Risk Factor For Cardiovascular Mortality Research Articles

The Impact of Semaglutide on Liver Fat Assessed by Serial Cardiac CT scans in Patients with Type 2 Diabetes: Results from STOP Trial

IntroductionThere is increasing prevalence of hepatic steatosis. Hepatic steatosis is increasingly recognized as the independent risk factor for cardiovascular mortality. However, there are limited options for the treatment of fatty liver. In this study we evaluated the effect of semaglutide on liver fat as measured by non-contrast cardiac CT scans. MethodsSTOP is a randomized controlled trial that evaluated semaglutide treatment effect on coronary atherosclerosis progression (STOP) in type 2 diabetes. We utilized unenhanced cardiac CT scans to quantify liver fat based on CT Hounsfield attenuation method. A total of 114 subjects qualified for this study of the 140 subjects randomized, 59 in semaglutide group and 55 in the placebo group and were followed for 12 months. Multivariate regression models were used to evaluate the change in liver fat content overtime. Results114 subjects were included in the study, 61% male, mean age of 57.8±8.1 years and mean BMI of 32.0±6.7. The average of the three liver measures showed an improvement in the semaglutide group 1.4±9.0 versus worsening in the placebo group of 1.9±9.5 mean HU. The multivariable linear regression models including age, gender, BMI, hypertension, hyperlipidemia, past smoking and baseline liver attenuation, showed that the semaglutide group average liver attenuation measures improved by 4.4 HU versus placebo across the trial, p=0.002 indicating improvement in the liver fat content in treatment group. ConclusionIn type 2 diabetes patients with hepatic steatosis, treatment with semaglutide resulted in a significant improvement in fatty liver resolution compared to placebo.

Antihypertensive Drugs - Ayurvedic Perspective

Hypertension is a very common disorder, particularly in past middle age. It is not a disease in itself, but is an important risk factor for cardiovascular mortality and morbidity. According to WHO, it is above 140/90 mmHg. An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension. American Association of Heart mentioned that normal blood pressure is less than 120 mmHg systolic and less than 80 mmHg diastolic. Epidemiological studies have confirmed that higher the pressure (systolic or diastolic or both) greater is the risk of cardiovascular disease. The principal focus of Ayurveda is on maintaining good health and adopting a healthy way of life. There is no description of such a single disease which can resemble with hypertension. It can be correlated with Vata Pradhaan Tridoshaj Vyadhi, Raktabhaar, Uchharaktachapa etc and involves dhatus like Rasa and Rakta and gets influenced by Mana. Our ancient science has provided us various drugs which influences the pressure of the blood. These drugs has directly or indirectly role in curing HTN for example Sarpagandha, Jatamansi, Rudraksh, Ashawgandha etc. which should be analysed by the physician clinically. This article would help future researchers and clinicians for administrating these drugs in different forms clinically and help further researches. There are specific alkaloids present in these drugs which influence different centres resulting in decrease in the Blood pressure. The present work deals with enhancing the role of Ayurvedic drugs and promoting more natural ways of treatment.

RAAS inhibitors in patients undergoing transcatheter aortic valve implantation: insights from the EffecTAVI registry

