Ischemic Heart Disease Morbidity Research Articles

A burden of proof study on alcohol consumption and ischemic heart disease

Cohort and case-control data have suggested an association between low to moderate alcohol consumption and decreased risk of ischemic heart disease (IHD), yet results from Mendelian randomization (MR) studies designed to reduce bias have shown either no or a harmful association. Here we conducted an updated systematic review and re-evaluated existing cohort, case-control, and MR data using the burden of proof meta-analytical framework. Cohort and case-control data show low to moderate alcohol consumption is associated with decreased IHD risk – specifically, intake is inversely related to IHD and myocardial infarction morbidity in both sexes and IHD mortality in males – while pooled MR data show no association, confirming that self-reported versus genetically predicted alcohol use data yield conflicting findings about the alcohol-IHD relationship. Our results highlight the need to advance MR methodologies and emulate randomized trials using large observational databases to obtain more definitive answers to this critical public health question.

Psychological Health and Ischemic Heart Disease in Women: A Review of Current Evidence and Clinical Considerations across the Healthspan.

Psychological health encompasses a constellation of negative and positive factors-i.e., psychosocial stress, depression, anxiety, trauma, loneliness and social isolation, anger and hostility, optimism, and a sense of purpose. This narrative review presents current evidence at the intersection of psychological health, risk of ischemic heart disease (IHD), and IHD-related outcomes, with an emphasis on associations in women. For women, relations between psychological health and IHD reflect important sex and gender differences in biological and psychosocial factors. Although efforts devoted to understanding psychological health and IHD risk have varied by psychological factor-scientific evidence is strongest for psychosocial stress and depression, while anxiety, trauma, and positive psychological factors warrant more investigation-less optimal psychological health is consistently associated with an earlier and greater risk of IHD morbidity and mortality in women. Still, many past prospective studies of psychological factors and IHD risk had a limited representation of women, did not include analyses by sex, or failed to account for other influential, sex-specific factors. Thus, there are multiple pathways for further, rigorous investigation into psychological health-IHD associations, mechanisms, and empirically supported psychological interventions to mitigate IHD risk among women. Given the robust evidence linking psychological health with women's risk for IHD, implementing routine, brief, psychological screening is recommended. Significant life events, developmental milestones specific to women, and IHD diagnoses or events could cue further psychological assessment and referral, efforts which will mutually strengthen the evidence for integrated psychological and IHD care and delivery of such care to this vulnerable group.

Systematic review and meta-analyses of association between transportation noise and Ischaemic heart disease based on studies published between 1994 - 2022

There is a growing body of evidence that exposure to transportation noise can increase the risk for ischaemic heart disease (IHD). However, there are significant variations in the pooled exposure-response relationships (ERRs) derived by recent meta-analyses. These discrepancies lead to uncertainties in health impact assessments and in public health policy decision-making. Updated analyses are needed to better understand this relationship. This paper presents an update to recent systematic reviews and meta-analyses investigating the effects of transportation noise exposure on IHD mortality and morbidity. Specific aims are to understand if studies published since 2019 affect pooled ERRs and assess if evidence for aircraft and railway noise exposure has strengthened. We included studies from two meta-analyses and one literature review covering the years 1994-2020. We then conducted an updated literature search in PubMed, Scopus, Web of Science and Medline for the period October 2020 and January 2022, following the same protocol as the WHO Environmental Noise Systemic Review Group. 30 studies were included from the previous reviews, and nine further studies were identified via the updated literature search. The studies present risk estimates for IHD incidence (n=36), prevalence (n=5) mortality (n=26). The updated evidence and exposure response analysis is presented for Lden.

