Ischemic Heart Disease Mortality Research Articles

Cardiovascular mortality risks during the 2017 exceptional heatwaves in China

Climate change has made disastrous heatwaves more frequent. Heatwave-related health impacts are much more devastating for more intense heatwaves. In the summer of 2017, exceptional heatwaves occurred in many regions, including China. This study aims to evaluate the cardiovascular mortality risk associated with the 2017 exceptional heatwaves and compare the mortality risk of the severe heatwaves with those in other years. Using daily data for a spectrum of cardiovascular mortality and temperature for 102 Chinese counties (2014–2017), we estimated the association between heatwave and mortality by generalized linear mixed-effects models. Compared with matched non-heatwave days, mortality risks on heatwaves days in 2017 increased 27.8% (95% CI, 14.8–42.3%), 26.7% (8.0–48.5%), 30.1% (10.2–53.7%), 27.3% (1.4–59.9%), 32.2% (3.4–68.4%), and 25.2% (1.0–57.7%) for total circulatory diseases, cerebrovascular disease, ischemic heart disease (IHD), acute IHD, chronic IHD, and myocardial infarction. The 2017 exceptional heatwaves impacted ischemic heart disease mortality and myocardial infarction mortality more than heatwaves in 2014–2016. Here we show that the severe heatwaves in 2017 posed catastrophic death threats for those under-studied cardiovascular diseases.

Time Trends in Ischemic Heart Disease Mortality Attributable to PM2.5 Exposure in Southeastern China from 1990 to 2019: An Age-Period-Cohort Analysis.

Data were extracted from the Global Burden of Disease study 2019 (GBD2019). The magnitude and direction of the trends in IHD mortality attributable to PM2.5 exposure were analyzed by Joinpoint regression. The age-period-cohort (APC) model was used to evaluate the cohort and period effect. Age-standardized mortality rate (ASMR) of IHD attributable to PM2.5 exposure decreased from 1990 to 2019, with an average annual percentage change (AAPC) of -1.71% (95%CI: -2.02~-1.40), which, due to ambient PM2.5 (APM) exposure and household PM2.5 (HPM) exposure increased with AAPCs of 1.45% (95%CI: 1.18~1.72) and -8.27% (95%CI: -8.84~-7.69), respectively. APC analysis revealed an exponential distribution in age effects on IHD mortality attributable to APM exposure, which rapidly increased in the elderly. The risk for IHD mortality due to HPM exposure showed a decline in the period and cohort effects, which, due to APM, increased in the period and cohort effects. However, favorable period effects were found in the recent decade. The overall net drift values for APM were above zero, and were below zero for HPM. The values for local drift with age both for APM and HPM exposures were initially reduced and then enhanced. The main environmental risk factor for IHD mortality changed from HPM to APM exposure in Jiangsu Province, China. Corresponding health strategies and prevention management should be adopted to reduce ambient air pollution and decrease the effects of APM exposure on IHD mortality.

Economic fluctuations and educational inequalities in premature ischemic heart disease mortality in Argentina.

Although mortality from ischemic heart disease has declined over the past decades in Argentina, ischemic heart disease remains one of the most frequent causes of death. This study aimed to describe the role of individual and contextual factors on premature ischemic heart disease mortality and to analyze how educational differentials in premature ischemic heart disease mortality changed during economic fluctuations in two provinces of Argentina from 1990 to 2018. To test the relationship between individual (age, sex, and educational level) and contextual (urbanization, poverty, and macroeconomic variations) factors, a multilevel Poisson model was estimated. When controlling for the level of poverty at the departmental level, we observed inequalities in premature ischemic heart disease mortality according to the educational level of individuals, affecting population of low educational level. Moreover, economic expansion was related to an increase in ischemic heart disease mortality, however, expansion years were not associated with increasing educational inequalities in ischemic heart disease mortality. At the departmental level, we found no contextual association beween area-related socioeconomic level and the risk of ischemic heart disease mortality. Despite the continuing decline in ischemic heart disease mortality in Argentina, this study highlighted that social inequalities in mortality risk increased over time. Therefore, prevention policies should be more focused on populations of lower socioeconomic status in Argentina.

