Decrease In Cardiovascular Mortality Research Articles

Beta-Blockers and Mortality Reduction in Heart Failure: A Systematic Review of Randomized Controlled Trials

Background: Heart failure is a leading cause of morbidity and mortality. This systematic review evaluates beta blockers' effects on all-cause mortality, cardiovascular mortality, and hospital admissions in heart failure, synthesizing data from over 50 randomized controlled trials. Methods: Using PRISMA principles, the data regarding the effect of beta blockers on heart failure mortality and hospitalizations were synthesized. Extensive database searches (PubMed, Embase, Cochrane Library, and Web of Science) and manual reference checks were used to identify randomized controlled studies that compared beta blockers with placebo or conventional treatment in adults. The quality of data extraction process was evaluated according to the Cochrane Risk of Bias tool following the guidelines. Heterogeneity was assessed (I2), sensitivity analyses guaranteed robustness, and random-effects meta-analyses quantified results. Transparency was guaranteed via PROSPERO registration. Results: Beta-blockers were linked to a 29% decrease in cardiovascular mortality (OR 0.71, 95% CI 0.64–0.79, p< 0.05) and a 33% decrease in all cause mortality (OR 0.67, 95% CI 0.59–0.76, p < 0.05) when compared to alternative therapies. Additionally, beta-blocker-treated patients saw a 37% decrease in hospital admissions (OR 0.63, 95% CI: 0.56–0.71, p < 0.05). The class impact of beta blockers in heart failure treatment is supported by these advantages which were constant across subgroups and beta blocker types. Conclusion: This systematic review corroborates the well-established benefit of beta blockers in lowering mortality and hospitalizations in heart failure patients, particularly with HFrEF. The findings support the use of beta blockers as a cornerstone of heart failure therapy and there is a need for further research to optimize the use of beta blockers in combination with other emerging therapies.

Age-dependent associations with the risk of mental disorders in patients with myocardial infarction: a UK Biobank cohort study

Abstract Background Despite an overall decrease in cardiovascular mortality in recent decades due to effective preventive strategies, a concerning trend is emerging among young adults, with a rising incidence of myocardial infarction (MI) and its poor prognosis. Previous studies report that a significant association between mental disorders and the incidence and prognosis of MI. However, a detailed age-specific information is still lacking. Purpose We aimed to determine whether the risk of developing mental disorders after MI differs based on age and to stratify individuals at a higher risk. Methods From the UK Biobank prospective database (n=502,386), we collected data on patients with a prior MI (n=10,840) and compared them to age- and sex-matched controls (n=54,197) in a 1:5 ratio. Diagnoses of mental disorders were ascertained through linked hospital admission and mortality data, using the appropriate ICD-10-CM codes. Mental disorders were defined by at least two inpatient or outpatient claims within 1 year. The primary outcome was a composite of incident mental disorders, including depression, anxiety, stress-related, and somatoform disorders. Follow-up was done until the first diagnosis of mental disorders or the end of 2022. Results During a median follow-up of 13.7 years (interquartile range 12.8-14.5 years), the incidence rate of the primary outcome was 9.28 vs. 5.37/1,000 person-years among patients with MI and controls, respectively (p<0.001). A prior MI history demonstrated an independent association with the risk of incident mental disorders, yielding an adjusted hazard ratio (aHR) of 1.41 (95% confidence interval [CI], 1.29–1.54; p<0.001) after adjusting for confounders. This was comparable to heavy drinking and family history of depression. Notably, the risk of mental disorders attributed to previous MI was more prominent in younger individuals aged <55 years than their older counterpart (aHR 1.61 vs. 1.33) (p-for-interaction 0.020). Similar results were observed in the analysis of two important components: depression and anxiety disorder. Furthermore, in younger patients with MI (<55 years), mental disorders significantly increased the risk of mortality, while not in older patients. Conclusion MI was associated with a higher risk of incident mental disorders, resulting in poor prognosis, particularly in young individuals. Active surveillance and prevention for incident mental disorders after young MI may be beneficial.Cumulative Incidence of Mental Disorders

New insights into the therapeutic options to lower lipoprotein(a).

