Incidence Of Ischemic Heart Disease Research Articles

Age-Period-Cohort Analysis of Ischemic Heart Disease Morbidity and Mortality in China, 1990-2019.

The disease burden of ischemic heart disease (IHD) continues to increase. This study aimed to assess the age, period, and cohort effects on the long-term trends of IHD incidence and mortality in China from 1990 to 2019. The data were obtained from the Global Burden of Disease Study (GBD) 2019, and the age-standardized incidence/mortality rate (ASIR/ASMR) was calculated. The age-period-cohort (APC) model, which is a generalized linear model revealing the correlation of disease rate and attained age, period, and cohort, was applied to estimate the net drift (estimated annual percentage change [EAPC]s), the local drifts (age-specific EAPCs), the age, period, and cohort effects. The analyses elucidated that the ASIR and ASMR of IHD declined after 2013. The net drift of incidence was 0.212% in females, and the net drift of mortality was 0.371% in males. The local drifts of mortality were above 0 in males aged 20-84 years and in females aged 65-84 years. The age effects showed elevated trends during the study period. The period effects declined after 2013. The cohort effects of mortality in males were higher than that in females. The decrease of ASIR and ASMR indicated that measures to prevent IHD have been effective in China. However, the cardiovascular health of the elderly and males should be considered in future policy decisions.

Resistant hypertension is associated with an increased cardiovascular risk compared to patients controlled on a similar multi-drug regimen.

The long-term risk associated with resistant hypertension compared to other phenotypes of hypertension is still unclear. We aimed to assess cardiovascular and renal outcomes over 10 years of follow-up of patients with uncontrolled resistant hypertension (uRH) compared to a similarly treated (≥ 3 medication classes including a diuretic) and adherent group whose blood pressure is under control. This retrospective cohort study utilized the computerized database of Maccabi Healthcare Services, a state-mandated health provider covering 25% of the Israeli population. Clinical outcomes were assessed using Cox regression multivariable analyses. A total of 1487 patients (50% males, mean age at baseline = 68.3 ± 10.4 years) were included in the uRH cohort and 1343 patients (50% males, 66.2 ± 10.6 years) in the controlled hypertension reference group (Controlled hypertension on multi drug regimen- CH-MDR). After adjusting for age, sex, BMI and patients' comorbidities, uRH was associated with a Hazard Ratio of 1.35 (95% CI: 1.08-1.69) for incidence of ischemic heart disease, 1.51 (1.06-2.16) for secondary cardiovascular events, and 1.36 (1.00-1.86) for risk of stroke or transient ischemic attack compared to the reference group. Patients with uRH were found to have more hospitalization days (mean, 4.2 vs. 3 days per year, p < 0.001), and more emergency room visits (83.3% vs. 77%, p < 0.001). Overall, uRH was associated with a 19% (95% CI 11% to 29%) increase in direct healthcare expenditures during the first year of follow-up. uRH is associated with a substantial increased risk of both cardiovascular and cerebrovascular events, when compared to similarly treated hypertensive patients whose blood pressure is under control.

Obesity, Burden of Ischemic Heart Diseases and Their Ecological Association: The Case of Uzbekistan.

Ischemic heart diseases are the leading cause of death in Uzbekistan. There are numerous risk factors affecting ischemic heart disease, and obesity is one of the major independent risk factors. This study is the first attempt to estimate the ecological association between obesity prevalence and the burden of ischemic heart disease between 1990 and 2019 in Uzbekistan. To define the prevalence of all obesity types, death, and incidences of ischemic heart disease for certain periods, the Joinpoint regression tool was used. A separate linear regression analysis was performed to analyze the relationship between obesity and ischemic heart disease mortality and morbidity. A positive linear relation was found between the prevalence of obesity types and incidence/death rates for both sexes (r = 0.59–0.87). All types of obesity were highly significant positive predictors of incidence of and death from ischemic heart disease (p < 0.0001). The slope (B1) suggested that for an increment in obesity prevalence of 1% among adults aged over 20, the incidence of ischemic heart disease increased by 40.2 (p < 0.0001) and 38.3 (p < 0.0001) per 100,000 persons for men and women, respectively. The current country-level conclusions are valuable, because it allows decision makers to draw specific conclusions, applicable at the state and local level for policymaking.