Abstract Background Aortic Stenosis (AS) is the most common heart disease in western countries, with a prevalence that is increasing in tandem with life expectancy. Renin-angiotensin-aldosterone system (RAAS) activation participates to myocardial fibrosis and worse clinical consequences. Purpose The association between baseline treatment with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) and cardiovascular (CV) mortality was evaluated in hypertensive patients with severe AS undergoing transcatheter aortic valve implantation (TAVI). Methods We retrospectively examined hypertensive patients with AS who had undergone TAVI at 2-year follow-up. Univariable and multivariable Cox regression models were built according to baseline RAAS inhibitors (RAASi) therapy status and a second analysis was undertaken by categorizing patients in ARBs (n= 110), ACEi (n= 112) and other antihypertensive meds (n= 105). As a sensitivity analysis, survival-time data were converted to case-control data in order to conduct a case–control study nested in the observational study. Results The present analysis included 327 hypertensive patients with severe AS undergoing TAVI. During the 2-year follow-up 43 patients died for CV death. In univariable Cox regression, the rate of the 2-year CV mortality was significantly lower in patients taking RAASi at baseline (HR=0.44, 95% CI 0.23-0.81 p=0.009), however after multivariable adjustment for significant confounders baseline treatment with RAASi was no more significant. Patients were then grouped based on ARBs/ACEIs/other antihypertensive therapy (Figure 1). In the univariate regression analysis ARBs therapy was associated with 65% reduction in CV mortality (HR=0.35, 95% CI 0.15-0.78 p=0.011) significantly lower than other anti-hypertensive meds (figure 1). The results were confirmed in multivariate analysis adjusted for significant confounders (HR=0.34, 95% CI 0.14-0.85 p=0.021). To reduce the risk of bias and better evaluate the stability of the results, a case–control study nested in the observational study was performed. Based on preliminary analysis, patients exposed to ARBs were selected as the case group, those not exposed as the control group, matching controls and cases in a 1:1 manner and balancing for sex, chronic kidney disease, atrial fibrillation and type 2 diabetes mellitus. Multivariable logistic regression analyses were conducted to determine the possible risk factors for CV mortality. After adjusting for the effect of significant confounders, the use of ARBs was found to be associated with a significant reduced risk of CV mortality (OR 0.30, 95% CI 0.11 – 0.82, p=0.019) (Figure 2). Conclusion In patients with severe AS undergoing TAVI, baseline treatment with ARBs was associated with reduced risk of CV mortality over 2 years of follow-up compared to the use of other antihypertensive drugs. The results were also confirmed by the nested, balanced, case-control analysis.KM curves grouped for ACEI/ARBs/otherAdjusted odds-ratio in the nested case-c

IgE to common food allergens is associated with cardiovascular mortality in the National Health and Examination Survey and the Multi-Ethnic Study of Atherosclerosis

In individuals without symptomatic food allergy, food-specific IgE is considered clinically irrelevant. However, recent studies have suggested that galactose-α-1,3-galactose (alpha-gal) IgE is associated with cardiovascular (CV) disease. We sought to determine whether sensitization to common food allergens is associated with CV mortality. The association between IgE sensitization to foods and CV mortality ascertained to 2019 was examined in the National Health and Examination Survey (NHANES) 2005-2006 and the Wake Forest site of the Multi-Ethnic Study of Atherosclerosis (MESA) cohort; MESA enrolled adults without baseline clinical CV diseases between 2000 and 2002. Total and specific IgE was measured to cow's milk, egg, peanut, shrimp, and a panel of aeroallergens (NHANES), and to cow's milk, alpha-gal, peanut, dust mite, and timothy grass (MESA). Cox proportional hazard models were constructed, adjusting for sex, age, race/ethnicity, smoking, education, and asthma. A total of 4414 adults from NHANES (229 CV deaths) and 960 from MESA (56 CV deaths) were included. In NHANES, sensitization to at least 1 food was associated with higher CV mortality (hazard ratio [HR], 1.7 [95% confidence interval (CI), 1.2-2.4], P= .005). Milk sensitization was particularly associated (HR, 2.0 [95% CI, 1.1-3.8], P= .026), a finding replicated in MESA (HR, 3.8 [95% CI, 1.6-9.1], P= .003). Restricting analyses in NHANES to consumers of the relevant allergen strengthened food sensitization relationships, unmasking shrimp and peanut sensitization as additional risk factors for CV mortality. The finding that food sensitization is associated with increased risk of CV mortality challenges the current paradigm that sensitization without overt allergy is benign. Further research is needed to clarify mechanisms of this association.

Hypotension at the Start of Dialysis Is a Risk Factor of Cardiovascular Mortality

Hypotension at the Start of Dialysis Is a Risk Factor of Cardiovascular Mortality

Associations between central pulse pressure, microvascular endothelial function, and fluid overload in peritoneal dialysis patients

