Early Cardiovascular Disease Research Articles

The association between polycystic ovary syndrome and early cardiovascular disease morbidity strengthens.

The association between polycystic ovary syndrome and early cardiovascular disease morbidity strengthens.

Tri-Hybrid Naive Bayes Classification Model for Early Cardiovascular Disease Detection

Tri-Hybrid Naive Bayes Classification Model for Early Cardiovascular Disease Detection

Air Pollution, Built Environment, and Early Cardiovascular Disease.

As the world's population becomes increasingly urbanized, there is growing concern about the impact of urban environments on cardiovascular health. Urban residents are exposed to a variety of adverse environmental exposures throughout their lives, including air pollution, built environment, and lack of green space, which may contribute to the development of early cardiovascular disease and related risk factors. While epidemiological studies have examined the role of a few environmental factors with early cardiovascular disease, the relationship with the broader environment remains poorly defined. In this article, we provide a brief overview of studies that have examined the impact of the environment including the built physical environment, discuss current challenges in the field, and suggest potential directions for future research. Additionally, we highlight the clinical implications of these findings and propose multilevel interventions to promote cardiovascular health among children and young adults.

Introduction to the Compendium on Early Cardiovascular Disease.

Introduction to the Compendium on Early Cardiovascular Disease.

Imaging Early Life Cardiovascular Phenotype.

The growing epidemics of obesity, hypertension, and diabetes, in addition to worsening environmental factors such as air pollution, water scarcity, and climate change, have fueled the continuously increasing prevalence of cardiovascular diseases (CVDs). This has caused a markedly increasing burden of CVDs that includes mortality and morbidity worldwide. Identification of subclinical CVD before overt symptoms can lead to earlier deployment of preventative pharmacological and nonpharmacologic strategies. In this regard, noninvasive imaging techniques play a significant role in identifying early CVD phenotypes. An armamentarium of imaging techniques including vascular ultrasound, echocardiography, magnetic resonance imaging, computed tomography, noninvasive computed tomography angiography, positron emission tomography, and nuclear imaging, with intrinsic strengths and limitations can be utilized to delineate incipient CVD for both clinical and research purposes. In this article, we review the various imaging modalities used for the evaluation, characterization, and quantification of early subclinical cardiovascular diseases.

Influence of genetic polymorphisms on serum biomarkers of cardiac health.

Cardiovascular diseases (CVDs) are a leading cause of death worldwide which is why early risk prediction is crucial. Discrete Polygenic risk score (PRS) measurement using saliva or dried blood spot samples collected at home poses a convenient means for early CVD risk assessment. The present study assessed the effects of 28 disease-associated single nucleotide polymorphisms (SNPs) on 16 serological cardiac markers and also aggregated the risk alleles into a PRS to evaluate its applicability in CVD-risk prediction. The study assessed genetic and serological markers in 184 individuals. The association between serological markers and individual genetic variants was evaluated using a two-tailed t test while the associations of serum markers with the PRS was analyzed using the Pearson correlation. The comparative analysis of genotypes revealed statistically significant associations between serum markers and CVD-associated SNPs with Apo B: Apo A-1, LDL Direct, Apo B, sdLDL, hsCRP, Lp(a), NT-proBNP, and PLAC levels being significantly associated with the risk alleles of the SNPs, rs12526453, rs5186, rs10911021, rs1801131, rs670, rs10757274, and rs10757278. Increased PLAC levels were associated with rs10757274 and rs10757278 (P < .05). The SNPs, rs1801133, rs1549758, rs1799983, rs5082, and rs5186 were significantly associated with an increase in the cardioprotective markers, HDL and ApoA1 (P < .05). Furthermore, the PRS was associated with increasing levels of several serum cardiac markers (r2 > 0.6). Significant correlations were observed between high PRSs and NT-proBNP and ox-LDL levels with the r2 values being 0.82 (95% CI = 0.13-0.99; P = .03) and 0.94 (95% CI = 0.63-0.99; P = .005), respectively. The present study reports that SNPs have differential effects on serum markers with rs12526453, rs5186, rs10911021, rs1801131, rs670, rs10757274, and rs10757278 showing significant associations with elevated marker levels, which are indicators of deteriorating cardiac health. A unified PRS using several SNPs was also associated with an increase in serum markers levels, especially, NT-proBNP and ox-LDL. Genetic assessment via a convenient at-home collection to calculate the PRS can serve as an effective predictive tool for early CVD-risk assessment. This may help identify the risk groups that may require increased serological monitoring.