MiRNA in Ischemic Heart Disease and Its Potential as Biomarkers: A Comprehensive Review.

Ischemic heart disease (IHD) constitutes the leading global cause of mortality and morbidity. Although significant progress has been achieved in the diagnosis, treatment, and prognosis of IHD, more robust diagnostic biomarkers and therapeutic interventions are still needed to circumvent the increasing incidence of IHD. MicroRNAs (miRNAs) are critical regulators of cardiovascular function and are involved in various facets of cardiovascular biology. While the knowledge of the role of miRNAs in IHD as diagnostic biomarkers has improved, research emphasis on how miRNAs can be effectively used for diagnosis and prognosis of IHD is crucial. This review provides an overview of the biology, therapeutic and diagnostic potential, as well as the caveats of using miRNAs in IHD based on existing research.

Association of anxiety with cardiovascular disease in a Chinese cohort of 0.5 million adults

BackgroundAnxiety might be a potentially modifiable risk factor of cardiovascular diseases (CVDs). Evidence relating anxiety symptoms and generalized anxiety disorder (GAD) to CVDs from prospective cohort study was still lacking in China. MethodsParticipants aged 30 to 79 years old from 10 areas across China were recruited during 2004–2008 and were followed up until 2017. 487,209 participants without CVDs at baseline remained for analyses. Anxiety symptoms (panic attacks and continuous anxiety) during the past 12 months were identified in a face-to-face interview. Participants with continuous anxiety were further assessed for GAD using Composite International Diagnostic Interview-Short Form. The primary outcomes were incident CVD, ischaemic heart disease (IHD), haemorrhagic stroke (HS), and ischaemic stroke (IS). ResultsDuring 4.7 million person-years of follow-up, we documented 140,365 incident cases of CVD. For panic attacks, the multivariable-adjusted HRs (95 % CI) were 1.08 (1.04–1.13), 1.10 (1.02–1.19), 1.20 (1.05–1.38) and 1.20 (1.11–1.30) for CVD, IHD, HS and IS, respectively. Continuous anxiety was positively associated with incident CVD and IHD, and the corresponding HRs were 1.12 (1.04–1.20) and 1.21 (1.07–1.37). LimitationsAnxiety symptoms were examined according to self-reported questionnaires, which could constitute key study limitations. ConclusionsAmong the Chinese adults, those with anxiety symptoms or GAD might be important at-risk population of CVD.

COVID impact on pattern of ischemic heart disease in comparable period

Aim: To compare the impact of COVID-19 on pattern of Ischemic Heart Disease in comparable period by assessing the incidence, severity of symptoms and in-hospital mortality of Ischemic Heart Disease patients before and during COVID-19. Background: COVID-19 directly or indirectly, affects the cardiovascular system it not only causes myocardial injury but also reduces the incidence and increasing the severity and mortality of Ischemic Heart Disease patients and it was seen that pneumonia and influenza infections increases the risk of acute MI by six folds. Methods: Data collected from health records of patients admitted in National Heart Institute from Ischemic Heart Disease in comparable four months period of before (Oct 2019-Jan 2020) and during (Oct 2020-Jan 2021)COVID-19 by using a self-structured bio physiological tool. The total samples taken were 421 out of which 237 were before COVID-19 and 184 were during COVID-19. STARD checklist used to report the study. Results: The major findings of the study reveals that incidence of ischemic heart disease indicates that before COVID-19 incidence was 13.32% whereas the incidence of ischemic heart disease during COVID-19 was 12.69%. This means incidence decreases during COVID-19 as compared to before COVID-19. Severity scores measured before COVID-19 showed the majority of the patient (61.2%) having no severity as compared to during COVID-19 whereas the majority of patients having mild (41.8%) and moderate (1.1%) severity as compared to before COVID-19. Mortality of ischemic heart disease indicates that before COVID-19 in-hospital mortality was 1.28% whereas in-hospital mortality of ischemic heart disease during COVID-19 was 0.54%. Conclusion: From findings the study interprets that incidence and in-hospital mortality of Ischemic Heart Disease patients decreases during COVID-19 as compared to before COVID-19, whereas the severity of Ischemic Heart Disease symptoms increases during COVID-19 as compared to before COVID-19. Implication: Patients are staying away from the hospital due to fear of contracting the infection which in return act as a major issue of increasing Ischemic Heart Disease severity so, the nurses should involve in a proactive campaign to alleviate patient concern and encourage them to seek timely medical attention despite the COVID-19 pandemic.