Pleomorphic Ventricular Tachycardia in Dilated Cardiomyopathy Predicts Ventricular Tachycardia Recurrence After Ablation Independent From Cardiac Function: Comparison With Patients With Ischemic Heart Disease

In dilated cardiomyopathy (DCM), outcome after catheter ablation of ventricular tachycardia (VT) is modest, compared with ischemic heart disease (IHD). Pleomorphic VT (PL-VT) has been associated with fibrotic remodeling and end-stage heart failure in IHD. The prognostic role of PL-VT in DCM is unknown. Consecutive IHD (2009-2016) or DCM (2008-2018) patients undergoing ablation for monomorphic VT were included. PL-VT was defined as ≥1 spontaneous change of the 12-lead VT-morphology during the same induced VT episode. Patients were followed for VT recurrence and mortality. A total of 247 patients (86% men; 63±13 years; IHD n=152; DCM n=95) underwent ablation for monomorphic VT. PL-VT was observed in 22 and 29 patients with IHD and DCM, respectively (14% versus 31%, P=0.003). In IHD, PL-VT was associated with lower LVEF (28±9% versus 34±12%, P=0.02) and only observed in those with LVEF<40%. In contrast, in DCM, PL-VT was not related to LVEF and induced in 27% of patients with LVEF>40%. During a median follow-up of 30 months, 79 (32%) patients died (IHD 48; DCM 31; P=0.88) and 120 (49%) had VT recurrence (IHD 59; DCM 61; P<0.001). PL-VT was associated with mortality in IHD but not in DCM. In IHD, VT recurrence was independently associated with LVEF, number of induced VTs, and procedural noncomplete success. Of note, in DCM, PL-VT (HR, 2.62 [95% CI, 1.47-4.69]), pathogenic mutation (HR, 2.13 [95% CI, 1.16-3.91]), and anteroseptal VT substrate (HR, 1.75 [95% CI, 1.00-3.07]) independently predicted VT recurrence. In IHD, PL-VT was associated with low LVEF and mortality. In DCM, PL-VT was not associated with mortality but a predictor of VT recurrence independent from LVEF. PL-VT in DCM may indicate a specific arrhythmic substrate difficult to control by current ablation techniques.

Changes in Cardiovascular Disease Burden in China after Release of the 2011 Chinese Guidelines for Cardiovascular Disease Prevention: A Bayesian Causal Impact Analysis

Objective: This study aimed to investigate the effects of the 2011 Chinese Society of Cardiology guidelines (2011 CSC guidelines) on the overall and subtype specific cardiovascular disease (CVD) burden in China. Methods: We conducted a Bayesian causal impact analysis to investigate changes in the burden of CVD overall and 13 subcategories, before and after release of the 2011 CSC guidelines, by using publicly available data during 1990–2019. Results: The 2011 CSC guidelines were associated with moderate declines in CVD mortality (5.7%; equivalent to 161 per 100,000) and DALYs (2.9%; 1429 per 100,000), but small increases in incidence and prevalence, with an approximately 1-year lagged effect. Similar impact patterns were observed for ischemic stroke, cardiomyopathy and myocarditis, and aortic aneurysm. Release of the 2011 CSC guidelines increased intracerebral hemorrhage incidence, but sharply decreased rheumatic, ischemic, and non-rheumatic valvular heart disease mortality and DALY rates. The burden of other CVD subcategories was unchanged. Health worker numbers, population size, disposable income, hospital admission rates, and crude death rates were critical contributors to CVD burden beyond the 2011 CSC guidelines. Conclusion: The 2011 CSC guidelines decreased the burden of CVD and several subcategories. However, efforts to enhance health promotion and strengthen healthcare remain urgently needed in China.

Schizophrenia as a risk factor for cardiovascular and metabolic health outcomes: a comparative risk assessment.

