Premature Heart Disease Research Articles

Comparative efficacy, toxicity, and insulin-suppressive effects of simvastatin and pravastatin in fatty acid-challenged mouse insulinoma MIN6 β-cell model.

Familial hypercholesterolemia, the highly prevalent form of dyslipidemia, is a well-known risk factor for premature heart disease and stroke worldwide. Statins, which inhibit 3-hydroxy 3-methylglutaryl coenzyme A (HMG-CoA) reductase, are the first-choice treatment for dyslipidemias, and have been effective in reducing the risk of stroke and myocardial infarction. However, emerging evidence indicates that statins may increase the incidence of new-onset type 2 diabetes by reducing β-cell mass and function. Notably, past in vitro reports studying the effects of statins on β-cells were performed without including free fatty acids in the model. This factor should have been addressed since these agents are used to treat individuals with hyperlipidemia. Here, we used a mouse insulinoma MIN6 β-cell culture model to assess the efficacy, cytotoxicity, and insulin-suppressive effects of simvastatin and pravastatin in the presence of palmitic, linoleic, and oleic acids cocktail to mimic mixed lipids challenge in a biologically relevant setting. Our findings indicate that simvastatin was more effective in lowering intracellular cholesterol but was more cytotoxic as compared to pravastatin. Similarly, simvastatin exhibited a higher suppression of total insulin content and insulin secretion. Both drugs suppressed insulin secretion in phases 1 and 2, dose-dependently. No significant effect was observed on mitochondrial respiration. More importantly, elution experiments showed that insulin content diminution by simvastatin treatment was reversible, while exogenous mevalonate did not improve total insulin content. This suggests that simvastatin's influence on insulin content is independent of its specific inhibitory action on HMG-CoA reductase. In conclusion, our study identified that simvastatin was more effective in lowering intracellular cholesterol, albeit it was more toxic and suppressive of β-cells function. Notably, this suppression was found to be reversible.

Dietary patterns and metabolic syndrome in patients with premature heart disease: a cross-sectional study

PurposeDue to the increase in the prevalence of other risk factors of heart diseases, the age of heart disease has decreased and it has led to premature heart disease. One of the main risk factors of this disease is metabolic syndrome (MetS). One of the key ways to control MetS is dietary modification. The purpose of this study is to investigate the relationship between dietary patterns and MetS in patients with premature heart disease.Design/methodology/approachThis study was conducted on 409 people with premature heart disease. The diagnosis of MetS was made based on the ATP III criteria. Dietary intake for the past year was collected using the validated semi-quantitative food frequency questionnaire. Dietary patterns were determined by factor analysis with principal components approach.FindingsThree dietary patterns were identified, including the healthy, western and traditional patterns. The findings showed that people who followed the traditional pattern more than those who followed less had a lower risk of MetS. (OR:0.23; 95% CI: 0.11–0.52). But, no relation was observed between healthy (OR:1.45; 95% CI:0.64–3.25) and western (OR:1.04; 95% CI:0.51–2.13) patterns with MetS.Originality/valueThe findings of this study showed that following a traditional dietary pattern based on high consumption of whole grains, red meat, viscera, fish, eggs, high-fat dairy products, soft drinks, mayonnaise and solid oil was associated with a lower risk of MetS.

Prevalence of elevated lipoprotein(a) in cardiac rehabilitation patients - results from a large-scale multicentre registry in Germany.

