Total Cardiovascular Mortality Research Articles

Cardiovascular risk and blood pressure lowering treatment among elderly individuals: Evidence for Cardiovascular Prevention from Observational Cohorts in Japan.

There is little evidence to support an increased risk of blood pressure (BP) elevation among elderly individuals receiving antihypertensive drug treatment. To clarify the impact on BP level and residual cardiovascular risk in treated elderly individuals, we analysed individual participant data of 26 133 residents aged 60-89 years from seven Japanese general populations and cross-classified participants by age category, 60-74 (young-old) versus 75-89 years (old-old), and by usage of antihypertensive medication at baseline survey (1980-1995). During a median follow-up period of 12.7 years, 2451 cardiovascular deaths were observed. Multivariable-adjusted hazard ratios of cardiovascular mortality in treated participants compared with untreated participants were 1.30 [95% confidence intervals, 1.16-1.46) and 1.35 (95% confidence interval, 1.16-1.56) in young-old and old-old participants, respectively. Irrespective of antihypertensive medication, the risk increase of total cardiovascular and stroke mortality with elevation of BP was significant among young-old (P ≤ 0.0013), but not significant among old-old participants (P ≥ 0.061). Although impact on BP was more evident among young-old than old-old individuals, clinicians who prescribe antihypertensive medication to elderly patients should consider that such patients require further monitoring.

Long-Term Outcomes in Patients With New Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement

ObjectivesThis study sought to evaluate the long-term clinical impact of permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR). BackgroundConduction disturbances leading to PPI are common following TAVR. However, no data exist regarding the impact of PPI on long-term outcomes post-TAVR. MethodsThis was a multicenter study including a total of 1,629 patients without prior PPI undergoing TAVR (balloon- and self-expandable valves in 45% and 55% of patients, respectively). Follow-up clinical, echocardiographic, and pacing data were obtained at a median of 4 years (interquartile range: 3 to 5 years) post-TAVR. ResultsPPI was required in 322 (19.8%) patients within 30 days post-TAVR (26.9% and 10.9% in patients receiving self- and balloon-expandable CoreValve and Edwards systems, respectively). Up to 86% of patients with PPI exhibited pacing >1% of the time during follow-up (>40% pacing in 51% of patients). There were no differences between patients with and without PPI in total mortality (48.5% vs. 42.9%; adjusted hazard ratio [HR]: 1.15; 95% confidence interval [CI]: 0.95 to 1.39; p = 0.15) and cardiovascular mortality (14.9% vs. 15.5%, adjusted HR: 0.93; 95% CI: 0.66 to 1.30; p = 0.66) at follow-up. However, patients with PPI had higher rates of rehospitalization due to heart failure (22.4% vs. 16.1%; adjusted HR: 1.42; 95% CI: 1.06 to 1.89; p = 0.019), and the combined endpoint of mortality or heart failure rehospitalization (59.6% vs. 51.9%; adjusted HR: 1.25; 95% CI: 1.05 to 1.48; p = 0.011). PPI was associated with lesser improvement in LVEF over time (p = 0.051 for changes in LVEF between groups), particularly in patients with reduced LVEF before TAVR (p = 0.005 for changes in LVEF between groups). ConclusionsThe need for PPI post-TAVR was frequent and associated with an increased risk of heart failure rehospitalization and lack of LVEF improvement, but not mortality, after a median follow-up of 4 years. Most patients with new PPI post-TAVR exhibited some degree of pacing activity at follow-up.

Mortality and Morbidity Due to Exposure to Ambient NO2, SO2, and O3 in Isfahan in 2013-2014.

Background:The presence of air pollutants such as CO, NO2, SO2, O3, and PM in the ambient air mainly emitted from fossil fuels combustion has become a major health concern. The aims of this study were to estimate the attribution of NO2, SO2, and O3 in the premature deaths and prevalence of cardiovascular and respiratory diseases in Isfahan in 2013–2014.Methods:In this study, short-term health effects (total mortality, cardiovascular and respiratory mortality, chronic obstructive pulmonary disease, and acute myocardial infarction) of exposure NO2, SO2, and O3 on the population of Isfahan were assessed using AirQ 2.2.3 software suggested by the World Health Organization (WHO).Results:The result showed that from nonaccident total mortality in 2013–2014 in Isfahan, the attributable proportion related to NO2, SO2, and O3 were 1.03% (109 cases), 3.46% (365 cases), and 1.29% (136 cases), respectively. The percentage of days that people were exposed to the highest concentration of NO2 (40–49 μg/m3), SO2 (60–69 μg/m3), and O3 (40–49 μg/m3) was 34.46%, 16.85%, and 42.74% of a year, respectively. Total mortality attributed to NO2, SO2, and O3 exposure was 0.36%, 0.79%, and 0.83%, respectively.Conclusions:The concentrations of NO2 and SO2 were upper than the WHO guidelines. The Air-Q software in spite of its limitations can provide useful information regarding the health outcome of the air pollutants. The results estimated in this study were considerable. This information can help the health authorities and policy makers to draw suitable strategies and fulfill effective emission control programs.