Changes in the Incidence of Cardiovascular Diseases during the COVID-19 Pandemic in Korea.

There is scarcity in the evidence addressing the indirect impact of the COVID-19 pandemic on the epidemiology of CVDs. In this study we aimed to examine possible changes in the incidence of CVDs in Korea during the COVID-19 pandemic. ICD-10 codes of six common CVDs (cerebral hemorrhage, cerebral infarction, myocardial infarction, ischemic heart disease, cardiac failure, and arrhythmia) were collected from clinical visits between January 2018 and March 2021 using the National Health Insurance service database, which stores data on all citizens of Korea (~50 million people). The number and distribution of monthly visits for CVDs were compared before and during the COVID-19 pandemic, and the differences were analyzed using the Mann–Whitney U test and Levene’s test. Our data showed similar incidences of cerebral hemorrhage and ischemic heart disease, a lower incidence of cerebral infarction, and higher incidences of myocardial infarction, cardiac failure, and arrhythmia during COVID-19. Despite statistical differences, the changes in incidences were not considered meaningful. The monthly incidences also remained similar throughout the year, without seasonal variations, both before and during the COVID-19 outbreak. This study found no significant changes in the incidences or monthly variation in CVDs due to the COVID-19 pandemic in Korea.

Change in the association between coffee intake and ischemic heart disease in an international ecological study from 1990 to 2018

In previous observational studies, the association between coffee intake and risk of cardiovascular disease has reversed from positive to negative over time. This long-term international ecological study examined whether the association between coffee intake and mortality and incidence rates of ischemic heart disease (IHD) changed between 1990 and 2018 using multiple coherent data. We obtained data on coffee intake per capita, IHD mortality and incidence rates per 100,000 population, and socioeconomic and lifestyle indicators for each country from various publicly available databases. We integrated and analyzed data from 147 countries with populations of ≥ 1 million. We employed a linear mixed model analysis to assess the association between coffee intake and IHD mortality and incidence rates by year. The mean global coffee intake increased (p < 0.001), whereas IHD mortality (p < 0.001) and incidence (p = 0.073) decreased. In all models, the interaction between coffee intake and year showed a significant inverse association for IHD mortality and incidence rates (p < 0.001 for all). The country-level association between coffee intake and IHD mortality and incidence rates between 1990 and 2018 was stronger in the negative direction.

Implications of updated epidemiological characteristics from heart diseases in China

Implications of updated epidemiological characteristics from heart diseases in China

Night and shift work characteristics and incident ischemic heart disease and atrial fibrillation among healthcare employees - a prospective cohort study.

This study aimed to examine the effects of various aspects of night and shift work on the risk of incident ischemic heart disease (IHD) and atrial fibrillation (AF) using detailed and registry-based exposure data. This prospective cohort study included >30 300 healthcare employees (eg, nurses, nursing assistants) employed for at least one year in Region Stockholm 2008-2016. Information on daily working hours was obtained from a computerized administrative employee register and outcomes from national and regional registers. Using discrete-time proportional hazard models, we analyzed the outcomes as functions of working hour characteristics the preceding year, adjusted for sex, age, country of birth, education, and profession. We observed 223 cases of IHD and 281 cases of AF during follow-up 2009-2016. The risk of IHD was increased among employees who the preceding year had permanent night shifts compared to those with permanent day work [hazard ratio (HR) 1.61, 95% confidence interval (CI) 1.06-2.43] and among employees working night shifts >120 times per year compared to those who never worked night (HR 1.53, 95% CI 1.05-2.21). When restricted to non-night workers, the risk of IHD was increased for employees having frequent quick returns from afternoon shifts. No increased risks were observed for AF. Night work, especially working permanent night shifts and frequent night shifts, is associated with an increased risk of incident IHD but not AF. Moreover, frequent quick returns from afternoon shifts (among non-night workers) increased IHD risk. Organizing work schedules to minimize these exposures may reduce IHD risk.