Global Burden of Ischemic Heart Disease and Attributable Risk Factors, 1990–2017: A Secondary Analysis Based on the Global Burden of Disease Study 2017

ObjectiveTo estimate the burden of ischemic heart disease (IHD) stratified by gender, age, geographic location, and social-demographic status for 21 regions across the world from 1990 to 2017.MethodsUsing the Global Burden of Disease Study (GBD) Results Tool, we extracted data on the incidence, mortality, disability-adjusted life years (DALYs), and age-standardized rates related to IHD, as IHD burden measures. Trend analyzes were conducted for major regions. Risk factors for DALYs (obtained from the GBD comparative risk assessment framework) were also analyzed.ResultsGlobally, 10.6 million (95% uncertainty interval [UI]: 9.6–11.8) cases of IHD occurred in 2017, with 8.9 million (95%UI:8.8–9.1) IHD-related deaths. Both the age-standardized incidence rate (ASIR) and death rate (ASDR) declined from 1990 to 2017 (percentage change: 27.4% and 30.0%, respectively), with average annual percent change (AAPC) values of −1.2% and −1.3%, respectively. In 2017, the global number of IHD-related DALYs was 170.3 million (95%UI:167.1–174.0), and the middle socio-demographic index (SDI) quintile contributed the most to these DALYs. In most regions, indicators (incidence, mortality, and DALYs) declined steadily with SDI increased. High systolic blood pressure (SBP) was the most significant contributor to the DALYs in most regions, accounting for 118.18 million DALYs in 2017 globally, followed by high low-density lipoprotein cholesterol and a diet low in nuts and seeds (101.78 and 52.86 million, respectively).ConclusionEven though the trend in IHD morbidity and mortality decreased globally, the IHD burden remains high, particularly in regions with lower SDI. It is necessary to learn successful and effective experience in controlling IHD risks and decreasing health disparities to reduce the IHD burden.

Road traffic noise, noise sensitivity, noise annoyance, psychological and physical health and mortality

BackgroundBoth physical and psychological health outcomes have been associated with exposure to environmental noise. Noise sensitivity could have the same moderating effect on physical and psychological health outcomes related to environmental noise exposure as on annoyance but this has been little tested.MethodsA cohort of 2398 men between 45 and 59 years, the longitudinal Caerphilly Collaborative Heart Disease study, was established in 1984/88 and followed into the mid-1990s. Road traffic noise maps were assessed at baseline. Psychological ill-health was measured in phase 2 in 1984/88, phase 3 (1989/93) and phase 4 (1993/7). Ischaemic heart disease was measured in clinic at baseline and through hospital records and records of deaths during follow up. We examined the longitudinal associations between road traffic noise and ischaemic heart disease morbidity and mortality using Cox Proportional Hazard Models and psychological ill-health using Logistic Regression; we also examined whether noise sensitivity and noise annoyance might moderate these associations. We also tested if noise sensitivity and noise annoyance were longitudinal predictors of ischaemic heart disease morbidity and mortality and psychological ill-health.ResultsRoad traffic noise was not associated with ischaemic heart disease morbidity or mortality. Neither noise sensitivity nor noise annoyance moderated the effects of road traffic noise on ischaemic heart disease morbidity or mortality. High noise sensitivity was associated with lower ischaemic heart disease mortality risk (HR = 0.74, 95%CI 0.57, 0.97). Road traffic noise was associated with Phase 4 psychological ill-health but only among those exposed to 56-60dBA (fully adjusted OR = 1.82 95%CI 1.07, 3.07). Noise sensitivity moderated the association of road traffic noise exposure with psychological ill-health. High noise sensitivity was associated longitudinally with psychological ill-health at phase 3 (OR = 1.85 95%CI 1.23, 2.78) and phase 4 (OR = 1.65 95%CI 1.09, 2.50). Noise annoyance predicted psychological ill-health at phase 4 (OR = 2.47 95%CI 1.00, 6.13).ConclusionsNoise sensitivity is a specific predictor of psychological ill-health and may be part of a wider construct of environmental susceptibility. Noise sensitivity may increase the risk of psychological ill-health when exposed to road traffic noise. Noise annoyance may be a mediator of the effects of road traffic noise on psychological ill-health.