ABSTRACT Background Microcirculatory endothelial dysfunction is a complex phenomenon that contributes to the development of cardiovascular disease. However, the relationship between microcirculatory endothelial dysfunction and macrovascular disease remains incompletely understood. Fluid overload is a risk factor for cardiovascular mortality in patients undergoing peritoneal dialysis. Therefore, we investigated the effects of chronic fluid overload on both the microcirculation and macrocirculation in these patients. Methods Thirty patients undergoing peritoneal dialysis were included in this cross-sectional study. We measured their central blood pressure and pulse wave velocity, assessed their microvascular endothelial function using drug-induced iontophoresis with laser Doppler flowmetry, and determined the amount of fluid overload using bioimpedance. We conducted a Spearman correlation analysis, univariate analysis, and stepwise multivariate regression models to determine the associations among the hemodynamic parameters. Results Acetylcholine-induced iontophoresis with laser Doppler flowmetry showed a correlation with both brachial and central pulse pressure (PP), but not with pulse wave velocity. Fluid overload was associated with both central and brachial PP and remained an independent predictor of central PP even after adjusting for multiple factors. However, fluid overload was not associated with microcirculatory endothelial function. Conclusion In peritoneal dialysis patients, we observed a significant association between central PP and microvascular endothelial function, indicating a connection between macrocirculation and microcirculation. However, conclusive evidence regarding fluid overload as a mediator between these circulatory systems is lacking. Further research is needed to investigate this relationship.

Estimation The Level of Superoxide Dismutase 1 Among Iraqi Patients with Hypertension

Background: Hypertension plays a critical role as a risk factor for cardiovascular mortality, encompassing conditions like coronary artery disease, organ damage, congestive heart failure, and cerebrovascular diseases. Furthermore, hypertension can lead to increased oxidation and peroxidation reactions due to elevated blood pressure and blood flow. Objective: This study aimed to evaluate the levels of superoxide dismutase in the sera of patients diagnosed with hypertension. Materials and Methods: The study involved 60 hypertensive patients who exhibited no significant abnormalities, such as liver disease, cardiomyopathy, renal disease, diabetes mellitus, congestive heart failure, or thyroid disease. Additionally, 25 healthy individuals, matched by age and sex to the patient group, were included in the study. The age range of the participants was between 32 and 70 years. The level of superoxide dismutase 1 in the sera was measured using an enzyme-linked immunosorbent assay (ELISA). Results: The results demonstrated a significant increase in the activity level of superoxide dismutase in hypertensive patients (732.91 ± 82.68 pg/ml) compared to the control group (590.63 ± 47.69 pg/ml). Conclusion: These findings have the potential to contribute to the diagnosis and management of hypertension, offering insights into the role of superoxide dismutase activity in the disease process.

Prevalence of metabolic syndrome in patients with end-stage renal disease: a systematic review and meta-analysis.

Metabolic syndrome, a significant risk factor for cardiovascular mortality in patients with end-stage renal disease, profoundly impacts patient prognosis and survival. Despite its clinical importance, the prevalence of metabolic syndrome remains unexplored in this population. Therefore, the objective of this study was to systematically assess the prevalence of metabolic syndrome among patients with end-stage renal disease and raise awareness among healthcare professionals. We conducted a comprehensive search in CNKI, WANFANG, WeiPu, CBM, PubMed, Web of Science, EMBASE, and The Cochrane Library databases. The search time was until August 21, 2023. Standardized tables were employed for data extraction and imported into Stata 16.0 software for subsequent meta-analysis. A random-effects model was employed to estimate combined prevalence and 95% confidence intervals. Subgroup and sensitivity analyses were conducted to explore potential sources of heterogeneity, while publication bias was evaluated using a funnel plot and Egger's test. Thisstudy has beenregistered with PROSPEROunder the registration numberCRD42023456284. This meta-analysis comprised 35 studies involving a total of 14,202 participants. The pooled prevalence estimate for metabolic syndrome was 49.0% [95% CI (46.0,53.0)]. We conducted subgroup analyses based on participant characteristics, gender distribution, publication year, national economic status, diagnostic criteria employed, and components of metabolic syndrome. The prevalence of metabolic syndrome is higher among patients with end-stage renal disease, necessitating early prevention and control measures to reduce its incidence and delay the progression of the disease, thereby improving patient life expectancy.