Elevated levels of lipoprotein(a) [Lp(a)] represent a risk factor for cardiovascular disease including aortic valve stenosis, myocardial infarction and stroke. While the patho-physiological mechanisms linking Lp(a) with atherosclerosis are not fully understood, from genetic studies that lower Lp(a) levels protect from CVD independently of other risk factors including lipids and lipoproteins. Hereby, Lp(a) has been considered an appealing pharmacological target. However, approved lipid lowering therapies such as statins, ezetimibe or PCSK9 inhibitors have a neutral to modest effect on Lp(a) levels, thus prompting the development of new strategies selectively targeting Lp(a). These include antisense oligonucleotides and small interfering RNAs (siRNAs) directed towards apolipoprotein(a) [Apo(a)], which are in advanced phase of clinical development. More recently, additional approaches including inhibitors of Apo(a) and gene editing approaches via CRISPR-Cas9 technology entered early clinical development. If the results from the cardiovascular outcome trials, designed to demonstrate whether the reduction of Lp(a) of more than 80% as observed with pelacarsen, olpasiran or lepodisiran translates into the decrease of cardiovascular mortality and major adverse cardiovascular events, will be positive, lowering Lp(a) will become a new additional target in the management of patients with elevated cardiovascular risk.

STAT1 regulates neutrophil gelatinase B-associated lipocalin induction in influenza-induced myocarditis

Influenza is a significant public health and economic threat around the world. Epidemiological studies have demonstrated a close association between influenza pandemics and cardiovascular mortality. Moreover, it has been shown that there is a decrease in cardiovascular mortality in high-risk patients following vaccination with the influenza vaccine. Here, we have investigated the role of anti-viral STAT1 signaling in influenza-induced myocarditis. Wild-type mice (C57BL/6) were infected with either influenza A/PR/8/34 or control, and cellular response and gene expression analysis from the heart samples were assessed 7 days later. The expression of interferon response genes STAT1, STAT2, Mx1, OASL2, ISG15, chemokines CCL2, CCL3, CXCL9 and CXCL10, and the frequency of neutrophils (CD45+CD11b+Ly6G+) and CD4+ T cells (CD45+CD4+) were all significantly increased in influenza-infected mice when compared to vehicle controls. These data suggest that influenza infection induces interferons, inflammatory chemokines, and cellular recruitment during influenza infection. We further investigated the role of STAT1 in influenza-induced myocarditis. The frequency of neutrophils and the levels of lipocalin 2 were significantly increased in STAT1−/− mice when compared to WT controls. Finally, we investigated the role of Lcn2 in viral-induced myocarditis. We found that in the absence of Lcn2, there was preserved cardiac function in Lcn2−/− mice when compared to WT controls. These data suggest that the absence of Lcn2 is cardioprotective during viral-induced myocarditis.

Contribution of ticagrelor therapy in patients with acute coronary syndrome and patients with myocardial infarction to the achievement of State Program "Health Development" target in Russia as a whole and Russian regions in 2023-2025

Aim. To evaluate the contribution ticagrelor compared with clopidogrel therapy in patients with acute coronary syndrome (ACS) and patients with myocardial infarction (MI) to achieving the State Program "Health Development" target "decrease of cardiovascular mortality" in the country as a whole and Russian regions in 2023-2025.Material and methods. In the first year of therapy, all patients over 18 years of age with a confirmed diagnosis of ACS who were indicated for dual antiplatelet therapy (DAPT) were considered as the target population. In the second and third years, therapy was continued by patients at high risk of coronary events after MI. The number of deaths that could be additionally prevented within 1 year after diagnosis using DAPT with ticagrelor compared with DAPT with clopidogrel was calculated based on the PLATO trial. For post-MI patients, the number of deaths that could be prevented in the second and third years of therapy using DAPT with ticagrelor+acetylsalicylic acid (ASA) compared with ASA monotherapy was calculated based on the PEGASUS trial. The proportion of the target "decrease of cardiovascular mortality of the population" in 2023-2025 that can be achieved by using DAPT with ticagrelor instead of clopidogrel or ASA monotherapy was calculated.Results. The use of ticagrelor as part of DAPT for patients with ACS will make it possible (compared to DAPT with clopidogrel or ASA) to contribute to achieving "decrease of cardiovascular mortality" target in the Russian Federation:in 2023 — 8,0% due to expected prevention of 4443 cardiovascular deaths,in 2024 — 30,3% due to expected prevention of 4753 cardiovascular deaths,in 2025, 5366 cardiovascular deaths can be Conclusion. The use of ticagrelor as part of DAPT for patients with ACS will contribute to achieving "decrease of cardiovascular mortality" target in the Russian Federation.