Estimated health benefits, costs, and cost-effectiveness of eliminating industrial trans-fatty acids in Australia: A modelling study.

trans-fatty acids (TFAs) are a well-known risk factor of ischemic heart disease (IHD). In Australia, the highest TFA intake is concentrated to the most socioeconomically disadvantaged groups. Elimination of industrial TFA (iTFA) from the Australian food supply could result in reduced IHD mortality and morbidity while improving health equity. However, such legislation could lead to additional costs for both government and food industry. Thus, we assessed the potential cost-effectiveness, health gains, and effects on health equality of an iTFA ban from the Australian food supply. Markov cohort models were used to estimate the impact on IHD burden and health equity, as well as the cost-effectiveness of a national ban of iTFA in Australia. Intake of TFA was assessed using the 2011-2012 Australian National Nutrition and Physical Activity Survey. The IHD burden attributable to TFA was calculated by comparing the current level of TFA intake to a counterfactual setting where consumption was lowered to a theoretical minimum distribution with a mean of 0.5% energy per day (corresponding to TFA intake only from nonindustrial sources, e.g., dairy foods). Policy costs, avoided IHD events and deaths, health-adjusted life years (HALYs) gained, and changes in IHD-related healthcare costs saved were estimated over 10 years and lifetime of the adult Australian population. Cost-effectiveness was assessed by calculation of incremental cost-effectiveness ratios (ICERs) using net policy cost and HALYs gained. Health benefits and healthcare cost changes were also assessed in subgroups based on socioeconomic status, defined by Socio-Economic Indexes for Areas (SEIFA) quintile, and remoteness. Compared to a base case of no ban and current TFA intakes, elimination of iTFA was estimated to prevent 2,294 (95% uncertainty interval [UI]: 1,765; 2,851) IHD deaths and 9,931 (95% UI: 8,429; 11,532) IHD events over the first 10 years. The greatest health benefits were accrued to the most socioeconomically disadvantaged quintiles and among Australians living outside of major cities. The intervention was estimated to be cost saving (net cost <0 AUD) or cost-effective (i.e., ICER < AUD 169,361/HALY) regardless of the time horizon, with ICERs of 1,073 (95% UI: dominant; 3,503) and 1,956 (95% UI: 1,010; 2,750) AUD/HALY over 10 years and lifetime, respectively. Findings were robust across several sensitivity analyses. Key limitations of the study include the lack of recent data of TFA intake and the small sample sizes used to estimate intakes in subgroups. As with all simulation models, our study does not prove that a ban of iTFA will prevent IHD, rather, it provides the best quantitative estimates and corresponding uncertainty of a potential effect in the absence of stronger direct evidence. Our model estimates that a ban of iTFAs could avert substantial numbers of IHD events and deaths in Australia and would likely be a highly cost-effective strategy to reduce social-economic and urban-rural inequalities in health. These findings suggest that elimination of iTFA can cost-effectively improve health and health equality even in countries with low iTFA intake.

Associations between acute exposure to ambient air pollution and length of stay for inpatients with ischemic heart disease: a multi-city analysis in central China.

Ambient air pollution (AAP) has been widely associated with increased morbidity of ischemic heart disease (IHD). However, no prior studies have investigated the effects of AAP exposure on the length of stay (LOS) due to IHD. Hospital data during 2015-2017 were obtained from hospital information system in five cities of Hubei province, China. We collected daily mean concentrations of air pollutants, including PM2.5, PM10, SO2, NO2, O3, and CO, and meteorological data during the same time period. Poisson regression was applied to estimate the acute impacts of AAP on the LOS of IHD inpatients. A total of 42,114 inpatients with primary diagnosis of IHD were included, 50.63% of which were chronic IHD inpatients. Annual average concentrations of PM2.5, PM10, SO2, NO2, O3, and CO were 61.93μg/m3, 95.47μg/m3, 18.59μg/m3, 35.87μg/m3, 100.30μg/m3, and 1.117mg/m3, respectively. After adjusting for temperature, relative humidity, gender, age group, payment method, number of hospital beds, location of hospital, and surgery or not, exposures to PM2.5, PM10, SO2, O3, and CO were associated with increased LOS for all IHD patients in both single- and multi-pollutant models, and stronger associations were observed among chronic IHD patients. In addition, subgroup analyses demonstrated that males and the group aged 65+ years were more vulnerable to air pollution, and the adverse effects were also promoted by low temperature in cold season. This study provides the first investigation of the adverse effects of AAP on the LOS for IHD patients. In order to shorten the LOS of IHD, measures should be taken to strengthen the AAP management and protect the high-risk population.