MICROALBUMINURIA IN NEWLY DIAGNOSED HYPERTENSIVE PATIENTS AND ITS CORRELATION WITH LEFT VENTRICULAR HYPERTROPHY”

Background: One of the most important factors in the development of cardiovascular diseases worldwide is Hypertension. A reliable indicator and a diagnostic modality in early stage of renal diseases and predictor of atrial hypertension (AH) progression is microalbminurea (MAU) which is also an independent risk factor of cardiovascular mortality and death.
 Objective: To determine the prevalence of microalbuminuria and left vertricular hypertrophy and assess correlation between micro albuminuria and LVH among newly diagnosed hypertensive patients.
 Methods: A cross sectional study conducted in Medical Unit IV, Jinnah Hospial Lahore from January to June, 2022. About 146 adults newly diagnosed hypertensive patients were included for study. Blood pressure was measured using sphygmomanometer with standard cuff in sitting position, with two measurements were made at least 5 min apart. Microalbuminuria was defined as albumin excretion 30 to 300 mg/dl in a spot urine sample report. Left ventricular hypertrophy (LVH) is defined as presence of concentric hypertrophy or diastolic dysfunction determined on Trans Thoracic ECHO by a cardiologist. Data was entered in SPSS Ver: 25.0 for data analysis and graphical presentation. For quantitative variables like age, ACR; mean and standard deviation was calculated. Prevalence and correlation of MAU and LVH in newly diagnosed hypertensive patients was using Spearmen’s Rank Correlation Analysis. Chi-square test was performed to compare MAU and LVH. P-value of < 0.05 was considered statistically significant. 
 Results: 146 subjects those fulfilling the inclusion criteria were admitted. Mean age was 48.281 + 24.865. 72.6% were male in our study. 30.8% of patients had LVH and microbuminurea was present in 47.5% of subject. About 28.6% of patient with LVH had MAU. (p=.030). There was a positive correlation between LVH and MAU. (r=0.135, P =.002).
 Conclusions: Our study concludes a high prevalence of micro albuminuria and LVH in newly diagnosed hypertensive. There is positive correlation between micro albuminuria and LVH and can be predictor of cardiovascular morbidity and mortality.

Long-term mortality risk of valvular heart disease adults over 35 years old in Chinese communities

Objective: To investigate the risk and influencing factors of long-term mortality of valvular heart disease (VHD) adults aged 35 years and over in Chinese communities. Methods: A cohort study was carried out. The data of the subjects who underwent echocardiography were collected from the Chinese Hypertension Survey between 2012 and 2015 and survival outcomes were followed up between 2018 and 2019. Kaplan-Meier survival curves were plotted and compared using log-rank test. Cox proportional hazards models were used to analyze the influence of VHD on mortality. Results: During an average follow-up time of (4.6±0.9) years, a total of 23 237 participants (10 881 males and 12 356 females) were pooled into the final analysis from 5 eastern, 5 central, and 4 western provinces, cities and autonomous regions in China, with a mean age of (56.9±13.2) years. Among the included participants, 1 004 had VHD (467 males and 537 females), with a mean age was of (68.1±12.6) years. In the Kaplan-Meier analysis, participants with VHD had a significantly increased risk of all-cause mortality (log-rank χ2=351.82, P<0.001) and cardiovascular mortality (log-rank χ2=284.14, P<0.001) compared with those without VHD. Multivariate Cox regression analysis showed that compared with those without VHD, the participants with rheumatic VHD had a 45% increased risk of all-cause mortality (HR=1.45, 95%CI: 1.12-1.89) and degenerative VHD increased the risk of cardiovascular mortality by 69% (HR=1.69, 95%CI: 1.19-2.38). The risk factors of cardiovascular mortality for VHD were age 55 years and over (55-<75 years: HR=4.93, 95%CI: 1.17-20.85;≥75 years: HR=11.92, 95%CI: 2.85-49.80) and diabetes mellitus (HR=1.71, 95%CI: 1.00-2.93). Conclusions: VHD is a risk factor of all-cause mortality and cardiovascular mortality among adults aged 35 years and over. Age 55 years and over and diabetes mellitus are adverse prognostic factors for patients with VHD.

Comparison of echocardiographic aortic stiffness index measurements and pulse wave velocity measurements in obese and overweight children.