Cardiometabolic diseases are responsible for the majority of premature deaths in people with schizophrenia. This study aimed to quantify the fatal burden of ischaemic heart disease (IHD), stroke and diabetes attributable to schizophrenia. Comparative Risk Assessment methodology from the Global Burden of Disease (GBD) study was used to calculate attributable burden; pooled relative risks (RRs) for IHD, stroke and diabetes were estimated via meta-regression, which were combined with GBD schizophrenia prevalence estimates to calculate the deaths and years of life lost (YLLs) caused by these health outcomes that were attributable to schizophrenia. The proportion of explained all-cause fatal burden and corresponding unexplained burden was also calculated. The pooled RRs for IHD, stroke and diabetes mortality were 2.36 [95% uncertainty interval (UI) 1.77 to 3.14], 1.86 (95% UI 1.36 to 2.54) and 4.08 (95% UI 3.80 to 4.38) respectively. Schizophrenia was responsible for around 50 000 deaths and almost 1.5 million YLLs globally in 2019 from these health outcomes combined. IHD, stroke and diabetes together explained around 13% of all deaths and almost 11% of all YLLs attributable to schizophrenia, resulting in 320 660 (95% UI 288 299 to 356 517) unexplained deaths and 12 258 690 (95% UI 10 925 426 to 13 713 646) unexplained YLLs. Quantifying the physical disease burden attributable to schizophrenia provides a means of capturing the substantial excess mortality associated with this disorder within the GBD framework, contributing to an important evidence base for healthcare planning and practice.

Comorbid Heart Disease in Patients with COPD is Associated with Increased Hospitalization and Mortality – A 15-Year Follow-Up

The aim of this study was to examine the association of comorbid heart disease, defined as chronic heart failure or ischemic heart disease, on all-cause and cause-specific hospitalization and mortality in patients with COPD over a period of nearly 15 years. The cohort study included patients with COPD from primary and secondary care in 2005 with data from questionnaires and medical record reviews. The Swedish Board of Health and Welfare provided hospitalization and mortality data from 2005 through 2019. Cox regression analyses, adjusted for sex, age, educational level, smoking status, BMI, exacerbations, dyspnea score and comorbid diabetes or hypertension, assessed the association of comorbid heart disease with all-cause and cause-specific time to first hospitalization and death. Linear regression analyses, adjusted for the same variables, assessed this association with hospitalization days per year for those patients that had been hospitalized. Of the 1071 patients, 262 (25%) had heart disease at baseline. Cox regression analysis showed a higher risk of hospitalization for patients with heart disease for all-cause (HR (95% CI) 1.55; 1.32-1.82), cardiovascular (2.14; 1.70-2.70) and other causes (1.27; 1.06-1.52). Patients with heart disease also had an increased risk of all-cause (1.77; 1.48-2.12), cardiovascular (3.40; 2.41-4.78) and other (1.50; 1.09-2.06) mortality. Heart disease was significantly associated with more hospitalization days per year of all-cause (regression coefficient 0.37; 95% CI 0.15-0.59), cardiovascular (0.57; 0.27-0.86) and other (0.37; 0.12-0.62) causes. No significant associations were found between heart disease and respiratory causes of hospitalization and death. Comorbid heart disease in patients with COPD is associated with an increased risk for all-cause hospitalization and mortality, mainly due to an increase of hospitalization and death of cardiovascular and other causes, but not because of respiratory disease. This finding advocates the need of a strong clinical focus on primary and secondary prevention of cardiovascular disease in patients with COPD.

Are air quality perception and PM2.5 exposure differently associated with cardiovascular and respiratory disease mortality in Brussels? Findings from a census-based study

BackgroundThere is ample evidence that air pollution increases mortality risk, but most studies are based on modelled estimates of air pollution, while the subjective perception of air quality is scarcely assessed. We aimed to compare the effects of objective and subjective exposure to air pollution on cardiorespiratory mortality in Brussels, Belgium. MethodsData consisted of the 2001 Belgian census linked to registry-based mortality data for the follow-up period 2001–2014. We included individuals aged >30 years of age residing in Brussels at baseline (2001). Air pollution exposure was assessed with objective (modelled annual mean concentrations of PM2.5 in micrograms per cubic metre, μg/m3) and subjective indicators (poor self-reported air quality perception in the census). We used Cox Proportional Hazard models with age as the underlying time scale to evaluate associations with cardiovascular disease (CVD) and respiratory disease mortality, and separately, ischaemic heart disease (IHD), cerebrovascular disease, and COPD excluding asthma mortality. We specified single- and two-exposure models and evaluated effect modification by neighbourhood unemployment rate. Results437,340 individuals were included at baseline. During follow-up (2001–2014), 22,821 (5%) individuals had died from CVDs and 8572 (2%) from respiratory diseases. In single-exposure models, PM2.5 was significantly associated with an increased risk in CVD and IHD mortality (e.g. for IHD, per 5 μg/m3 increase: Hazard Ratio, HR:1.22, 95%CI:1.08–1.37), and poor air quality perception with COPD excluding asthma mortality (HR:1.23, 95%CI:1.15–1.33). Associations remained significant in the two-exposure models, and additionally, perception was associated with respiratory disease mortality. Associations became gradually stronger with increasing neighbourhood unemployment rate [e.g. in the highest, Q3: PM2.5 and cerebrovascular disease mortality (HR:1.53, 95%CI:1.04–2.24)]. ConclusionOur findings suggest that objective and subjective exposure to air pollution increased the risk of dying from cardiovascular and respiratory diseases respectively in Brussels. These results encourage policies reducing pollution load in Brussels whilst considering socio-economic inequalities.