P0895THE RELATIONSHIP OF ARTERIAL CALCIFICATIONS IN CHRONIC KIDNEY DISEASE PATIENTS WITH INDIRECT ANTICOAGULANT INTAKE AND HEART MORBIDITY

Abstract Background and Aims In patients with chronic kidney disease (CKD), arterial calcification (AC) is a potential mechanism for the progression of cardiovascular disease. AC is common in CKD patients and is a consequence of mineral-bone disorders. Indirect anticoagulants or vitamin K deficiency lead to matrix γ-carboxyglutamate decarboxylation, which may potentiate vascular calcification formation. The impaired renal function and indirect anticoagulants intake may lead to vitamin K deficiency and increased AC. The aim of this study is to determine if oral intake of Acenocoumarol has influence on abdominal aorta calcium score (AACS) and the AC relation with atrial fibrillation (AF) and / or ischemic heart disease (IHD) morbidity. Method We observe 129 patients with CKD (glomerular filtration rate below 44 ml/min/1,73 m2, MDRD formula calculated). X - ray of the lateral abdominal aorta is performed for the AACS assessment according to L. I. Kauppila et al. method. The assessment of calcium score is formed by the involvement grade of each segment on the anterior and posterior wall of the vessel along the first four lumbar vertebrae. Calcification affecting less than 1/3 of the anterior wall of the aorta along the lumbar vertebral body receives 1 score and calcification extending over ½ of the vertebral body length receives 3 scores (total score - 24). The patients are distributed into three groups: I group with calcium score from 0 to 7, II - from 8 to 15 and III group - from 16 to 24. The data from assessed AACS are compared with Acenocoumarol intake and the presence/absence of AF and/or IHD. The results are processed with χ2 statistical analysis. Results One hundred twenty nine patients with CKD (95 males and 34 females) are included in the study. The patients data (mean, percentages, degrees, etc.) are summarized in tabl.1 and tabl. 2. Clinically significant is the correlation between the grades of AACS and Acenocoumarol intake (p &amp;lt; 0,05). With the calcium score increasing, the patients percentage treated with Acenocoumarol also increases (fig. 1). There is a moderate correlation (Cramer’s coefficient is 0,39) between the AACS grades and heart morbidity from AF and / or IHD (p &amp;lt; 0,05). The data shows that the higher calcium score is related with increased patients percentage with AF and / or IHD morbidity (fig. 2). In our study, vascular calcifications are found in the abdominal aorta walls in all of the observed patients. We found that a higher AACS is associated with an Acenocoumarol intake in CKD patients and corresponds to an increased morbidity of AF and / or IHD. Acenocoumarol intake may lead to increased AACS. The higher calcium score is associated with a higher incidence of AF and / or IHD morbidity. Conclusion The study outcome supported the hypothesis that the increased AC formation and cardiovascular morbidity high risk could be a reason for the limited vitamin K antagonists (acenocoumarol) use in CKD patients. Furthermore, vitamin K2 supplementation is reasonable and may reduce the progression of AC.

Guidelines for the Diagnosis and Management of Chronic Coronary Syndromes in Primary Health Care - the Issue of Acceptability for the Russian Federation

In 2019, the European Society for Cardiology (ESC) published guidelines with a new term, "chronic coronary syndromes" (CCS). These guidelines presented 6 clinical scenarios, which are most common in outpatient practice. The diagnostic approach described in these guidelines shifts from the standardization to the rationality of individualized solutions on using various diagnostic methods. The diagnostic approach suggested in the ESC guidelines requires extensive medical discussion and consensus because this will definitely entail a) further increase in indexes that reflect the morbidity of ischemic heart disease (IHD) due to unconfirmed diagnoses and b) administration of unreasoned therapy. This article presents statements of the guidelines, which cannot be automatically transmitted to the existing medical practice and should be discussed and adjusted by experts of the Russian Society of Cardiology.