Predictors of microalbuminuria in workers of locomotive crews: prospective observational study

BACKGROUND: Cardiorenal relationships are one of the key problems in cardiology and nephrology. Microalbuminuria is a symptom of kidney pathologies and cardiovascular diseases. Studying the causes of microalbuminuria will help in solving the issue of pathological cardiorenal relationships.&#x0D; AIM: To study the causes of the origin of microalbuminuria on the group of locomotive crews employees of the Trans-Baikal Railway.&#x0D; MATERIALS AND METHODS: Predictors of microalbuminuria were established using data from a 6-year prospective follow-up of 22 clinical and anamnestic items in a natural cohort group of initially healthy 7,959 men (workers of locomotive crews) aged 1866 years. A confusion matrix, multivariate regression model, and relative risk assessment were used for this purpose.&#x0D; RESULTS: Microalbuminuria was found to be caused by excessive alcohol consumption, arterial hypertension, dyslipidemia, family history of early cardiovascular disease, grade III retinopathy, and smoking. The established predictors of microalbuminuria showed statistical heterogeneity in different analyses, referring to the significance of their assessment in the models used.&#x0D; CONCLUSION: The statistical heterogeneity of microalbuminuria predictors of is probably determined by and related to their qualitative characteristics and the unique implementation of their damaging effect in the formation and progression of microalbuminuria at the cellular level. The results of the study showed the need to continue the examination of predictors of microalbuminuria using other statistical analysis tools until their unique specific characteristics are known and the effects of damage on the formation of this pathological symptom are clarified.

Cardiovascular disease/stroke risk stratification in deep learning framework: a review.

The global mortality rate is known to be the highest due to cardiovascular disease (CVD). Thus, preventive, and early CVD risk identification in a non-invasive manner is vital as healthcare cost is increasing day by day. Conventional methods for risk prediction of CVD lack robustness due to the non-linear relationship between risk factors and cardiovascular events in multi-ethnic cohorts. Few recently proposed machine learning-based risk stratification reviews without deep learning (DL) integration. The proposed study focuses on CVD risk stratification by the use of techniques mainly solo deep learning (SDL) and hybrid deep learning (HDL). Using a PRISMA model, 286 DL-based CVD studies were selected and analyzed. The databases included were Science Direct, IEEE Xplore, PubMed, and Google Scholar. This review is focused on different SDL and HDL architectures, their characteristics, applications, scientific and clinical validation, along with plaque tissue characterization for CVD/stroke risk stratification. Since signal processing methods are also crucial, the study further briefly presented Electrocardiogram (ECG)-based solutions. Finally, the study presented the risk due to bias in AI systems. The risk of bias tools used were (I) ranking method (RBS), (II) region-based map (RBM), (III) radial bias area (RBA), (IV) prediction model risk of bias assessment tool (PROBAST), and (V) risk of bias in non-randomized studies-of interventions (ROBINS-I). The surrogate carotid ultrasound image was mostly used in the UNet-based DL framework for arterial wall segmentation. Ground truth (GT) selection is vital for reducing the risk of bias (RoB) for CVD risk stratification. It was observed that the convolutional neural network (CNN) algorithms were widely used since the feature extraction process was automated. The ensemble-based DL techniques for risk stratification in CVD are likely to supersede the SDL and HDL paradigms. Due to the reliability, high accuracy, and faster execution on dedicated hardware, these DL methods for CVD risk assessment are powerful and promising. The risk of bias in DL methods can be best reduced by considering multicentre data collection and clinical evaluation.