Predictive Value of Serum Uric Acid to HDL Cholesterol Ratio for Incident Ischemic Heart Disease in Non-Diabetic Koreans.

HDL cholesterol, besides its function in lipid metabolism, plays a role in suppressing blood oxidation reactions and protecting vascular endothelial cells. The uric acid/HDL cholesterol ratio (UHR) has recently attracted attention as a new biomarker for evaluating interactions between inflammatory and anti-inflammatory substances in the blood. This study aimed to investigate the longitudinal association between UHR and incident ischemic heart disease (IHD). Data from 16,455 participants without diabetes from the Health Risk Assessment Study (HERAS) and Korean Health Insurance Review and Assessment (HIRA) were assessed. Over 50 months after baseline enrolment, 321 (2.0%) participants developed IHD. The HRs of incident IHD were 0.85 (95% CI, 0.55–1.29), 1.42 (95% CI, 0.94–2.13), and 1.57 (95% CI, 1.01–2.45) in the second, third, and fourth UHR quartiles, respectively, after adjusting for potential confounding variables. In the subgroup analysis by sex-specific quartile, women tended to have higher HRs in the highest UHR quartile. We found that high UHR values were positively associated with incident IHD in Koreans without diabetes. An increased UHR may be a useful measure by which to assess cardiovascular risk in the preclinical stage.

Abstract 5303: Cardiovascular disease risk associated with breast cancer chemotherapy drugs: The Pathways Heart Study

Abstract Purpose: Chemotherapy drugs to treat breast cancer (BC) are cardiotoxic, but few studies have examined the effects of specific chemotherapy combinations on cardiovascular disease (CVD). We examined the additive effects of combinations of BC chemotherapy drugs associated with incident CVD events among women with a history of BC compared to those without. Methods: The Pathways Heart Study is a cohort study within Kaiser Permanente Northern California (KPNC) examining incident CVD events and risk factors in women with BC. Eligibility criteria included invasive BC diagnosis from 11/2005 to 3/2013, age&amp;ge;21 years, and KPNC membership&amp;ge;12 months at BC diagnosis. Controls without BC were matched 5:1 on birth year and race/ethnicity. KPNC electronic health records were used to collect demographic, clinical, and treatment characteristics. Chemotherapy drugs identified from clinical data included anthracyclines, cyclophosphamides, taxanes, and trastuzumab. Mutually exclusive groups were created according to the types of chemotherapy drugs received. Outcomes identified from ICD9/10 diagnosis codes included incident ischemic heart disease, heart failure (HF)/cardiomyopathy and stroke. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of the CVD outcome by chemotherapy drug combinations received relative to matched controls. Results: A total of 6,761 women with BC who received chemotherapy were identified and were matched to 33,801 controls. On average, women were 55.2 years old (standard deviation (SD)=10.9) and were followed for 7.1 years (SD=3.6). Four groups of women with distinct chemotherapy combinations were identified: anthracyclines + cyclophosphamide (AC, 10.5%), AC + taxanes (39.0%), AC + taxanes + trastuzumab (8.8%), and cyclophosphamide + taxanes (20.7%). Women who received AC had a 2.00 (95% CI: 1.27-3.14) increased risk of incident HF/cardiomyopathy relative to matched controls without BC. When taxanes were added to this combination, risk was similar (HR=1.88; 95% CI: 1.44-2.47). However, when trastuzumab was further added, risk of HF/cardiomyopathy increased more than 1.5-fold (HR=3.18; 95% CI: 1.91-5.30). The combined receipt of cyclophosphamide and taxanes was associated with a 1.42 (95% CI: 1.05-1.92) increased risk of developing stroke, but including anthracyclines with this combination inversed the association for stroke (HR: 0.73, 95% CI: 0.54- 0.99). No combinations examined were associated with incidence of ischemic heart disease. Conclusion: Findings suggest specific chemotherapy drug combinations may differentially affect the risk of incident HF/cardiomyopathy and stroke in BC survivors. Future work will examine dosage and duration of chemotherapy exposure, comparisons of the groups’ characteristics to account for possible confounding by indication, and competing risk analysis. Citation Format: Hanjie Shen, Eileen Rillamas-Sun, Carlos Iribarren, Richard Cheng, Jamal S. Rana, Mai Nguyen-Huynh, Cecile A. Laurent, Valerie S. Lee, Janise M. Roh, Dawn L. Hershman, Lawrence H. Kushi, Marilyn L. Kwan, Heather Greenlee. Cardiovascular disease risk associated with breast cancer chemotherapy drugs: The Pathways Heart Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5303.

