1
|
LI FR, WANG S, LI X, CHENG ZY, JIN C, MO CB, ZHENG J, LIANG FC, GU DF. Multimorbidity and mortality among older patients with coronary heart disease in Shenzhen, China. J Geriatr Cardiol 2024; 21:81-89. [PMID: 38440336 PMCID: PMC10908585 DOI: 10.26599/1671-5411.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND The current understanding of the magnitude and consequences of multimorbidity in Chinese older adults with coronary heart disease (CHD) is insufficient. We aimed to assess the association and population-attributable fractions (PAFs) between multimorbidity and mortality among hospitalized older patients who were diagnosed with CHD in Shenzhen, China. METHODS We conducted a retrospective cohort study of older Chinese patients (aged ≥ 65 years) who were diagnosed with CHD. Cox proportional hazards models were used to estimate the associations between multimorbidity and all-cause and cardiovascular disease (CVD) mortality. We also calculated the PAFs. RESULTS The study comprised 76,455 older hospitalized patients who were diagnosed with CHD between January 1, 2016, and August 31, 2022. Among them, 70,217 (91.9%) had multimorbidity, defined as the presence of at least one of the predefined 14 chronic conditions. Those with cancer, hemorrhagic stroke and chronic liver disease had the worst overall death risk, with adjusted HRs (95% CIs) of 4.05 (3.77, 4.38), 2.22 (1.94, 2.53), and 1.85 (1.63, 2.11), respectively. For CVD mortality, the highest risk was observed for hemorrhagic stroke, ischemic stroke, and chronic kidney disease; the corresponding adjusted HRs (95% CIs) were 3.24 (2.77, 3.79), 1.91 (1.79, 2.04), and 1.81 (1.64, 1.99), respectively. All-cause mortality was mostly attributable to cancer, heart failure and ischemic stroke, with PAFs of 11.8, 10.2, and 9.1, respectively. As for CVD mortality, the leading PAFs were heart failure, ischemic stroke and diabetes; the corresponding PAFs were 18.0, 15.7, and 6.1, respectively. CONCLUSIONS Multimorbidity was common and had a significant impact on mortality among older patients with CHD in Shenzhen, China. Cancer, heart failure, ischemic stroke and diabetes are the primary contributors to PAFs. Therefore, prioritizing improved treatment and management of these comorbidities is essential for the survival prognosis of CHD patients from a holistic public health perspective.
Collapse
Affiliation(s)
- Fu-Rong LI
- Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Shuang WANG
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Xia LI
- Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Zhi-Yuan CHENG
- Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Cheng JIN
- Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Chun-Bao MO
- Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Jing ZHENG
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Feng-Chao LIANG
- Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Dong-Feng GU
- Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
- School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, China
| |
Collapse
|
2
|
Peña-Longobardo LM, Oliva-Moreno J, Fernández-Rodriguez C. The effect of hepatitis C-associated premature deaths on labour productivity losses in Spain: a ten-year analysis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:1271-1283. [PMID: 36352296 PMCID: PMC9646468 DOI: 10.1007/s10198-022-01540-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
Hepatitis C virus (HCV) infection causes a substantial economic burden, not only in terms of healthcare costs, but also in labour productivity losses. The main objective of this study is to provide objective and comparable information about the trend in labour productivity losses caused by premature HCV-associated deaths in Spain in recent years (2009-2018). We used nationwide data from several official sources to create a simulation model based on the human capital approach and to estimate the flows in labour productivity losses due to deaths identified in the period considered. Based on a pessimistic scenario, the annual number of deaths due to HCV infections decreased by 19.7% between 2009 and 2018. The years of potential labour productive life lost (YPLPLL) decreased by 38.1%. That reduction led to a decrease in annual labour productivity losses from €236 million in 2009 to €156 million in 2018 (-33.8%). The aggregate HCV-related labour productivity losses between 2009 and 2018 ranged from €1742 million (optimistic scenario) to €1949 million (pessimistic scenario), with an intermediate estimation of €1846 million (moderately optimistic scenario). These results show a substantial reduction in annual deaths, working-age deaths, YPLPLL, and labour productivity losses associated with HCV infection over this period.