Ischemic Heart Disease Burden and Attributable Risk Factors in 195 Countries and Territories, 1990-2017: Results from the Global Burden of Disease Study 2017

Background: Ischemic heart disease (IHD) is the leading cause of death worldwide. We aimed to estimate IHD incidence, mortality, and disability-adjusted life years (DALYs) by country, sex, age group, and social-demographic status for 21 world regions for the years from 1990 to 2017. Methods: In current study of the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2017, we extracted data for incidence, deaths of cases, disability-adjusted life-years (DALYs), and age-standardized rates as measures of ischemic heart disease burden using the GBD Results Tool. Trend analyzes of incidence, mortality, and DALYs were conducted for major regions. Risk factors for DALYs from the GBD comparative risk assessment framework were also evaluated and analyzed. Findings: Globally, 10,636,538 cases of IHD occurred overall in 2017, with 8,930,369 deaths. IHD mortality was highest in the low-middle SDI quantile. From 1990 to 2017, both IHD ASIR and ASDR declined globally, especially in high SDI countries. IHD related DALYs were 170,275,348 globally in 2017, for which the middle SDI quintile contributed the most. According to the results of regional analysis of SDI over time, incidence, mortality, and DALYs in most regions declined steadily as SDI increased during the same period. Among the risk factors associated with DALY, high systolic blood pressure (SBP) was the most significant contributor in most GBD regions. In contrast, other risk factors included high LDL cholesterol, diet low in nuts and seeds, high fasting plasma glucose (FPG), diet low in whole grains, and smoking. Interpretation: Even though the trend of IHD morbidity and mortality were decreasing globally, it is still at a high level, leading to a considerable burden of disease. Particularly in lower SDI countries, the rate of decline is limited in many ways and the performance is much worse than that in higher SDI countries. Therefore, sustained global and regional IHD epidemiology estimates are needed for estimating the worldwide burden of IHD. Finally, yet importantly, effective measures should be taken to address the attributable risk factors to reduce the burden of IHD. Funding Statement: This research was funded by the National Key Research and Development Program of China (No. 2018YFC1315302, 2017YFC 1200502); the National Natural Science Foundation of China (Grant No. 81773552). Declaration of Interests: The authors have declared that no competing interests exist.

Meta-analysis of the association between the short-term exposure to fine particular matter and the morbidity of ischemic heart disease

Objective: Using Meta-analysis to evaluate the association between the short-term exposure to fine particular matter (PM(2.5)) and the morbidity of ischemic heart disease (IHD). Methods: In this paper, "particulate matter" , "PM2.5" , "ischemic heart disease" , "coronary heart disease" , "coronary artery disease" , "atherosclerotic heart disease" , and "atherosclerotic cardiovascular disease" were used to systematically search for the literature on the association between the short-term exposure to PM(2.5) and the ischemic heart disease through China Biology Medicine disc (CBMdisc), China National Knowledge Infrastructure (CNKI), Wanfang, Vip as well as Pubmed and Web of Science. The time was up to January 31(st) 2019. The quality of literature was evaluated by the Newcastle-Ottawa Scale. Meta-analysis method was performed by using R3.5.0 software and was used to perform heterogeneity test, calculate combined risk of IHD with short-term exposure to PM(2.5) and carry out publication bias test. Results: A total of 1 424 literatures were retrieved. Of the 23 literatures included studies (2 literatures in Chinese and 21 literatures in English) according to the inclusion and exclusion criteria, 14 used a time-series design and 9 used a case-crossover design. The heterogeneity existed across all identified studies (I(2)=81%, P<0.05). The Random effect model showed that a 10 μg/m(3) increase in PM(2.5) was associated with estimated relative risk of IHD morbidity at 1.007 (95%CI: 1.005-1.009); Publication bias was noted in the analysis (t=2.76, P<0.05), and the combined effect values of IHD morbidity was reduced to 1.005(95%CI: 1.004-1.007) after adjusting for asymmetry. Conclusion: Short-term exposure to PM(2.5) may lead to the increase of ischemic heart disease morbidity.