Underestimated Ischemic Heart Disease in Major Adverse Cardiovascular Events after Septicemia Discharge.

Background and Objectives: Sepsis increases cardiovascular disease and causes death. Ischemic heart disease (IHD) without acute myocardial infarction has been discussed less, and the relationship between risk factors and IHD in septicemia survivors within six months is worthy of in-depth study. Our study demonstrated the incidence of IHD and the possible risk factors for IHD in septicemia patients within six months. Materials and Methods: An inpatient dataset of the Taiwanese Longitudinal Health Insurance Database between 2001 and 2003 was used. The events were defined as rehospitalization of stroke and IHD after discharge or death within six months after the first septicemia hospitalization. The relative factors of major adverse cardiovascular events (MACEs) and IHD were identified by multivariate Cox proportional regression. Results: There were 4323 septicemia survivors and 404 (9.3%) IHD. New-onset atrial fibrillation had a hazard ratio (HR) of 1.705 (95% confidence interval (C.I.): 1.156–2.516) for MACEs and carried a 184% risk with HR 2.836 (95% C.I.: 1.725–4.665) for IHD by adjusted area and other risk factors. Conclusions: This study explored advanced-aged patients who experienced more severe septicemia with new-onset atrial fibrillation, which increases the incidence of IHD in MACEs within six months of septicemia. Therefore, healthcare providers must identify patients with a higher IHD risk and modify risk factors beforehand.

Effects of statins on the risks of ischemic stroke and heart disease in human immunodeficiency virus infection, influenza and severe acute respiratory syndrome–associated coronavirus: respiratory virus infection with steroid use

Objectives We sought to fill the research gap on the effects of statins on the risks of ischemic stroke and heart disease among individuals with human immunodeficiency virus infection, influenza, and severe acute respiratory syndrome associated–coronavirus (HIS) disorders. Methods We enrolled a HIS cohort treated with statins (n = 4921) and a HIS cohort not treated with statins (n = 4921). The cumulative incidence of ischemic stroke and heart disease was analyzed using a time-dependent Cox proportional regression analysis. We analyzed the adjusted hazard ratio (aHR) and 95% confidence interval (CI) of ischemic stroke and heart disease for statins users relative to nonusers based on sex, age, comorbidities and medications. Results The aHR (95% CI) was 0.38 (0.22–0.65) for ischemic stroke. The aHR (95% CI) of heart disease was 0.50 (0.46–0.55). The aHRs (95% CI) of statin users with low, medium, and high adherence (statin use covering <33%, 33%–66%, and >66%, respectively, of the study period) for the risks of ischemic stroke were 0.50 (0.27–0.92), 0.31 (0.10–1.01), and 0.16 (0.04–0.68) and for heart disease were 0.56 (0.51–0.61), 0.40 (0.33–0.48), and 0.44 (0.38–0.51), respectively, compared with statin nonusers. Conclusion Statin use was associated with lower aHRs for ischemic stroke and heart disease in those with HIS disorders with comorbidities.