Collapse
Affiliation(s)
- L M Peña-Longobardo
- Department of Economic Analysis and Finance and Seminar on Economics and Health, Universidad de Castilla-La Mancha, Toledo, Spain
| | - J Oliva-Moreno
- Department of Economic Analysis and Finance and Seminar on Economics and Health, Universidad de Castilla-La Mancha, Toledo, Spain.
| | - C Fernández-Rodriguez
- Service of Gastroenterology, Fundación Alcorcón University Hospital, University Rey Juan Carlos, Madrid, Spain
| |
Collapse
|
3
|
Aljehani R, Aljehani G, Alharazi H, Horta PM, Kümmel Duarte C, Ghisi GLDM. The Mediterranean Diet Scale (MDS): Translation and validation of the Arabic version. PLoS One 2023; 18:e0287497. [PMID: 37616224 PMCID: PMC10449107 DOI: 10.1371/journal.pone.0287497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVES The self-administered version of the Mediterranean Diet Scale (MDS) has been developed to test the inherent characteristics of this dietary pattern in a quick and simple way, due to the need of this assessment in the clinical and research setting. This study aimed to translate and psychometrically validate the self-administered MDS in Arabic (CRBS-A). METHODS The original (English) version was originally translated to Arabic, followed by back-translation. Next, 10 healthcare providers, followed by 10 cardiovascular disease (CVD) patients rated the face and content validity (CV) of materials, providing input to improve cross-cultural applicability. Then, 200 patients from Saudi Arabia completed the questionnaire, of which factor structure, internal consistency, criterion and construct validity were assessed. RESULTS Content and face validity was supported based on experts and patients' reviews (ranges: CV scores 0.9-1.0/1.0 and clarity 3.5 to 4.5/5). Minor edits were made. Subsequent factor analysis revealed 4 factors consistent with the original version of the instrument, all internally consistent. Total CRBS-A α was 0.74. Criterion validity was confirmed by the significantly higher scores in patients who participated in CR. Construct validity was also established by significant associations between MDS scores and monthly family income, having the diagnosis of acute coronary syndrome or with a history of valve repair or replacement, being obese or having dyslipidemia. CONCLUSIONS Overall, these results confirm the validity and reliability of the MDS in Arabic-speaking patients.
Collapse
Affiliation(s)
- Raghdah Aljehani
- Rehabilitation Department, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Ghaidaa Aljehani
- Rehabilitation Department, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Hanaa Alharazi
- Cardiology Department, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Paula M. Horta
- Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Camila Kümmel Duarte
- Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Gabriela Lima de Melo Ghisi
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| |
Collapse
|
4
|
Perera V, Allen LN, Farrand C, Kwong EJL, Liyanage I, Wickramasinghe K. Evaluating the role of salt intake in achieving WHO NCD targets in the Eurasian Economic Union: A PRIME modeling study. PLoS One 2023; 18:e0289112. [PMID: 37478108 PMCID: PMC10361522 DOI: 10.1371/journal.pone.0289112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 07/11/2023] [Indexed: 07/23/2023] Open
Abstract
The World Health Organization has set clear global targets in reducing non-communicable disease mortality by 2030 in its sustainable development goals. This study models the number of deaths that could be averted if Eurasian Economic Union (EEU) member states met the target of reducing their population's current mean salt intake by 30% to achieve mortality reduction targets. Using the WHO Preventable Risk Integrated ModEl (PRIME), we modelled the mortality impact of reducing salt consumption by 30%, as well as according to WHO recommended levels (5 g/person/day), for the five member states of the EEU. PRIME models the number of averted deaths from reducing salt intake by applying established risk ratios to a given population. The baseline demographic and mortality data that are required to generate these estimates were obtained from the relevant government statistical bodies, and salt intake data were referenced from surveillance studies. Uncertainty intervals were generated using Monte Carlo simulation. If salt consumption was reduced by 30%, we estimate that there would have been 94,150 (95%UI: 47,329 to 137,131) fewer deaths due to cardiovascular disease in the EEU in the baseline year, with males and the elderly being more affected. If the WHO-recommended maximum salt intake of 5 g/day was achieved, a total of 193,155 (95%UI: 98,548 to 272,536) deaths would have been prevented. These findings underline the importance of incorporating effective policy changes to meet targets in reducing NCD mortality by one-third by 2030.
