Global Burden Of Cardiovascular Disease Research Articles

Optimizing the Personalized, Risk-Adjusted Management of Pulmonary Embolism: An Integrated Clinical Trial Programme.

Acute pulmonary embolism (PE) contributes significantly to the global burden of cardiovascular disease. The severity of the acute PE event determines the expected estimated risk of early death. This risk is influenced by the degree of dysfunction of the right ventricle (RV), as assessed by the presence of acute RV pressure overload on imaging and/or elevated cardiac biomarkers, and by demographic and clinical factors, including relevant comorbidities. Haemodynamic instability and cardiogenic shock is at the top of the PE severity spectrum, as it represents the most extreme manifestation of RV failure and a key determinant of poor prognosis. Ideally, risk-adjusted treatment should implement: (1) optimized timing and regimens of reperfusion therapy for unstable patients; (2) early discharge and continuation of anticoagulation treatment at home (low-risk PE); or (3) hospital admission and clinical/haemodynamic monitoring in patients at intermediate risk. The challenge is now to provide the basis for a comprehensive personalized, risk-adjusted care for patients with acute PE. The aim of the integrated academic clinical trial programme of the Center for Thrombosis and Hemostasis at the University of Mainz is to develop and prospectively validate, in multinational studies, strategies for reperfusion and anticoagulant treatment of acute PE across the entire spectrum of early risk as well as clinical pathways for post-PE patient care and follow-up.

Conventional Dendritic Cells Impair Recovery after Myocardial Infarction.

Ischemic myocardial injury results in sterile cardiac inflammation that leads to tissue repair, two processes controlled by mononuclear phagocytes. Despite global burden of cardiovascular diseases, we do not understand the functional contribution to pathogenesis of specific cardiac mononuclear phagocyte lineages, in particular dendritic cells. To address this limitation, we used detailed lineage tracing and genetic studies to identify bona fide murine and human CD103+ conventional dendritic cell (cDC)1s, CD11b+ cDC2s, and plasmacytoid DCs (pDCs) in the heart of normal mice and immunocompromised NSG mice reconstituted with human CD34+ cells, respectively. After myocardial infarction (MI), the specific depletion of cDCs, but not pDCs, improved cardiac function and prevented adverse cardiac remodeling. Our results showed that fractional shortening measured after MI was not influenced by the absence of pDCs. Interestingly, however, depletion of cDCs significantly improved reduction in fractional shortening. Moreover, fibrosis and cell areas were reduced in infarcted zones. This correlated with reduced numbers of cardiac macrophages, neutrophils, and T cells, indicating a blunted inflammatory response. Accordingly, mRNA levels of proinflammatory cytokines IL-1β and IFN-γ were reduced. Collectively, our results demonstrate the unequivocal pathological role of cDCs following MI.

Global Burden of Atherosclerotic Cardiovascular Disease in People Living With HIV: Systematic Review and Meta-Analysis.

With advances in antiretroviral therapy, most deaths in people with HIV are now attributable to noncommunicable illnesses, especially cardiovascular disease. We determine the association between HIV and cardiovascular disease, and estimate the national, regional, and global burden of cardiovascular disease attributable to HIV. We conducted a systematic review across 5 databases from inception to August 2016 for longitudinal studies of cardiovascular disease in HIV infection. A random-effects meta-analysis across 80 studies was used to derive the pooled rate and risk of cardiovascular disease in people living with HIV. We then estimated the temporal changes in the population-attributable fraction and disability-adjusted life-years (DALYs) from HIV-associated cardiovascular disease from 1990 to 2015 at a regional and global level. National cardiovascular DALYs associated with HIV for 2015 were derived for 154 of the 193 United Nations member states. The main outcome measure was the pooled estimate of the rate and risk of cardiovascular disease in people living with HIV and the national, regional, and global estimates of DALYs from cardiovascular disease associated with HIV. In 793 635 people living with HIV and a total follow-up of 3.5 million person-years, the crude rate of cardiovascular disease was 61.8 (95% CI, 45.8-83.4) per 10 000 person-years. In comparison with individuals without HIV, the risk ratio for cardiovascular disease was 2.16 (95% CI, 1.68-2.77). Over the past 26 years, the global population-attributable fraction from cardiovascular disease attributable to HIV increased from 0.36% (95% CI, 0.21%-0.56%) to 0.92% (95% CI, 0.55%-1.41%), and DALYs increased from 0.74 (95% CI, 0.44-1.16) to 2.57 (95% CI, 1.53-3.92) million. There was marked regional variation with most DALYs lost in sub-Saharan Africa (0.87 million, 95% CI, 0.43-1.70) and the Asia Pacific (0.39 million, 95% CI, 0.23-0.62) regions. The highest population-attributable fraction and burden were observed in Swaziland, Botswana, and Lesotho. People living with HIV are twice as likely to develop cardiovascular disease. The global burden of HIV-associated cardiovascular disease has tripled over the past 2 decades and is now responsible for 2.6 million DALYs per annum with the greatest impact in sub-Saharan Africa and the Asia Pacific regions. URL: https://www.crd.york.ac.uk/prospero . Unique identifier: CRD42016048257.