MO084: Resistant Hypertension is Associated With an Increased Cardiovascular Risk Compared to Patients Controlled on a Similar Multi-Drug Regimen

Abstract BACKGROUND AND AIMS The long-term risk associated with resistant hypertension as compared with other phenotypes of hypertension is still unclear. This has been a result of heterogeneity in the definition of both resistant and non-resistant hypertension. We aimed at assessing the cardiovascular and renal outcomes of resistant hypertension compared with a similarly treated (≥3 medication classes including a diuretic) patients whose blood pressure is under control. METHOD This retrospective cohort study utilized the computerized database of Maccabi Healthcare Services (MHS). Over a 10 years follow up, a historical cohort of patients with baseline uncontrolled resistant hypertension were compared to a similar cohort of hypertensive examinees, whose BP was well controlled. Clinical outcomes were assessed using Cox regression multivariable analyses. RESULTS —A total of 1487 patients (50% males, mean age at baseline = 68.3 ± 10.4 years) were included in the resistant hypertension cohort and 1343 patients (50% males, 66.2 ± 10.6y) in the controlled hypertension reference group. After adjusting for age, sex, BMI and patients’ comorbidities, uncontrolled resistant hypertension was associated with a hazard ratio (HR) of 1.35 (95% CI: 1.08–1.69) for incidence of ischemic heart disease and 1.51 (1.06–2.16) for secondary cardiovascular events compared to the reference group. It also was associated with an increased risk of stroke or TIA (HR = 1.36; 95% CI: 1.00–1.86). Patients with resistant hypertension had more hospitalization days (mean = 4.2 days versus 3 days per year, P &amp;lt; 0.001), and more emergency room visits during follow-up period (83.3% versus 77%, P &amp;lt; 0.001). Overall, uncontrolled resistant hypertension was associated with a 19% (95% CI: 11–29%) increase in the direct healthcare expenditure during the first year of follow-up. CONCLUSION Resistant hypertension is associated with a 35% increased risk of both cardiovascular and cerebrovascular events, when compared with a similarly treated hypertensive patients whose blood pressure is under control. Physicians should overcome therapeutic inertia and add a fourth or a fifth anti-hypertensive medication, even when treating patients who are already on a multi-drug regimen.

Long-term exposure to ambient fine particulate matter (PM2.5) and associations with cardiopulmonary diseases and lung cancer in Taiwan: a nationwide longitudinal cohort study

Although a number of studies have reported on the health effects of fine particulate matter (PM2.5) exposure, particularly in North American and European countries as well as China, the evidence about intermediate to high levels of PM2.5 exposures is still limited. We aimed to investigate the associations between long-term exposure to PM2.5 and risk of cardiopulmonary disease incidence in Taiwan with intermediate levels of PM2.5 exposure. A cohort of Taiwanese adults, who participated in the 2001, 2005, 2009 and 2013 National Health Interview Surveys, was followed through 2016 to identify cardiopulmonary disease onset. Exposure to PM2.5 was estimated by incorporating a widespread monitoring network of air quality monitoring stations and microsensors. We used time-dependent Cox regression models to examine the associations between the PM2.5 exposures and health outcomes, adjusting for individual characteristics and ecological covariates. The natural cubic spline functions were used to explore the non-linear effects of the PM2.5 exposure. A total of 62 694 adults from 353 towns were enrolled. Each 10-μg/m3 increase in 5-year average exposure to PM2.5 was associated with a 4.8% increased risk of incident ischaemic heart disease (95% CI: -3.3, 13.6), 3.9% increased risk of incident stroke (95% CI: -2.9, 11.1), 6.7% increased risk of incident diabetes (95% CI: 1.1, 12.7), 15.7% increased risk of incident lung cancer (95% CI: -0.9, 35.1) and 11.5% increased risk of incident chronic obstructive pulmonary disease (95% CI: -0.8, 25.2). The concentration-response curve showed that there was no statistical evidence of non-linearity for most of the disease outcomes except for ischaemic heart disease (P for non-linearity = 0.014). Long-term exposure to intermediate levels of ambient PM2.5 was associated with cardiopulmonary health outcomes. Our study adds value to future application and national burden of disease estimation in evaluating the health co-benefits from ambient air pollution reduction policy in Asian countries.