Lipoprotein(a) (Lp(a)) is an independent risk factor for myocardial infarction and aortic valve stenosis. European guidelines recommend assessing it at least once in a lifetime, particularly in premature atherosclerotic heart disease. A non-interventional registry was conducted at MEDIAN rehabilitation facilities in Germany to assess the frequency of Lp(a) testing in referring acute care hospitals and the prevalence of elevated Lp(a) levels in aortic valve stenosis or premature myocardial infarction. All consecutive patients referred after coronary intervention or aortic valve surgery were included in four cohorts: aortic valve intervention (cohort 1), current/previous myocardial infarction at < 60 years of age (cohorts 2a/2b), and myocardial infarction at ≥ 60 years of age (control). The analysis included 3393 patient records (cohort 1, n = 1063; cohort 2a, n = 1351; cohort 2b, n = 381; control, n = 598). Lp(a) had been determined at the referring hospital in 0.19% (cohort 1), 4.96% (cohort 2a), 2.36% (cohort 2b), and 2.01% (control) of patients. Lp(a) levels were > 50 mg/dL or > 125 nmol/L in 28.79% (cohort 1), 29.90% (cohort 2a), and 36.48% (cohort 2b; p < 0.001) compared to 24.25% (control). Family history of premature cardiovascular disease was reported in 13.45% (cohort 1), 38.56% (cohort 2a), and 32.81% (cohort 2b) compared to 17.89% (control; p < 0.05 for each comparison). Lp(a) had been rarely assessed in acute management of aortic valve stenosis or premature myocardial infarction despite expanding scientific evidence and guideline recommendation. Given the above-average incidence of elevated Lp(a) levels, awareness for Lp(a) has to increase substantially to better identify and manage high-risk patients.

Prevalence and management of familial hypercholesterolaemia in patients with chest pain admitted to hospital: a retrospective observational study

ObjectivesPatients with familial hypercholesterolaemia (FH) are genetically burdened by a lifelong elevation of the low-density lipoprotein cholesterol (LDL-C) level, putting them at a very high risk of premature ischaemic heart...

Traditional risk factors and premature acute coronary syndromes in South Eastern Europe: a multinational cohort study

The age-standardized death rates under 65 years from ischemic heart disease in South Eastern Europe are approximately twice as high than the Western Europe average, but the reasons are not completely recognized. The aim of the present study was to address this issue by collecting and analyzing data from a large, multinational cohort. We enrolled 70,953 Caucasian patients with first acute coronary syndrome, from 36 urban hospital in 7 South Eastern European countries and assessed their life expectancy free of acute coronary syndrome and mortality within 30 days after hospital admission from acute coronary syndrome as estimated in relation to dichotomous categories of traditional risk factors (current smoking, hypertension, diabetes and hypercholesterolemia) stratified according to sex. Compared with patients without any baseline traditional risk factors, the presence of all four risk factors was associated with a 5-year shorter life expectancy free of acute coronary syndrome (women: from 67.1±12.0 to 61.9±10.3 years; r=-0.089; p<0.001 and men: from 62.8±12.2 to 58.9±9.9 years; r=-0.096; p<0.001). Premature acute coronary syndrome (women <67 years and men <63 years) was remarkably related to current smoking and hypercholesterolemia among women (RRs: 3.96; 95% CI: 3.72-4.20 and 1.31; 95% CI: 1.25-1.38, respectively) and men (RRs: 2.82; 95% CI: 2.71-2.93 and 1.39; 95% CI: 1.34-1.45, respectively). Diabetes was most strongly associated with death from premature acute coronary syndrome either in women (RR: 1.52; 95% CI: 1.29-1.79) or men (RR: 1.63; 95% CI: 1.41-1.89). Public health policies in South Eastern Europe should place significant emphasis on the four traditional risk factors and the associated lifestyle behaviors to reduce the epidemic of premature ischemic heart disease. None.

PM2.5 pollution in Texas: a geospatial analysis of health impact functions.

Air pollution is the greatest environmental threat to human health in the world today and is responsible for an estimated 7-9 million deaths annually. One of the most damaging air pollutants is PM2.5 pollution, fine airborne particulate matter under 2.5 microns in diameter. Exposure to PM2.5 pollution can cause premature death, heart disease, lung cancer, stroke, diabetes, asthma, low birthweight, and IQ loss. To avoid these adverse health effects, the WHO recommends that PM2.5 levels not exceed 5 μg/m3. This study estimates the negative health impacts of PM2.5 pollution in Texas in 2016. Local exposure estimates were calculated at the census tract level using the EPA's BenMAP-CE software. In BenMAP, a variety of exposure-response functions combine air pollution exposure data with population data and county-level disease and death data to estimate the number of health effects attributable to PM2.5 pollution for each census tract. The health effects investigated were mortality, low birthweight, stroke, new onset asthma, new onset Alzheimer's, and non-fatal lung cancer. This study found that approximately 26.7 million (98.9%) of the 27.0 million people living in Texas in 2016 resided in areas where PM2.5 concentrations were above the WHO recommendation of 5 μg/m3, and that 2.6 million people (9.8%) lived in areas where the average PM2.5 concentration exceeded 10 μg/m3. This study estimates that there were 8,405 (confidence interval [CI], 5,674-11,033) premature deaths due to PM2.5 pollution in Texas in 2016, comprising 4.3% of all deaths. Statewide increases in air-pollution-related morbidity and mortality were seen for stroke (2,209 - CI: [576, 3,776]), low birthweight (2,841 - CI: [1,696, 3,925]), non-fatal lung cancers (636 - CI: [219, 980]), new onset Alzheimer's disease (24,575 - CI: [20,800, 27,540]), and new onset asthma (7,823 - CI: [7,557, 8,079]). This study found that air pollution poses significant risks to the health of Texans, despite the fact that pollution levels across most of the state comply with the EPA standard for PM2.5 pollution of 12 μg/m3. Improving air quality in Texas could save thousands of lives from disease, disability, and premature death.