Aortic/arterial stiffness is a reliable, independent predictor and a risk factor for cardiovascular mortality. Arterial stiffness is assessed by pulse wave velocity and echocardiography. The purpose of this study is to analyse aortic/arterial stiffness in patients using echocardiographic and pulse wave velocity techniques. The participants of this study consisted of 62 patients who presented to the Gazi University Pediatric Endocrinology and Pediatric Cardiology outpatient clinics, including 21 obese, 20 overweight, and 21 normal-weight patients. Echocardiography was performed on all patients, and echocardiographic measurements were compared to pulse wave velocity measurements. The mean (min-max) arterial strain measurements were 0.146 ± 0.0 (0.06-0.3) in the obese group and 0.106 ± 0.0 (0.05-0.18) in the overweight group. In comparison to the overweight group, the obese group had greater arterial strain measurements. The pulse wave velocity measurements in the obese and overweight groups were greater than those in the normal weight group (p > 0.05). Elastic modulus and aortic stiffness ß index values were shown to be positively correlated with pulse wave velocity measurements in the obese group (r = 0.56, r = 0.53, respectively; p = 0.008, p = 0.01, respectively). Systolic and diastolic blood pressure measurements were correlated with pulse wave velocity measurements in the obese group (r = 0.98, p = 0.0001, respectively). In our study, echocardiographic aortic measurements showing the vessel wall were correlated with pulse wave velocity measurements. Echocardiographic evaluation should be included in the routine follow-up of patients because pulse wave velocity measurement devices are not available in all centres, echocardiography is available in many centres, it is easily applicable, and it facilitates the follow-up of patients.

Cardiovascular mortality in patients with advanced chronic kidney disease with and without diabetes: a nationwide cohort study

BackgroundCardiovascular mortality and the impact of cardiac risk factors in advanced chronic kidney disease (CKD) remain poorly investigated. We examined the risk of cardiovascular mortality in patients with advanced CKD with and without diabetes as well as the impact of albuminuria, plasma hemoglobin, and plasma low-density lipoprotein (LDL) cholesterol levels.MethodsIn a Danish nationwide registry-based cohort study, we identified persons aged ≥ 18 years with an estimated glomerular filtration rate < 30 mL/min/1.73m2 between 2002 and 2018. Patients with advanced CKD were age- and sex-matched with four individuals from the general Danish population. Cause-specific Cox regression models were used to estimate the 1-year risk of cardiovascular mortality standardized to the distribution of risk factors in the cohort.ResultsWe included 138,583 patients with advanced CKD of whom 32,698 had diabetes. The standardized 1-year risk of cardiovascular mortality was 9.8% (95% CI 9.6–10.0) and 7.4% (95% CI 7.3–7.5) for patients with and without diabetes, respectively, versus 3.1% (95% CI 3.1–3.1) in the matched cohort. 1-year cardiovascular mortality risks were 1.1- to 2.8-fold higher for patients with diabetes compared with those without diabetes across the range of advanced CKD stages and age groups. Albuminuria and anemia were associated with increased cardiovascular mortality risk regardless of diabetes status. LDL-cholesterol was inversely associated with cardiovascular mortality risk in patients without diabetes, while there was no clear association in patients with diabetes.ConclusionsDiabetes, albuminuria, and anemia remained important risk factors of cardiovascular mortality whereas our data suggest a limitation of LDL-cholesterol as a predictor of cardiovascular mortality in advanced CKD.

Age-specific association of stage of hypertension at diagnosis with cardiovascular and all-cause mortality among elderly patients with hypertension: a cohort study

BackgroundHypertension affects 31.1% of adults worldwide, with higher prevalence of great than 60% in elderly. Advanced hypertension stage was associated with the higher risk of mortality. However, little is known about the age-specific association of stage of hypertension at diagnosis on cardiovascular mortality or all-cause mortality. Therefore, we aim to explore this age-specific association among the hypertensive elderly through stratified and interaction analyses.MethodsThis cohort study included 125,978 elderly hypertensive patients aged 60+ years from Shanghai of China. Cox regression was used to estimate the independent and joint effect of hypertension stage and age at diagnosis on cardiovascular and all-cause mortality. Interactions were evaluated both additively and multiplicatively. Multiplicative interaction was examined by the Wald test of the interaction term. Additive interaction was assessed by relative excess risk due to interaction (RERI). All analyses were performed stratified by sex.Results28,250 patients died during the follow-up up to 8.85 years, and 13,164 died of cardiovascular events. Older age and advanced hypertension stage were risk factors of cardiovascular mortality and all-cause mortality. Besides, smoking, rarely exercise, BMI < 18.5 and diabetes were also the risk factors. When we compared stage 3 hypertension with stage 1 hypertension, hazard ratios (95% confidence interval) of cardiovascular mortality and all-cause mortality were 1.56(1.41–1.72) and 1.29(1.21–1.37) for males aged 60–69 years, 1.25(1.14–1.36) and 1.13(1.06–1.20) for males aged 70–85 years, 1.48(1.32–1.67) and 1.29(1.19–1.40) for females aged 60–69 years, and 1.19(1.10–1.29) and 1.08(1.01–1.15) for females aged 70–85 years, respectively. Negative multiplicative interaction and positive additive interaction between age at diagnosis and stage of hypertension at diagnosis on cardiovascular mortality were observed in males (HR: 0.81, 95% CI: 0.71–0.93 RERI: 0.59, 95% CI: 0.09–1.07) and females (HR: 0.81, 95% CI: 0.70–0.93 RERI: 0.66, 95% CI: 0.10–1.23).ConclusionsDiagnosed with stage 3 hypertension was associated with higher risks of cardiovascular mortality and all-cause mortality, which were stronger among patients with age at diagnosis of 60–69 years compared with those with age at diagnosis of 70–85 years. Therefore, for the younger part of the elderly, the Department of Health should pay more attention to treating patients with stage 3 hypertension.