MUDANÇAS EPIDEMIOLÓGICAS NA DOENÇA ARTERIAL CORONÁRIA NO BRASIL

Cardiovascular diseases (CVD) are the leading cause of death in Brazil. The main etiologies are ischemic heart disease (IHD) and stroke. Since 1984, we have observed a continuous and significant reduction in mortality from these diseases in men and women, but the death rate was consistently higher in men than in women. The prevalence and death rate from CVD predominated in the South and Southeast and capitals in the 1990s. In the 2000s, we observed the proximity of CVD mortality in the five regions due to the more significant reduction in mortality in the South and Southeast. The proximity of stroke mortality trends occurred earlier than those due to IHD, reflecting the population's greater awareness of hypertension control. Between 2007 and 2012, we had a short interruption in the downward trend in the IHD death rate in women and men, but not for all CVD and stroke, which continued to decline. However, from that period, the downward trend continued. Recent studies showed that mortality from all causes of cancer would exceed mortality from CVD in the population aged between 35 to 74. The intensification of primary prevention with greater access to a healthy life and control of risk factors can have an even more significant impact on reducing mortality from CVD.

EPH25 Premature Mortality From Ischaemic Heart Disease Among Women in Hungary by District

Ischaemic heart disease (IHD) has been one of the leading causes of mortality in the world. This study was aimed to assess the IHD mortality in Hungary. Our aim was to analyse premature mortality rates due to ischaemic heart disease among women in Hungary, by district.

Influence of Unhealthy Food Environment on Premature Cardiovascular Disease Mortality in Brazil: An Ecologic Approach

Cardiovascular disease is the main cause of general and premature death of adults aged 30-69 years in Brazil and around the world. Unhealthy food environments have been implicated as one of the factors associated with cardiovascular disease morbimortality because they affect people's health conditions and nutrition. This study aims to explore the association between unhealthy food environments (deserts/swamps) and premature cardiovascular disease mortality in the Brazilian population. This is an ecologic study using data from 5,558 Brazilian municipalities in 2016. The cardiovascular disease mortality data were obtained from the Mortality Information System of the Ministry of Health. The study on mapping food deserts in Brazil, developed by the Interministerial Chamber of Food and Nutrition Security, was used to evaluate the physical dimension of food access. The authors calculated the standardized rates of premature general and specific cardiovascular disease (stroke and ischemic heart disease) causes of death in the same period. To characterize food environments, the density of unprocessed and ultraprocessed foods per 10,000 population in tertiles was used. Crude and adjusted negative binomial regression models were used to study the associations of interest. After the necessary adjustments (human development index, gross domestic product per capita, unemployment rate, Gini index and Family Health Strategy coverage), it was found that municipalities with low unprocessed food supply were at the highest risk of increased mortality among women with ischemic heart disease (rate ratio first tertile: 1.08 [95% CI=1.01, 1.15]). Conversely, the municipalities where there was a greater offer of ultraprocessed foods showed a higher risk of death from cardiovascular diseases (rate ratio second tertile: 1.17 [95% CI=1.12, 1.22]; rate ratio third tertile: 1.20 [95% CI=1.14, 1.26]), from strokes (rate ratio second tertile: 1.19 [95% CI=1.13, 1.25]; rate ratio third tertile: 1.22 [95% CI=1.15, 1.30]), and ischemic heart disease (rate ratio second tertile: 1.19 [95% CI=1.12, 1.25]; rate ratio third tertile: 1.22 [95% CI=1.13, 1.29]). This study's findings show an increase in the risk of cardiovascular disease, stroke, and ischemic heart disease mortality, especially in the municipalities where there was a greater offer of ultraprocessed foods. Initiatives aiming to minimize the effects of these food environments are urgently needed in the Brazilian context.