Loneliness among the elderly in Baltic nations during the beginning of the Covid-19 pandemic

Abstract Background The population in the Baltic states of Estonia, Latvia, and Lithuania is ageing rapidly. Loneliness is one of the most disruptive transformations facing older adults. Loneliness implies a lack of meaningful social relations or absence of human contact, and adversely impacts the health and quality of life of older adults. Loneliness is associated with an increased risk of premature death, dementia, heart disease, depression anxiety and suicide. This study is based on the Cacioppo Evolutionary Theory of Loneliness (ETL), that posits, that an individual's perception of loneliness triggers nonconscious evolutionary behavior that may have long term deleterious consequences. There is evidence of the heritability of loneliness as a population parameter. Research Objectives To determine the nature of loneliness experienced by older adults in Baltic states, specifically is loneliness among older adults the same across countries, genders, age and employment status. Study Design Data from Wave 9, COVID-19 Survey 2 (Summer 2021) of the of the cross-national panel dataset of the Survey of Health, Ageing and Retirement in Europe (SHARE) were examined using a sample of 6303 adults over 50 years old from Latvia, Lithuania and Estonia. Analysis: Nonparametric one-way ANOVA (Kruskal-Wallis test) was performed to test the null hypothesis that the rate of loneliness is equal across gender, age, and country in Baltic states. Principal Findings There was a statistically significant difference in the loneliness reported by country. The indicate that country is a significant factor [χ2= 77.14, df = 2; p&amp;lt; .001], and the rate of loneliness varies significantly by gender [χ2= 93.94, df = 1; p&amp;lt; .001, and age [χ2= 187.80, df = 6; p&amp;lt; .001]. Conclusions These finding suggest that age and gender are significant predictors of loneliness. Implications for Policy and Practice: Care of older adults should aim at alleviating loneliness difficulties faced by this population. Key messages • Age and gender was a significant predictor of loneliness among the elderly in Baltic states at the beginning of the Covid-19 pandemic. • Policy initiatives that aim to alleviate loneliness among older adults should address age and gender factors.

Increasing Incidence of ST-Elevation Acute Coronary Syndrome in Young South Asian Population, a Challenge for the World? An Assessment of Clinical and Angiographic Patterns and Hospital Course of Premature Acute Myocardial Infarction

The incidence of premature ischemic heart disease (IHD) is increasing because of urbanization, a sedentary lifestyle, and various other unexplored factors, especially in South Asia. This study aimed to assess the distribution of premature ST-elevation acute coronary syndrome (STE-ACS) with its clinical and angiographic pattern along with hospital course in a contemporary cohort of patients who underwent primary percutaneous intervention at a tertiary care center in the South Asian region. We included consecutive patients of either gender diagnosed with STE-ACS and who underwent primary percutaneous intervention. Patients were stratified based on age as ≤40years (young) and >40years (old). Clinical characteristics, angiographic patterns, and hospital course were compared between the 2 groups. Of the total of 4,686 patients, 466 (9.9%) were young (≤40years). Young patients had a lower prevalence of hypertension (40.8% vs 54.5%, p<0.001), diabetes (26.6% vs 36.4%, p<0.001), metabolic syndrome (14.8% vs 24%, p<0.001), history of IHD (5.8% vs 9.3%, p=0.013) and a higher frequency of smoking (33% vs 24.7%, p<0.001), positive family history (8.2% vs 3.2%, p<0.001), and single-vessel involvement (60.1% vs 33.2%, p<0.001). The composite adverse clinical outcome occurrence was significantly lower in young patients (14.2% vs 19.5%, p=0.006). On multivariable analysis, history of IHD in young, whereas age, Killip class III/IV, intubated, arrhythmias on arrival, diabetes, history of IHD, pre-procedure left ventricular end-diastolic pressure, ejection fraction <40%, and slow flow/no-reflow during the procedure were found to be the independent predictors of adverse clinical outcome in old patients. In conclusion, we have a substantial burden of premature STE-ACS, mostly in male patients potentially driven by smoking and positive family history. Despite favorable pathophysiology, with mostly single-vessel hospital courses of STE-ACS in the young equally lethal in nature.