Hypertension and atrial fibrillation: a bench to bedside perspective.

Atrial Fibrillation (AF) is the most common cardiac arrhythmia in clinical practice and its prevalence increases markedly with advancing age, worldwide. Almost every primary care physician, internist, or cardiologist, has dealt with stroke or with other complications of AF. Still, its management remains a hot issue for clinicians and the debate over which treatment strategy is the best is ongoing. Moreover, AF increases significantly the total cardiovascular (CV) morbidity and mortality. Despite a great bulk of data in the existing medical literature, the pathophysiology of AF in patients with hypertensive heart disease (HHD) is poorly understood, and the underlying signaling pathways linking hypertension (HTN) to AF remain to be fully elucidated. The scope of this article is to discuss the myocardial anatomical and physiological alterations that occur in HTN, and highlight the proposed electrophysiological mechanisms that cause the hypertensive heart to fibrillate. In addition, we will focus on the latest ESC 2016 guidelines for the risk stratification of AF patients as a tool to guide anticoagulation which represents the mainstay of treatment for AF. Last, the other therapeutic approaches for hypertensives with AF currently adopted for optimal patient management will be reviewed.

Prognostic value of average home blood pressure and variability: 19-year follow-up of the Didima study.

The current general population study explored the prognostic value of home blood pressure (HBP) average and variability (BPV) versus office measurements (OBP). In 1997, 665 adults of Didima, Argolida, Greece were evaluated with OBP (two visits, six readings) and HBP (3 days, 12 readings) measurements. Total mortality and cardiovascular morbidity and mortality (CVD) were assessed after 19.0 ± 1.4 years. BPV was quantified by using SD and coefficient of variation. During follow-up, 216 deaths (124 cardiovascular) and 146 cardiovascular events (fatal and nonfatal) were documented. Hazard ratios for total mortality were 1.39/1.20 (P < 0.01/ < 0.01) per 10/5 mmHg increase in systolic/diastolic HBP and 1.36/1.02 (P < 0.01/NS) for OBP (similar hazard ratios for CVD). After adjustment for baseline risk factors, OBP and HBP lost their prognostic ability, except from diastolic OBP that predicted CVD (hazard ratio 1.10, P = 0.03). Sustained, masked and white-coat hypertension were associated with increased risk of death and CVD (P < 0.01 versus normotensive participants). After adjustment, the risk of death remained significant for all, but CVD only for white-coat hypertension. Systolic home BPV (not diastolic) predicted total mortality (adjusted hazard ratios 1.18/1.17 for 1-SD increase in SD/coefficient of variation; P < 0.05) and CVD. Unadjusted systolic/diastolic office BPV predicted CVD outcome (for total mortality only systolic), yet not after adjustment. Systolic home BPV predicted total mortality and CVD independent of office BPV. In this general population study with 19-year follow-up, average HBP predicted total mortality and CVD as reliably as OBP. Only normotension (low OBP and HBP) was associated with low risk. Systolic home BPV exhibited superior prognostic ability than OBP, deserving further research.

Antithrombotic treatment in peripheral artery disease.