Cardiovascular outcomes of dapagliflozin in type 2 diabetes mellitus in real clinical practice: a meta-analysis of observational studies

Aim. To conduct a meta-analysis of population-based observational studies of dapagliflozin compared with therapy without iNGLT-2 to assess its effect on the risk of cardiovascular events in patients with type 2 diabetes mellitus in real-world practice.
 Materials and methods. A systematic search was carried out in 3 bibliographic databases PubMed (Medline), Embase and eLibrary. According to the search results, 1,451 records were identified. 3 studies were selected for inclusion in the meta-analysis: CVD-REAL Nordic, EASEL Population-Based Cohort Study and CARDIA-MOS. The criteria for evaluating the effectiveness were the frequency of major adverse cardiovascular events (MACE) and cardiovascular mortality. The meta-analysis was carried out in the RevMan 5.4.1.
 Results. According to the results of the meta-analysis, there was a statistically significant association between the use of dapagliflozin and a decrease in the risk of MACE: relative risk 0.73, 95% confidence interval 0.650.82, as well as a decrease in cardiovascular mortality: relative risk 0.67, 95% confidence interval 0.480.92.
 Conclusion. Our results demonstrated that the use of dapagliflozin is associated with a reduction in the risk of developing MACE and cardiovascular mortality in patients with type 2 diabetes mellitus with cardiovascular diseases or cardiovascular risk factors.

Impact of heat on all-cause and cause-specific mortality: A multi-city study in Texas

BackgroundStudies on the health effects of heat are particularly limited in Texas, a U.S. state in the top 10 highest number of annual heat-related deaths per capita from 2018 to 2020. This study assessed the effects of heat on all-cause and cause-specific mortality in 12 metropolitan statistical areas (MSAs) across Texas from 1990 to 2011. MethodsFirst, we determined the heat thresholds for each MSA above which the relation between temperature and mortality is linear. We then conducted a distributed lag non-linear model for each MSA, followed by a random effects meta-analysis to estimate the pooled effects for all MSAs. We repeated this process for each mortality cause and age group to achieve the effect estimates. ResultsWe found a 1 °C temperature increase above the heat threshold is associated with an increase in the relative risk of all-cause mortality of 0.60% (95%CI [0.39%, 0.82%]) and 1.10% (95%CI [0.65%, 1.56%]) for adults older than 75. For each MSA, the relative risk of mortality for a 1 °C temperature increase above the heat threshold ranges from 0.10% (95%CI [0.09%, 0.10%]) to 1.29% (95%CI [1.26%, 1.32%]). Moreover, elevated temperatures showed a slight decrease in cardiovascular mortality (0.37%, 95%CI [-0.35%, 1.09%]) and respiratory disease (1.97%, 95%CI [-0.11%, 4.08%]), however this effect was not considered statistically significant.. ConclusionOur study found that high temperatures can significantly impact all-cause mortality in Texas, and effect estimates differ by MSA, age group, and cause of death. Our findings generate critical information on the impact of heat on mortality in Texas, providing insights for policymakers on resource allocation and strategic intervention to reduce heat-related health effects.

Effects of Sodium-Glucose Cotransporter Inhibitor Use in Type 2 Diabetes Mellitus Patients With Heart Failure.