Quantitative evaluation using single-photon emission computed tomography with acetazolamide is reliable for preoperative evaluation before cardiac surgery in severe carotid intracranial artery stenotic and/or occlusive disease: a case report

BackgroundSevere carotid and intracranial artery stenosis disease (CIAD) is major risk for perioperative stroke in coronary artery bypass grafting. Then, preoperative risk assessment is quite important.Case presentationA 58-years old Japanese woman with bilateral carotid stenosis and bilateral middle cerebral artery occlusion was suffered from worsening effort angina due to severe three coronary vessel disease. Magnetic resonance imaging angiography demonstrated severe carotid and intracranial vessel stenosis. Selective carotid/cerebral angiography also showed severe stenosis and delayed filling of the right internal carotid artery and moderate stenosis of the left internal carotid artery, with occlusion of the bilateral middle cerebral arteries. However, quantitative evaluation with brain perfusion, single-photon emission computed tomography (SPECT) with acetazolamide showed depleted cerebral perfusion volume and vascular responses, particularly in the left middle cerebral artery area. However, both sides of MCA reserve cerebral blood flow was maintained at > 34 ml/100 g/min. So, we finally considered that her cerebral perfusion reserve was maintained a certain level and could tolerate open heart surgery. Then, she underwent off-pump coronary artery grafting. Before sternotomy, prophylactic intra-aortic balloon pump support was used to minimize possible perioperative stroke. As a result, hemodynamic status and brain regional oxygen saturation were stable throughout the operation, and recovered uneventfully.ConclusionsPreoperative quantitative evaluation using brain perfusion SPECT with acetazolamide is useful in assessing hemodynamic cerebrovascular risk in patients with severe obstructive CIAD. Off pump coronary artery bypass grafting with intra aortic balloon pump assist is a good option for prevention of cerebrovascular morbidity in ischemic heart disease with severe CIAD.

The organization of high-tech medical care of patients with ischemic heart diseasein the Far East federal region in 2004-2013

To determine both perspectives of development of high-tech medical care in Russia and actuality of possible restructuring of system of cardio-surgery care of population it is appropriate to evaluate condition of surgical and intervention treatment of ischemic heart disease i the country and regions using the example of the Far East federal region. The analyzed indices were calculated for 100 000 of adult population. In Russia, during last decade, total common morbidity of ischemic heart disease increased up to 13.25±0,11% (n ± m) and primary morbidity factually doubled. In the Far East region indices increased up to 21,34 ± 0,13% and 67,33 ± 0,15% correspondingly. In Russia, the number of patients after coronary bypass surgery in increased up to 3.3 times (percentage of patients after ischemic heart disease surgery decreased on 42.5%) and number of patients with endovascular correction increased up to 7.8 times (their percentage increased up to 37.2%). In the Far East region increasing of coronary bypass surgery increased in 12.4 times, endovascular procedures - in 32.1 times. In Russia from 2005 lethality during direct myocardium re-vascularization surgery decreased on 21.6% and in case of endovascular interventions increased up to 2.1-2.9 times, including planned operations. The dynamics of most analyzed indices corresponds to international tendencies. However, the level of coronary surgery in Russia is still significantly lower than in the developed countries of Europe and America. In the Far East region, in 2013 situation with coronary surgery looks more reassuring than in 2004-2005 when it factually stopped developing. The health care authorities are to implement in the regions more elaborated analysis ofepidemiological indices with the purpose to develop effective activities concerning indices' amelioration; to standardize evaluation of lethality in case of surgery intervention; to adjust national standards of medical care under ischemic heart disease according international standards.

Do cardiovascular disease prevention programs in northern Sweden impact on population health? An interrupted time series analysis

BackgroundCardiovascular disease (CVD) is the main cause of morbidity and mortality in Sweden. This study aims to assess the impact of a CVD intervention implemented in 1993 in northern Sweden on the reduction of premature ischemic heart disease (IHD) morbidity and mortality in women and men during the period 1987–2013.MethodsAn ecological controlled interrupted time series design, with pre-intervention period defined as 1987–1993 and post-intervention period 1994–2013 was carried out. For each year, IHD events, stratified by sex, were retrieved from national registers.ResultsImpressive reductions on IHD premature morbidity and mortality were observed to a similar degree in both the intervention county and the other comparison counties across the last 27 years. Significant differences in the pre-post intervention trends indicating the intervention group had smaller reductions than expected from its pre-intervention trend and the trend of control counties were found among men for both IHD morbidity and mortality. A similar pattern was observed among women but without significant differences.ConclusionsTaken together, the data do not support that the intervention has contributed to an additional reduction on IHD morbidity and mortality, above and beyond that which is already seen in neighbouring counties without similar programs.

Oral antiplatelet agents in cardiovascular disease.