Collapse
Affiliation(s)
- Vern Perera
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
| | - Luke N. Allen
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Clare Farrand
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Edwin Jit Leung Kwong
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Isurujith Liyanage
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
| | - Kremlin Wickramasinghe
- WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office), Moscow, Russian Federation
| |
Collapse
|
5
|
Fry ETA, Piñeiro DJ. One World, One Heart. J Am Coll Cardiol 2023; 81:1211-1213. [PMID: 36898956 DOI: 10.1016/j.jacc.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
|
6
|
Ekinci G. Economic Impacts of Cardiovascular Diseases: An Econometric Evaluation in Turkey. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:118-127. [PMID: 36824237 PMCID: PMC9941436 DOI: 10.18502/ijph.v52i1.11673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/09/2022] [Indexed: 01/18/2023]
Abstract
Background The study aimed to determine the impact of the burden of cardiovascular diseases on Gross Domestic Product (GDP) in Turkey. Methods GDP was taken as the dependent variable and the burden of cardiovascular diseases was taken as the independent variable. The variables were analyzed within the frame of Panel Data Analysis. Results Significant relationships were found between GDP and burden of cardiovascular diseases. The unidirectional Granger causality relationship was determined from burden of cardiovascular diseases to GDP and revealed that they acted together in the long term. The analysis that made with using econometric regression models revealed that generally 1 unit increased in per capita of cardiovascular diseases decreased GDP by between 477651.8 - 624485.6 units (PPP$). Conclusion The empirical results of the study revealed that the cardiovascular disease burden was one of the reasons for the decrease in GDP and their economic effects would continue in the long term in Turkey. From this perspective establishing and implementing policies to improve the burden of cardiovascular diseases in Turkey could be an important approach for the economic development.
Collapse
Affiliation(s)
- Gülay Ekinci
- Health Management Department, Faculty of Health Sciences, Öğretim Üyesi/Istanbul Sabahattin Zaim University, Istanbul, Turkey,Correspondence:
| |
Collapse
|
7
|
Xu J, Zhou H, Cheng Y, Xiang G. Identifying potential signatures for atherosclerosis in the context of predictive, preventive, and personalized medicine using integrative bioinformatics approaches and machine-learning strategies. EPMA J 2022; 13:433-449. [PMID: 36061826 PMCID: PMC9437201 DOI: 10.1007/s13167-022-00289-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022]
Abstract
Background Atherosclerosis is a major contributor to morbidity and mortality worldwide. Although several molecular markers associated with atherosclerosis have been developed in recent years, the lack of robust evidence hinders their clinical applications. For these reasons, identification of novel and robust biomarkers will directly contribute to atherosclerosis management in the context of predictive, preventive, and personalized medicine (PPPM). This integrative analysis aimed to identify critical genetic markers of atherosclerosis and further explore the underlying molecular immune mechanism attributing to the altered biomarkers. Methods Gene Expression Omnibus (GEO) series datasets were downloaded from GEO. Firstly, differential expression analysis and functional analysis were conducted. Multiple machine-learning strategies were then employed to screen and determine key genetic markers, and receiver operating characteristic (ROC) analysis was used to assess diagnostic value. Subsequently, cell-type identification by estimating relative subsets of RNA transcript (CIBERSORT) and a single-cell RNA sequencing (scRNA-seq) data were performed to explore relationships between signatures and immune cells. Lastly, we validated the biomarkers' expression in human and mice experiments. Results A total of 611 overlapping differentially expressed genes (DEGs) included 361 upregulated and 250 downregulated genes. Based on the enrichment analysis, DEGs were mapped in terms related to immune cell involvements, immune activating process, and inflaming signals. After using multiple machine-learning strategies, dehydrogenase/reductase 9 (DHRS9) and protein tyrosine phosphatase receptor type J (PTPRJ) were identified as critical biomarkers and presented their high diagnostic accuracy for atherosclerosis. From CIBERSORT analysis, both DHRS9 and PTPRJ were significantly related to diverse immune cells, such as macrophages and mast cells. Further scRNA-seq analysis indicated DHRS9 was specifically upregulated in macrophages of atherosclerotic lesions, which was confirmed in atherosclerotic patients and mice. Conclusions Our findings are the first to report the involvement of DHRS9 in the atherogenesis, and the proatherogenic effect of DHRS9 is mediated by immune mechanism. In addition, we confirm that DHRS9 is localized in macrophages within atherosclerotic plaques. Therefore, upregulated DHRS9 could be a novel potential target for the future predictive diagnostics, targeted prevention, patient stratification, and personalization of medical services in atherosclerosis. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-022-00289-y.
