Burden of cardiovascular disease among elderly: based on the Global Burden of Disease Study 2019

Association of neutrophil-percentage-to-albumin ratio with mortality in older stroke survivors

Background

The neutrophil-percentage-to-albumin ratio (NPAR) functions as an integrative marker representing inflammatory response and nutritional health. However, its association with mortality in elderly stroke survivors has not been explored.

Methods

This cohort study analyzed data from 1,026 elderly stroke survivors in the National Health and Nutrition Examination Survey (NHANES, 1999-2018). The association of NPAR with mortality was analyzed using Cox proportional hazards regression, restricted cubic splines (RCS), Kaplan-Meier survival analysis, and time-dependent receiver operating characteristic (ROC) curves. Subgroup analyses and interaction tests were also performed.

Results

During the 6.65-year median follow-up, elevated NPAR showed independent associations with increased all-cause and cardiovascular mortality. Quartile-based analysis revealed 69 and 87% greater mortality hazards for the highest versus lowest NPAR groups, respectively. RCS analysis revealed a non-linear threshold effect at NPAR = 14.5, beyond which the risk of all-cause mortality increased sharply. NPAR demonstrated stable predictive accuracy, with time-dependent AUC ranging from 0.664 to 0.607 for all-cause mortality and 0.652-0.609 for cardiovascular mortality over 3-10 years. Subgroup analyses confirmed consistency across different sex, BMI, lifestyle habits, and comorbidity categories.

Conclusion

This study underscores a strong positive correlation between NPAR and prognosis in older adult stroke survivors in the United States, indicating its potential as a novel biomarker for prognostic assessment.

Temporal trend and attributable risk factors of cardiovascular disease burden for adults 55 years and older in 204 countries/territories from 1990 to 2021: an analysis for the Global Burden of Disease Study 2021

AIMS

The ageing global population and overall population growth have significantly increased the burden of cardiovascular diseases (CVDs). This study aims to examine global temporal trends in the incidence, disability-adjusted life years (DALYs), and mortality rates of both overall and type-specific CVDs among adults aged 55 and older from 1990 to 2021, with a focus on identifying changes over time, regional disparities, and the key risk factors contributing to this burden.

METHODS AND RESULTS

We analysed data from the Global Burden of Disease Study 2021, covering 204 countries and territories. Trends in age-standardized rates of incidence, DALY, and mortality for both overall and specific types of CVDs were assessed, alongside the impact of key risk factors. Between 1990 and 2021, global age-standardized incidence, DALY, and mortality rates showed a declining trend, with estimated annual percentage changes of -0.39, -1.30, and -1.11, respectively. However, due to overall population growth and ageing, the absolute number of CVD cases continued to rise. Regions with high-middle socio-demographic index (SDI) exhibited the highest incidence and mortality rates, while high SDI regions saw the greatest declines. Men had higher age-standardized rates of CVD incidence, DALY, and mortality compared with women. The burden increased with age, with the oldest age groups (80+ years) showing the highest rates. High systolic blood pressure was the leading modifiable risk factor, contributing to more than half of the CVD-related DALY globally. Other major risk factors included high LDL cholesterol, smoking, and ambient particulate matter pollution.

CONCLUSION

While age-standardized rates of CVD incidence, DALY, and mortality have declined over the past three decades, the total burden of CVDs continues to rise due to population ageing and growth. These findings highlight the need for targeted prevention strategies in regions with high CVD burden, particularly those with lower socioeconomic status.

Triglyceride to high-density lipoprotein ratio as a predictor for 10-year cardiovascular disease in individuals with diabetes in Thailand

BACKGROUND

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. The triglyceride to high-density lipoprotein cholesterol (TG/HDL) ratio has emerged as a potential marker for CVD risk. However, its predictive value for high 10-year predicted Cardiovascular (CV) risk remains unclear; This study evaluates the predictive value of the TG/HDL-C ratio for 10-year cardiovascular risk using the Framingham Heart Study (FHS) risk prediction model in individuals with Type 2 Diabetes Mellitus (T2DM).

METHODS

A cross-sectional study was conducted on 61,004 adults from 2014,2015, and 2018 aged 30-74 years with T2DM, without a history of CVD. The FHS model was used to estimate 10-year predicted CV risk, and high CVD risk was defined as ≥ 20%. ROC curve analysis was used to determine the optimal TG/HDL cutoff for high 10-year predicted CV risk in the overall population and age-specific subgroups. Logistic regression was performed to find the association between TG/HDL and high 10-year predicted CV risk, adjusting for potential confounders.