A primer for the student joining the adult cardiac surgery service tomorrow: Primer 1 of 7

A primer for the student joining the adult cardiac surgery service tomorrow: Primer 1 of 7

470 Evaluation of cardiovascular risk factor control among people with diabetes in the community pharmacy setting – a cross sectional study

Abstract Introduction Diabetes affects almost 140,000 Irish people and the prevalence is increasing.(1) In Ireland there is no structured programme in place for community pharmacists to provide care to people with diabetes, outside of dispensing medications and supplying medical devices. Research shows that community pharmacists can provide advanced services to people with diabetes that improve glycaemic control, cardiovascular risk, and medication profile.(2) A pharmacist-led intervention among people with diabetes in the Irish community pharmacy setting may be beneficial in addressing these treatment goals. However, baseline data to support this is not available. Aim To assess the cardiovascular risk profile of people with diabetes attending community pharmacy in Ireland. Methods This was a cross-sectional study. Data collection took place in 10 pharmacies, identified by purposeful sampling, in four Irish counties, and was conducted by five pharmacy students. Data collection in each pharmacy lasted between five and six weeks and took place between July 2018 and October 2019. A target sample size was not set. Study participants were aged 18 years and older, with type 1 or type 2 diabetes, attending a participating pharmacy and to whom oral diabetes medicines, insulin or devices for monitoring glycaemic control were dispensed. A data collection form was designed for the study, based on the RxEACH study.(2) Participants were asked their demographics, medical history, and cardiovascular risk factors. Current medications were identified using dispensing software. Data were presented as mean±standard deviation or number (%). Data were analysed in SPSS v28. Results Data were available for 106 participants, 70 (66.0%) male, mean age 63.5±13.7 years. Of these, 90 (84.9%) had type 2 diabetes and 16 (15.1%) had type 1 diabetes. Hypertension and dyslipidaemia were reported by 60 (56.6%) and 59 (55.7%) participants, respectively. This was followed by family history of premature heart disease (N=40, 37.7%), coronary artery disease (N=10, 9.4%), and atrial fibrillation (N=9, 8.5%). Twenty-one participants (19.8%) were current smokers, 31 (29.2%) followed no specific diet, and 44 (41.5%) did not undertake exercise. Oral diabetes medication was prescribed to 85 (80.2%) participants and insulin to 29 (27.4%) participants. Antihypertensive medication was prescribed to 67 (63.2%), lipid-lowering therapy to 53 (50.0%) and an antiplatelet agent to 51 (48.1%) participants. Participants reported that they received education about diabetes medicines from their general practitioner (N=49, 46.2%), endocrinologist (N=21, 19.8%), diabetes nurse (N=28, 26.4%), dietician (N=3, 2.8%), pharmacist (N=17, 16.0%), other source (N=17, 16.0%). Twelve (11.3%) participants reported never receiving medication education. Conclusion Study limitations include being confined to a small number of pharmacies in a geographically limited area and that medical history was based on self-report. Strengths include the use of a robust method of collecting medication data. People with diabetes attending study pharmacies had high rates of behaviours associated with cardiovascular risk including smoking and lack of exercise. Fewer than one-in-six participants reported receiving diabetes medication education from their pharmacist. Pharmacist-led interventions to engage people with diabetes in discussing health behaviours and medication education should be developed and explored as potential future professional services delivered by Irish pharmacists.