Collapse
Affiliation(s)
- Jinling Xu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515 Guangdong China
- Department of Endocrinology, General Hospital of Central Theater Command, Wuhan, 430070 Hubei China
| | - Hui Zhou
- Department of General Surgery, Central South University, The Third Xiangya Hospital, Changsha, 410013 Hunan China
| | - Yangyang Cheng
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515 Guangdong China
- Department of Endocrinology, General Hospital of Central Theater Command, Wuhan, 430070 Hubei China
| | - Guangda Xiang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515 Guangdong China
- Department of Endocrinology, General Hospital of Central Theater Command, Wuhan, 430070 Hubei China
| |
Collapse
|
8
|
Beasant B, Lee G, Vaughan V, Lotfaliany M, Hosking S. Health literacy and cardiovascular disease prevention: a systematic scoping review protocol. BMJ Open 2022; 12:e054977. [PMID: 35676010 PMCID: PMC9185497 DOI: 10.1136/bmjopen-2021-054977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Health literacy is 'The skills and resources of a person to access, understand and use information to make decisions, and take action on their own health and healthcare'. Literature investigating cardiovascular disease (CVD) prevention and health literacy often exist in silos, only exploring one element of prevention. This protocol aims to establish a scoping method of articles investigating health literacy and CVD preventive practices or knowledge in lay populations. METHODS AND ANALYSIS A scoping review was deemed the most appropriate study design. The topic was conceptualised, with preliminary searching informing subsequent development of search strings. A search of the following databases will be conducted on 31 January 2022: MEDLINE, Global Health, PubMed, Embase, PsycINFO and CINAHL. Studies included will be published in English, of appropriate design, measuring health literacy and some aspect of primary CVD prevention in lay-populations. These criteria will be tested against 25 'pilot' articles from the results, undergoing necessary review before screening commences. A secondary author will screen 10% of abstracts, with a third subject-matter expert reviewing conflicts. ETHICS AND DISSEMINATION This review will be disseminated through peer-reviewed scholarly networks, most likely including journal publication and conference presentation. ARTICLE SUMMARY CVD is the leading cause of death around the world. This paper proposes an exploration of health literacy's relationship with CVD prevention as a whole, contrasting with the more segmented reviews currently published.
Collapse
Affiliation(s)
- Bonnie Beasant
- Institute for Mental and Physical Health and Clinical Translation, Deakin University School of Medicine, Geelong, Victoria, Australia
| | - Georgie Lee
- Institute for Mental and Physical Health and Clinical Translation, Deakin University School of Medicine, Geelong, Victoria, Australia
| | - Vanessa Vaughan
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Mojtaba Lotfaliany
- Institute for Mental and Physical Health and Clinical Translation, Deakin University School of Medicine, Geelong, Victoria, Australia
| | - Sarah Hosking
- Institute for Mental and Physical Health and Clinical Translation, Deakin University School of Medicine, Geelong, Victoria, Australia
| |
Collapse
|
9
|
Hastings K, Marquina C, Morton J, Abushanab D, Berkovic D, Talic S, Zomer E, Liew D, Ademi Z. Projected New-Onset Cardiovascular Disease by Socioeconomic Group in Australia. PHARMACOECONOMICS 2022; 40:449-460. [PMID: 35037191 PMCID: PMC8761535 DOI: 10.1007/s40273-021-01127-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 05/22/2023]
Abstract
BACKGROUND Socioeconomic status has an important effect on cardiovascular disease (CVD). Data on the economic implications of CVD by socioeconomic status are needed to inform healthcare planning. OBJECTIVES The aim of this study was to project new-onset CVD and related health economic outcomes in Australia by socioeconomic status from 2021 to 2030. METHODS A dynamic population model was built to project annual new-onset CVD by socioeconomic quintile in Australians aged 40-79 years from 2021 to 2030. Cardiovascular risk was estimated using the Pooled Cohort Equation (PCE) from Australian-specific data, stratified for each socioeconomic quintile. The model projected years of life lived, quality- adjusted life-years (QALYs), acute healthcare medical costs, and productivity losses due to new-onset CVD. All outcomes were discounted by 5% annually. RESULTS PCE estimates showed that 8.4% of people in the most disadvantaged quintile were at high risk of CVD, compared with 3.7% in the least disadvantaged quintile (p < 0.001). From 2021 to 2030, the model projected 32% more cardiovascular events in the most disadvantaged quintile compared with the least disadvantaged (127,070 in SE 1 vs. 96,222 in SE 5). Acute healthcare costs in the most disadvantaged quintile were Australian dollars (AU$) 183 million higher than the least disadvantaged, and the difference in productivity costs was AU$959 million. Removing the equity gap (by applying the cardiovascular risk from the least disadvantaged quintile to the whole population) would prevent 114,822 cardiovascular events and save AU$704 million of healthcare costs and AU$3844 million of lost earnings over the next 10 years. CONCLUSION Our results highlight the pressing need to implement primary prevention interventions to reduce cardiovascular health inequity. This model provides a platform to incorporate socioeconomic status into health economic models by estimating which interventions are likely to yield more benefits in each socioeconomic quintile.