This review treats antithrombotic use for peripheral arterial disease (PAD). In asymptomatic patients, there are no scientific data to support single antiplatelet therapy (SAPT) for primary prophylaxis. In symptomatic PAD, SAPT with aspirin or clopidogrel is indicated. The efficacy of aspirin is controversial. Clopidogrel may be preferred over aspirin. Ticagrelor is not superior to clopidogrel in reducing major adverse cardiovascular events and major adverse limb events, but lowers the risk of ischaemic stroke. In symptomatic PAD, dual antiplatelet therapy (DAPT) with clopidogrel and aspirin does not provide benefit over SAPT with aspirin alone and is associated with increased risk of major bleeding. DAPT with ticagrelor 60 mg b. i. d. and aspirin provides a significant major adverse cardiovascular events reduction in symptomatic PAD patients and may be considered in PAD patients with prior myocardial infarction. The use of a new thrombin receptor antagonist, vorapaxar, on top of SAPT or DAPT with aspirin and/or clopidogrel, reduces the risk of acute limb ischaemia and peripheral artery revascularization in patients with symptomatic PAD, at the cost of an increased risk for bleeding. Rivaroxaban (2.5 mg b. i. d.) plus aspirin (100 mg daily) is the first antithrombotic association that proved significant benefit for PAD patients, in terms of strong endpoints - total mortality and cardiovascular mortality. Therefore, this association shows the strongest evidence for secondary prevention of symptomatic PAD patients. In PAD patients undergoing percutaneous peripheral interventions, at least four weeks of DAPT with aspirin and clopidogrel is recommended after infrainguinal stent implantation. Stenting below-the-knee arteries is often followed by a longer period of DAPT, but no specific evidence is available. Anticoagulation is mandatory to prevent arterial occlusion during radial or brachial invasive procedures. The strategy includes use of unfractioned heparin, bivalirudin or enoxaparin. Vitamin K antagonists may be considered after autologous vein infrainguinal bypass.

The Interaction between Ambient PM10 and NO₂ on Mortality in Guangzhou, China.

Air pollution is now a significant environmental issue in China. To better understand the health impacts of ambient air pollution, this study investigated the potential interaction between PM10 and NO2 on mortality in Guangzhou, China. Time series data of daily non-accidental mortality and concentrations of PM10 and NO2 from 2006 to 2010 were collected. Based on generalized additive model, we developed two models (bivariate model and stratified model) to explore the interaction both qualitatively and quantitatively. At lag of 0–2 days, greater interactive effects between PM10 and NO2 were presented in the graphs. Positive modified effects were also found between the two pollutants on total non-accidental death and cardiovascular death. When the NO2 concentration was at a high level (>76.14 μg/m3), PM10 showed the greatest excess relative risk percentage (ERR%) for total non-accidental mortality (0.46, 95% CI: 0.13–0.79) and cardiovascular disease mortality (0.61, 95% CI: 0.06–1.16) for each 10 μg/m3 increase. During the period of high PM10 concentration (>89.82 μg/m3), NO2 demonstrated its strongest effect for total non-accidental mortality (ERR%: 0.92, 95% CI: 0.42–1.42) and cardiovascular disease mortality (ERR%: 1.20, 95% CI: 0.38–2.03). Our results suggest a positive interaction between PM10 and NO2 on non-accidental mortality in Guangzhou.

Health impact assessment of exposure to PM10 in Ilam city using Air Q software

Air pollution is a major environmental issue in the world that can be harmful for human health. The aim of this study was to determine the health impacts of particulate matter with an aerodynamic diameter ≤10μm (PM10) in Ilam in 2013 and 2014. The air pollution data were obtained from the Ilam Department of Environmental Protection. The data were analyzed by Excel software, and the annual mortality and morbidity due to cardiovascular and respiratory diseases attributed to PM10 exposure were estimated by AirQ software.According to the results, the average of annual, winter, and summer PM10 concentration was 68.1, 46.7, and 89.3 μg/m3, respectively, in 2013. In 2014, the average annual, winter, and summer PM10 concentrations were 51.4, 40.3, and 62.6μg/m3, respectively. The total mortality, cardiovascular mortality, respiratory mortality, and hospital admissions due to cardiovascular and respiratory diseases in 2013 were estimated at 89, 47, 9, 46, and 119 cases, respectively, and in 2014 they were estimated at 64, 33, 6, 33 and 85 cases, respectively. The results revealed that 9.6% of total mortality in 2013 and 5.8% total mortality in 2014 were associated with concentrations of more than 20 μg/m3 PM10 concentration. Therefore, it is concluded that exposure to PM10 can increase morbidity and mortality. Thus, urgent and substantial actions to deal with the adverse effects of particulate matters are found to be necessary.

The Short-Term Effects of Visibility and Haze on Mortality in a Coastal City of China: A Time-Series Study.