The Global Burden of Cardiovascular Disease in Women

Cardiovascular disease (CVD) is the leading cause of mortality worldwide, accounting for one third of all deaths in 2015. Alarmingly, there has been slowing of the decline in age-standardized CVD mortality over the last 5years compared to the previous 25years. Given the increasing global CVD burden, in 2011, the United Nations declared the goal to reduce premature mortality from the four main non-communicable diseases by 25% from 2010 to 2025, abbreviated as the 25 × 25 goal. The United Nations has further created nine targets to achieve the 25 × 25 goal. These targets emphasize risk factor modification and strengthening of healthcare delivery systems. Achieving the nine targets and 25 × 25 goal set by the United Nations will undoubtedly benefit the world as a whole. However, women face additional, unacceptable, disproportionate CVD risk factors that need to be addressed, including psychological stressors contributing to ischemic heart disease, pregnancy-related CVD, environmental and infectious exposures in low socioeconomic settings, and limited healthcare access and delivery. This paper highlights global CVD gender disparities in order to stimulate awareness and discussion of potential interventions to address the rapidly growing burden of heart disease in women.

Inhibition of the CD36 receptor reduces visceral fat accumulation and improves insulin resistance in obese mice carrying the BDNF-Val66Met variant

Obesity-induced metabolic dysfunctions increase the risk for vascular diseases, including type II diabetes and stroke. Managing obesity is of interest to address the worldwide health problem; however, the role of genetic variability in human obesity development and specific targets for obesity-related metabolic disease have not been thoroughly studied. A SNP in the brain-derived neurotropic factor (BDNF) gene that results in the substitution of a valine with a methionine at codon 66 (Val66Met) occurs with a high frequency in humans. This study addressed the effect of genetic variability in developing obesity and the efficacy of the inhibition of cluster of differentiation 36 (CD36), a multifunctional receptor implicated in obesity and insulin resistance, in WT mice and mice with the BDNF Val66Met variant. CD36 inhibition by salvionolic acid B (SAB) in diet-induced obese WT mice reduced visceral fat accumulation and improved insulin resistance. The benefit of SAB was abrogated in CD36 knockout mice, showing the specificity of SAB. In addition, mice with the Val66Met variant in both alleles (BDNFM/M) fed a high-fat diet exhibited extreme obesity with increased CD36 gene and protein levels in macrophages. Chronic SAB treatment in BDNFM/M mice significantly decreased visceral fat accumulation and improved insulin resistance. Notably, the effect of SAB was greater in the extremely obese BDNFM/M mice compared with the WT mice. The study demonstrated a link between BDNF Val66Met and elevated CD36 expression and suggested that CD36 inhibition may be a potential strategy to improve metabolic dysfunctions and to normalize risk factors for vascular diseases in the obese population.

Who you are and where you live can determine how long you live: What nurses need to know about cardiovascular disease among low‐income urban‐dwelling minority communities

Who you are and where you live can determine how long you live: What nurses need to know about cardiovascular disease among low‐income urban‐dwelling minority communities

Cardiovascular Nursing Science Priorities: A Statement From the American Heart Association Council on Cardiovascular and Stroke Nursing.