Collapse
Affiliation(s)
- Kaitlyn Hastings
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Clara Marquina
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Jedidiah Morton
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Dina Abushanab
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | | | - Stella Talic
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.
| |
Collapse
|
10
|
Cardiac Cell Therapy with Pluripotent Stem Cell-Derived Cardiomyocytes: What Has Been Done and What Remains to Do? Curr Cardiol Rep 2022; 24:445-461. [PMID: 35275365 PMCID: PMC9068652 DOI: 10.1007/s11886-022-01666-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW Exciting pre-clinical data presents pluripotent stem cell-derived cardiomyocytes (PSC-CM) as a novel therapeutic prospect following myocardial infarction, and worldwide clinical trials are imminent. However, despite notable advances, several challenges remain. Here, we review PSC-CM pre-clinical studies, identifying key translational hurdles. We further discuss cell production and characterization strategies, identifying markers that may help generate cells which overcome these barriers. RECENT FINDINGS PSC-CMs can robustly repopulate infarcted myocardium with functional, force generating cardiomyocytes. However, current differentiation protocols produce immature and heterogenous cardiomyocytes, creating related issues such as arrhythmogenicity, immunogenicity and poor engraftment. Recent efforts have enhanced our understanding of cardiovascular developmental biology. This knowledge may help implement novel differentiation or gene editing strategies that could overcome these limitations. PSC-CMs are an exciting therapeutic prospect. Despite substantial recent advances, limitations of the technology remain. However, with our continued and increasing biological understanding, these issues are addressable, with several worldwide clinical trials anticipated in the coming years.
Collapse
|
11
|
de Souza E Silva CG, Nishijuka FA, de Castro CLB, Franca JF, Myers J, Laukkanen JA, de Araújo CGS. Women Have Lower Mortality Than Men After Attending a Long-Term Medically Supervised Exercise Program. J Cardiopulm Rehabil Prev 2022; 42:120-127. [PMID: 34117185 DOI: 10.1097/hcr.0000000000000623] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Medically supervised exercise programs (MSEPs) are equally recommended for men and women with cardiovascular disease (CVD). Aware of the lower CVD mortality in women, we hypothesized that among patients attending a MSEP, women would also have better survival. METHODS Data from men and women, who were enrolled in a MSEP between 1994 and 2018, were retrospectively analyzed. Sessions included aerobic, resistance, flexibility and balance exercises, and cardiopulmonary exercise test was performed. Date and underlying cause of death were obtained. Kaplan-Meier methods and Cox proportional hazards regression were used for survival analysis. RESULTS A total of 2236 participants (66% men, age range 33-85 yr) attended a median of 52 (18, 172) exercise sessions, and 23% died during 11 (6, 16) yr of follow-up. In both sexes, CVD was the leading cause of death (39%). Overall, women had a more favorable clinical profile and a longer survival compared to men (HR = 0.71: 95% CI, 0.58-0.85; P < .01). When considering those with coronary artery disease and similar clinical profile, although women had a lower percentage of sex- and age-predicted maximal oxygen uptake at baseline than men (58 vs 78%; P < .01), after adjusting for age, women still had a better long-term survival (HR = 0.68: 95% CI, 0.49-0.93; P = .02). CONCLUSION Survival after attendance to a long-term MSEP was better among women, despite lower baseline cardiorespiratory fitness. Future studies should address whether men and women would similarly benefit when participating in an MSEP.