Few studies have been conducted to investigate the acute health effects of visibility and haze, which may be regarded as proxy indicators of ambient air pollution. We used a distributed lag non-linear model (DLNM) combined with quasi-Poisson regression to estimate the relationship between visibility, haze and mortality in Ningbo, a coastal city of China. We found that the mortality risk of visibility was statistically significant only on the current day, while the risk of haze and PM10 peaked on the second day and could last for three days. When the visibility was less than 10 km, each 1 km decrease of visibility at lag 0 day was associated with a 0.78% (95% CI: 0.22–1.36%) increase in total mortality and a 1.61% (95% CI: 0.39–2.85%) increase in respiratory mortality. The excess risk of haze at lag 0–2 days on total mortality, cardiovascular and respiratory mortality was 7.76% (95% CI: 3.29–12.42%), 7.73% (95% CI: 0.12–15.92%) and 17.77% (95% CI: 7.64–28.86%), respectively. Greater effects of air pollution were observed during the cold season than in the warm season, and the elderly were at higher risk compared to youths. The effects of visibility and haze were attenuated by single pollutants. These findings suggest that visibility and haze could be used as surrogates of air quality where pollutant data are scarce, and strengthen the evidence to develop policy to control air pollution and protect vulnerable populations.

Association between Spot urine Phytoestrogens as Biomarkers on Their Dietary Intake on the Risk of Death from Cancer and Cardiovascular Disease

This study suggests that phytoestrogen intake alters cancer and cardiovascular risk. This study investigated the associations of urinary phytoestrogens with total cancer (n = 198), cardiovascular (n = 152), and all-cause (n = 363) mortality among 5179 participants in the continuous National Health and Nutrition Examination Survey Canada (2009–2014). Methods Urinary phytoestrogens were measured using high-performance liquid chromatography with tandem mass spectrometric detection. Survival analysis was per-formed to evaluate hazard ratios (HRs) and 95 % confi-dence intervals (CIs) for each of the three outcomes in relation to urinary phytoestrogens. Results: After adjustment for confounders, higher urinary concentrations of total enterolignans were associated with a reduced risk of death from cardiovascular disease (HR for tertile 3 vs. tertile 10.48; 95 % CI 0.24, 0.97), whereas higher urinary concentrations of total isoflavones (HR for tertile 3 vs. tertile 12.14; 95 % CI 1.03, 4.47) and daidzein (HR for tertile 3 vs. tertile 12.05; 95 % CI 1.02, 4.11) were associated with an increased risk death from Cardiovascular Disease. A reduction in all-cause mortality was observed for elevated urinary concentrations of total enterolignans (HR for tertile 3 vs. tertile 10.65; 95 % CI 0.43, 0.96) and enterolactone (HR for tertile 3 vs. tertile 1 0.65; 95 % CI 0.44, 0.97). Conclusions: Some urinary phytoestrogens were associ-ated with cardiovascular and all-cause mortality in a rep-resentative sample of the Canadian population. This is one of the first studies that used urinary phytoestrogens as biomarkers of their dietary intake to evaluate the effect of these bioac-tive compounds on the risk of death from cancer and car-diovascular disease.

Blood pressure targets for the treatment of people with hypertension and cardiovascular disease.