P210 Morbidity and mortality in rheumatoid arthritis: review of data from ‘Basildon Early Inflammatory Arthritis Cohort’

Abstract Background/Aims Rheumatoid arthritis is a chronic inflammatory autoimmune condition associated with multi-system involvement, cardiovascular risk, worsening quality of life measures and increased mortality. Analysing registry data helps identify parameters that may contribute to morbidity and mortality. Recognising limitations in current treatment could facilitate development of new management strategies. Objective is to assess long-term outcome of patients diagnosed with rheumatoid arthritis in ‘Early Arthritis Cohort’ at a district general hospital in UK. Methods A retrospective cohort study was conducted on 185 patients newly diagnosed with rheumatoid arthritis between 2009 &amp; 2013. Anonymised data from the Basildon Early Arthritis registry were analysed. Measured parameters included patient demographics, disease activity score (DAS28), laboratory and imaging investigations, treatment regime, development of new disease manifestations &amp; mortality. Results Complete data were available for analysis in 157 patients. This comprised 56 men &amp; 101 women with median age of 57 years (Q1 = 47 years, Q3 = 67 years) and median follow-up time of 93 months (Q1 = 67 months, Q3 = 108 months). At baseline, 40.1% of patients had DAS28 score &amp;gt; 5.1, whilst 2.5% had DAS28 score &amp;gt; 5.1 at time of their last follow up. 74% of patients were in clinical remission at time of their last follow up, with the majority continuing to require pharmacological therapy, either as single DMARD 39.5%, combination csDMARD 29.3% or biologic therapy 17.2%. Drug-free remission was achieved in 14% of patients. Analysis of new comorbidities revealed cancer burden with 14.6% (23/157) developing malignancy, lung cancer having highest incidence 5.7% (9/157). 39% of the cohort were current or ex-smokers. Other malignancies included prostate, haematological and breast cancers. Cardiac involvement was noted in 11.5% with incidence of ischaemic heart disease at 7% (11/157) and heart failure at 4.5% (7/157). Cerebrovascular and pulmonary diseases were detected in 5.7% (9/157) and 5.1% (8/157) respectively. A mortality rate of 21% (33/157) was observed in our cohort. Patients in the mortality group had median baseline age of 72 as compared to 53 for remaining cohort. This age difference did not reach statistical significance. Duration of illness prior to death was less than 5 years in 45% of patients and between 5-10 years in 55% of patients. Predominant cause of death was underlying malignancy 8.3% (13/157), ischaemic heart disease 3.8% (6/157), frailty 3.2% (5/157), and pulmonary disease 2.5% (4/157). The DAS28 score was found to be significantly higher in the mortality group compared to remaining cohort (p = 0.006). Conclusion Long-term outcomes in patients with rheumatoid arthritis recruited from early arthritis cohort reveal mortality rate of 21% and cancer burden of 14.6%. Patients in the mortality group displayed significantly higher DAS28 scores at time of their last follow-up. Disclosure D. Laila: None. K. Jain: None. A. Nandagudi: None. A. Bharadwaj: None.

Association between Blood Copper Levels and the Incidence of Ischemic Heart Disease

Background: Ischemic heart disease is one of the interrelated disease amongst cardiovascular disease group. Pathophysiological model of ischemic heart disease and myocardial ischemia are caused by obstructive atherosclerotic plaque, which involves the narrowing of small blood vessels that oxygenate the heart muscle by the build-up of plaque. Diet plays an important role in ischemic heart disease. Copper, an essential trace metal micronutrient, is required for myocardial angiogenesis action. Copper deficiency leads to cardiac mitochondrial structural defect and interference in oxidative phosphorylation.&#x0D; Aims: This study aims to examine the association between blood copper levels amd the incidence of ischemic heart disease.&#x0D; Methods: A total of 30 patients in cardiovascular clinic in Universitas Sumatera Utara Hospital in Medan, Indonesia from September 2021 until January 2022 were included in this cross-sectional study, with descriptive analytics. Demographic data, smoking behavior, supplement consumption, anthropometry measurements, body mass index, medical history were collected. Food frequency questionnaire (semiquantitative FFQ) was used to obtain food recall data. Blood level of copper were analysed in Prodia Clinical Laboratory.&#x0D; Results: Out of 30 patients in this study, 70% were male with a mean age of 60.6 years old. Research subjects who had risk factor of smoking were as much as 33.3%. Comorbidities such as dyslipidemia and diabetes mellitus were apparent, which were 63.3% and 30%, respectively. Sixty percent of the subjects were sedentary with mean body mass index 25.9 kg/m2. Median level of copper consumed daily was 1400 mcg/day and mean blood copper level was 1034,5 mg/L. Based on the blood copper level analysis of the subjects, we found an insignificant negative correlation between blood copper level with the incidence of ischemic heart disease (r = -0.050; p &lt;0.795).&#x0D; Conclusion: This study found no association between blood copper levels and the incidence of ischemic heart disease.