Platelet adhesion mediated by von Willebrand factor in patients with premature coronary artery disease

Aim To study platelet adhesion mediated by von Willebrand factor (VWF) in patients with premature ischemic heart disease (IHD).Material and methods This study enrolled 58 patients with stable IHD, including 45 men younger than 55 years with the first manifestation of IHD at the age of &lt;50 years and 13 women younger than 65 years with the first manifestation of IHD at the age of &lt;60 years. The control group consisted of 33 patients, 13 men younger than 55 years and 20 women younger than 65 years without IHD. Platelet adhesion to the collagen surface at the shear rate of 1300 s-1 was studied by evaluating the intensity of scattered laser light from the collagen-coated optical substrate in a flow chamber of a microfluidic device after 15-min circulation of whole blood in the chamber. Decreases in platelet adhesion after addition to the blood of monoclonal antibodies (mAb) to platelet receptors glycoproteins Ib (GPIb) to inhibit the receptor interaction with VWF were compared for patients of both groups.Results In patients with premature IHD, the decrease in platelet adhesion following the platelet GPIb receptor inhibition was significantly less than in patients of the control group (74.8 % (55.6; 82.7) vs. 28.9 % (-9.8; 50,5), p &lt;0.001). For the entire sample, the median decrease in platelet adhesion following the GPIb receptor inhibition was 62.8 % (52.2; 71.2). With an adjustment for traditional risk factors of IHD, a decrease in platelet adhesion of &gt;62.8% after blocking GPIb receptors increased the likelihood of premature IHD (OR=9.84, 95 % CI: 2.80-34.59; p &lt;0.001).Conclusion Blocking the interaction of GPIb receptors with VWF in patients with premature IHD and increased shear rate induced a greater decrease in platelet adhesion than in patients without this disease. This suggested that an excessive interaction of VWF with platelets might contribute to the pathogenesis of premature IHD.

Association of sleep complaints with all-cause and heart disease mortality among US adults.

Compared with sleep disorders, no consensus has been reached on whether a subjective complaint of having trouble sleeping is associated with increased all-cause and heart disease mortality risk. Previous studies displayed considerable heterogeneity in population disease characteristics and duration of follow-up. Therefore, the aims of this study were to examine the relationship between sleep complaints and all-cause and heart disease mortality and whether the associations were influenced by follow-up time and population disease characteristics. In addition, we aimed to figure out the influence of the joint effects of sleep duration and sleep complaints on mortality risk. The present study utilized data from five cycles of the National Health and Nutrition Examination Survey (NHANES) (2005~2014) linked with the most updated 2019 National Death Index (NDI). Sleep complaints were determined by answers to "Have you ever told a doctor or other health professional that you have trouble sleeping?" and "Have you ever been told by a doctor or other health professional that you have a sleep disorder?". Those who answered 'Yes' to either of the aforementioned two questions were considered as having sleep complaints. A total of 27,952 adult participants were included. During a median follow-up of 9.25 years (interquartile range, 6.75-11.75 years), 3,948 deaths occurred and 984 were attributable to heart disease. A multivariable-adjusted Cox model revealed that sleep complaints were significantly associated with all-cause mortality risk (HR, 1.17; 95% CI, 1.07-1.28). Subgroup analysis revealed that sleep complaints were associated with all-cause (HR, 1.17; 95% CI, 1.05-1.32) and heart disease (HR, 1.24; 95% CI, 1.01-1.53) mortality among the subgroup with cardiovascular disease (CVD) or cancer. In addition, sleep complaints were more strongly associated with short-term mortality than long-term mortality. The joint analysis of sleep duration and sleep complaints showed that sleep complaints mainly increased the mortality risk in those with short (< 6 h/day, sleep complaints HR, 1.40; 95% CI, 1.15-1.69) or recommended (6-8 h/day, sleep complaints HR, 1.15; 95% CI, 1.01-1.31) sleep duration group. In conclusion, sleep complaints were associated with increased mortality risk, indicating a potential public benefit of monitoring and managing sleep complaints in addition to sleep disorders. Of note, persons with a history of CVD or cancer may represent a potentially high-risk group that should be targeted with a more aggressive intervention of sleep problems to prevent premature all-cause and heart disease death.