Is elevated calcium score alone or with the additional contribution of excess epicardial fat the trigger causing early inflammation leading to ECG abnormalities?

Abstract Funding Acknowledgements Type of funding sources: None. Background Elevated EFV has been recently reported to be prevalent and a possible contributor to higher cardiovascular morbidity and mortality, particularly in the presence of elevated CACS. Purpose To assess whether elevated EFV in the presence of CACS has significant effects on the cardiac electrical activity as evidenced by 12-lead ECG abnormalities, in addition to triggering inflammation in the microvasculature (C2), altering the lipid profile and altering BP rise PME, in comparison to population without elevated EFV and the same demographic. Methods 2932 asymptomatic subjects, 50 years +, underwent cardiovascular disease (CVD) risk assessment using the Early Cardiovascular Disease Risk Scoring System (ECVDRS), known as Rasmuessen Risk Score (RRS), which has been previously reported. The ECVDRS includes 10 cardiovascular tests, 7 of these tests are vascular and 3 are cardiac. 334 subjects underwent a cardiac CT for EFV and CACS determination. Out of these, 55 participants (43M + 12F) with significantly elevated CACS and elevated or normal EFV were further assessed regarding their exercise level, structural/functional abnormalities, presence of significant OCAD or INOCAD as assessed by cardiac catheterization, exercise stress test, and nuclear stress test. Results As shown in Table: Conclusion Increased CACS in the presence of normal EFV is not associated with significant inflammatory factors, obstructive CAD, and functional abnormalities. We postulate that increased CACS in the presence of normal EFV may be associated with perivascular rather than intravascular calcium deposition. Subjects with normal EFV have less structural and functional abnormalities even in the presence of elevated CACS in comparison to subjects with elevated EFV. Subjects with elevated EFV are associated with significant prevalence of ECG abnormalities. Based on our data, we recommend lifestyle modification with an emphasis on high levels of exercise along with novel treatment reported recently to decrease EFV aiming to reduce the risk of arrhythmia.

Genotyping of patients with severe dyslipidemia in a screening program for familial hypercholesterolemia. Studio Gioconda

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Familial hypercholesterolemia (FH) is one of the diseases of genetic origin that produces early cardiovascular disease (CVD), because the levels of low-density lipoproteins (LDL) are increased from an early age. In addition, when there are genetic variants in certain genes, the cardiovascular prognosis worsens. The objective of our work, was to evaluate those conditions that influence the genotyping of severe dyslipidemia in the context of a FH detection program. Material and methods We prospectively included all patients in the HF screening program at our center from February 1 to September 30, 2022. It was performed from Clinical Analysis, with an alarm system to detect severe dyslipidemia in patients over 18 years of age (LDL &amp;gt;190 mg/dl) in coordination with the Cardiology and Genetics Cardiovascular Prevention Unit, to select cases suitable for genetic study (Lipid Score of the Dutch Guidelines ³6 points). Results n = 353. Mean age 52.2 years. 51.6% women. 30% were hypertensive, 6% diabetic, 36% obese and 24% smokers. 33% had a family history (FaH) of CVD, 60% FaH of severe dyslipidemia and 10% FaH&amp;lt;18 years-LDLhigh. 2.6% had had a previous coronary event. Only 13% were on lipid-lowering treatment. The mean LDL-C levels were 207mg/dl and the rest of the lipid profile are shown in Table 1. 26.4% of patients underwent genetic study, 6.2% had pathogenic variants and 14% variants of uncertain significance (VUS). Patients with some genetic variant had higher levels of LDL (217 vs209 mg/dl;p0.016), Lp(a) (92vs40mg/dl;p0.003) and Non-HDL (248 vs 236 mg/dl;p0.015), were younger (45 vs. 52 years; p0.019) and FaH&amp;lt;18 years-LDLhigh (43vs8%;p&amp;lt;0.001). Patients with pathogenic variants had higher levels of LDL (219vs201 mg/dl;p0.008), Lp(a) (102vs43mg/dl;p&amp;lt;0.001) and Non-HDL (270vs236mg/dl;d&amp;lt;0.001), were younger (32vs52years;p0.003), FaH of&amp;lt;18 years-LDLhigh (100% vs9%:p&amp;lt;0.001) and CVD FaH (100% vs32%;p&amp;lt;0.014), with no differences between patients with pathogenic variants and VUS in terms of lipid levels, but if age [pathogenic variants (32 years) vs VUS (50 years);p 0.016]. Conclusions In our study, 20% of probable diagnoses of FH present some type of genetic variant, influenced by age, LDL levels, Lp(a), Non-HDL and FaH of CVD and dyslipidemia.

Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review.

Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review.

Can change in phase angle predict the risk of morbidity and mortality during an 18-year follow-up period? A cohort study among adults.

Phase angle (PhA, degrees), measured via bioimpedance (BIA, 50 kHz), is an index that has been used as an indicator of nutritional status and mortality in several clinical situations. This study aimed to determine the relationship between 6-year changes in PhA and total mortality as well as the risk of incident morbidity and mortality from cardiovascular disease (CVD) and coronary heart disease (CHD) during 18 years of follow-up among otherwise healthy adults. A random subset (n = 1,987) of 35-65 years old men and women was examined at the baseline in 1987/1988 and 6 years later in 1993/1994. Measures included weight, height, and whole-body BIA, from which PhA was calculated. Information on lifestyle was obtained through a questionnaire. The associations between 6-year PhA changes (ΔPhA) and incident CVD and CHD were assessed by Cox proportional hazard models. The median value of ΔPhA was used as the reference value. The hazard ratio (HR) model and confidence intervals (CIs) of incident CVD and CHD were used according to the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles of ΔPhA. During 18 years of follow-up, 205 women and 289 men died. A higher risk of both total mortality and incident CVD was present below the 50th percentile (Δ = -0.85°). The highest risk was observed below the 5th percentile (ΔPhA = -2.60°) in relation to total mortality (HR: 1.55; 95% CI: 1.10-2.19) and incident CVD (HR: 1.52; 95% CI: 1.16-2.00). The larger the decrease in PhA, the higher the risk of early mortality and incident CVD over the subsequent 18 years. PhA is a reliable and easy measure that may help identify those apparently healthy individuals who may be at increased risk of future CVD or dying prematurely. More studies are needed to confirm our results before it can be definitively concluded that PhA changes can improve clinical risk prediction.

Endothelial Function in Youth With Bipolar Disorder: Preliminary Evidence for Mood Polarity Differences.

Background: Bipolar disorder (BD) confers risk for accelerated atherosclerosis and early cardiovascular disease (CVD). In adults, mood symptom burden is associated with CVD. Here we examine endothelial dysfunction, considered an early predictor of CVD, in relation to mood states and symptoms among youth with BD.Methods: Participants were 209 youth, aged 13-20 years, including 114 with BD and 95 healthy controls (HC) recruited between 2012 and 2020. Diagnoses and mood symptoms were ascertained using validated, semi-structured interviews based on DSM-IV-TR criteria. Reactive hyperemia index (RHI), a measure of endothelial function, was assessed non-invasively via pulse amplitude tonometry (PAT). RHI was compared across 4 groups: BD-euthymic (n = 34), BD-depressed (n = 36), BD-hypomanic/mixed (n = 44), and HC (n = 95) controlling for age, sex, and obesity. Analyses also examined for RHI-mood associations in the overall BD group.Results: RHI was significantly different between groups (F3,202 = 4.47, P = .005, ηp2 = 0.06). Specifically, RHI was lower in the BD-depressed group compared to HC (P = .04, d = 0.4). Additionally, the BD-hypomanic/mixed group had higher RHI compared to the BD-euthymic (P = .02, d = 0.55), BD-depressed (P < .001, d = 0.79), and HC (P = .04, d = 0.55) groups. Lastly, within the BD group, higher RHI was associated with higher mania scores (P = .006, β = 0.26), but not depression scores. All analyses remained significant in sensitivity analyses further controlling for cardiovascular risk factors and for current lithium, second-generation antipsychotic, and any medication use.Conclusions: We found that symptomatic youth with BD have anomalous RHI, which varies according to mood polarity. Future studies in larger samples, with prospective repeated measures, should investigate whether endothelial dysfunction partially subserves the psychiatric symptoms and cardiovascular risk observed in BD.