The advances in the development of sodium-glucose cotransporter 2 inhibitors (SGLT2i) have expanded the variety of favorable approaches to treating diabetes mellitus. It is possible to have an improvement in insulin resistance and natriuresis by inhibiting the reabsorption of sodium and glucose at theproximal tubules in the kidney, and a decrease in cardiovascular mortality in patients with diabetes mellitus (DM). In addition, SGLT2i provides renoprotection by reducing intraglomerular higher blood pressure. The usage of SGLT2i also provides hemodynamic and metabolic benefits. SGLT2i demonstrates large cardiovascular benefits in patients both with and without diabetes, as well as in existing heart failure patients. These SGLT2i have direct and indirect effects on the kidney, likely contributing to stated cardiovascular benefits. Here we review the literature on the direct effects of SGLT2 inhibitors in diabetic patients with heart failure (HF).We assume that the benefit in cardiac cells modulated by SGLT2i is due to theinhibition of sodium transporters affecting intracellular sodium homeostasis. In conclusion, the sodium transporters in cardiac cells provide, at least partly, an example of the clinical benefits of SGLT2i observed in HF patients.

Evaluation of the effectiveness of serelaxin in the treatment of patients with acute decompensation of heart failure: Five-year follow-up

Aim. To evaluate the effectiveness of serelaxin with subsequent quadritherapy in the treatment of patients with acute decompensation of heart failure in the long term outcomes.Material and Methods. A five-year observational, comparative, longitudinal study was conducted with the participation of 34 patients with heart failure. Standard laboratory and instrumental methods of examination were performed, including the determination of the level of Nt-proBNP, electrocardiography, echocardiography. The quality of life was assessed on the basis of the SF-36 questionnaire, the state of health using a visual analog scale (VAS), a survival forecast was made using the MAGGIC scale and the Seattle Heart Failure Model calculator. The assessment of adherence to treatment was carried out using the questionnaire “COP-25”.Results and Discussion. With serelaxin therapy at the 14th day, there was a significant decrease (p ˂ 0,05) of Nt-proBNP level, pulmonary artery pressure, as well as an increase of left ventricular (LV) ejection fraction (EF) by an average of 5%, which coincided with the leveling of manifestations of heart failure (HF) decompensation and improvement of clinical and instrumental parameters. There was a statistically significant (p ˂ 0,05) improvement in the quality of life based on the patient’s subjective assessment. Stable positive dynamics was recorded on the basis of the SF-36 questionnaire for all health indicators, not only physical, but also social and mental. Subsequent quadrotherapy reduced the mortality rate of patients in the study cohort of patients, as well as increased adherence to treatment.Conclusion. The use of serelaxin does not lead to a decrease in cardiovascular mortality, however, it reduces the number of hospitalizations due to acute decompensation of heart failure. The subsequent quadrotherapy leads to an increase in the quality of life, physical, social activity and adherence to the treatment. Reverse remodeling of the left heart chambers and an increase in EF LV is characterized by a decrease of the functional class of CHF, which indicates the influence of this therapy on the key pathogenetic mechanisms of the disease.

CKD-Associated Cardiovascular Mortality in the United States: Temporal Trends From 1999 to 2020

Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular (CV) mortality, but there are limited data on temporal trends disaggregated by sex, race, and urban/rural status in this population. Retrospective observational study. The Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research database. Patients with CKD and end-stage kidney disease (ESKD) stratified according to key demographic groups. Etiologies of CKD- and ESKD-associated mortality between 1999 and2000. Presentation of age-adjusted mortality rates (per 100,000 people) characterized by CV categories, ethnicity, sex (male or female), age categories, state, and urban/rural status. Between 1999 and 2020, we identified 1,938,505 death certificates with CKD (and ESKD) as an associated cause of mortality. Of all CKD-associated mortality, the most common etiology was CV, with 31.2% of cases. Between 1999 and 2020, CKD-related age-adjusted mortality increased by 50.2%, which was attributed to an 86.6% increase in non-CV mortality but a 7.1% decrease in CV mortality. Black patients had a higher rate of CV mortality throughout the study period, although Black patients experienced a 38.6% reduction in mortality whereas White patients saw a 2.7% increase. Hispanic patients experienced a greater reduction in CV mortality over the study period (40% reduction) compared to non-Hispanic patients (3.6% reduction). CV mortality was higher in urban areas in 1999 but in rural areas in2020. Reliance on accurate characterization of causes of mortality in a large dataset. Among patients with CKD-related mortality in the United States between 1999 and 2020, there was an increase in all-cause mortality though a small decrease in CV-related mortality. Overall, temporal decreases in CV mortality were more prominent in Hispanic versus non-Hispanic patients and Black patients versus White patients.

