor for fall-related injury and that higher consumption of fruit and vegetables could alleviate this effect.

Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial

Symptomatic relief is the primary goal of percutaneous coronary intervention (PCI) in stable angina and is commonly observed clinically. However, there is no evidence from blinded, placebo-controlled randomised trials to show its efficacy. ORBITA is a blinded, multicentre randomised trial of PCI versus a placebo procedure for angina relief that was done at five study sites in the UK. We enrolled patients with severe (≥70%) single-vessel stenoses. After enrolment, patients received 6 weeks of medication optimisation. Patients then had pre-randomisation assessments with cardiopulmonary exercise testing, symptom questionnaires, and dobutamine stress echocardiography. Patients were randomised 1:1 to undergo PCI or a placebo procedure by use of an automated online randomisation tool. After 6 weeks of follow-up, the assessments done before randomisation were repeated at the final assessment. The primary endpoint was difference in exercise time increment between groups. All analyses were based on the intention-to-treat principle and the study population contained all participants who underwent randomisation. This study is registered with ClinicalTrials.gov, number NCT02062593. ORBITA enrolled 230 patients with ischaemic symptoms. After the medication optimisation phase and between Jan 6, 2014, and Aug 11, 2017, 200 patients underwent randomisation, with 105 patients assigned PCI and 95 assigned the placebo procedure. Lesions had mean area stenosis of 84·4% (SD 10·2), fractional flow reserve of 0·69 (0·16), and instantaneous wave-free ratio of 0·76 (0·22). There was no significant difference in the primary endpoint of exercise time increment between groups (PCI minus placebo 16·6 s, 95% CI -8·9 to 42·0, p=0·200). There were no deaths. Serious adverse events included four pressure-wire related complications in the placebo group, which required PCI, and five major bleeding events, including two in the PCI group and three in the placebo group. In patients with medically treated angina and severe coronary stenosis, PCI did not increase exercise time by more than the effect of a placebo procedure. The efficacy of invasive procedures can be assessed with a placebo control, as is standard for pharmacotherapy. NIHR Imperial Biomedical Research Centre, Foundation for Circulatory Health, Imperial College Healthcare Charity, Philips Volcano, NIHR Barts Biomedical Research Centre.

Foundation for a smoke-free world

The current and future health effects of smoking are well described. More than 7 million deaths per year are attributable to smoking, and projections suggest 1 billion deaths this century. 1 WHOWHO report on the global tobacco epidemic, 2017: monitoring tobacco use and prevention policies. World Health Organization, Geneva2017http://www.who.int/tobacco/global_report/en Google Scholar Over a decade ago, in my role to facilitate the establishment of WHO's Framework Convention on Tobacco Control (FCTC), I warned about the potential for complacency in the years following the FCTC's adoption. 2 Yach D Injecting greater urgency into global tobacco control. Tob Control. 2005; 14: 145-148 Crossref PubMed Scopus (12) Google Scholar We knew that implementation of the FCTC would take decades, and that it would be challenged from the outset by constrained funding, shifting priorities and political will, weak human and institutional capacity, and continuing opposition from the tobacco industry. Tobacco control: a Foundation too far?Tobacco smoking is the leading cause of preventable mortality worldwide and is responsible for more than 7 million deaths each year. In today's issue of The Lancet, we publish a Viewpoint describing the mission and goals of the recently established Foundation for a Smoke-Free World, funded by tobacco giant Philip Morris International. Led by former WHO executive director Derek Yach, the Foundation, whose aim is “to eliminate cigarette smoking worldwide”, will receive US$1 billion in funding over the next 12 years. Full-Text PDF Towards a smoke-free world? Philip Morris International's new Foundation is not credibleSmoking causes more than 7 million deaths each year1 and tobacco companies have known, since at least 1950, that their products are lethal and addictive. Now Philip Morris International (PMI) is committing nearly US$1 billion over 12 years to the Philip Morris Foundation for a Smoke-Free World that will “fund scientific research designed to eliminate the use of smoked tobacco around the globe”.2 In a Lancet Viewpoint in this issue, the Foundation's President Derek Yach argues it will support “an unswerving focus…to improve public health and human wellbeing”. Full-Text PDF Condemning industry attempts to subvert public policy for a tobacco-free worldThe World Heart Federation, alongside its partners in the Global Coalition for Circulatory Health, condemns outright the launch of the Foundation for a Smoke-Free World,1 which is a vehicle for the tobacco industry. Full-Text PDF Department of ErrorYach D. Foundation for a smoke-free world. Lancet 2017; 390: 1807–10—The third sentence of the second paragraph of this Viewpoint should have read “Nonetheless, the capacity of developing countries remains threatened by the growing health and financial burden associated with behavioural risk factors contributing to non-communicable diseases.” with a revised citation from Bollyky TJ, Templin T, Cohen M, Dieleman JL. Lower-income countries that face the most rapid shift in noncommunicable disease burden are also the least prepared. Full-Text PDF Nuclear war and public health: rebalancing priorities and global health leadershipRecently, the North Korean nuclear and missile crisis has gripped international media headlines.1 In the streets of Seoul, the vast majority of civilians remain remarkably calm, confident that this threat will pass like those of the past. Yet, complacency would not serve an excuse in the face of war by either intention or tragic miscalculation. By then, the silence of the global health community will likely be seen as an opportunity missed. Why does it remain silent? Perhaps the community feels out of its depth in an area of competence of the UN Security Council—surely they must know what they are doing? Full-Text PDF