Hypertension is a prominent preventable cause of premature morbidity and mortality. People with hypertension and established cardiovascular disease are at particularly high risk, so reducing blood pressure below standard targets may be beneficial. This strategy could reduce cardiovascular mortality and morbidity but could also increase adverse events. The optimal blood pressure target in people with hypertension and established cardiovascular disease remains unknown. To determine if 'lower' blood pressure targets (≤ 135/85 mmHg) are associated with reduction in mortality and morbidity as compared with 'standard' blood pressure targets (≤ 140 to 160/ 90 to 100 mmHg) in the treatment of people with hypertension and a history of cardiovascular disease (myocardial infarction, angina, stroke, peripheral vascular occlusive disease). The Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials up to February 2017: the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1946), Embase (from 1974), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched the Latin American and Caribbean Health Science Literature Database (from 1982) and contacted authors of relevant papers regarding further published and unpublished work. There were no language restrictions. We included randomized controlled trials (RCTs) with more than 50 participants per group and at least six months follow-up. Trial reports needed to present data for at least one primary outcome (total mortality, serious adverse events, total cardiovascular events, cardiovascular mortality). Eligible interventions were lower target for systolic/diastolic blood pressure (≤ 135/85 mmHg) compared with standard target for blood pressure (≤ 140 to 160/90 to 100 mmHg).Participants were adults with documented hypertension or who were receiving treatment for hypertension and cardiovascular history for myocardial infarction, stroke, chronic peripheral vascular occlusive disease or angina pectoris. Two review authors independently assessed search results and extracted data using standard methodological procedures expected by The Cochrane Collaboration. We included six RCTs that involved a total of 9795 participants. Mean follow-up was 3.7 years (range 1.0 to 4.7 years). Five RCTs provided individual patient data for 6775 participants.We found no change in total mortality (RR 1.05, 95% CI 0.90 to 1.22) or cardiovascular mortality (RR 0.96, 95% CI 0.77 to 1.21; moderate-quality evidence). Similarly, no differences were found in serious adverse events (RR 1.02, 95% CI 0.95 to 1.11; low-quality evidence). There was a reduction in fatal and non fatal cardiovascular events (including myocardial infarction, stroke, sudden death, hospitalization or death from congestive heart failure) with the lower target (RR 0.87, 95% CI 0.78 to 0.98; ARR 1.6% over 3.7 years; low-quality evidence). There were more participant withdrawals due to adverse effects in the lower target arm (RR 8.16, 95% CI 2.06 to 32.28; very low-quality evidence). Blood pressures were lower in the lower' target group by 9.5/4.9 mmHg. More drugs were needed in the lower target group but blood pressure targets were achieved more frequently in the standard target group. No evidence of a difference in total mortality and serious adverse events was found between treating to a lower or to a standard blood pressure target in people with hypertension and cardiovascular disease. This suggests no net health benefit from a lower systolic blood pressure target despite the small absolute reduction in total cardiovascular serious adverse events. There was very limited evidence on adverse events, which lead to high uncertainty. At present there is insufficient evidence to justify lower blood pressure targets (≤ 135/85 mmHg) in people with hypertension and established cardiovascular disease. More trials are needed to answer this question.

SEX DIFFERENCES IN HEART FAILURE INCIDENCE AND OUTCOMES

Heart failure (HF) contributes to 35% of total female cardiovascular mortality but remains poorly understood in women. We examined the sex differences in HF incidence, mortality and hospitalization in a population-based cohort. We conducted a retrospective cohort study in Ontario residents who were diagnosed with HF in an ambulatory setting between April 1, 2009 and March 31, 2014, using linked administrative databases. HF is captured through physician billing using a validated algorithm with high sensitivity and specificity for identifying HF events. Outcomes of interest were all-cause mortality and hospitalization at 1 year following HF diagnosis. Analyses were stratified by sex. Mortality rate in each group were calculated using Kaplan-Meier method. The relative hazard of death was assessed using Cox proportional hazard models. During the study period, a total of 90,707 patients were diagnosed with HF in an ambulatory setting (47% female). Female HF patients were more likely to be older, more frail, of lower income status, have comorbid conditions such as hypertension, hypothyroidism, anemia, dementia and depression, but are less likely to have ischemic heart disease, diabetes and alcohol abuse compared to men (Table). The age standardized mortality rate was 8.57 (95% CI, 8.12-9.04) per 100 female patients and 8.23 (95% CI, 7.89-8.58) per 100 male patients. Female sex is associated with an increased risk of death (HR 1.14, 95% CI 1.10-1.18). Age standardized 1-year hospitalization rates were 9.18 (95% CI, 8.69-9.69) per 100 person years for women and 9.59 (95% CI, 9.16-10.03) for men. We found higher rates of 1-year mortality and lower rates of hospitalization in female patients compared to male patients with incident HF. HF occurs in nearly equal frequency in men and women. Further studies should focus on sex differences in risk factors and HF management to improve outcomes in women.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Whole grain cereals for the primary or secondary prevention of cardiovascular disease.