RESULTS

The optimal TG/HDL-C cutoff was 2.52 (AUC = 0.618, 95% CI: 0.612-0.624), with 67% sensitivity and 50% specificity. Higher TG/HDL were associated with increased odds of high predicted CVD risk in a dose-dependent manner, with an adjusted odds ratio (AOR) of 5.16 (95% CI: 4.86-5.49) in the highest TG/HDL quartile (> 4.91). Age-stratified analysis identified lower cutoffs for older adults (≥ 60 years: 2.42, AUC = 0.694) than younger individuals (< 60 years: 2.98, AUC = 0.636), indicating stronger predictive performance in older adults.

CONCLUSIONS

The TG/HDL ratio is significantly associated with 10-year predicted CVD risk in T2DM with age-specific differences in predictive value. The lower cutoff for older adults (2.42) suggests even modest elevations indicate increased risk. These findings support TG/HDL integration into routine CVD risk assessments and highlight the importance of age-specific cutoffs for improved risk stratification.

Global trends and patterns in cardiovascular disease burden attributable to low physical activity: A systematic analysis for Global Burden of Disease Study from 1990 to 2021

BACKGROUND

This study analyzes the global burden of cardiovascular diseases (CVD) related to low physical activity from 1990 to 2021, focusing on spatiotemporal changes.

METHOD

Using data from the GBD study, we examined trends in CVD burden linked to low physical activity, including mortality counts, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMR), and age-standardized disability rates (ASDR). Decomposition analysis was used to identify key drivers of these changes, and frontier analysis visualized each country's potential to reduce the burden. An autoregressive integrated moving average model was used to forecast the burden from 2022 to 2036.

RESULTS

In 2021, approximately 370,000 deaths globally were attributed to CVD due to low physical activity. The ASMR and ASDR for CVD were 4.53 per 100,000 (95% uncertainty interval: 1.52 to 8.05) and 85.95 (95% UI: 35.25 to 140.65), respectively. From 1990 to 2021, the global burden increased, particularly in regions with a middle socio-demographic index, driven by aging populations and population growth. The ASMR is projected to decrease to 3.49 per 100,000 by 2036.

CONCLUSIONS

Low physical activity is a major contributor to CVD-related mortality and disability worldwide. Public health interventions aimed at increasing physical activity, especially in regions with rising burdens, are essential to reduce the global CVD burden.

Metabolic Homeostasis of Immune Cells Modulates Cardiovascular Diseases

Recent investigations into the mechanisms underlying inflammation have highlighted the pivotal role of immune cells in regulating cardiac pathophysiology. Notably, these immune cells modulate cardiac processes through alternations in intracellular metabolism, including glycolysis and oxidative phosphorylation, whereas the extracellular metabolic environment is changed during cardiovascular disease, influencing function of immune cells. This dynamic interaction between immune cells and their metabolic environment has given rise to the novel concept of "immune metabolism". Consequently, both the extracellular and intracellular metabolic environment modulate the equilibrium between anti- and pro-inflammatory responses. This regulatory mechanism subsequently influences the processes of myocardial ischemia, cardiac fibrosis, and cardiac remodeling, ultimately leading to a series of cardiovascular events. This review examines how local microenvironmental and systemic environmental changes induce metabolic reprogramming in immune cells and explores the subsequent effects of aberrant activation or polarization of immune cells in the progression of cardiovascular disease. Finally, we discuss potential therapeutic strategies targeting metabolism to counteract abnormal immune activation.

Invasive Strategy With Intended Percutaneous Coronary Intervention Versus Conservative Treatment in Older People With ST-Segment-Elevation Myocardial Infarction: A Meta-Analysis

BACKGROUND

Patients ≥80 years old were underrepresented or excluded from landmark trials demonstrating the superiority of primary percutaneous coronary intervention (PCI) in ST-segment-elevation myocardial infarction. The current meta-analysis assessed the effects of an invasive strategy with intended PCI compared with conservative treatment in older people (≥80 years) with ST-segment-elevation myocardial infarction.

METHODS

A structured literature search was performed. The primary outcome was overall survival. Secondary outcome analyses included but were not limited to 30-day and 1-year mortality.

RESULTS

Thirteen studies reporting on 102 158 older adults were included. Of these, 31 629 (31%) were assigned to PCI and 70 529 (69%) were treated conservatively. The overall survival was 76.5% in PCI and 67.2% in conservative treatment at the time of longest available follow-up (odds ratio [OR], 2.18 [95% CI, 1.79-2.66], P<0.001, I2=88%, favoring PCI). The follow-up period ranged from 30 days to 26.5 months. The 30-day. (OR, 0.39 [95% CI, 0.31-0.50], P<0.001, I2=0%) and 1-year mortality (OR, 0·34 [95% CI, 0.25-0.46], P<0.001, I2=0%), were lower in the PCI group.