Antiplatelet agents significantly reduce mortality and morbidity in ischemic heart disease, cerebrovascular disease and peripheral artery disease (PAD), and are therefore part of guideline-driven daily medical treatment in these patients. Due to its beneficial effects in the secondary prevention of atherothrombotic events, aspirin remains the most frequently prescribed antiplatelet agent in cardiovascular disease. In patients with acute coronary syndromes (ACS) and in those undergoing angioplasty with stent implantation dual antiplatelet therapy with aspirin and an adenosine diphosphate (ADP) receptor antagonist is indicated. The development of the newer ADP P2Y12 inhibitors prasugrel and ticagrelor has further improved prognosis in ACS patients compared to clopidogrel. Moreover, vorapaxar allows the inhibition of platelet activation by thrombin via protease-activated receptor-1 and has been approved for the use in patients with PAD and in those with a history of myocardial infarction. This review article summarizes the current evidence on oral antiplatelet agents in cardiovascular disease. Keywords: Aspirin, clopidogrel, prasugrel, ticagrelor, vorapaxar, cardiovascular disease.

A Model of Ischaemic Heart Disease in the UK that Suggests Reductions in Air Pollution Increase Overall Disease Prevalence

Objectives We have previously used a simple toy model to suggest that the proportion of people with ever-diagnosed ischaemic heart disease (IHD) from air pollution is heavily influenced by the effect of air pollution on case fatality as well as on disease incidence, and that this effect may lead to counter-intuitive changes on disease prevalence. We now report the results of a microsimulation model for the UK that provides more formal quantification of air pollution-related IHD morbidity burdens.Methods The model was based on a three health-state model of disease progression (&amp;#8216;disease free&amp;#8217;, prevalent disease, death), initialized using current incidence and disease prevalence data for the UK, and using literature-based estimates of state transition probabilities and the relative risks (RRs) for disease incidence, case fatality and mortality. We examined the impact over 106 years (to extinction of the current birth cohort) of removal of all ambient PM2.5 of anthropogenic origin.Results The model indicated that for all primary outcomes (disease incidence, prevalence, and mortality) removal of anthropogenic PM2.5 would lead reductions in the absolute number of cases at young ages but appreciably increased numbers at older age-groups, reflecting improved survival and the expansion of the population at older ages. After a 106-year simulation there was a 7% net increase in the number of cases of people with ever-diagnosed ischaemic heart disease.Conclusions This modelling confirms more nuanced patterns of the impact of air pollution on IHD morbidity than those suggested by studies based on disease incidence alone. It suggests counterintuitive effects, which may increase prevalence following reduction of PM2.5 air pollution as a consequence of effects on survival. Reductions in air pollution may not therefore reduce health service costs for IHD treatment as commonly assumed.

Occupational noise and ischemic heart disease: A systematic review.

Noise exposure might be a risk factor for ischemic heart disease (IHD). Unlike residential exposure, however, evidence for occupational noise is limited. Given that high-quality quantitative synthesis of existing data is highly warranted for occupational safety and policy, we aimed at conducting a systematic review and meta-analysis of the risks of IHD morbidity and mortality because of occupational noise exposure. We carried out a systematic search in MEDLINE, EMBASE, and on the Internet since April 2, 2015, in English, Spanish, Russian, and Bulgarian. A quality-scoring checklist was developed a priori to assess different sources of methodological bias. A qualitative data synthesis was performed. Conservative assumptions were applied when appropriate. A meta-analysis was not feasible because of unresolvable methodological discrepancies between the studies. On the basis of five studies, there was some evidence to suggest higher risk of IHD among workers exposed to objectively assessed noise >75–80 dB for <20 years (supported by one high, one moderate, and one low quality study, opposed by one high and one moderate quality study). Three moderate and two low quality studies out of six found self-rated exposure to be associated with higher risk of IHD, and only one moderate quality study found no effect. Out of four studies, a higher mortality risk was suggested by one moderate quality study relying on self-rated exposure and one of high-quality study using objective exposure. Sensitivity analyses showed that at higher exposures and in some vulnerable subgroups, such as women, the adverse effects were considerably stronger. Despite methodological discrepancies and limitations of the included studies, occupational noise appeared to be a risk factor for IHD morbidity. Results suggested higher risk for IHD mortality only among vulnerable subgroups. Workers exposed to high occupational noise should be considered at higher overall risk of IHD.