There is evidence from observational studies that whole grains can have a beneficial effect on risk for cardiovascular disease (CVD). Earlier versions of this review found mainly short-term intervention studies. There are now longer-term randomised controlled trials (RCTs) available. This is an update and expansion of the original review conducted in 2007. The aim of this systematic review was to assess the effect of whole grain foods or diets on total mortality, cardiovascular events, and cardiovascular risk factors (blood lipids, blood pressure) in healthy people or people who have established cardiovascular disease or related risk factors, using all eligible RCTs. We searched CENTRAL (Issue 8, 2016) in the Cochrane Library, MEDLINE (1946 to 31 August 2016), Embase (1980 to week 35 2016), and CINAHL Plus (1937 to 31 August 2016) on 31 August 2016. We also searched ClinicalTrials.gov on 5 July 2017 and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) on 6 July 2017. We checked reference lists of relevant articles and applied no language restrictions. We selected RCTs assessing the effects of whole grain foods or diets containing whole grains compared to foods or diets with a similar composition, over a minimum of 12 weeks, on cardiovascular disease and related risk factors. Eligible for inclusion were healthy adults, those at increased risk of CVD, or those previously diagnosed with CVD. Two review authors independently selected studies. Data were extracted and quality-checked by one review author and checked by a second review author. A second review author checked the analyses. We assessed treatment effect using mean difference in a fixed-effect model and heterogeneity using the I2 statistic and the Chi2 test of heterogeneity. We assessed the overall quality of evidence using GRADE with GRADEpro software. We included nine RCTs randomising a total of 1414 participants (age range 24 to 70; mean age 45 to 59, where reported) to whole grain versus lower whole grain or refined grain control groups. We found no studies that reported the effect of whole grain diets on total cardiovascular mortality or cardiovascular events (total myocardial infarction, unstable angina, coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, total stroke). All included studies reported the effect of whole grain diets on risk factors for cardiovascular disease including blood lipids and blood pressure. All studies were in primary prevention populations and had an unclear or high risk of bias, and no studies had an intervention duration greater than 16 weeks.Overall, we found no difference between whole grain and control groups for total cholesterol (mean difference 0.07, 95% confidence interval -0.07 to 0.21; 6 studies (7 comparisons); 722 participants; low-quality evidence).Using GRADE, we assessed the overall quality of the available evidence on cholesterol as low. Four studies were funded by independent national and government funding bodies, while the remaining studies reported funding or partial funding by organisations with commercial interests in cereals. There is insufficient evidence from RCTs of an effect of whole grain diets on cardiovascular outcomes or on major CVD risk factors such as blood lipids and blood pressure. Trials were at unclear or high risk of bias with small sample sizes and relatively short-term interventions, and the overall quality of the evidence was low. There is a need for well-designed, adequately powered RCTs with longer durations assessing cardiovascular events as well as cardiovascular risk factors.

Pharmacotherapy for hypertension in adults aged 18 to 59 years.

Hypertension is an important risk factor for adverse cardiovascular events including stroke, myocardial infarction, heart failure and renal failure. The main goal of treatment is to reduce these events. Systematic reviews have shown proven benefit of antihypertensive drug therapy in reducing cardiovascular morbidity and mortality but most of the evidence is in people 60 years of age and older. We wanted to know what the effects of therapy are in people 18 to 59 years of age. To quantify antihypertensive drug effects on all-cause mortality in adults aged 18 to 59 years with mild to moderate primary hypertension. To quantify effects on cardiovascular mortality plus morbidity (including cerebrovascular and coronary heart disease mortality plus morbidity), withdrawal due adverse events and estimate magnitude of systolic blood pressure (SBP) and diastolic blood pressure (DBP) lowering at one year. The Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials up to January 2017: the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1946), Embase (from 1974), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. We contacted authors of relevant papers regarding further published and unpublished work. Randomized trials of at least one year' duration comparing antihypertensive pharmacotherapy with a placebo or no treatment in adults aged 18 to 59 years with mild to moderate primary hypertension defined as SBP 140 mmHg or greater or DBP 90 mmHg or greater at baseline, or both. The outcomes assessed were all-cause mortality, total cardiovascular (CVS) mortality plus morbidity, withdrawals due to adverse events, and decrease in SBP and DBP. For dichotomous outcomes, we used risk ratio (RR) with 95% confidence interval (CI) and a fixed-effect model to combine outcomes across trials. For continuous outcomes, we used mean difference (MD) with 95% CI and a random-effects model as there was significant heterogeneity. The population in the seven included studies (17,327 participants) were predominantly healthy adults with mild to moderate primary hypertension. The Medical Research Council Trial of Mild Hypertension contributed 14,541 (84%) of total randomized participants, with mean age of 50 years and mean baseline blood pressure of 160/98 mmHg and a mean duration of follow-up of five years. Treatments used in this study were bendrofluazide 10 mg daily or propranolol 80 mg to 240 mg daily with addition of methyldopa if required. The risk of bias in the studies was high or unclear for a number of domains and led us to downgrade the quality of evidence for all outcomes.Based on five studies, antihypertensive drug therapy as compared to placebo or untreated control may have little or no effect on all-cause mortality (2.4% with control vs 2.3% with treatment; low quality evidence; RR 0.94, 95% CI 0.77 to 1.13). Based on 4 studies, the effects on coronary heart disease were uncertain due to low quality evidence (RR 0.99, 95% CI 0.82 to 1.19). Low quality evidence from six studies showed that drug therapy may reduce total cardiovascular mortality and morbidity from 4.1% to 3.2% over five years (RR 0.78, 95% CI 0.67 to 0.91) due to reduction in cerebrovascular mortality and morbidity (1.3% with control vs 0.6% with treatment; RR 0.46, 95% CI 0.34 to 0.64). Very low quality evidence from three studies showed that withdrawals due to adverse events were higher with drug therapy from 0.7% to 3.0% (RR 4.82, 95% CI 1.67 to 13.92). The effects on blood pressure varied between the studies and we are uncertain as to how much of a difference treatment makes on average. Antihypertensive drugs used to treat predominantly healthy adults aged 18 to 59 years with mild to moderate primary hypertension have a small absolute effect to reduce cardiovascular mortality and morbidity primarily due to reduction in cerebrovascular mortality and morbidity. All-cause mortality and coronary heart disease were not reduced. There is lack of good evidence on withdrawal due to adverse events. Future trials in this age group should be at least 10 years in duration and should compare different first-line drug classes and strategies.