Meta analysis of health effects of ambient air pollution exposure in low- and middle-income countries

It is well established that exposure to ambient air pollution affects human health. A majority of literature concentrated on health effects of air pollution in high income countries. Only fewer studies analyzing health effects of air pollution in Low- and Middle-Income Countries (LMICs) are available. To bridge this gap in literature, this study investigated short term and long-term health impacts of ambient air pollutants focussed in LMICs. We evaluated Total Non-accidental mortality, Respiratory Mortality, Stroke Mortality, Cardio-vascular Mortality, Chronic Obstructive Pulmonary Disease (COPD), Ischemic Heart Disease (IHD) and Lung Cancer Mortality in LMICs particularly. Random Effects Model was utilised to derive overall risk estimate. Relative Risk (RR) estimates per 10 μg/m3 was used as input for model. Subgroup and Sensitivity Analysis by Design and Country was conducted. A total of 152 studies were included for quantitative analysis. We found positive associations between pollutants and Total Non-accidental mortality for PM10 ((RR:1.0043–1.0036), p < 0.0001), NO2 (RR:1.0222 (1.0111–1.0336), p < 0.0001), SO2 (RR:1.0107 – (1.0073–1.0140), p < 0.0001), O3 (RR: 1.0038 (1.0023–1.0053), p < 0.0001) and PM2.5 (RR: 1.0048 (1.0037–1.0059), p < 0.0001) for every 10 μg/m3 increase. We found positive association between Long-term exposure to PM10 and Total Non-accidental mortality (RR: 1.0430 (1.0278–1.0583), p < 0.0001) We also found statistically significant positive associations between pollutants and Cardiorespiratory and Cardiovascular morbidity. The positive associations persisted when analysed amongst sub-groups. However, the high heterogeneity amongst studies persisted even after performing sub-group analysis. The study has found statistically significant positive associations between short-term and long-term exposure to Ambient air pollution with various health-outcome combinations.

Abstract 11777: The Prognostic Impact of Living Alone on Long-Term Cardiac Mortality in Patients With Chronic Coronary Syndrome After Percutaneous Coronary Intervention

Background: It has been reported that social frailty is associated with increased mortality in elderly patients with heart failure. However, the prognostic impact of social frailty on mortality in ischemic heart disease is unclear. Here we examined the relationship between living alone, which is one of the criteria for social frailty, and long-term mortality in patients with chronic coronary syndrome (CCS) who underwent percutaneous coronary intervention (PCI). Methods and Results: Consecutive 830 patients with CCS who underwent PCI were enrolled. Patients were divided into two groups according to whether they lived alone or not at the time of discharge. We compared clinical characteristics between two groups and followed cardiac mortality. Patients living alone were younger (66.3 vs. 69.9 years, P = 0.002). The prevalence of comorbidities such as hypertension, diabetes, dyslipidemia, chronic kidney disease, anemia, atrial fibrillation, heart failure, stroke and peripheral artery disease were comparable between two groups. In addition, the rates of medications such as beta-blockers, renin-angiotensin-aldosterone system inhibitors, statins and anti-thrombotic agents did not differ between two groups. In the Kaplan-Meier analysis (mean follow-up period of 1703.9 days), cardiac mortality was significantly higher in the group of patients who were living alone than those who were not (P = 0.008). In the multivariable Cox proportional hazard analyses after adjusting for confounding factors, living alone was an independent predictor of cardiac mortality (hazard ratio 2.44, 95% confidence interval 1.25 - 4.74, P = 0.009). Subgroup analysis which was performed adjusting for interactions between living alone and clinically important variables revealed no interactions. Conclusion: Among CCS patients who underwent PCI, living alone was associated with long-term cardiac mortality regardless of other comorbidities and medications.