CONCLUSIONS

This meta-analysis indicates a potential underuse of PCI in older adults with ST-segment-elevation myocardial infarction. PCI was advantageous in short- and long-term survival, but these results were affected by confounding. Nonetheless, every second patient not referred for invasive treatment survived at least 1 year. These findings have hypothesis generating implications, but they indicate ageism and emphasize that PCI should not be automatically withheld in older patients.

Hypertensive heart disease in older patients: considerations for clinical practice

Appropriate management of older people with hypertension is essential to reduce the burden of hypertensive heart disease and further cardiovascular sequelae but there may be challenges given the presence of concurrent senescent changes, comorbidities and impairment in functionality. It is recommended that frailty level and functional status are assessed periodically to understand patient needs and to guide treatment decisions. Office blood pressure should be measured with an appropriate cuff as per standard guidelines. There should be a high index of suspicion for orthostatic hypotension and white coat/masked hypertension, both common in older individuals. Cardiac imaging often identifies age-related changes that may not result from hypertension alone, including smaller ventricular volumes, a sigmoid septum and non-ischaemic fibrosis. Diastolic dysfunction is common and other pathologies, including cardiac amyloidosis, may need to be considered in the presence of red flags. Screening for atrial fibrillation during blood pressure evaluation is advised. Decisions for blood pressure management should follow current recommendations and take into consideration the patient's age and tolerance. There is limited evidence regarding heart failure management in older patients, however, disease-modifying therapy as per guidelines should be pursued. Sufficient outcome data are lacking for this patient group and a multidisciplinary approach is often needed to design optimal therapy.

Association of clinical biomarker-based biological age and aging trajectory with cardiovascular disease and all-cause mortality in Chinese adults: a population-based cohort study

BACKGROUND

Evidence on the association of clinical biomarker-based biological age (BA) with cardiovascular disease (CVD) and mortality remains insufficient, particularly concerning aging trajectories' relationship with these two outcomes.

METHODS

Seventy-five thousand five hundred thirty-seven Chinese adults from the Kailuan study who participated in the first checkup (2006-2007) were included. BA was predicted by 32 clinical indicators using deep neural networks models. Aging status was divided into decelerated, accelerated, and normal aging based on BA in the first checkup. Six aging trajectories were developed in the initial three checkups. CVD and mortality were followed up till December 31, 2021.

RESULTS

After adjusting for chronological age, sex, education level, occupation, physical activity, smoking status, alcohol consumption, salt consumption habit, history of hypertension, diabetes, and dyslipidemia, as well as the use of antihypertensive, antidiabetic, and lipid-lowering drugs, Cox proportional hazard models showed that relative to normal aging, accelerated aging was a risk factor for CVD (adjusted hazard ratio [aHR], 1.17 [95% CI 1.11-1.23]) and mortality (aHR, 1.17 [1.12-1.22]), while participants with decelerated aging had a lower risk for CVD (aHR, 0.85 [0.80-0.90]) and mortality (aHR, 0.86 [0.82-0.90]). Relative to low-stable trajectory, other aging trajectories associated with higher risk of CVD and death, and high-stable trajectory associated with the highest risk of CVD (aHR, 1.62 [1.45-1.81]) and mortality (aHR, 1.55 [1.41-1.71]). Relative to high-stable trajectory, high-decreasing trajectory was associated with lower risk of CVD (aHR, 0.76 [0.67-0.86]) and death (aHR, 0.78 [0.70-0.87]), and decreasing-increasing trajectory was associated with lower risk of death (aHR, 0.86 [0.75-0.98]).

CONCLUSIONS

Accelerated BA aging is associated with a higher risk of CVD and mortality, whereas decelerated aging is associated with a lower risk compared to normal aging. Those persistently at high aging levels are at the highest risk for both CVD and death; conversely, it is the act of lowering and continually maintaining a reduced aging state that effectively mitigates these risks.

Global burden of non-rheumatic valvular heart disease in older adults (60-89 years old), 1990-2019: Systematic analysis of the Global Burden of Disease Study 2019

BACKGROUND

Understanding the global burden and risk factors of non-rheumatic valvular heart disease (NRVHD) in older adults is important for effective disease control. We wanted to analyze the prevalence, incidence, disability-adjusted life years (DALY) rate, mortality rate, and risk factors of NRVHD in older adults aged 60-89 years.

METHODS

Global Burden of Disease Study (GBD) 2019 was used as the data source. Age standardized incidence rate, prevalence, DALY rate, and mortality rate of NRVHD among older adults aged 60-89 years from 1990 to 2019. We analyzed different age groups, genders, regions, sociodemographic index (SDI) across 204 countries/territories. Proportional DALY and mortality attributable to risk factors were calculated.