Prevalence of elevated blood pressure and hypertension and its associated factors among children attending high schools in a rural panchayath of Kerala

Abstract CONTEXT: Hypertension (HTN) in childhood and adolescence causes premature atherosclerosis and early cardiovascular disease. Although asymptomatic, they may have target organ damage. In 2017, the American Academy of Pediatrics updated the Clinical Practice Guideline for screening and managing high blood pressure (BP) in children and adolescents. However, no published studies from India have utilized this updated criterion for pediatric HTN. The coronavirus disease of 2019 (COVID-19) pandemic forced many children to spend long hours indoors, with increased exposure to digital devices and decreased physical activity. Hence, this study was done to assess the prevalence of HTN among children and to find associated risk factors. AIMS: This study aimed to determine the prevalence of elevated BP and HTN among children attending high schools of a rural panchayath in Kerala, to evaluate the anthropometric and epidemiological factors associated with elevated BP among them, and to find the prevalence of obesity among these children. SETTINGS AND DESIGN: This is a school-based cross-sectional study conducted among students attending high schools in Ambalappuzha North panchayat of Alappuzha, Kerala. MATERIALS AND METHODS: The study was conducted over 9 months from November 2022 to July 2023. Consent was requested from parents of all children (N = 847) studying in high schools. Children who provided assent and met the inclusion–exclusion criteria were enrolled (N = 576). Data were collected using a pre-validated semi-structured questionnaire. Children were interviewed about their lifestyle, including physical activity, sleep, diet, and exposure to smoking. Height and weight were recorded, and body mass index (BMI) was calculated. BP was measured using a digital oscillometric apparatus (OMRON HEM 7143T1A). STATISTICAL ANALYSIS USED: Data were analyzed using Statistical Package for the Social Sciences version 16 software. RESULTS: The study population comprised 345 boys and 231 girls. Elevated BP affected 12.3%, while stage I HTN affected 0.7% of the screened children. Additionally, 16% of the screened children were overweight, 8% were obese, and 7.5% were undernourished. The prevalence of abnormal BP (elevated BP + HTN) was 10.3% among children with normal BMI, 18.47% among overweight. and 26.08% among obese children. CONCLUSIONS: Elevated BP, HTN, obesity, and overweight are prevalent among adolescent children in Ambalappuzha North Panchayath, a rural coastal area. High BMI correlates with elevated BP and HTN and should be the focus of interventions.

Early Subclinical Cardiovascular Disease is Associated with Elevated Remnant Cholesterol and ApoB-lipoproteins in Young Women with and without Polycystic Ovary Syndrome

Early Subclinical Cardiovascular Disease is Associated with Elevated Remnant Cholesterol and ApoB-lipoproteins in Young Women with and without Polycystic Ovary Syndrome

Can allostatic load in pregnancy explain the association between race and subsequent cardiovascular disease risk: A cohort study.