Assault on salt Intake

Assault on salt Intake

INCREASING HYPERTENSION KNOWLEDGE THROUGH EXTENSION INTERVENTION IN RT 04 DUKUH DRUWO, BANGUNHARJO, SEWON, BANTUL, YOGYAKARTA

Hypertension is one of the causes of premature death and heart disease worldwide. Complications of hypertension can attack various organs of the body such as the heart (ischemic heart disease, left ventricular hypertrophy, heart failure), brain (stroke), kidneys (kidney failure), eyes (retinopathy), and peripheral arteries (intermittent claudication). Damage to these organs depends on the patient's high blood pressure and how long the high blood pressure is uncontrolled and untreated. Risk factors that cause hypertension can be influenced by unhealthy lifestyles such as lack of physical activity, stress factors, and the wrong diet. Modern food factors as a major contributor to the occurrence of hypertension in the community. Based on the 2013 Riskesdas results, the prevalence of hypertension in DIY was 25.7%. Based on the 2016 DIY health profile, the prevalence of hypertension in Bantul Regency is 26.12%. This community service is implemented through the dissemination of face-to-face education to the community on the subject of hypertension prevention. Throughout the execution of the activity, Pre-Test and Post-Test measurements were conducted. Thirty individuals in Dukuh Druwu were educated via poster medium. The average score for public comprehension of hypertension prevention increased by 20%. The increase in the average score is one of the evidences of the success of the extension. Then posters were installed at two points in RT 04, namely at the house of the cadre's mother and the mosque's wall magazine.

Targeted sequencing of a gene panel in patients with familial hypercholesterolemia from Southern Poland.

Familial hypercholesterolemia (FH) is an autosomal dominant monogenic lipid metabolism disorder characterized by a significantly elevated level of low‑density lipoprotein (LDL) cholesterol and leading to premature ischemic heart disease. FH is caused by mutations in the LDLR, APOB, and PCSK9 genes; however, these mutations account for only about 40% of FH cases. In order to obtain a genetic diagnosis of FH, sequencing of other genes involved in the lipid metabolism might be useful. This study aimed to describe genetic variants in genes associated with FH in a group of patients from the Małopolska province in Southern Poland, using the targeted next generation sequencing (NGS) technology. The study involved 90 unrelated adults (age range, 18-70 years) with FH diagnosed clinically according to the Simon Broome Register criteria. A custom‑designed capture assay and the Illumina MiSeq platform were used. The panel included exons and exon / intron boundaries of known FH‑causing genes: LDLR, APOB, and PCSK9, as well as genes previously associated with high cholesterol levels: APOE, ABCG5, ABCG8, LPL, NPC1, LDLRAP1, LIPC, STAP1, and CELSR2. Genetic variants were classified based on in silico predictions and ClinVar reports. We detected 4 patients with variants in the LDLR and APOB genes that had not been previously linked to FH in ClinVar. We also found APOB mutations outside the common LDL receptor-binding region, in exons 26 and 29. Interestingly, we observed a high frequency of pathogenic variants in exon 4 of the APOE gene: rs7412, probably damaging (4 patients) and rs429358, benign (16 patients). NGS is a useful and reliable method to detect new variants in genes related to FH. In addition, the results enable the detection of FH phenocopies and introduction of appropriate treatment.

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.

Primary Care Physicians' Perspectives on Identifying Familial Hypercholesterolaemia in Primary Care: A Qualitative Study.

Context Familial hypercholesterolaemia (FH) is a common autosomal dominant disorder, causing elevated cholesterol from birth, premature heart disease, and early death. Objective This study explored primary care physicians' experiences and perspectives on identifying FH in Malaysian primary care. Study Design and Analysis A qualitative study involving semi-structured interviews and focus group discussions with 22 primary care physicians (PCPs) in two primary care clinic settings. The interviews and focus group discussions were audio recorded, and the recordings were transcribed verbatim. The data in the transcripts were analysed using thematic approach. Setting Primary Care Clinics Population Studied Primary Care Physicians in two primary care clinics. Intervention A qualitative study involving semi-structured interviews and focus group discussions Outcome Measures Primary Care Physicians' perceptions and experiences of identifying individuals at high risk of FH in their clinical practice, and the acceptability and perceived challenges of trying to do this were explored during the interviews and focus group discussions. Findings PCPs felt there was potential for FH to be identified earlier in primary care. They had some existing knowledge and awareness of diagnostic criteria for FH but highlighted several challenges. In their practice, this included limited time in routine clinical care, availability of medication and clinical expertise; and critical lack of family history and physical examination findings in health records. The barriers on a systemic level were shortage of lipid specialist services and the absence of local care pathways for FH. The PCPs recommended a user-friendly case-finding tool for FH, and establishing FH registry and clinical practice guideline in Malaysia, alongside a national FH screening strategy and awareness campaigns for both clinicians and general public. Conclusions PCPs are positive about improving the identification of FH in primary care. However greater support in their practice and wider system developments and change are needed.