Diabetes and associated risk factors for cardiovascular mortality in Cuba: prospective study of 146,556 participants

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Hyporeninemic hypoaldosteronism as a manifestation of autonomic neuropathy in a patient with type 2 diabetes mellitus against the background of coronavirus disease. A clinical case

Coronavirus disease (COVID-19) is often associated with endocrine complications. The article describes a clinical case of the patient with type 2 diabetes mellitus and COVID-19 after which, for the first time, there was a need for basal-bolus insulin therapy, and secondly, a significant arterial hypotension occurred. The mechanism of damage to β-cells of the pancreas in the patient is debatable. After analyzing the features of diabetes course, we found an acute onset of the disease at the age of 44 years with pronounced hyperglycemia and ketosis, which required insulin therapy. Then for a long time there was no need in insulin therapy, and the patient took metformin, having overweight, no antibodies to β-cell antigens. It is also impossible to exclude the effect of SARS-CoV-2 on the secretory function of β-cells of the pancreas. Accordingly, clinical cases are interesting, as their analysis helps to understand not only the mechanism of development and progression of this infection, but also the diagnosis and treatment of its complications. We have described a rare clinical case of the hyporeninemic hypoaldosteronism in the patient with type 2 diabetes mellitus after COVID-19 infection. Afeature of the hyporeninemic hypoaldosteronism course was the absence of electrolyte disorders in the patient, with severe arterial hypotension, suppression of renin and aldosterone. We believe that the hyporeninemic hypoaldosteronism has been associated with the progression of chronic diabetes complications, mainly autonomic neuropathy against the background of COVID-19. To improve the identified disorders, replacement therapy with mineralocorticoids was prescribed. The blood pressure, symptoms of fluid retention and electrolyte levels were monitored when selecting the dose of fludrocortisone. The patient has been under observation for 14 months, the need for fludrocortisone replacement therapy persists to this day. Practicing doctors need to pay attention to the diagnosis of autonomic disorders, which reduce the patients’ quality of life and are an independent risk factor for cardiovascular mortality.

The number of valvular insufficiency is a strong predictor of cardiovascular and all-cause mortality in hemodialysis patients.

To investigate the relationship between the number of valvular insufficiency (VI) and emergency hospitalization or mortality in maintenance hemodialysis (HD) patients. The maintenance HD patients with cardiac ultrasonography were included. According to the number of VI ≥ 2 or not, the patients were divided into two groups. The difference of emergency hospitalized for acute heart failure, arrhythmia, acute coronary syndrome (ACS) or stroke, cardiovascular mortality, and all-cause mortality between the two groups were compared. Among 217 maintenance HD patients, 81.57% had VI. 121 (55.76%) patients had two or more VI, and 96 (44.24%) with one VI or not. The study subjects were followed up for a median of 47 (3-107) months. At the end of the follow up, 95 patients died (43.78%), of whom 47 (21.66%) patients died because of cardiovascular disease. Age (HR 1.033, 95% CI 1.007-1.061, P = 0.013), number of VI ≥ 2 (HR 2.035, 95% CI 1.083-3.821, P = 0.027) and albumin (HR 0.935, 95% CI 0.881-0.992, P = 0.027) were independent risk factors for cardiovascular mortality. The three parameters were also independent risk factors for all-cause mortality. The patients with number of VI ≥ 2 were more likely to be emergency hospitalized for acute heart failure (56 [46.28%] vs 11 [11.46%], P = 0.001). On the contrary, the number of VI was not associated with emergency hospitalized for arrhythmia, ACS or stroke. Survival analysis results showed that probability of survival was statistically different in the two groups (P < 0.05), no matter based on cardiovascular mortality or all-cause mortality. Based on age, number of VI ≥ 2 and albumin, nomogram models for 5-year cardiovascular and all-cause mortality were built. In maintenance HD patients, the prevalence of VI is prominently high. The number of VI ≥ 2 is associated with emergency hospitalized for acute heart failure, cardiovascular and all-cause mortality. Combining age, number of VI ≥ 2, and albumin can predict cardiovascular and all-cause mortality.