Abstract 11089: Comparison of Long-Term Cardiovascular Events of Influenza Patients With versus Without Pre-Existing Cardiovascular Disease in the Infection Treated With Antiviral Agents

Introduction: The antiviral agents are highly recommended to prevent cardiovascular mortality in patients with pre-existing cardiovascular disease in the pandemic era, but the long-term cardiovascular mortality have not yet been comprehensively characterized in the influenza infection treated with antiviral agents. Hypothesis: This study aimed to compare long-term cardiovascular mortality of influenza patients with versus without pre-existing cardiovascular disease in patients with anti-viral agents. Methods: The data were extracted from the National HealthDatabase from 2001 to 2010, which covers nearly the entire population of South Korea. 865,522 influenza patients treated with anti-viral agents were selected and cardiovascular disease was classified as atrial fibrillation (AF), heart failure (HF), ischemic heart disease (IHD) and 5-year mortality were analyzed using Cox proportional hazard regression model. Results: Of these, 96,433 patients (11.1%, mean age 46) had IHD (86.4%), HF (23.1%) and AF (12.5%) in the influenza infection treated with anti-viral agents. The incidence of IHD was 0.25 per 100-person year in the pre-existing IHD, 0.25 per 100-person year in the pre-existing HF and 0.20 per 100-person year in the pre-existing AF. The incidence of myocarditis was 0.008 per 100-person year in the pre-existing IHD, 0.006 per 100-person year in the pre-existing HF and 0.01 per 100-person year in the pre-existing AF. The incidence of cardiovascular death was 0.49 per 100-person year in the pre-existing IHD, 0.47 per 100-person year in the pre-existing HF and 0.47 per 100-person year in the pre-existing AF. Conclusions: Long-term cardiovascular mortality in influenza patients with pre-existing cardiovascular disease treated with antiviral agents were not significantly different from those without pre-existing cardiovascular disease.

Atmospheric PM2.5 exposure and risk of ischemic heart disease: A systematic review and meta-analysis of observational studies.

Fine particulate matter <2.5μm in diameter (PM2.5) has been validated to associate with cardiovascular diseases (CVD) incidence and mortality. So far, no study has quantitatively evaluated the relationship between the atmospheric PM2.5 exposure and ischemic heart disease (IHD). We conducted a meta-analysis to illustrate the relationship between PM2.5 and IHD. Published articles were systematically searched (until June 2022) from PubMed, EMBASE, Cochrane Library. A random-effect model was performed to summarize the total relative risks (RRs) and 95% confidence intervals (CIs). Meta-analysis was performed using Stata 12.0 software. A total of 28 studies among 23 cohorts (23.38 million individuals and 256256 IHD cases) were included. With PM2.5 increasing 10μg/m3, the total RRs of IHD incidence and mortality were 1.07 (95% CI: 0.99-1.17), 1.21 (95% CI: 1.15-1.28), respectively. In sub-analyses, our study revealed that the combined RRs of exposure to PM2.5 on IHD mortality in Asian and European population [1.11 (95% CI: 0.93-1.33); 1.06 (95% CI: 1.02-1.11)] were much lower compared with American and Canadian people [1.27 (95% CI: 1.17-1.37); 1.30 (95% CI: 1.24-1.35)]. Furthermore, study duration, size and some adjustments were related with the total RR. Our findings indicated that exposure of an increase in the concentration of atmospheric PM2.5 may increase the risk of IHD incidence and mortality. Further evidence is needed to confirmed the association.

Personal Activity Intelligence and Ischemic Heart Disease in a Healthy Population: China Kadoorie Biobank Study.

Personal Activity Intelligence (PAI) is a physical activity metric that translates heart rate during physical activity into a simple score, where a weekly score of 100 or greater is associated with a lower risk of cardiovascular disease and mortality. Here, we prospectively investigated the association between PAI and ischemic heart disease (IHD) mortality in a large healthy population from China. Using data from the China Kadoorie Biobank, we studied 443,792 healthy adults (60% women). The weekly PAI score of each participant was estimated based on the questionnaire data and divided into four groups (PAI scores of 0, ≤50, 51-99, or ≥100). Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for fatal IHD and nonfatal myocardial infraction (MI) related to PAI were estimated using Cox proportional hazard regression analyses. There were 3050 IHD deaths and 1808 MI events during a median follow-up of 8.2 years (interquartile range, 7.3-9.1; 3.6 million person-years). After adjustments for multiple confounders, a weekly PAI score ≥ 100 was associated with a lower risk of IHD (aHR: 0.91 (95% CI: 0.83-1.00)), compared with the inactive group (0 PAI). The corresponding aHR for MI was 0.94 (95% CI: 0.83-1.05). In participants aged 60 years or older at baseline, the aHR associated with a weekly PAI score ≥ 100 was 0.84 (95% CI, 0.75-0.93) for IHD and 0.84 (95% CI, 0.73-0.98) for MI. Among healthy Chinese adults, a weekly PAI score of 100 or greater was associated with a lower risk of IHD mortality across all age groups; moreover, a high PAI score significantly lowered the risk of MI but only in those 60 years and older at baseline. The present findings extend the scientific evidence that PAI may have prognostic significance in diverse settings for IHD outcomes and suggest that the PAI metric may be useful in delineating the magnitude of weekly physical activity needed to reduce the risk of IHD mortality.