Early atrial fibrillation rhythm control after stroke

In patients with atrial fibrillation, attempts to restore and maintain sinus rhythm are generally made when arrhythmia is symptomatic. The primary analysis of the EAST-AFNET 4 trial showed a significant decrease in cardiovascular mortality and stroke with early rhythm control compared with usual care in patients with atrial fibrillation diagnosed in the previous 12 months.1 This finding corroborates a recent meta-analysis.2 In patients with atrial fibrillation and a history of stroke, however, the benefit of rhythm therapy is less certain.

Abstract 15520: The Relationships Between Daily Step Counts With All-Cause and Cardiovascular Mortality: A Meta-Analysis

Introduction: There is good evidence that inactivity and walking less steps per day increase risk of cardiovascular (CV) disease and general health. However, the golden limit of steps and their role in health is still debatable. Hypothesis: The aim of this meta-analysis was to evaluate the relationship between step count and all-cause and CV mortality. Methods: We systematically searched all electronic databases from inception until 12 th June 2022. Main endpoints were all-cause mortality and CV mortality. Inverse-variance weighted random effects model was used to calculate the number of steps per day and mortality. Results: Eighteen cohort studies with a total of 67,111 (general healthy subjects and/or patients at cardiovascular risk) with a median follow up 6.9 years were included in the meta-analysis. A 1000-step increment was associated with 12% decreased risk of all-cause mortality HR 0.88 (95%CI: 0.85 to 0.91; p<0.001), while a 500-step increment was associated with 6% decrease of CV mortality - HR 0.94 (95%CI 0.91 to 0.97; p<0.001, Figure 1 ]. Compared to quartile with median steps per day 4038 used as reference quartile, the quartile 1 (Q1, median steps: 6201), quartile 2 (Q2, median steps 7094) and quartile 3 (Q3, median steps 11275) were associated with lower risk for all-cause mortality (49%, 55% and 67% respectively; p≤0.001 for all), and reduced cardiovascular mortality by 10 and 55% for Q1 and Q2, respectively (p≤0.02 for all ; Figure 2 ). Conclusions: This meta-analysis reveals the clear inverse association with the number of step count and all-cause and cardiovascular mortality with the largest health benefit for individuals with the highest number of steps daily.

Adherence to exercise and fitness following exercise-based outpatient cardiac rehabilitation: a cross-sectional survey for Germany

BackgroundExercise-based cardiac rehabilitation is safe and effective, evidence-based and implemented in national and international cardiac rehabilitation guidelines. Recent data show a decrease in cardiovascular mortality, reduced hospital admissions and an overall improvement in quality of life. To maintain positive effects and to prevent further cardiovascular events a major goal of cardiac rehabilitation is to induce a long-term health behaviour change and the integration of regular physical activity and exercise training in everyday life. The aim of this study is to evaluate the adherence of cardiac patients to exercise-based programs following rehabilitation phase III.MethodsA nationwide online cross-sectional survey was conducted. All outpatient aftercare providers who offer sports rehabilitation programs (heart groups) for cardiac patients in Germany were contacted. The questionnaire comprised 15 questions in five subcategories (general information regarding the outpatient aftercare provider, structure of rehabilitation sport programs, membership structure, content of heart groups, adherence to exercise-based programs).Results560 of 2447 outpatient aftercare providers participated in the survey (response rate: 23%). On average, rehabilitation sport facilities hosted 2 (IQR 2) heart groups per week, and 23 patients (IQR 30) (61% males; 31% females) per facility completed rehabilitation sport prescription in 2018. Almost all providers offer follow-up programs on a self-payer basis after rehabilitation sport prescription ends. Adherence to follow-up programs was at 54% (IQR 65; 55% males and 50% females). With 60% (IQR 71), patients with a statutory health insurance (mainly pensioners) adhere slightly more often to a follow-up program compared to privately insured persons (mainly population with a high income or civil servants) with 50% and significantly more often compared to persons who were insured by the German pension fund (covering working population) with only 9% (IQR 89) adherence.ConclusionAlmost all outpatient aftercare providers offer follow-up programs for cardiac rehabilitation patients but only half of them actually participate. Younger people (working population) do not adhere sufficiently to sport and exercise programs following rehabilitation phase III. This seems critical to address in terms of achieving long-term rehabilitation goals.