RESULTS

Globally, age-standardized DALY rate (per 100,000 population) for NRVHD in older adults decreased significantly from 44.46 (95 % confidence interval 39.95 to 49.18) in 1990 to 35.94 (32.32 to 40.19) in 2019 with an average annual percent change (AAPC) of -0.19 % (-0.24 % to -0.14 %), and the mortality rate also decreased significantly from 2.48 (2.21 to 2.64) to 2.25 (1.89 to 2.47) with an AAPC of -0.09 % (-0.16 % to -0.03 %,). However, the age-standardized incidence rate (per 100,000 population) increased from 18.37 (17.41 to 19.35) in 1990 to 19.77(18.62 to 20.95) in 2019 with an AAPC of 0.08 % (0.05 % to 0.10 %), and the age-standardized prevalence rate significantly increased from 391.40 (372.71 to 411.20) to 399.50 (378.31 to 420.75) with an AAPC of 0.02 % (0.00 % to 0.05 %). At the regional level, the greatest burden of NRVHD was seen in parts of high-income North America. At the national level, the highest age standardized incidence rate, age standardized DALY rate, and age standardized mortality rate in 2019 were all from Niger, Philippines and Belarus, making it the region with the greatest burden of NRVHD. The age standardized incidence and DALY rate were higher in women 20.83 (19.68 to 22.02) than in men 18.64 (17.39 to 19.88) globally, while the mortality rate was similar in different genders. The differences between men and women in incidence, DALY and mortality were mainly found in age groups of 80-84 and 85-89 years. A significant negative association was found between estimated annual percentage change (EAPCs) and age standardized rate (q=-0.19, p = 0.00). A significant positive relation was detected between EAPCs and human development index (q = 0.17, p = 0.02). The main attributable risk factor for DALY was high body mass index in all regions by SDI.

CONCLUSION

There is a substantial global burden of NRVHD in older adults in 2019, which is varied by age, gender, SDI and region. NRVHD in older people should be paid attention to. Risk factors described here should provide more evidence and clues for disease prevention in the future.

Physical Inactivity and Cardiovascular Health in Aging Populations: Epidemiological Evidence and Policy Implications from Riyadh, Saudi Arabia

BACKGROUND

Cardiovascular Diseases (CVDs) are the leading cause of morbidity and mortality globally, particularly among older adults. Physical inactivity, a modifiable risk factor, is strongly associated with the development and progression of CVD through its correlation with hypertension, diabetes, obesity, and hyperlipidemia. This study examines the association between physical inactivity and cardiovascular health among older adults in the Riyadh region, Saudi Arabia.

METHODS

A cross-sectional study was conducted on 168 participants aged 60 years and older attending a tertiary hospital in Riyadh. Data were collected using a structured questionnaire, the Physical Activity Scale for the Elderly (PASE), anthropometric measurements, and medical record reviews. Cardiovascular health indicators and risk factors were analyzed using descriptive statistics, chi-square tests, and multivariate logistic regression.

RESULTS

Participants with low physical activity levels had a higher prevalence of hypertension (78.2%), diabetes (64.4%), and obesity (51.3%) compared to those with high activity levels (41.8%, 28.7%, and 22.3%, respectively). Multivariate analysis showed that physical inactivity was significantly associated with an increased likelihood of CVD (adjusted OR: 1.98, p < 0.001), with hypertension and diabetes also being strong predictors.

CONCLUSIONS

Physical inactivity is strongly correlated with adverse cardiovascular outcomes in older adults. Interventions targeting increased physical activity are essential to reducing the CVD burden. Community-based programs and policy-driven initiatives tailored to the Riyadh region's specific environmental and cultural factors are crucial in promoting active lifestyles among aging populations.

The global burden of cardiovascular disease attributable to high alcohol use from 1990 to 2021: an analysis for the global burden of disease study 2021

Background

Cardiovascular diseases (CVDs) are the leading global disease burden, with alcohol consumption closely linked to their occurrence. This study analyzes data from the Global Burden of Disease Study 2021 (GBD 2021) to assess the distribution and trends of high alcohol use-related CVD from 1990 to 2021 across global, regional, and national levels.

Materials and methods

We used the data from the GBD 2021 to conduct stratification by region, country, gender, age, SDI, and disease type in terms of the number of deaths, age-standardized mortality rate (ASMR), disability-adjusted life years (DALYs), age-standardized rate of DALYs (ASDR), years lived with disability (YLDs), age-standardized rate of YLDs, years of life lost (YLLs), and age-standardized rate of YLLs to comprehensively assess the burden of high alcohol use-related CVD from 1990 to 2021. All statistical analyses in this study were performed using R statistical software (version 4.1.2).