The temporal trend of cause-specific mortality: comparing Estonia and Lithuania, 2001 – 2019

BackgroundDespite being two Baltic countries with similar histories, Estonia and Lithuania have diverged in life expectancy trends in recent years. We investigated this divergence by comparing cause-specific mortality trends.MethodsWe obtained yearly mortality data for individuals 20 + years of age from 2001–2019 (19 years worth of data) through Statistics Lithuania, the Lithuanian Institute for Hygiene, and the National Institute for Health Development (Estonia). Using ICD-10 codes, we analyzed all-cause mortality rates and created eight major disease categories: ischemic heart disease, cerebrovascular disease, all other cardiovascular disease, cancers (neoplasms), digestive diseases, self-harm and interpersonal violence, unintentional injuries and related conditions, and other mortality (deaths per 100,000 population). We used joinpoint regression analysis, and analyzed the proportional contribution of each category to all-cause mortality.ResultsThere was a steeper decline in all-cause mortality in Estonia (average annual percent change, AAPC = -2.55%, 95% CI: [-2.91%, -2.20%], P < .001) as compared to Lithuania (AAPC = -1.26%, 95% CI: [-2.18%, -0.57%], P = .001). For ischemic heart disease mortality Estonia exhibited a relatively larger decline over the 19-year period (AAPC = -6.61%, 95% CI: [-7.02%, -6.21%], P < .001) as compared to Lithuania (AAPC = -2.23%, 95% CI: [-3.40%, -1.04%], P < .001).ConclusionEstonia and Lithuania showed distinct mortality trends and distributions of major disease categories. Our findings highlight the role of ischemic heart disease mortality. Differences in public health care, management and prevention of ischemic heart disease, alcohol control policies may explain these differences.

State-level disparities in burden of ischemic heart diseases mortality attributable to ambient fine particulate matter in the United States, 1990–2019: Observational analysis for the Global Burden of Disease (2019) study

Background: ambient fine particulate air pollution (PM2.5) is an important yet often overlooked risk factor for cardiovascular disease in the United States. However, epidemiologic evidence suggests that current knowledge does not comprehensively capture state-level disparities in mortality for ambient PM2.5-related ischemic heart diseases. MethodsI performed serial cross sectional analysis with ambient PM2.5-attributable ischemic heart diseases decedents between 1990 and 2019. I used the Global Health Data Exchange to extract age adjusted mortality rates in each state, and used Joinpoint software to calculate average annual percentage change.Results: the average age adjusted mortality rates (AAMR) for ischemic heart diseases attributable to ambient PM2.5 for both sex ranged from 1.5 (1.3–1.8) per 100,000 in Hawaii to 1.1 (0.9–1.3) per 100,000 in Mississippi, respectively. The rate of change in AAMR varied widely across states. Compared with the national level, the number of states with smaller decline has increased from 3 before 2002 to 10 after 2011. Oregon, Idaho, and Montana showed an upward trend in AAMR, which was independent of sex after 2011. Between 1990 and 2019, average AAMR for ischemic heart diseases attributable to ambient PM2.5 was higher for male than female in all states. But the number of states with sex disparities in the rate of change has decreased, from 13 in 1990–2002 to 5 after 2011.Conclusions: wide state-level disparities exist in burden of ischemic heart diseases attributable to ambient PM2.5. After 2011, the association between rate of AAMR decline and sex weakened across states. State-level policies and programs are needed to address the avoidable burden of ischemic heart diseases deaths attributable to ambient particulate pollution, with priority for states with a higher burden.

Prediction of cardiovascular diseases mortality- and disability-adjusted life-years attributed to modifiable dietary risk factors from 1990 to 2030 among East Asian countries and the world.