To assess the relationship between allostatic load, a measure of cumulative chronic stress in early pregnancy and cardiovascular disease risk, 2-7 years postpartum, and pathways contributing to racial disparities in cardiovascular disease risk. Secondary analysis of a prospective cohort study. Pregnant women. Our primary exposure was high allostatic load in the first trimester, defined as at least 4 of 12 biomarkers (systolic blood pressure, diastolic blood pressure, body mass index, cholesterol, low-density lipoprotein, high-density lipoprotein, high-sensitivity C-reactive protein, triglycerides, insulin, glucose, creatinine and albumin) in the unfavourable quartile. Logistic regression was used to test the association between high allostatic load and main outcome adjusted for confounders: time from index pregnancy and follow up, age, education, smoking, gravidity, bleeding in the first trimester, index adverse pregnancy outcomes, and health insurance. Each main outcome component and allostatic load were analysed secondarily. Mediation and moderation analyses assessed the role of high allostatic load in racial disparities of cardiovascular disease risk. Incident cardiovascular disease risk: hypertension, or metabolic disorders. Cardiovascular disease risk was identified in 1462/4022 individuals (hypertension: 36.6%, metabolic disorder: 15.4%). After adjustment, allostatic load was associated with cardiovascular disease risk (adjusted odds ratio [aOR] 2.0, 95% CI 1.8-2.3), hypertension (aOR 2.1, 95% CI 1.8-2.4) and metabolic disorder (aOR 1.7, 95% CI 1.5-2.1). Allostatic load was a partial mediator between race and cardiovascular disease risk. Race did not significantly moderate this relationship. High allostatic load during pregnancy is associated with cardiovascular disease risk. The relationships between stress, subsequent cardiovascular risk and race warrant further study.

Combined Dyslipidemia in Children and Adolescents: a Proposed New Management Approach.

Combined dyslipidemia (CD), the predominant abnormal lipid pattern in children and adolescents, is characterized by moderate/severe triglyceride elevation with reduced high-density lipoprotein cholesterol. CD is prevalent, present in 30-50% of obese adolescents. Epidemiologic and lipid sub-population findings demonstrate CD to be highly atherogenic. In the short term, CD responds well to lifestyle change; long-term results are lacking. Major longitudinal studies now confirm that CD in childhood predicts early cardiovascular disease events in adults. Targeted nutritional interventions can be safely and effectively introduced in young children. These findings support introduction of a new approach to CD management. New evidence supporting the atherosclerotic risk associated with CD and the effectiveness of lifelong diet interventions is reviewed and a new family-based primordial approach to CD beginning in infancy is proposed. Aligned with existing pediatric care recommendations, this has the potential to significantly decrease the development of CD.

Central androgen action reverses hypothalamic astrogliosis and atherogenic risk factors induced by orchiectomy and high-fat diet feeding in male mice.

Hypogonadism in males confers elevated cardiovascular disease (CVD) risk by unknown mechanisms. Recent radiological evidence suggests that low testosterone (T) is associated with mediobasal hypothalamic (MBH) gliosis, a central nervous system (CNS) cellular response linked to metabolic dysfunction. To address mechanisms linking CNS androgen action to CVD risk, we generated a hypogonadal, hyperlipidemic mouse model with orchiectomy (ORX) combined with hepatic PCSK9 overexpression. After 4 wk of high-fat, high-sucrose diet (HFHS) consumption, despite equal body weights and glucose tolerance, androgen-deficient ORX mice had a more atherogenic lipid profile and increased liver and leukocyte inflammatory signaling compared with sham-operated control mice. Along with these early CVD risk indicators, ORX markedly amplified HFHS-induced astrogliosis in the MBH. Transcriptomic analysis further revealed that ORX and high-fat diet feeding induced upregulation of inflammatory pathways and downregulation of metabolic pathways in hypothalamic astrocytes. To interrogate the role of sex steroid signaling in the CNS in cardiometabolic risk and MBH inflammation, central infusion of T and dihydrotestosterone (DHT) was performed on ORX mice. Central DHT prevented MBH astrogliosis and reduced the liver inflammatory signaling and monocytosis induced by HFHS and ORX; T had a partial protective effect. Finally, a cross-sectional study in 41 adult men demonstrated a positive correlation between radiological evidence of MBH gliosis and plasma lipids. These findings demonstrate that T deficiency in combination with a Western-style diet promotes hypothalamic gliosis concomitant with increased atherogenic risk factors and provide supportive evidence for regulation of lipid metabolism and cardiometabolic risk determinants by the CNS action of sex steroids.NEW & NOTEWORTHY This study provides evidence that hypothalamic gliosis is a key early event through which androgen deficiency in combination with a Western-style diet might lead to cardiometabolic dysregulation in males. Furthermore, this work provides the first evidence in humans of a positive association between hypothalamic gliosis and LDL-cholesterol, advancing our knowledge of CNS influences on CVD risk progression.