Time series analysis of ambient air pollution effects on daily mortality.

Although the growths of ambient pollutants have been attracting public concern, the characteristic of the associations between air pollutants and mortality remains elusive. Time series analysis with a generalized additive model was performed to estimate the associations between ambient air pollutants and mortality outcomes in Shenzhen City for the period of 2012-2014. The results showed that nitrogen dioxide (NO2)-induced excess risks (ER) of total non-accidental mortality and cardiovascular mortality were significantly increased (6.05% (95% CI 3.38%, 8.78%); 6.88% (95% CI 2.98%, 10.93%), respectively) in interquartile range (IQR) increase analysis. Also, these associations were strengthened after adjusting for other pollutants. Moreover, similar associations were estimated for sulfur dioxide (SO2), particulate matter with an aerodynamic diameter of <10μm (PM10), and total non-accidental mortality. There were significant higher ERs of associations between PM10 and mortality for men than women; while there were significant higher ERs of associations between PM10/NO2 and mortality for elders (65 or elder) than youngers (64 or younger). Season analyses showed that associations between NO2 and total non-accidental mortality were more pronounced in hot seasons than in warm seasons. Taken together, NO2 was positively associated with total non-accidental mortality and cardiovascular mortality in Shenzhen even when the concentrations were below the ambient air quality standard. Policy measures should aim at reducing residents' exposure to anthropogenic NO2 emissions.

Number of total mortality, cardiovascular mortality and Chronic Obstructive Pulmonary Disease due to exposure with Nitrogen dioxide in Tehran during 2005-2014

Air pollution has adverse effects on human health and cause various diseases including cardiovascular disease and respiratory. Therefore this study with aim of study of Number of total mortality, cardiovascular mortality and Chronic Obstructive Pulmonary Disease due to exposure with Nitrogen dioxide in Tehran during 2005-2014 were performed. Materials & Methods: This study is a descriptive–analytic. At first hourly data were taken from Tehran environmental protection agency and Air Quality Control Company. Then validated according to the WHO guidelines and Statistical parameters for quantifying health effects were calculated in excel. Finally, assessment of cases total mortality with software was performed. Results: The results showed that the number of total mortality caused by exposure to NO2 In the past decade is 15141 people. Also the total number of cardiovascular mortality in the past decade is 8480 people and the total number of Chronic Obstructive Pulmonary Disease in the past decade is 2454 people in 2005-2014 years. Conclusion: Air pollution, especially nitrogen dioxide leads to mortality And Morbidity in a lot of people. According to the results of this study should such actions, policies and planning and management to reduce air pollution preparedness of hospitals and health centers, educating the public Be done

Efficacy of aspirin and statins in primary prevention of cardiovascular mortality in uncomplicated hypertensive participants