Unhealthy eating habits are a significant modifiable risk factor for cardiovascular diseases (CVDs); nevertheless, no evidence of their impact on the CVD burden has been reported in East Asian countries. We aimed to determine the trend and predict the future CVDs burden attributed to modifiable dietary risk factors in the East Asian countries (China, Japan, South Korea, and North Korea) and the world. The Global Burden of Disease (GBD) 2019 data were used to find the trend of CVDs [ischemic heart disease (IHD) and ischemic stroke (IS)] mortality- and disability-adjusted life-years (DALYs) attributed to dietary risk factors in the East Asian countries and the world (1990-2019) and its prediction from 2020 to 2030. We used the joinpoint regression model and the autoregressive integrated moving average (ARIMA) model for trend and future forecast, respectively. From 1990 to 2019, regardless of sex, the age-standardized mortality rate (ASMR) and DALYs of IHD attributed to dietary risk factors significantly decreased in Japan, South Korea, and the world. However, the ASMR of IHD significantly increased in Chinese males and for both sexes in North Korea. The ASMR and DALYs of IHD and IS due to dietary risk factors were higher in males than in females in the world. From 2020 to 2030, the ASMR of IHD is predicted to increase in South Korean females and Japanese males. Globally, a diet low in whole grains was the top risk factor for the highest IHD mortality and DALYs in 2019, followed by a diet low in legumes and a diet high in sodium. A diet low in whole grains, a diet high in sodium, and a diet low in legumes were the leading risk factors for high IHD mortality in East Asian countries. The trend of IHD and IS burden due to dietary risk factors varies substantially across the East Asian countries compared to the trend of CVDs burden in the world. The study findings may help the public health policymakers to design proper strategies for improvement of the quality of life to combat the CVDs burden in the future for the East Asian countries.

Echocardiographic assessment of left ventricular structure and function in hypertensive disorders of pregnancy at six months and two years postpartum

Abstract Purpose Hypertensive disorders of pregnancy (HDP) are associated with longer term postpartum cardiovascular sequelae, including double the risk of ischaemic heart disease and cardiovascular mortality (1). Transthoracic echocardiograms (TTE) were performed in women with pregnancies complicated by gestational hypertension and pre-eclampsia, or uncomplicated pregnancy, at six months and two years postpartum. The aim was to longitudinally assess cardiac structure and function in women with HDP and compare this to women who had a normotensive pregnancy. The six-month results have been previously reported, we now present the two-year data. Methods A prospective cohort study was conducted in a pre-specified subgroup of 126 patients within a single, tertiary referral centre as part of the P4 (Post Partum, Physiology, Psychology, and Paediatric Follow Up) study (2). 74 (59%) women had a normotensive pregnancy, and 52 (41%) had a pregnancy complicated by HDP. Women with pre-existing hypertension were excluded from the study. The mean patient age at time of six-month postpartum TTE was 32 years (range 22–47 years). TTEs were performed by blinded experienced sonographers and reported by a single blinded imaging cardiologist. Results Six months postpartum. 126 women underwent TTE at six months postpartum. Although all results fell within normal ranges, compared to women with a normotensive pregnancy, those with HDP had increased left ventricle (LV) wall thickness, higher relative wall thickness, and increased LV mass. E/A ratio was lower, and E/E' ratios higher in the group with pregnancy complicated by HDP, indicating a trend towards poorer diastolic function (2,3). Two years postpartum. 35 women completed a two year postpartum TTE (18 normotensive, 17 HDP). Measurements fell within normal ranges in both groups of women. At two years postpartum, women with HDP had larger BSA (1.9 vs 1.71 m2 p=0.003), larger LV internal diastolic diameter (48.4 vs 45.5mm p=0.017) and increased inter-ventricular septum thickness (8.5 vs 7.7mm p=0.007) compared to those with normotensive pregnancy. LV mass was greater in women with HDP (98.1 vs 81.5g), as was LA volume indexed (25.4 vs 23.4 cm3/m3), however these differences did not reach significance (p=0.053 and 0.196 respectively). Compared to normotensive women, those with HDP had higher septal (8.7 vs 7.3 p=0.014) and lateral (6.6 vs 5.4 p=0.017) E/E' ratios, indicating a trend towards diastolic dysfunction. Conclusion Despite measurements falling within normal ranges, our results indicate that women with HDP have changes in cardiac structure and function that persist out to two years postpartum. Limitations exist due to incomplete follow up, leading to small sample size; this was partially due to restrictions on service provision in the context of the COVID-19 pandemic. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The St George and Sutherland Research Foundation.Philanthropic donation from Emeritus Professor Richard Henry.