Preterm birth ---- A novel risk factor of Ischemic Heart Disease and Stroke

Madam, preterm birth (PTB) is classified as having a gestational age of fewer than 37 weeks; annually, approximately 15 million infants are born preterm worldwide(1). Major risk factors of PTB include placenta previa, fetal distress, maternal thyroid disease, and maternal asthma(2). Both teenage (&lt;20 years) and advanced age (&gt;35 years) mothers carry an increased risk of giving birth prematurely(2). Previous studies have shown a positive correlation between PTB and numerous disorders, including hypertension, diabetes mellitus, and hyperlipidemia(3). Mounting evidence suggests PTB is a significant risk factor for ischemic heart disease (IHD) and stroke. However, due to prior discrepant findings, there is a possibility that these associations might be spurious. However, recent literature surfaced two cohorts by Crump et al. in 2019(4) and 2021(3). In 2019, compiled data from 2,141,709 participants over 43 years, and preterm babies were found to have a significantly higher risk of developing IHD in the future (aHR: 1.44 [1.19-1.73](4). Moreover, the incidence of IHD was more prevalent among preterm-born men than preterm-born women(4). The 2021 cohort evaluated the frequency of stroke with PTB. It concluded that PTB was associated with higher risks of both hemorrhagic stroke (aHR: 1.15 [0.97–1.35]) and ischemic stroke (aHR: 1.31 [1.07–1.60]), compared with full-term birth(3). These results are worrisome for Pakistan since it has a high tally of PTB cases, as highlighted by a 2017 study by Hanif et al., which showed a 21.64% prevalence of PTB among 1691 females(2). These preterm infants have an increased likelihood of acquiring IHD and Stroke coupled with the already established diseases including hypertension, diabetes, and hyperlipidemia later in life, which exacerbates the already high disease burden in Pakistan. Moreover, unaware of the medicines’ cost-effectiveness, medical practitioners commonly prescribe expensive popular generics for treating IHD(5), which inflicts a substantial financial burden on these patients. Hence, paediatricians should be advised to follow up with preterm babies regularly assess their progress, educate mothers about the risk factors of PTB and minimize the chances of them showing up down the line by emphasizing proper diet, regular exercise, and abstinence from smoking. Nationwide campaigns and awareness drives are a few ways the general population could be made aware of PTB and its threat to the health of these children in the future. Continue...

Incidence and Mortality of Cardiovascular Disease in the Republic of Kazakhstan: 2004-2017.

Background:We aimed to evaluate the impact of national health programs implemented in Kazakhstan from 2011 on CVD incidence and mortality.Methods:Incidence and mortality rates from CVD were studied in Kazakhstan from 2004 to 2017. The official data obtained from “Medinform” company were analyzed based on the annual population statistics.Results:There was an increase in the incidence of cardiovascular disease among the population of Kazakhstan from 1845.4 per 100,000 in 2004 to 2597.5 per 100,000 in 2017. This might be attributed to the implementation of the national health programs, which improved early CVD identification. Incidence of ischemic heart disease (IHD) was grown almost in all provinces of Kazakhstan during the study period. The mortality from cardiovascular disease had a considerable decline over the study period, in particular after 2010, it might be influenced by early diagnosis and provision of timely treatment.Conclusion:The experience of Kazakhstan national health programs shows improved identification of CVD and IHD and timely treatment for cardiovascular disease. A significant variation in incidence and mortality rates of cardiovascular disease was observed between the country provinces.