Prevalence of undiagnosed hypertension and related risk factors in Wad-Medani Alkobra locality in Gezira State, Sudan, 2022

Background: Hypertension is defined as blood pressure ≥140/90 mm Hg. It is emerging as one of the major healthcare challenges in low- and middle-income countries. Hypertension is considered as a silent killer and is the leading risk factor for cardiovascular mortality and accounts for a large proportion of premature deaths in developing countries. Most people with hypertension are asymptomatic and are undiagnosed for years. Objectives: This study aimed to find out the prevalence of undiagnosed hypertension and related risk factors among adults in Wad Medani Alkobra locality in Gezira State, Sudan. Methods: A community-based cross-sectional study involving 464 adults in different locations in Wad-Medani Alkobra locality, from June 2022 to August 2022 was performed in collaboration with the Sudanese Society of Hypertension within May Measure Month (MMM) 2022 study. WHO Stepwise Approach to Surveillance (STEPS) questionnaire was used to collect data, and was analyzed by SPSS version 20. Demographics, blood pressure, pulse, and socioeconomic status were measured. Diagnosis of hypertension was defined based on a systolic and diastolic blood pressure of ≥140 mmHg and ≥90 mmHg, respectively and three readings were obtained. Blood pressure was measured in all women and men aged 15 years and above. Results: Total number of study population was 464, males were 239 (52%), females were 225 (48%). Mean age was 45 years. 68 were known hypertensive (15%). Of those who are hypertensive, 27 (39%) had high blood pressure. Undiagnosed hypertension in the study population was found to be 10% (39 individual) which equals to 59.1% from the total number of the populations who had HTN (66). The prevalence of HTN (new and old cases) in this study group was 25%. There was positive relation between high blood pressure and old age, diabetes mellitus increased body weight and sex (more common in males}, P-value was (,0.00, 0.026, 0.014, 0.033) respectively. Conclusions: The prevalence of hypertension was high and associated with some modifiable risk factors which should be addressed. Frequent screening and proper treatment is required to prevent complications of this hidden epidemic.

Excessive daytime sleepiness, but not sleep apnea, sleep duration or insomnia, was associated with poor adherence to anti-hypertensive treatment: The ELSA-Brasil study

Hypertension is the leading risk factor for cardiovascular mortality. Poor adherence may partially explain this scenario. Beyond traditional factors, it is conceivable that sleep conditions such as Obstructive Sleep Apnea (OSA), Sleep Duration (SDUR), sleepiness and insomnia may contribute to impair adherence but the evidence is scanty. Consecutive participants with hypertension from the ELSA-Brasil study performed a home sleep monitoring and 7-days actigraphy to determine OSA (apnea-hypopnea index ≥15 events/hour) and SDUR, respectively. Excessive daytime sleepiness (EDS) and insomnia were evaluated by Epworth Sleepiness Scale (ESS) and Clinical Interview Scheduled Revised (CIS-R), respectively. The 4-itens Morisky questionnaire was used to evaluate adherence to anti-hypertensive therapy. A total of 411 patients were including in the analysis (mean age: 54 ± 8 years, 47% men). Medium/low adherence to anti-hypertensive therapy was observed in 62%. Compared to the high adherence group, the participants with medium/low adherence had lower frequencies of Whites (64.1 vs. 47.8%), high-degree education (50.6 vs. 40%), and monthly per-capita income ($1021.90 vs. $805.20). In contrast, we observed higher frequency of EDS (35.9 vs. 46.1%). No differences were observed for OSA, short SDUR (<6 h) and insomnia. Logistic regression analysis showed that race other than White (OR: 1.80; 95% IC:1.15–2.82), lower monthly income (OR: 1.74; 95% IC:1.01–3.0) and EDS (OR: 1.63; 95% IC:1.05–2.53) were independently associated with medium/low adherence to the anti-hypertensive treatment. Interestingly, EDS mediated the abdominal obesity-adherence outcome. In conclusion, among sleep-related parameters, EDS, but not OSA, short SDUR or insomnia, were associated to impaired adherence to anti-hypertensive therapy.