공간 자료를 이용한 대기오염이 순환기계 건강에 미치는 영향 분석

공간 자료를 이용한 대기오염이 순환기계 건강에 미치는 영향 분석

Blacks’ Death Rate Due to Circulatory Diseases Is Positively Related to Whites’ Explicit Racial Bias

Perceptions of racial bias have been linked to poorer circulatory health among Blacks compared with Whites. However, little is known about whether Whites’ actual racial bias contributes to this racial disparity in health. We compiled racial-bias data from 1,391,632 Whites and examined whether racial bias in a given county predicted Black-White disparities in circulatory-disease risk (access to health care, diagnosis of a circulatory disease; Study 1) and circulatory-disease-related death rate (Study 2) in the same county. Results revealed that in counties where Whites reported greater racial bias, Blacks (but not Whites) reported decreased access to health care (Study 1). Furthermore, in counties where Whites reported greater racial bias, both Blacks and Whites showed increased death rates due to circulatory diseases, but this relationship was stronger for Blacks than for Whites (Study 2). These results indicate that racial disparities in risk of circulatory disease and in circulatory-disease-related death rate are more pronounced in communities where Whites harbor more explicit racial bias.

Nitric Oxide in Health and Physical Performance: Considering the Molecule 2 Nitrooxy Ethyl 2 Amino 3 Methylbutanoate

&lt;p class="jbls-body"&gt;&lt;span lang="EN-GB"&gt;Nitric oxide (NO&lt;sup&gt;∙&lt;/sup&gt;) is an important signaling molecule that has received considerable attention in recent years for its beneficial impact on a variety of health related outcomes. The effects range from improving various aspects of circulatory health to aiding exercise performance. Although NO&lt;sup&gt;∙&lt;/sup&gt; is produced naturally within the body, methods have been proposed to increase circulating NO&lt;sup&gt;∙&lt;/sup&gt; within humans. Most notably, the performance of regular exercise, the use of pharmaceutical agents, and the use of nutritional ingredients has been studied. A newly developed molecule known as 2 nitrooxy ethyl 2 amino 3 methylbutanoate (VEEN™) is now being studied as a next generation NO&lt;sup&gt;∙&lt;/sup&gt; agent. This paper discusses the importance of NO&lt;sup&gt;∙&lt;/sup&gt; in human health, with a particular focus on methods to increase NO&lt;sup&gt;∙&lt;/sup&gt;. Attention is given to VEEN™, highlighting the studies performed to date using this molecule. &lt;/span&gt;&lt;/p&gt;

Universal structures of normal and pathological heart rate variability

The circulatory system of living organisms is an autonomous mechanical system softly tuned with the respiratory system, and both developed by evolution as a response to the complex oxygen demand patterns associated with motion. Circulatory health is rooted in adaptability, which entails an inherent variability. Here, we show that a generalized N-dimensional normalized graph representing heart rate variability reveals two universal arrhythmic patterns as specific signatures of health one reflects cardiac adaptability, and the other the cardiac-respiratory rate tuning. In addition, we identify at least three universal arrhythmic profiles whose presences raise in proportional detriment of the two healthy ones in pathological conditions (myocardial infarction; heart failure; and recovery from sudden death). The presence of the identified universal arrhythmic structures together with the position of the centre of mass of the heart rate variability graph provide a unique quantitative assessment of the health-pathology gradient.

A National Survey of Mentoring Practices for Young Investigators in Circulatory and Respiratory Health.

Background. Improving mentorship may help decrease the shortage of young investigators (graduate students, postdoctoral fellows, and new investigators) available to work as independent researchers in cardiovascular and respiratory health. Objectives. To determine (1) the mentoring practices for trainees affiliated with the Canadian Institutes of Health Research (CIHR), Institute of Circulatory and Respiratory Health (ICRH), (2) the positive attributes of mentors, and (3) the recommendations regarding what makes good mentorship. Methods. We conducted a survey and descriptive analysis of young investigators with a CIHR Training and Salary Award from 2010 to 2013 or who submitted an abstract to the ICRH 2014 Young Investigators Forum. Clinicians were compared to nonclinicians. Results. Of 172 participants, 7.0% had no mentor. Only 43.6% had defined goals and 40.7% had defined timelines, while 54.1% had informal forms of mentorship. A significant proportion (33.1%) felt that their current mentorship did not meet their needs. Among clinicians, 22.2% would not have chosen the same mentor again versus 11.4% of nonclinicians. All participants favored mentors who provided guidance on career and work-life balance. Suggestions for improved mentoring included formal mentorship, increased networking, and quality assurance. Conclusion. There is an important need to improve mentoring in cardiovascular and respiratory health.