Eyes as the windows into cardiovascular disease in the era of big data.

Cardiovascular disease (CVD) is a major cause of mortality and morbidity worldwide and imposes significant socioeconomic burdens, especially with late diagnoses. There is growing evidence of strong correlations between ocular images, which are information-dense, and CVD progression. The accelerating development of deep learning algorithms (DLAs) is a promising avenue for research into CVD biomarker discovery, early CVD diagnosis, and CVD prognostication. We review a selection of 17 recent DLAs on the less-explored realm of DL as applied to ocular images to produce CVD outcomes, potential challenges in their clinical deployment, and the path forward. The evidence for CVD manifestations in ocular images is well documented. Most of the reviewed DLAs analyze retinal fundus photographs to predict CV risk factors, in particular hypertension. DLAs can predict age, sex, smoking status, alcohol status, body mass index, mortality, myocardial infarction, stroke, chronic kidney disease, and hematological disease with significant accuracy. While the cardio-oculomics intersection is now burgeoning, very much remain to be explored. The increasing availability of big data, computational power, technological literacy, and acceptance all prime this subfield for rapid growth. We pinpoint the specific areas of improvement toward ubiquitous clinical deployment: increased generalizability, external validation, and universal benchmarking. DLAs capable of predicting CVD outcomes from ocular inputs are of great interest and promise to individualized precision medicine and efficiency in the provision of health care with yet undetermined real-world efficacy with impactful initial results.

Remote health monitoring services in nursing homes

Aged people are challenged by serious complications from chronic diseases, such as mood disorder, diabetes, heart disease, and infectious diseases, which are also the most common causes of death in older people. Therefore, elderly care facilities are more important than ever. The most common causes of death in elderly care facilities were reported to be diabetes, cardiovascular disease, and pneumonia. Recently, the coronavirus disease 2019 (COVID-19) pandemic have a great impact on blind spots of safety where aged people were isolated from society. Elderly care facilities were one of the blind spots in the midst of the pandemic, where major casualties were reported from COVID-19 complications because most people had one or two mortality risk factors, such as diabetes or cardiovascular disease. Therefore, medical governance of public health center and hospital, and elderly care facility is becoming important issue of priority. Thus, remote health monitoring service by the Internet of Medical Things (IoMT) sensors is more important than ever. Recently, technological breakthroughs have enabled healthcare professionals to have easy access to patients in medical blind spots through the use of IoT sensors. These sensors can detect medically urgent situations in a timely fashion and make medical decisions for aged people in elderly care facilities. Real-time electrocardiograms and blood sugar monitoring sensors are approved by the medical insurance service. Real-time monitoring services in medical blind spots, such as elderly care facilities, has been suggested. Heart rhythm monitoring could play a role in detecting early cardiovascular disease events and monitoring blood glucose levels in the management of chronic diseases, such as diabetes, in aged people in elderly care facilities. This review presents the potential usefulness of remote monitoring with IoMT sensors in medical blind spots and clinical suggestions for applications.