The American Heart Association's (AHA) Council on Cardiovascular and Stroke Nursing (CVSN) plays a critical role in advancing the mission of the AHA in the discovery of new scientific knowledge. The aim was to identify priority research topics that would promote and improve cardiovascular (CV) health, provide direction for the education of future nurse scientists, and serve as a resource and catalyst for federal and organizational funding priorities. A Qualtrics survey, which included 3 questions about priorities for CVSN nurse researchers, was sent to the CVSN Leadership Committee and all CVSN Fellows of the AHA (n = 208). Responses to the questions were reviewed for word repetitions, patterns, and concepts and were then organized into thematic areas. The thematic areas were reviewed within small groups at the November (2016) in-person CVSN leadership meeting. Seventy-three surveys were completed. Five thematic areas were identified and included (1) developing and testing interventions, (2) assessment and monitoring, (3) precision CV nursing care, (4) translational and implementation science, and (5) big data. Topic areas noted were stroke, research methods, prevention of stroke and CV disease, self-management, and care and health disparities. Five thematic areas and 24 topic areas were identified as priorities for CV nursing research. These findings can provide a guide for CV nurse scientists and for federal and foundational funders to use in developing funding initiatives. We believe additional research and discovery in these thematic areas will help reduce the rising global burden of CV disease.

The role of miRNA regulation in fetal cardiomyocytes, cardiac maturation and the risk of heart disease in adults.

Myocardial infarction is a primary contributor towards the global burden of cardiovascular disease. Rather than repairing the existing damage of myocardial infarction, current treatments only address the symptoms of the disease and reducing the risk of a secondary infarction. Cardiac regenerative capacity is dependent on cardiomyocyte proliferation, which concludes soon after birth in humans and precocial species such as sheep. Human fetal cardiac tissue has some ability to repair following tissue damage, whereas a fully matured human heart has minimal capacity for cellular regeneration. This is in contrast to neonatal mice and adult zebrafish hearts, which retain the ability to undergo cardiomyocyte proliferation and can regenerate cardiac tissue after birth. In mice and zebrafish models, microRNAs (miRNAs) have been implicated in the regulation of genes involved in cardiac cell cycle progression and regeneration. However, the significance of miRNA regulation in cardiomyocyte proliferation for humans and other large mammals, where the timing of heart development in relation to birth is similar, remains unclear. miRNAs may be valuable targets for therapies that promote cardiac repair after injury. Therefore, elucidating the role of specific miRNAs in large animals, where heart development closely resembles that of humans, remains vitally important for identifying therapeutic targets that may be translated into clinical practice focused on tissue repair.

CORRELATION BETWEEN GRADE OF HYPERTENSION AND EXTENSION OF CORONARY ARTERY DISEASE IN HYPERTENSIVE PATIENTS – CROSS-SECTIONAL STUDY FROM CENTRAL ROMANIA

Objective: The prevalence of coronary artery disease (CAD) is more susceptible to develop in hypertensive patients with multiple associated cardiovascular risk (c-v) factors. We hypothesized that the number and severity of coronary lesions is directly related to hypertension grade and concomitant presence of different c-v risk factors. Design and method: Between September 2015 to February 2016, 283 hypertensive patients (mean age 63+/−9.039 y.o.) performed invasive evaluation of coronary arterial tree. Clinical indications were: ischemic heart disease, cardiomyopathies, valvular heart disease and rhythm and conduction disturbances. An observational, cross-sectional study was conducted; clinical and imaging results were computed. Hypertensive patients were stratified to 3 grades according to 2013 ESH/ESC guidelines for the management of arterial hypertension (HT). Patients were divided according to the number of coronary arteries involved: single, double, triple vessel CAD. Results: With regard to hypertension grades correlated with CAD, in our study 3.1%(9) pts were included in grade 1 HT, 53.0% (150) grade 2 HT and 19.08% (54) patients were diagnosed with HT grade 3. No significant CAD was described in 70 pts (24.73%) presenting grades 1, 2 and 3 HT. Out of 190 male and 93 female hypertensive patients, 61.13% (173 pts) had significant CAD (>50% reference vessel diameter reduction). Single vessel disease was present in 88.8% of grade 1 hypertensive patients, and triple vessel disease was identified in 29.3% of patients presenting hypertension grade 2 compared to 24.0% in grade 3 hypertensive patients. Correlation between grade of HT and severity of CAD (number of affected vessels) was studied using chi-square test, demonstrating a very strong statistically correlation (p < 0.0001). Conclusions: Not optimally treated high grades of hypertension will increase the number of patients requiring different procedures of myocardial revascularization. Extended research on risk factors predisposing to coronary artery disease and their synergism, among them high blood pressure, is necessary in order to reduce the global burden of cardiovascular disease.