Remote monitoring of outpatients discharged from the emergency cardiac care department

The coronavirus disease 2019 (COVID-19) pandemic has shown the need for the development of telemedicine technologies, especially remote follow-up using vital sign telemonitoring. In the Russian Federation, this approach is also justified by the remoteness factor with a shortage of medical workers in distant areas of the country.Aim. To study the potential of remote monitoring in outpatients discharged after acute decompensated heart failure and acute coronary syndrome.Material and methods. The study included 392 patients randomized to active follow-up groups with remote blood pressure (BP) monitoring (group 1, n=197) and standard management (group 2, n=195). The follow-up period lasted 3 months.Results. During the follow-up period, patients managed with BP and heart rate telemonitoring tended to decrease in systolic BP from 132 (interquartile range (IQR), 121-139) mm Hg up to 125 (IQR, 115-130) mm Hg (p=ns). On the contrary, the 2nd group patients had a slight increase in systolic BP from 127 (IQR, 115-137) mm Hg up to 132 (IQR, 124-142) mm Hg (p=ns).The patients of group 2 were more likely to receive diuretics and nitrates after 3-month follow-up, which can be considered a negative factor. This may indicate no improvement in the course of heart failure and chronic coronary artery disease with the absence of therapy correction over time.During follow-up, four patients from group 1 were hospitalized due to decompensated heart failure or an episode of acute coronary syndrome with a total duration of 30 days, compared with 13 hospitalizations for the same reasons in group 2 (p=0,027; OR 3,4; 95% CI 1,1-10,8). In total, six patients died during the follow-up period in group 1, and eleven patients died in group 2 (p=0,226; OR 1,9; 95% CI 0,7-5,3). At the same time, three patients in the 1st group and one patient from the 2nd group died during the follow-up period due to COVID-19. Thus, cardiovascular mortality consisted of 3 and 10 patients in groups 1 and 2, respectively (p=0,052; OR 3,5; 95% CI 0,9-12,9).Conclusion. Three-month remote management of patients after decompensated heart failure or acute coronary syndrome, including BP monitoring, showed a significant reduction in the hospitalization rate and a trend towards a decrease in cardiovascular mortality.

Estimation of the Effect of Salt-Intake Reduction on Cardiovascular Mortality Decline between 1950 and 2017 in Japan: A Retrospective Simulation Study.

In Japan, a decrease in cardiovascular mortality has coincided with reduced population salt intake since the 1950s. The purpose of this study was to quantify the effect of reduced population salt intake on the long-term trends of cardiovascular mortality. Using government statistics and epidemiological study results in people of 20–69 years old from 1950 to 2017, including the National Health and Nutrition Survey, we developed a system dynamics model of age-specific cardiovascular mortality and salt intake. We estimated the period and cohort effects on mortality and calibrated the model for the historical mortality rate. We then simulated the counterfactual scenario of no decrease in salt intake to estimate the reduction in cardiovascular deaths associated with decreased mean salt intake. Compared with the base run and calibrated to the actual data, approximately 298,000 and 118,000 excess deaths were observed in men and women, respectively, assuming no change in salt intake over the entire period. The model suggests that the decline in salt intake since the 1950s has contributed to a non-negligible reduction in cardiovascular mortality.