Predictive role of cardiac valvular calcification in all-cause mortality of Chinese initial haemodialysis patients: a follow-up study of 4 years

BackgroundCardiac valvular calcification (CVC) is prevalent in haemodialysis (HD) patients. Its association with mortality in Chinese incident haemodialysis (IHD) patients remains unknown.MethodsA total of 224 IHD patients who had just begun HD therapy at Zhongshan Hospital, Fudan University, were enrolled and divided into two groups according to the detection of cardiac valvular calcification (CVC) by echocardiography. The patients were followed for a median of 4 years for all-cause mortality and cardiovascular mortality.ResultsDuring follow-up, 56 (25.0%) patients died, including 29 (51.8%) of cardiovascular disease. The adjusted HR related to all-cause mortality was 2.14 (95% CI, 1.05–4.39) for patients with cardiac valvular calcification. However, CVC was not an independent risk factor for cardiovascular mortality in patients who had just begun HD therapy.ConclusionCVC at baseline is an independent risk factor for all-cause mortality in HD patients and makes an independent contribution to the prediction of all-cause mortality. These findings support the use of echocardiography at the beginning of HD.

Urgent Notification Of High Temperature Induced Mortality of Patients with Diabetes and Hypertension in Hodeidah Governorate ،Yemen

Dear Editor: Many researches and studies have shown a relationship between high and cold air temperature and an increase in mortality, especially for patients with cardiovascular disease.[5,6] Recently, associations between ambient temperature and morbidity have also been reported,[7,8] even though these associations have not always been similar in magnitude to mortality,[8] and null findings have also been reported.[9] Also, while the association between temperature and cardiovascular mortality has been reported to be U- shaped in many studies,[10] the association with cardiovascular hospitalization was reported to be linear in the US [7]. Increased blood pressure (BP) is a risk factor for cardiovascular mortality [14,15] and for coronary heart disease and stroke morbidity [16,17]. Therefore changes in BP might also play a part in the development of cardiovascular events that are associated with changes in temperature. The mechanisms behind temperature-related cardiovascular mortality and morbidity are not fully established. As elevated BP is a known risk factor for cardiovascular disease and stroke events, BP can also be part of the mechanism leading to temperature-related deaths. Epidemiological studies have shown that cardiovascular diseases rank first among the causes of death in China and have become a major disease within the Chinese population [18]. The effects of type 1 and type 2 diabetes on the body's physiological response to thermal stress is a relatively new topic in research. Diabetes tends to place individuals at greater risk for heat- related illness during heat waves and physical activity due to an impaired capacity to dissipate heat. Specifically, individuals with diabetes have been reported to have lower skin blood flow and sweating responses during heat exposure and this can have important consequences on cardiovascular regulation and glycemic control. Those who are particularly vulnerable include individuals with poor glycemic control and who are affected by diabetes-related complications [19]. As a result of the war and the siege on Yemen, the deterioration of living and health conditions, the interruption of electricity, the suspension of salaries for six years, and the arrival of about 80% of the population of Al-Hodeidah Governorate to a level below the poverty line. We have monitored as a result of the high temperature, which reached 48 degrees Celsius in the city of Hodeidah, 28 deaths of people with diabetes and arterial hypertension were monitored for the period from 5-6-2022 to 25-6-2022. This catastrophe occurred due to the government power outage as a result of the war and the siege on Yemen and the inability of people to buy expensive commercial electricity. This is considered a humanitarian disaster that requires a serious stand by the government, international organizations and the international community to save Hodeidah residents from extreme heat and poverty by providing electricity and humanitarian aid to contribute to improving the health and living situation in the governorate and supporting hospitals with fuel by the World Health Organization.