Healthy Food Recommendation Using a Time-Aware Community Detection Approach and Reliability Measurement

Food recommendation systems have been increasingly developed in online food services to make recommendations to users according to their previous diets. Although unhealthy diets may cause challenging diseases such as diabetes, cancer, and premature heart diseases, most of the developed food recommendation systems neglect considering health factors in their recommendation process. This emphasizes the importance of the reliability of the recommendation from the health content perspective. This paper proposes a new food recommendation system based on health-aware reliability measurement. In particular, we develop a time-aware community detection approach that groups users into disjoint sets and utilizes the identified communities as the nearest neighbors set in rating prediction. Then, a novel reliability measurement is introduced by considering both the health and accuracy criteria of predictions to evaluate the reliability of predicted ratings. Also, the unreliable predictions are recalculated by removing ineffective users from the nearest neighbors set. Finally, the recalculated predictions are utilized to generate a list of foods as recommendations. Different experiments on a crawled dataset demonstrate that the proposed method enhances the performance around 7.63%, 6.97%, 7.37%, 15.09%, and 16.17% based on precision, recall, F1, normalized discounted cumulative gain (NDCG), and health metrics, respectively, compared to the second-best model.

The association between non-HDL cholesterol and SYNTAX score in premature heart disease

&lt;b&gt;Aim: &lt;/b&gt;This study aimed to estimate the association of coronary artery disease complexity with non-HDL-C levels in premature CAD.&lt;br /&gt; &lt;b&gt;Background: &lt;/b&gt;Primary prevention has utmost importance in terms of minimizing the number of patients who had premature coronary artery disease (CAD). Non-high density lipoprotein cholesterol (non-HDL-C) contains potentially atherogenic lipoprotein fractions.&lt;br /&gt; &lt;b&gt;Material and methods&lt;/b&gt;: Coronary angiographic recordings of two hundred acute coronary syndrome patients were evaluated by two cardiologists. Clinical, demographic and lipid parameters of the patients were compared with SYNTAX score.&lt;br /&gt; &lt;b&gt;Results&lt;/b&gt;: Median age of the study group was 41 (18-45) years. One hundred eighty five (90.5%) of them were male, nineteen (9.5%) of them were female. Median SYNTAX score and ejection fraction of the patients were 17 (4.5-39) and 50 (33-68), respectively. SYNTAX score of the male patients was significantly higher compared to females [17 (4.5-39) vs 12 (8-26), p=0.048), similarly, diabetic patients had higher values of syntax score compared to non-diabetic patients [19 (10-39) vs 16 (4.5-37), p=0.005), There were no differences of SYNTAX score with respect to presence of hypertension, smoking status and family history of CAD. &amp;nbsp;There were very strong positive correlation between SYNTAX score and non-HDL-C, TC and LDL-C levels (r=0.958, r=0.946 and r=0.921, respectively, p&amp;lt;0.001 for all).&amp;nbsp;&amp;nbsp; HgA1c levels showed positive correlation, whereas HDL-C showed negative correlation with SYNTAX score (r=0.793 and r=-0.620, respectively, p&amp;lt;0.001 for both).&lt;br /&gt; &lt;b&gt;Conclusion&lt;/b&gt;: non-HDL-C was a valuable tool in assessing the complexity of atherosclerotic cardiovascular disease in young patients.

Prevention and treatment of premature ischaemic heart disease with European Society of Cardiology Guidelines

ObjectiveTo determine if the changes in the European Society Cardiology/European Atherosclerotic Society (ESC/EAS) guidelines improved the identification for primary prevention therapy in young adults at risk of a premature myocardial...