Results

Between 1990 and 2021, global deaths, DALYs, YLDs, and YLLs attributable to high alcohol use-related CVD showed notable variation. By 2021, global deaths had doubled compared to 1990, while ASMR, ASDR, age-standardized YLD rate, and YLL rate all declined. Eastern Europe had the highest rates in 2021. Males consistently had higher ASMR, ASDR, YLD, and YLL rates compared to females, with the highest number of deaths occurring in the 70-74 age group, and the 65-69 age group showing the highest DALYs, YLDs, and YLLs. These rates increased with age. Stroke was the most common high alcohol use-related CVD, while ischemic heart disease (IHD) was the least common.

Conclusion

Between 1990 and 2021, the overall burden of high alcohol use-related CVD declined globally, though some regions experienced an increase. This highlights the need for continued public health efforts, particularly targeting high-risk regions and populations, to mitigate the impact of alcohol on cardiovascular health.

Global, Regional and National Burden of Maternal Obstructed Labour and Uterine Rupture, 1990-2021: Global Burden of Disease Study 2021

BACKGROUND

Maternal obstructed labour and uterine rupture (MOLUR) are among the major maternal labour complications that threaten maternal and child health.

OBJECTIVE

The objective of this study was to systematically analyse the global burden of MOLUR using the Global Burden of Disease 2021 (GBD 2021) database to inform further improvements in maternal-related public health policies.

METHODS

Incidence and disability-adjusted life-year (DALY) data on MOLUR from 1990 to 2021 were collected in the GBD 2021. The joinpoint and Bayesian age-period-cohort models were used to analyse and predict time burden trends. The slope index and concentration index were used to evaluate health inequality. Frontier analysis was used to visualise the potential for burden reduction in individual countries or territories.

RESULTS

In 2021, 13,471,093 (95% uncertainty interval [UI] 8,938,373, 19,008,282) incident cases of MOLUR were reported worldwide, which caused 1,067,270 (95% UI 896,161, 1,275,042) DALYs. Over the past three decades, there has been an overall downward trend in the age-standardised incidence rate (ASIR) and age-standardised DALY rate (ASDR) of MOLUR globally, with the ASIR decreasing from 554.0 (95% UI 355.6, 786.3) per 100,000 in 1990 to 347.0 (95% UI 228.8, 489.4) in 2021. The ASDR decreased from 65.4 (95% UI 56.0, 75.7) per 100,000 in 1990 to 27.0 (95% UI 22.7, 32.2) in 2021. By 2040, the global ASIRs and ASDRs projections for MOLUR will likely continue to decline. Socioeconomic-related inequalities are narrowing, but the burden remains concentrated in low socioeconomically developed countries. Israel and Afghanistan showed the largest differences from the frontier boundaries of ASIR and ASDR.

CONCLUSIONS

Although the global burden of MOLUR has declined in the last three decades, it remains high and is still concentrated in economically underdeveloped countries. The reduction in DALYs attributable to MOLUR globally reflects significant progress in improving maternal health and reducing complications of childbirth.

Brain natriuretic peptide is a long-term cardiovascular predictor in carotid endarterectomy

BACKGROUND

In noncardiac surgery, several biomarkers are known to play a role in predicting long-term complications, such as major adverse cardiovascular events (MACE), myocardial infarction, or death. Carotid endarterectomy (CEA) is considered a low to medium-risk surgery for carotid stenosis aimed at preventing stroke events. Brain natriuretic peptide (BNP) is a biomarker with potential prognostic value regarding MACE. Since its role in patients undergoing CEA is unknown, this study aims to assess the potential role of BNP as a short and long-term predictor of all-cause mortality and MACE in patients undergoing CEA.

METHODS

From a prospective database, patients who underwent CEA under regional anesthesia (RA) at a tertiary hospital center were enrolled, and a post hoc analysis was conducted. Patients on which BNP levels were measured up to fifteen days before surgery, and two groups based on the BNP threshold (200 pg/mL) were defined and compared. Kaplan Meier survival curves and adjusted hazard ratios (aHR) were assessed by multivariable Cox regression. The primary outcome was the incidence of long-term MACE and all-cause mortality. Secondary outcomes included the incidence of AMI and AHF.

RESULTS

A total of 89 patients were evaluated. The mean age of the cohort was 71.2 ± 8.7 years, with 71 (79.8%) males, and presented a median follow-up of 30 [13.5-46.4] months. BNP > 200 pg/mL has demonstrated positive predictive value for MACE (aHR: 5.569, confidence interval (CI): 2.441-12.7, p < 0.001) and all-cause mortality (aHR: 3.469, CI: 1.315-9.150, p = 0.018).

CONCLUSION

BNP has been demonstrated to independently predict long-term all-cause mortality, MACE and AMI following CEA. It serves as a low-cost, ready-to-use biomarker, although further studies are necessary.