Blood pressure control in the general and high risk populations, longitudinal trends

Abstract Introduction Despite better control of high blood pressure (BP) in the general as well as high cardiovascular (CV) risk populations as a factor contributing to the decrease in CV mortality since 1990, the targets set by the guidelines may not have been reached. Purpose We analysed longitudinal trends in BP control in the general and high risk populations, to assess implementation of guidelines and to identify subpopulations with still unsatisfactory BP control. Methods Analysis of seven independent surveys of the general population (Czech MONICA and post-MONICA studies, 1985–2017) and five independent surveys of patients with stable manifest coronary heart disease (CHD) 1995–2017 (Czech samples of the EUROASPIRE I-V surveys). Results A total of 15 000 persons (Czech MONICA) and 2 098 patients (Czech EUROASPIRE) were investigated. In the 1985–2017 period, mean systolic BP decreased in the general population (MONICA) from 134 to 128 mmHg (p<0.001) and diastolic BP from 84 to 82.5 mmHg (p<0.01), hypertensive levels of BP (>140/90mmHg) were found in 45% in 1995 but only in 27.5% in 2017, and the prevalence of uncontrolled severe hypertension (BP>180/110 mmHg) decreased from 3 to 1%. The proportion of properly controlled hypertension increased from 13.2 to 53% (p<0.0001). In the 1995–2017 surveys of the high-risk population (EUROASPIRE) systolic BP decreased from 144.1 to 135.5 mmHg (p<0.001), diastolic BP from 87.5to 83.5mmHg (p<0.01), higher than recommended BP (>140/90mmHg, >140/85mmHg in diabetics) was found in 66.2% in 1995, still present as much as in 54.4% in 2017. Proportion of patients with very high BP (BP>180/110 mmHg) decreased from 18.4 to 1% only. Drugs with a potentially antihypertensive effect were used in 79.9 and 95.3% of patients in 1995 and 2017, respectively (p<0.0001). Population BP levels ceased to decline since 2000/01 survey, in the CHD population since the 2012/13 survey. This is obviously due to considerable increase in prevalence of obesity, and an increasing prevalence of diabetes, both in the general and high-risk populations. The more intensive medical high BP treatment seems to have a beneficial effect on hypertension control, even more in the general than in the high risk population. Conclusions The recent trend in BP levels, both in the general and high-risk populations, are far from satisfactory, with the main causative factor suggested to be the increasing prevalence of obesity and diabetes. While there has been progress in hypertension control, more in the general nad limited in high-risk population, truly effective BP control may be illusory without comprehensive CV risk factor control. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Agency for Medical Research, Ministry of Health of the Czech Republic

Prognostic effects of cardiovascular rehabilitation: facts and myths.

Since CR was introduced, studies have been carried out to discover the effect of CRHPs on cardiovascular morbidity and mortality and on heart-disease patients' quality of life. The first meta-analyses showed improvement in cardiovascular morbidity and mortality, although the studies were conducted in the coronary pre-reperfusion era, before the generalized use in secondary prevention of drugs such as statins, beta-blockers, or renin-angiotensin-system inhibitors, which have produced a decrease in cardiovascular mortality. In Europe, analyzing 25 studies with more than 200,000 patients. It concluded that, in spite of the great heterogeneity of the programs, CR clearly decreases mortality after ACS. Nevertheless, a strategy of CRHP standardization and evaluation is needed. In 2017, a study was carried out in our hospital to evaluate the effectiveness of multidisciplinary CRHP intervention on cardiovascular morbidity and mortality, recurrence of cardiovascular events, the control of RFCV and lifestyle changes in patients after ACS. A total of 442 patients were included who had presented an acute cardiovascular event in the previous six months; 306 patients from the CR group and 136 others with standard cardiology follow-up were used as controls. 405 patients completed follow-up for a median of 60 months. Compared to the usual treatments in cardiology, the patients who underwent CRHPs presented fewer readmissions for cardiovascular reasons (17% vs. 43.38%, P<0.001), fewer major cardiovascular events (11.9% vs. 27.2%, P<0.001) and new revascularizations (9.3% vs. 21.32%, P=0.001), with lower cardiovascular mortality (0 vs. 2.2%, P=0.014). It also led to better control of the RFCV (66% vs. 19.85%, P<0.001) and favored lifestyle changes in these patients (91% vs. 61%, P<0.001). Therefore, in our setting, the performance of CRHPs was shown to be effective in reducing cardiovascular morbidity and mortality and in the secondary prevention of coronary patients.