Comparison Of Dietary Habits Between Volunteer Firefighters And Non-firefighters

As the global burden of cardiovascular disease (CVD) rises, public health-related interventions aimed at prevention have gained increased attention. Physicians and public health officials may be unaware that CVD or cardiac events are related to more than half of the line-of-duty deaths in firefighters (FF). Diet is one of the main modifiable CVD risk factors, yet poor diet and the risk factors it contributes to, including obesity, continue to be an issue as the prevalence of obesity is high in FF. Dietary patterns can also influence other risk factors like blood pressure, lipid levels, body composition and glucose metabolism. However, healthy diets are not always feasible for FF, due to the fast-paced unpredictable nature of work, and thus FF often rely on quick meals that may not be nutritiously optimal. Limited research has examined FF dietary intake and preferences. PURPOSE: To examine the dietary habits of local volunteer FF and compare these to adult non-FF in the area. METHODS: 76 adults (36 FF, 37.0 ±11 years, BMI 30.4 ±5.7 kg/m2; 40 non-FF, 30.6 ±11 years, BMI 28.3 ±5.7 kg/m2) were studied. All participants completed a 3-day dietary recall, and had height and weight measured. Three-day diet recalls were obtained from volunteer FF who attended dietary workshops in their firehouse and from non-FF adults in the area who were interested to find out their dietary habits. Data was analyzed using Diet Analysis Plus. RESULTS: Macronutrient composition of the diets were similar. The FF average diet was 2037.9 ±597.3 calories; including 34.8% fat, 46.0% carbohydrates, and 17.8% protein. The average diet for non-FF adults was 2185.7 ±405.9 calories; including 34.1% fat, 48.6% carbohydrates, and 17.8% protein. FF had significantly lower levels of vitamin B-6 (1.7 ±0.9 vs 2.3 ±1.2 mg), folate (498.3 ±253 vs 685.7 ±375 μg), and vitamin C (50.8 ±48.5 vs 111.9 ±87.8 mg) intake compared to non-FF, respectively, p<0.05. FF diets were lacking in several key micronutrients, including calcium (961.8 ± 410 mg), magnesium (227.1 ±138mg), potassium (2177.7 ± 1059 mg), and vitamin D (4.2 ±4.6 μg). For these, >90% of the FF diets did not meet recommended levels. CONCLUSION: These data suggests that volunteer FF exhibit deficiencies in several micronutrients and may benefit from diets that encourage increased consumption of fruits and vegetables.

A First Step Towards Behavioral Coaching for Managing Stress: A Case Study on Optimal Policy Estimation with Multi-stage Threshold Q-learning.

Psychological stress is a major contributor to the adoption of unhealthy behaviors, which in turn accounts for 41% of global cardiovascular disease burden. While the proliferation of mobile health apps has offered promise to stress management, these apps do not provide micro-level feedback with regard to how to adjust one's behaviors to achieve a desired health outcome. In this paper, we formulate the task of multi-stage stress management as a sequential decision-making problem and explore the application of reinforcement learning to provide micro-level feedback for stress reduction. Specifically, we incorporate a multi-stage threshold selection into Q-learning to derive an interpretable form of a recommendation policy for behavioral coaching. We apply this method on an observational dataset that contains Fitbit ActiGraph measurements and self-reported stress levels. The estimated policy is then used to understand how exercise patterns may affect users' psychological stress levels and to perform coaching more effectively.