The impact of dual antiplatelet therapy duration on primary composite endpoint after drug-eluting stent implantation: A meta-analysis of 10 randomized trials

a Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China b Sheffield Teaching Hospitals and the University of Sheffield, Sheffield, United Kingdom c Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands d Department of Cardiology, University College London Hospital, London, United Kingdom e Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing 100037, China f International Centre for Circulatory Health, Imperial College London, London, United Kingdom

The influence of chronic health problems and work-related factors on loss of paid employment among older workers

BackgroundWith an ageing society and increasing retirement ages, it is important to understand how employability can be promoted in older workers with health problems. The current study aimed to determine...

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Objective: To investigate the association between paternal circulatory health in middle age and offspring blood pressure across childhood and adolescence in order to examine the importance of inter-generational influences on blood pressure trajectories and the potential development of hypertension in later adult life. Design and method: We used data from 1,969 paternal-offspring pairs recruited as part of the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. Paternal pressures and arterial stiffness (systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse wave velocity (PWV) and augmentation index (AI)) were measured at the Focus on Fathers clinic between 2011 to 2013. This was linked to 6 prior measures of offspring SBP and DBP taken at research clinics when the ALSPAC participants were approximately 7, 9, 10, 11, 15 and 17 years old. We used both multivariable linear regression and 2 level linear-spline models to model the associations between a one standard deviation increase (z-score) in paternal circulatory measures and offspring SBP and DBP at each time point as well as the intercept (BP at age 7) and rate of blood pressure change from linear slopes between ages 7–11, 11–15 and 15–17 from our multi-level model. Results: A positive association was found between paternal SBP and male offspring systolic and diastolic blood pressures in simple and adiposity adjusted analyses (SBP +1.48 mmHg; CI 0.82 - 2.14 mmHg, p < 0.0001 at age 7 for 1 z-score increase in paternal SBP). These associations remained similar throughout adolescence. No associations were seen with paternal PWV or AI and male offspring pressures. Far weaker or null associations were seen for female blood pressures (p-value for gender interaction=0.01 at 7 years). Conclusions: This study demonstrates sexual dimorphism for associations between paternal and offspring blood pressures which require replication from other studies. The associations were strongest in the pre-pubertal period and, if anything, weakened with adolescence suggesting other environmental factors may be more important in determining age-related increases in blood pressure. Future follow-up is required to test whether associations reappear in later life.

Is vitamin B12 deficiency a risk factor for cardiovascular disease in vegetarians?

The goal of this paper is to describe the role of vitamin B12 deficiency in cardiovascular disease development among vegetarians. Vegetarians have a high prevalence of vitamin B12 deficiency. Deficiency of this vitamin is associated with a variety of atherogenic processes that are mainly, but not exclusively, due to vitamin B12 deficiency-induced hyperhomocysteinemia. Each 5-μmol/L increase above 10 μmol/L of serum homocysteine is associated with a 20% increased risk of circulatory health problems. Mean homocysteine concentration >10 μmol/L among vegetarians was reported in 32 of 34 reports. Macrocytosis associated with vitamin B12 deficiency is also associated with fatal and non-fatal coronary disease, myocardial infarction, stroke, and other circulatory health problems. Compared with non-vegetarians, vegetarians have an improved profile of the traditional cardiovascular disease risk factors, including serum lipids, blood pressure, serum glucose concentration, and weight status. However, not all studies that assessed cardiovascular disease incidence among vegetarians reported a protective effect. Among studies that did show a lower prevalence of circulatory health problems, the effect was not as pronounced as expected, which may be a result of poor vitamin B12 status due to a vegetarian diet. Vitamin B12 deficiency may negate the cardiovascular disease prevention benefits of vegetarian diets. In order to further reduce the risk of cardiovascular disease, vegetarians should be advised to use vitamin B12 supplements.

Natural alternatives to tackling high cholesterol: guidance for community nurses.

The National Institute for Health and Care Excellence issued its final guidance in July on lipid modification, making millions more adults eligible for statin treatment. However, community nurses may encounter many patients for whom statin use is not appropriate for a variety of reasons. This article provides advice for community nurses on methods for improving patients' cholesterol levels and reducing the risk of developing cardiovascular disease if statins are not to be used. The article explains the current situation in the UK in relation to cholesterol, then gives dietary and lifestyle modifications that may help to lower cholesterol levels and help maintain good heart and circulatory health.