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.

Dynamics of blood lipid spectrum indicators in children with juvenile idiopathic arthritis taking into account basic therapy

Summary. In patients with rheumatoid arthritis, the risk of cardiovascular disease associated with atherosclerosis, is significantly increased compared to the general population. Studies of a cohort of children and young adults indicated that the atherosclerotic process usually begins long before its clinical manifestation, and the degree of vascular changes is associated with both the number of risk factors and their severity. The use of basic drugs in rheumatic patients contributed to a decrease in cardiovascular mortality, mainly due to the elimination of the activity of the process, which itself is an inducer of the onset and progression of atherosclerosis. The aim of the study was to establish the nature of changes in the blood lipid spectrum in children with juvenile idiopathic arthritis under the influence of basic therapy. Object and methods. We examined 85 children (8–18 years old) with juvenile idiopathic arthritis and oligo- (61.5 %) and polyarticular (38.5 %) variants of the disease, twice, with an interval of one year. The parameters of the blood lipid spectrum were determined by the level of: total cholesterol, triglycerides, high density lipoproteins, atherogenic coefficient by the enzymatic method on an automatic biochemical analyzer-photometer A25, low lipoproteins and very low density cholesterol by calculation method. Research results. Analysis of the lipid profile in the group as a whole showed that patients with juvenile idiopathic arthritis had significantly higher total cholesterol values (p &lt; 0.05), a tendency to an increase in the level of triglycerides, low lipoproteins and very low density cholesterol, which led to an increase in the atherogenic coefficient level. When analyzing the lipid spectrum of blood after a year, a tendency towards a decrease in the level of atherogenic and an increase in antiatherogenic fractions of the lipid spectrum with normalization of atherogenic coefficient was noted. In the group of patients receiving monotherapy with methotrexate, no significant changes in the lipid spectrum of blood were observed after one year. Against the background of combined basic therapy, the blood lipid spectrum normalizes, namely, a decrease in total cholesterol, an increase in high density lipoproteins of cholesterol, a decrease in the level of low density cholesterol (p &lt; 0.05), triglycerides and very low density cholesterol and, as a consequence, significant decrease in atherogenic coefficient (p &lt; 0.01). Conclusions. The dynamics of changes in blood lipid spectrum indicators in children with juvenile idiopathic arthritis confirms the need to use combined basic therapy not only to control the activity of main pathological process, but also to prevent the development of atherogenic dyslipoproteinemias.

Residential greenness and cardiovascular disease incidence, readmission, and mortality

Background: Living in greener areas of cities was linked to increased physical activity levels, improved mental wellbeing, and lowered harmful environmental exposures, all of which may influence health. However, whether living near urban green spaces may modify the risks of cardiovascular disease incidence, progression, and premature mortality is unclear. We aimed to examine the associations between residential green spaces and the incidence of acute myocardial infarction (AMI) and heart failure (HF), post-AMI and HF hospital readmissions, and mortality. Methods: We simultaneously followed four large population-based cohorts in Ontario, Canada, including the entire adult population, adults free of AMI and HF, and survivors of AMI or HF from 2000 to 2014. We estimated residential exposure to green spaces using the satellite-derived observations and ascertained health outcomes using validated disease registries. We estimated the associations using spatial random-effects Cox proportional hazards models. We conducted various sensitivity analyses including further adjusting for property values and performing exploratory mediation analysis. Results: Each interquartile range increase in residential greenness was associated with a 7% (95% confidence interval [CI]: 4%-9%) decrease in incident AMI and a 6% (95% CI: 4%-7%) decrease in incident HF. Residential greenness was linked to a ~10% decrease in cardiovascular mortality in both adults free of AMI and HF and the entire adult population. These associations remained consistent in sensitivity analyses and were accentuated among younger adults. Additionally, ~53% of the protective association between greenness and cardiovascular mortality was found to be mediated through its effect on AMI and HF. Conversely, living near green spaces was not associated with any delay in readmission or mortality among AMI and HF patients. Conclusions: Living in urban areas with more green spaces was associated with improved cardiovascular health in people free of AMI and HF, but not among individuals already developed these conditions.