Novel Marine Compounds Modulate Mitochondrial Function in H9c2 Cells: Potential New Pharmaceutical Targets to Control Cardiac Metabolism

IntroductionThe global burden of cardiovascular disease is increasing and is the leading cause of morbidity and mortality worldwide. As the heart is a highly metabolic organ, mitochondrial health is critical to normal cardiac function and is compromised in a number of cardiac diseases. Therefore, new pharmaceutical agents and screening tools to modulate and evaluate cardiac metabolism may offer novel therapeutics for cardiovascular disease.MethodsA number of marine compounds have been curated over the years by faculty at the Scripps Institution of Oceanography. Chemical structures have been largely elucidated through nuclear magnetic resonance spectroscopy and mass spectrometry, and these have been broadly available for biological screening through the UCSD Center for Compound Resources. Seventy‐three promising marine compounds were evaluated by application on H9c2 rat cardiomyoblasts while measuring oxygen consumption rate and extracellular acidification rate with a Seahorse XF96 extracellular flux analyzer. Mitochondrial metabolism was tested at a range of compound concentrations (0.1–1.6 mM). Subsequently, dose response curves of compounds that showed biological activity in the initial screen were performed. Dose response assay concentrations ranged from 0.01 nM to 3 μM with vehicle only as the control.ResultsEight compounds showed significant dose dependent alterations in mitochondrial metabolism in the initial screen. Dose response assays of glycospongosine revealed an increase in ATP linked‐maximal respiration ratio. In contrast, higher glycospongosine concentrations led to a gradual dose dependent decrease in reserve capacity. Injection of leptochelin A first increased basal respiration of the cardiomyoblasts, after the first increase, basal respiration gradually decreased. Increasing concentrations of honaucin A lowered the maximal mitochondrial respiration dose dependently. In addition, kabiramide C decreased maximal respiration normalized to basal respiration.ConclusionWe present here the results of screening multiple marine natural products in a cell based metabolic assay. Marine compounds have a demonstrated potential to modulate cardiac metabolism in a variety of settings; however, further research in disease models is necessary to determine if such modulation via these compounds is beneficial or harmful to cardiovascular disease.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Effects of circuit exercise training on vascular health and blood pressure.

As the global burden of cardiovascular disease (CVD) rises, public health-related interventions aimed at prevention of heart disease have gained medical attention. Clinical research reports that exercise is a protective risk factor associated with CVD and that clinicians need to provide exercise recommendations to patients. Nevertheless, physical inactivity remains a public health problem. In certain populations, like firefighters (FF), increased risk of CVD is especially concerning. The workload FF face is extreme, 50% of line-of-duty deaths (LODD) in FF are cardiac-related, and research on the volunteer FF population is scarce. Government regulations do not require volunteer FF companies to have fitness testing or programming, so exercise intervention studies are necessary to improve the burden of CVD risk in this population. Therefore, this study examined the effects of a 4-week exercise circuit training (CT) intervention on vascular health and fitness in volunteer FF (N = 27) from the Philadelphia PA area compared to a control group of Non-FF (N = 25). Carotid artery intima-media thickness (IMT), brachial artery flow-mediated dilation (FMD), augmentation index, and pulse pressure (PP), brachial and central blood pressure (BP) and fitness were measured pre- and post- intervention. Overall, volunteer FF had more significant improvements (p < 0.05) in vascular health measures (FMD, IMT, and PP). In both groups, we also found that brachial and central BP decreased with exercise. We show that a 4 week CT program can improve vascular structure and function in the volunteer FF population, suggesting that clinicians may be able to reduce or prevent cardiac LODD by exercise.

Developing a Clinical Approach to Air Pollution and Cardiovascular Health.

Nearly 3 billion people are exposed to household air pollution emitted from inefficient cooking and heating stoves, and almost the entire global population is exposed to detectable levels of outdoor air pollution from traffic, industry, and other sources. Over 3 million people die annually of ischemic heart disease or stroke attributed to air pollution, more than from traditional cardiac risk factors such as obesity, diabetes mellitus, or smoking. Clinicians have a role to play in reducing the burden of pollution-attributable cardiovascular disease. However, there currently exists no clear clinical approach to this problem. Here, we provide a blueprint for an evidence-based clinical approach to assessing and mitigating cardiovascular risk from exposure to air pollution. We begin with a discussion of the global burden of pollution-attributable cardiovascular disease, including a review of the mechanisms by which particulate matter air pollution leads to cardiovascular outcomes. Next, we offer a simple patient-screening tool using known risk factors for pollution exposure. We then discuss approaches to quantifying air pollution exposures and cardiovascular risk, including the development of risk maps for clinical catchment areas. We review a collection of interventions for household and outdoor air pollution, which clinicians can tailor to patients and populations at risk. Finally, we identify future research needed to quantify pollution exposures and validate clinical interventions. Overall, we demonstrate that clinicians can be empowered to mitigate the global burden of cardiovascular disease attributable to air pollution.