To determine whether the addition of aspirin to a statin regimen is beneficial in reducing cardiovascular mortality, we analyzed data for uncomplicated hypertensive patients included in the Korea National Health Insurance sample cohort. Among the 758 433 eligible participants aged 20 years or older in 2005, 31 115 participants were selected and divided into four groups: no-treatment group (N = 19 628); aspirin alone group (N = 4814); statins alone group (N = 4717); and combined treatment group (N = 1956). The mean follow-up duration was 94 ± 13 months. The primary outcome of the study was all-cause and cardiovascular mortality from 2007 to 2013. Treatment with aspirin alone [hazard ratio (HR), 0.62; 95% confidence interval (CI), 0.55-0.70; P < 0.001), treatment with statins alone (HR, 0.48; 95% CI, 0.41-0.57; P < 0.001), and combined treatment (HR, 0.43; 95% CI, 0.34-0.55; P < 0.001) were independently associated with reductions in all-cause mortality. Treatment with aspirin alone (HR, 0.66; 95% CI, 0.53-0.84; P < 0.001), treatment with statins alone (HR, 0.46; 95% CI, 0.33-0.64; P < 0.001), and combined treatment (HR, 0.50; 95% CI, 0.31-0.79; P = 0.003) were also independently associated with reductions in cardiovascular mortality. The addition of aspirin to statins was not associated with an additive benefit in reducing total mortality or cardiovascular mortality. Primary prevention with aspirin and/or statins is beneficial in reducing both all-cause and cardiovascular mortality in uncomplicated hypertensive participants. Nevertheless, as aspirin administration is associated with an increased risk of major bleeding, care must be taken to assess the risk/benefit of using aspirin in primary prevention.

Trends in Sudden Cardiac Death as a Proportion of Total Cardiovascular Mortality in Prevalent Hemodialysis Patients

Trends in Sudden Cardiac Death as a Proportion of Total Cardiovascular Mortality in Prevalent Hemodialysis Patients

No modifying effect of education level on the association between lifestyle behaviors and cardiovascular mortality: the Japan Collaborative Cohort Study

We examined the effect of education level on the association between healthy lifestyle behaviors and cardiovascular mortality in the Japanese population. A total of 42,647 community-based men and women aged 40–79 years were enrolled at baseline (1988–1990), followed through 2009. The components of the healthy lifestyle score included the intake of fruits, fish, and milk; body mass index; exercise; avoidance of smoking; moderate alcohol intake; and moderate sleep duration. During the 19.3 years of follow-up, 8,314 all-cause and 2,377 total cardiovascular mortality cases were noted. Inverse associations were observed between healthy lifestyle scores and total cardiovascular disease (CVD) for both the lower and higher education level groups. Multivariable hazard ratios (95% confidence interval) for CVD mortality from the highest to the lowest healthy lifestyle scores, and the population attributable fraction (95% CIs) without healthy lifestyle scores of 7–8 were 0.51 (0.33–0.52) and 42% (24–58%), and 0.38 (0.27–0.47) and 55% (36–69%) for the higher and lower education levels, respectively. Our findings suggest that the association between higher CVD mortality and lower education level can be explained by the individuals’ lower adherence to a healthy lifestyle; hence, lifestyle modification would be beneficial for the prevention of cardiovascular mortality, irrespective of the education level.

Arterial stiffness in the light of thromboembolic complications in elderly patients with atrial fibrillation

According to available data reported by numerous national and international studies, one of the parameters reflecting the degree of lesioning of the vascular wall is arterial stiffness, which makes a fundamental contribution to the risk of developing cardiovascular diseases and the total cardiovascular mortality, especially in the elderly. Patients with cardiac arrhythmias, especially with atrial fibrillation (AF), deserve our special care, since it is this group of patients that is susceptible to a high risk of developing primary and recurrent thromboembolic episodes. This category of patients had a very high risk of death and invalidation, considering the age factor and comorbidity of the pathology. The analysis of factors involved in the development of not only AF, but also its complications, is a task necessary to improve technologies of correction. In view of this, the parameter of vascular-wall stiffness, being one of the mechanisms involved in AF maintenance and a risk factor for the development of acute thromboembolic complications, primarily stroke, should be given very serious consideration. This survey aims to discuss the results of studies devoted to arterial stiffness in patients with atrial fibrillation (AF), as well as the issues related to the risk of developing thromboembolic complications in this category of patients.