Influence of Health Literacy on Physical Activity and Sedentary Behaviors in Older Patients with Coronary Artery Disease

BACKGROUND

Coronary artery disease is a chronic condition that requires continuous adherence to healthy behaviors. Adhering to physical activity and reducing prolonged sedentary behavior are important for the physical health of older patients with coronary artery disease (CAD). Health literacy is increasingly recognized as a key factor in secondary prevention for these patients. However, evidence regarding the associations among health literacy, physical activity, and sedentary behaviors for secondary prevention in older patients with coronary artery disease remains limited.

OBJECTIVES

This study aimed to identify the prevalence of limited health literacy and the influence of health literacy on physical activity and sedentary behaviors in older patients with CAD.

METHODS

This study was a descriptive cross-sectional study conducted from May to December 2022 in South Korea. A total of 186 patients aged 65 and older diagnosed with coronary artery disease participated. Data on health literacy, physical activity, and sedentary behaviors were collected through self-reported questionnaires and electronic medical records.

RESULTS

The prevalence of limited health literacy in older patients was 66.7%. Hierarchical linear regression revealed that health literacy was a significant determinant of physical activity (β = -0.50, P < .001) and sedentary behaviors (β = 0.58, P < .001) after adjusting for confounding variables.

CONCLUSIONS

Our main findings showed that health literacy can facilitate improvements in physical activity and sedentary behaviors. Health literacy can facilitate health decisions for secondary prevention in older patients with CAD. Thus, healthcare professionals should assess patient health literacy and illness severity when designing secondary prevention programs.

Disease burden and health inequality of older adults with edentulism and the projected trend until 2040: based on the global burden of disease study 2021

OBJECTIVES

To comprehensively analyze the current situation and the trends over the next 21 years, focusing on health inequalities related to edentulism among the elderly across global regions.

MATERIALS AND METHODS

Data on edentulism in older adults were collected from the 2021 global burden of disease (GBD) study. Disease burden trends were analyzed using a joinpoint model. We used the Slope Index of Inequality (SII) and the Concentration Index (CI) to assess health inequalities. A Bayesian age-period-cohort (BAPC) model was used to analyze the projected trend of prevalence up to 2040.

RESULTS

The number of incident, prevalent, and years lived with disability (YLD) cases of edentulism in older adults is increasing globally, while the rate is declining. According to the analysis of health inequality, the burden of edentulism among older adults was gradually concentrated in countries with lower Sociodemographic Index (SDI). Significant downward trends were expected in the global age-standardized prevalence rate (ASPR) of edentulism for both genders from 2020 to 2040; however, the number is increasing.

CONCLUSIONS

Taken together, the burden of edentulism in older people remains high and generally shifts from higher-SDI countries to lower-SDI countries. There are great differences between countries, and effective measures should be taken in countries with poorer economies.

CLINICAL RELEVANCE

The disease burden of edentulism in older adults is gradually shifting towards lower SDI countries. It is crucial to optimize the utilization and allocation of healthcare resources to reduce health inequities in edentulism in older adults.

The Burden of Peripheral Artery Disease in China From 1990 to 2019 and Forecasts for 2030: Findings From the Global Burden of Disease Study 2019

Objectives

The incidence of peripheral arterial disease (PAD) in China is increasing. We aim to conduct a comprehensive analysis of the burden of PAD.

Methods

We collected information from 1990 to 2019 in the Global Burden of Disease (GBD 2019) study. Joinpoint regression analysis was used to calculate the annual percentage change (APC). Trends in incidence, mortality and DALYs were forecasted by Bayesian age-period-cohort (BAPC) analysis.

Results

In 2019, the number of new cases and prevalence of PAD in China accounted for nearly a quarter of the global proportion. The age-standardized incidence rate (ASIR) declined after rising until 2005. The age-standardized death rate (ASDR) maintained an upward trend. The DALYs was 0.16 million. Incidence, prevalence and DALYs are predominantly female, except for mortality, which is predominantly male. Smoking predominantly affected males, while hypertension and diabetes had a greater impact on females. By 2030, ASDR is elevated, predominantly in males. ASIR and age-standardized DALY rate decline, predominantly in females.

Conclusion

It is urgent for China to develop strategies based on the specific distribution characteristics of the PAD burden.

Association between cMIND diet and hypertension among older adults in China: a nationwide survey

BACKGROUND

Existing research indicates that the Mediterranean diet has a positive impact on preventing and treating hypertension. However, its specific effect on hypertension among elderly Chinese individuals is unclear.

AIMS

The objective of this research was to explore the association between the Chinese version of the Mediterranean-DASH Intervention for Neurodegenerative Delay (cMIND) diet and hypertension among elderly Chinese individuals, aiming to offer novel strategies for alleviating the burden of hypertension in this demographic.