Precision Medicine and Personalized Medicine in Cardiovascular Disease.

Precision medicine aims to offer "the right treatment to the right patient at the right time." In cardiovascular medicine the potential of precision medicine applies to all stages of the disease development and includes risk prediction, preventative measures, and targeted therapeutic approaches. Precision medicine will benefit from new developments in the area of genomics and other omics but equally heavily depends on established biomarkers, functional tests, and imaging. Cardiovascular medicine often relies on noninvasive diagnostic procedures and symptom-based disease management. In contrast, other clinical disciplines including oncology and immunology have already moved to molecular diagnostics that lend themselves to precision medicine approaches. There are opportunities to implement precision medicine approaches by focusing on common diseases such as hypertension, conditions with diagnostic and prognostic uncertainty such as angina, and conditions that are associated with high mortality and involve costly and potentially harmful interventions such as dilated cardiomyopathy and cardiac resynchronization therapy. Sex and gender issues have not yet been fully explored in precision medicine although the opportunity to use molecular data to more accurately manage men and women with cardiovascular disease has been acknowledged. A mindshift is required in order to fully exploit the potential of precision medicine to tackle the global burden of cardiovascular diseases.

Metabolic Syndrome and its Risk Factors among Overweight and Obese Palestinian Schoolchildren using IDF and NCEP-ATP/III Definitions

Background: Warning signs of metabolic syndrome (MetS) can appear during childhood. Early detection and treatment of MetS is likely to reduce morbidity and mortality in adulthood and help to keep to minimum the global burden of cardiovascular diseases and type II diabetes. This study aimed to establish the prevalence and to characterize metabolic syndrome and its individual components among overweight and obese Palestinian schoolchildren aged 6-<18 years in the West Bank. Methods: A cross sectional study was conducted in the West Bank-Palestine in the year 2014. Out of the 840 schoolchildren, 216 (30.7%) were overweight and obese; 146 of them were evaluated for MetS using the International Diabetes Federation and modified National Cholesterol Education Program-Third Adult Treatment Panel definitions. Results: Using NCEP criteria, MetS was significantly more prevalent in overweight and obese children (23.3%) than IDF (15.8%) and among boys (22.2% for NCEP vs 12.3% for IDF) and girls (23.3% for NCEP vs 20.0% for IDF). No sex-specific differences in the prevalence of MetS between age groups were determined using both criteria. The prevalence of individual MetS components according the IDF and NCEP criteria were respectively; (32% and 25.3%) for increased waist circumference, (15.8% and 37.0%) for increased blood pressure, (9.7% and 24.8%) for increased triglyceride, (57.2% and 55.9%) for low HDL, and (39.7% and 15.8%) for increased fast blood sugar. Clustering of metabolic abnormalities had significantly increased by increasing body mass index and waist circumferences, and with decreased HDL and elevated triglyceride. Conclusions: The prevalence of MetS among overweight and obese Palestinian schoolchildren is high with dyslipidemia being the most common MetS abnormality. Regardless the definition used to diagnose MetS among children; the findings of this study present a serious threat to current and future health of Palestinian children.