Air Pollution and Cardiovascular Disease: A Review.

Air pollution is comprised of different compounds and particulate matter (PM) of sizes 2.5 and 10 μm, with the former size posing the greatest danger to humans. Evidence suggests that the global rise in air pollution levels during the past century is correlated with the increased incidence of diseases of the cardiovascular system. On a global scale, 7 million individuals died as a result of the effects of air pollution in 2012. Air pollution leads to tremendous amounts of financial burden (in 2010, $16 trillion in the US and Europe) on the health-care system. The severity of effects experienced by varying populations due to air pollution can differ due to locale, length of exposure, weather conditions, residential proximity to major highways or factories, and soil aridity. Pollutants affect the heart, blood vessels, and blood at a molecular level through proinflammatory or oxidative stress response, autonomic nervous system imbalance, and the direct permeation of harmful compounds into the tissue. The dysfunction of cells and biological processes of the cardiovascular system due to PM leads to an increased prevalence of cardiovascular diseases (CVDs) such as atherosclerosis, hypertension, myocardial infarction, thrombosis, and restricted valve motion. Studies in countries such as China have shown an increase of 0.25% in ischemic heart disease (IHD) mortality and a 0.27% increase in IHD morbidity due to a 10 μg/m3 increase in PM. In a study conducted in the US, PM2.5 concentrations ranged from 9.2-22.6 μg/m3, and every 5-μg/m3 increase in PM2.5 caused coronary calcification to increase by 4.1 Agatston units/yr. Studies on traffic-related air pollution found that nonhypertensive participants residing within 100 m of major roadways experienced an increase in systolic (0.35 mmHg) and diastolic (0.22 mmHg) blood pressure as a result of increases in traffic. The progression of CVD due to pollution has been found to fluctuate within individuals based on age, gender, location of exercise, smoking, pregnancy, diabetes, preexisting cardiovascular or pulmonary diseases, and other factors. Considering the number of individuals affected by pollution on a daily basis and the burden that this places on society through the health-care system, immediate preventive measures are needed to address these problems. Increased knowledge about the widespread effects of pollution on human physiological systems should aid in remediating the problem across the globe. Biomedical engineers can have a great positive impact in developing better instrumentation to measure discrete pollutants and characterizing their harmful effects on physiological systems.

Relationship between fine particulate air pollution and ischaemic heart disease morbidity and mortality

ObjectiveTo assess the relationship between fine particulate matter (PM2.5) concentration and ischaemic heart disease (IHD) morbidity and mortality.MethodsA time-series study conducted in Beijing from 1 January 2010 to 31 December...

Risk of ischemic heart disease following occupational exposure to welding fumes: a systematic review with meta-analysis.

Air pollution has been linked to an increased risk of ischemic heart disease (IHD), but less is known about occupational exposure to welding fumes and the risk of IHD. The objective of this paper was to review the epidemiological evidence on causal links between welding fume exposure and risk of IHD and to investigate whether the risk of IHD depends on specific welding characteristics. A systematic search in Medline 1979-2013 and EMBASE 1974-2013 identified 18 epidemiological studies with at least one risk estimate of IHD morbidity or mortality among workers exposed to welding fumes. Following an assessment of completeness of reporting, confounding, and bias, each risk estimate was characterized as more or less reliable. Pooled risk estimates were computed across studies by random effect meta-analyses. The weighted relative risk (RR) for IHD following exposure to welding fumes was 1.09 [95 % confidence interval (CI) 1.00, 1.19]. We calculated a RR of 1.39 (95 % CI 0.96, 2.02) among studies using an internal reference group and 1.08 (95 % CI 0.99, 1.18) for studies using an external reference group. An increased risk was observed for acute myocardial infarction RR = 1.69 (95 % CI 1.18, 2.42) and other IHDs RR = 1.06 (95 % CI 0.98, 1.14). There was too limited evidence to evaluate the risk of IHD related to specific welding characteristics. Several studies indicate that welding is associated with a moderately increased risk of IHD; however, bias and confounding cannot be ruled out with reasonable confidence.