METHODS

In this study, we used cross-sectional data published in 2018 by the China Longitudinal Health and Longevity Survey (CLHLS) to develop a binary logistic regression model to investigate the correlation between cMIND diet and hypertension in a Chinese elderly population. Restricted cubic spline was used to test for linear associations, and further subgroup analyses were performed to test for interactions.

RESULTS

In total, 7,103 older adults were included in the study, with a prevalence of hypertension of 39.0%. When the cMIND diet score was used as a continuous variable, a significant protective effect against hypertension was present (OR = 0.955, 95% CI:0.923-0.988, p = 0.008); when used as a categorical variable, this protective effect was still present at higher levels (compared to lower levels) of the cMIND diet (OR = 0.869, 95% CI: 0.760-0.995, p = 0.042).

DISCUSSION

Although the Mediterranean diet has great potential to reduce the chance of hypertension, it should also consider the effect on the Chinese population. The results of this study provide new ways to reduce the disease burden of hypertension in Chinese older adults and improve quality of life in later life.

CONCLUSION

The cMIND diet can considerably reduce the risk of hypertension among older adults in China.

The Role of Endothelial Cell Mitophagy in Age-Related Cardiovascular Diseases

Aging is a major risk factor for cardiovascular diseases (CVD), and mitochondrial autophagy impairment is considered a significant physiological change associated with aging. Endothelial cells play a crucial role in maintaining vascular homeostasis and function, participating in various physiological processes such as regulating vascular tone, coagulation, angiogenesis, and inflammatory responses. As aging progresses, mitochondrial autophagy impairment in endothelial cells worsens, leading to the development of numerous cardiovascular diseases. Therefore, regulating mitochondrial autophagy in endothelial cells is vital for preventing and treating age-related cardiovascular diseases. However, there is currently a lack of systematic reviews in this area. To address this gap, we have written this review to provide new research and therapeutic strategies for managing aging and age-related cardiovascular diseases.

Evaluating the effect of green tea intake on cardiovascular diseases: A Mendelian randomization study in European and East Asian populations

Previous research shows that more than 70% of cardiovascular diseases (CVDs) are attributed to modifiable risk factors. Here, we investigated relationship between consumption of green tea in European and East Asian populations and risk of CVDs using Mendelian randomization (MR). Instrumental variables for green tea intake were obtained from genome-wide association studies (GWASs) of 64,949 Europeans and 152,653 East Asians. GWASs for CVDs were derived from UK BioBank and BioBank Japan projects. The main method selected for MR analysis was either the inverse variance weighted (IVW) or Wald ratio, depending on the quantity of single nucleotide polymorphisms. Furthermore, we performed sensitivity analyses to confirm the reliability of the findings. Based on the results of IVW, there is no causal relationship between consumption of green tea and risk of 4 CVDs among Europeans (atrial fibrillation: OR = 1.000, 95% CI: 0.995-1.005, P = .910; heart failure: OR = 1.003, 95% CI: 0.994-1.012, P = .542; ischemic stroke: OR = 1.002, 95% CI: 0.993-1.011, P = .690; coronary artery disease: OR = 1.001, 95% CI: 0.996-1.007, P = .677). Sensitivity analyses and supplementary MR analyses also verify the robustness of the findings. Likewise, there was no correlation between the consumption of green tea and the occurrence of CVDs in East Asians. The consumption of green tea is not associated with a reduced risk of CVDs in populations from Europe and East Asia. This means that those who are trying to reduce their risk of CVDs by drinking more green tea may not benefit from doing so.

Comparative analysis of atherosclerotic cardiovascular disease burden between ages 20-54 and over 55 years: insights from the Global Burden of Disease Study 2019

BACKGROUND

To systematically analyze differences in atherosclerotic cardiovascular disease (ASCVD) burden between young and older adults.

METHODS

We estimated the prevalence, mortality, and disability-adjusted life years (DALYs) of ASCVD, including ischemic heart disease (IHD), ischemic stroke (IS), and peripheral artery disease (PAD), in individuals aged 20-54 and > 55 years from 1990-2019, utilizing data from the 2019 Global Burden of Disease Study. The annual percentage changes (EAPCs) for age-specific prevalence, mortality, or DALY rates were calculated to quantify the temporal trends of ASCVD burden. We also analyzed population attribution fractions (PAF) of premature ASCVD mortality and DALYs for different risk factors and compared the burden of extremely premature, premature, and non-premature ASCVD cases based on clinical classifications.