Cardiovascular Disease Risk Assessment in the United States and Low- and Middle-Income Countries Using Predicted Heart/Vascular Age

Almost 80% of the global burden of cardiovascular disease (CVD) occurs in low- and middle-income countries (LMICs). However, LMICs do not have well-established, low-technology ways to quantify and communicate CVD risk at population or individual levels. We examined predicted heart/vascular age (PHA) in six LMICs and the United States. Data were from CVD-free adults in World Health Organization Study on Global Aging and Adult Health (n = 29094) and US National Health and Nutritional Examination Survey (n = 6726). PHA was calculated using the non-laboratory Framingham CVD risk equation. High excess PHA (HEPHA) was defined as the differences between PHA and chronological age >5 years. Logistic regression models were used to identify factors associated with HEPHA. Age-standardized prevalence of HEPHA was higher in Russia 52%; China 56%; Mexico 59%; and South Africa 65% compared to the US 45%, Ghana 36%; and India 38%. In LMICs, higher income, being divorced/widowed, alcohol intake and abdominal obesity had higher odds of HEPHA; higher education, fruit intake and physical activity had lower odds of HEPHA. The use of PHA may offer a useful avenue to communicate CVD risk. Interventions tailored at socioeconomic and cultural factors that influence CVD risk factors may be necessary to prevent CVD in LMICs.

Clinical characteristics and 12-month outcomes of patients with valvular and non-valvular atrial fibrillation in Kenya.

BackgroundAtrial fibrillation (AF) is a major contributor to the global cardiovascular disease burden. The clinical profile and outcomes of AF patients with valvular heart diseases in sub-Saharan Africa (SSA) have not been adequately described. We assessed clinical features and 12-month outcomes of patients with valvular AF (vAF) in comparison to AF patients without valvular heart disease (nvAF) in western Kenya.MethodsWe performed a cohort study with retrospective data gathering to characterize risk factors and prospective data collection to characterize their hospitalization, stroke and mortality rates.ResultsThe AF patients included 77 with vAF and 69 with nvAF. The mean (SD) age of vAF and nvAF patients were 37.9(14.5) and 69.4(12.3) years, respectively. There were significant differences (p<0.001) between vAF and nvAF patients with respect to female sex (78% vs. 55%), rates of hypertension (29% vs. 73%) and heart failure (10% vs. 49%). vAF patients were more likely to be taking anticoagulation therapy compared to those with nvAF (97% vs. 76%; p<0.01). After 12-months of follow-up, the overall mortality, hospitalization and stroke rates for vAF patients were high, at 10%, 34% and 5% respectively, and were similar to the rates in the nvAF patients (15%, 36%, and 5%, respectively).ConclusionDespite younger age and few comorbid conditions, patients with vAF in this developing country setting are at high risk for nonfatal and fatal outcomes, and are in need of interventions to improve short and long-term outcomes.

Effective approaches to address the global cardiovascular disease burden.

Describe the global burden of cardiovascular disease (CVD), highlight barriers to evidence-based care and propose effective interventions based on identified barriers. The global burden of CVD is increasing worldwide. This trend is steeper in lower income countries, where CVD incidence and fatality remains high. Risk factor control, around the world, remains poor, especially in lower and middle-income countries. Barriers at the patient, healthcare provider and health system have been identified. The use of multifaceted interventions that target identified contextual barriers to care, including increasing awareness of CVD and related risk, improving health policy (i.e. taxation of tobacco), improving the availability and affordability of fixed-dose combined medications and task-shifting of healthcare responsibilities are potential solutions to improve the global burden of CVD. There is a need to address identified barriers using evidence-based and multifaceted interventions. Global initiatives, led by the World Heart Federation and the WHO, to facilitate the implementation of such interventions are underway.

Reducing the Global Burden of Cardiovascular Disease, Part 2: Prevention and Treatment of Cardiovascular Disease.

In this second part of a 2-part series on the global burden of cardiovascular disease, we review the proven, effective approaches to the prevention and treatment of cardiovascular disease. We specifically review the management of acute cardiovascular diseases, including acute coronary syndromes and stroke; the care of cardiovascular disease in the ambulatory setting, including medical strategies for vascular disease, atrial fibrillation, and heart failure; surgical strategies for arterial revascularization, rheumatic and other valvular heart disease, and symptomatic bradyarrhythmia; and approaches to the prevention of cardiovascular disease, including lifestyle factors, blood pressure control, cholesterol-lowering, antithrombotic therapy, and fixed-dose combination therapy. We also discuss cardiovascular disease prevention in diabetes mellitus; digital health interventions; the importance of socioeconomic status and universal health coverage. We review building capacity for conduction cardiovascular intervention through strengthening healthcare systems, priority setting, and the role of cost effectiveness.