RESULTS

From 1990-2019, the global prevalence rates of IHD, IS, and PAD in the 20-54 years age group increased by 20.55% (from 694.74 to 837.49 per 100,000 population), 11.50% (from 439.48 to 490.03 per 100,000 population), and 7.38% (from 384.24 to 412.59 per 100,000 population), respectively. Conversely, the ASCVD prevalence in > 55years age group decreased. Adverse outcome burdens, including mortality and DALYs, varied among ASCVD subtypes. The decrease in the mortality/DALY burden of IHD and IS was lower in the 20-54 years group than in the > 55 years group. For PAD, DALYs among those aged 20-54 increased but decreased among those aged > 55 years. When grouped according to socio-demographic index (SDI) values, lower SDI regions exhibited a higher proportion of young ASCVD burden. The prevalence of young IHD, IS, and PAD in low SDI regions reached 20.70%, 40.05%, and 19.31% in 2019, respectively, compared with 12.14%, 16.32%, and 9.54%, respectively, in high SDI regions. Metabolic risks were the primary contributors to the ASCVD burden in both age groups. Increased susceptibility to ambient particulate matter pollution and inadequate control of high body-mass index and high fasting plasma glucose in young individuals may partially explain the differing temporal trends between young and older individuals.

CONCLUSIONS

The ASCVD burden in young individuals may become a growing global health concern, especially in areas with lower socioeconomic development levels that require more effective primary prevention strategies.

Sex-associated differences in cardiac ageing: Clinical aspects and molecular mechanisms

Despite the extensive clinical and scientific advances in prevention, diagnostics and treatment, cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality worldwide for people aged 65 and over. Of all ageing-related diseases, CVD are responsible for almost one-third of deaths in the elderly, being above all cancers combined. Age is an independent and unavoidable risk factor contributing to the impairment of heart and blood vessels. As the average age of the population in industrialized countries has doubled in the last century, and almost a fifth of the world's population is predicted to be over 65 in the next decade, we can assume that the burden of CVD will fall primarily on the elderly. Evidence from basic and clinical science has shown that sex significantly influences the onset and severity of CVD. In women, CVD usually develop later than in men and with atypical symptomatology. After menopause, however, the incidence and severity of CVD increase in women, reaching equality in both sexes. Although intrinsic sexual dimorphism in cardiovascular ageing may contribute to the sex differences in CVD progression, the molecular mechanisms associated with cardiovascular ageing and their clinical value are not known in detail. In this review, we discuss the scientific knowledge available, focusing on structural, hormonal, genetic/epigenetic and inflammatory pathways, seeking to transfer these findings to the cardiovascular clinic in terms of prevention, diagnosis, prognosis and management of these pathologies and proposing possible validation of target specifics.

Association of leukocyte telomere length with risk of all-cause and cardiovascular mortality in middle-aged and older individuals without cardiovascular disease: a prospective cohort study of NHANES 1999-2002

BACKGROUND

Leukocyte telomere length (LTL) shorting was significantly associated with mortality. This study aimed to investigate the potential association between LTL and all-cause mortality as well as cardiovascular disease (CVD) mortality in middle-aged or older individuals without a history of CVD.

METHODS

A total of 4174 participants from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2002 were included in this analysis. Cox proportional hazards regression models were utilized to estimate the association between LTL and mortality outcomes. Restricted cubic spline (RCS) curves were employed to evaluate the potential non-linear association.

RESULTS

Over a median follow-up period of 217 months, the weighted rates of all-cause mortality and CVD mortality were 28.58% and 8.32% respectively. Participants in the highest LTL group exhibited a significantly decreased risk of both all-cause mortality (HR: 0.65, 95% CI: 0.54-0.78, P < 0.001) and CVD mortality (HR: 0.64, 95% CI: 0.45-0.93, P < 0.001) compared to those in the lowest group. Kaplan-Meier survival curves further supported a significant association between shorter telomere length and increased risks of both all-cause and CVD mortality (log-rank test P < 0.001). RCS curves demonstrated a linear dose-response relationship between LTL and all-cause mortality as well as CVD mortality. Subgroup and sensitivity analyses confirmed the robustness of the results.

CONCLUSION

Shorter leukocyte telomere length could serve as a potential biomarker for risk stratification of all-cause and CVD mortality among middle-aged and older individuals without a history of CVD.

Marine Compounds and Age-Related Diseases: The Path from Pre-Clinical Research to Approved Drugs for the Treatment of Cardiovascular Diseases and Diabetes

Ageing represents a main risk factor for several pathologies. Among them, cardiovascular diseases (CVD) and type 2 diabetes mellitus (T2DM) are predominant in the elderly population and often require prolonged use of multiple drugs due to their chronic nature and the high proportion of co-morbidities. Hence, research is constantly looking for novel, effective molecules to treat CVD and T2DM with minimal side effects. Marine active compounds, holding a great diversity of chemical structures and biological properties, represent interesting therapeutic candidates to treat these age-related diseases. This review summarizes the current state of research on marine compounds for the treatment of CVD and T2DM, from pre-clinical studies to clinical investigations and approved drugs, highlighting the potential of marine compounds in the development of new therapies, together with the limitations in translating pre-clinical results into human application.