Collapse
Affiliation(s)
- Christina Grüne de Souza E Silva
- Exercise Medicine Clinic (Clínica de Medicina do Exercício, CLINIMEX), Rio de Janeiro, Brazil (Drs de Souza e Silva, Castro, Franca, and Araújo); Escola de Medicina Souza Marques, Rio de Janeiro, Brazil (Dr Nishijuka); Division of Cardiology, VA Palo Alto, Palo Alto, California, and Stanford University School of Medicine, Stanford, Stanford, California (Dr Myers); and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland, and Central Finland Health Care District Hospital, Jyväskylä, Finland, and Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland (Dr Laukkanen)
| | | | | | | | | | | | | |
Collapse
|
12
|
Alsayegh F, Alkhamis MA, Ali F, Attur S, Fountain-Jones NM, Zubaid M. Anemia or other comorbidities? using machine learning to reveal deeper insights into the drivers of acute coronary syndromes in hospital admitted patients. PLoS One 2022; 17:e0262997. [PMID: 35073375 PMCID: PMC8786175 DOI: 10.1371/journal.pone.0262997] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 01/10/2022] [Indexed: 11/26/2022] Open
Abstract
Acute coronary syndromes (ACS) are a leading cause of deaths worldwide, yet the diagnosis and treatment of this group of diseases represent a significant challenge for clinicians. The epidemiology of ACS is extremely complex and the relationship between ACS and patient risk factors is typically non-linear and highly variable across patient lifespan. Here, we aim to uncover deeper insights into the factors that shape ACS outcomes in hospitals across four Arabian Gulf countries. Further, because anemia is one of the most observed comorbidities, we explored its role in the prognosis of most prevalent ACS in-hospital outcomes (mortality, heart failure, and bleeding) in the region. We used a robust multi-algorithm interpretable machine learning (ML) pipeline, and 20 relevant risk factors to fit predictive models to 4,044 patients presenting with ACS between 2012 and 2013. We found that in-hospital heart failure followed by anemia was the most important predictor of mortality. However, anemia was the first most important predictor for both in-hospital heart failure, and bleeding. For all in-hospital outcome, anemia had remarkably non-linear relationships with both ACS outcomes and patients' baseline characteristics. With minimal statistical assumptions, our ML models had reasonable predictive performance (AUCs > 0.75) and substantially outperformed commonly used statistical and risk stratification methods. Moreover, our pipeline was able to elucidate ACS risk of individual patients based on their unique risk factors. Fully interpretable ML approaches are rarely used in clinical settings, particularly in the Middle East, but have the potential to improve clinicians' prognostic efforts and guide policymakers in reducing the health and economic burdens of ACS worldwide.
Collapse
Affiliation(s)
- Faisal Alsayegh
- Faculty of Medicine, Department of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Moh A. Alkhamis
- Faculty of Public Health, Department of Epidemiology and Biostatistics, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Fatima Ali
- Faculty of Medicine, Department of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Sreeja Attur
- Faculty of Medicine, Department of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| | - Nicholas M. Fountain-Jones
- School of Natural Sciences, University of Tasmania, Hobart, Australia
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, United States of America
| | - Mohammad Zubaid
- Faculty of Medicine, Department of Medicine, Health Sciences Center, Kuwait University, Kuwait City, Kuwait
| |
Collapse
|
13
|
Lim HY, Donnan G, Nandurkar H, Ho P. Global coagulation assays in hypercoagulable states. J Thromb Thrombolysis 2022; 54:132-144. [PMID: 34997471 DOI: 10.1007/s11239-021-02621-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/26/2022]
Abstract
Thrombosis is one of the major global causes of morbidity and mortality, and predicting the risk of thrombotic and cardiovascular complications remains one of the key challenges in modern medicine. Conventional coagulation testing does not provide sufficient information, primarily because they measure the time to start of blood clotting and do not evaluate total thrombin generation. Possible adjunctive tools that may be helpful are global coagulation assays, which includes the assessment of the final products of the coagulation cascade, namely thrombin and fibrin. Whilst these assays have been more widely investigated in bleeding states, their role in thrombotic disorders is less established. We have previously investigated the use of assays such as thromboelastography, calibrated automated thrombogram and overall haemostatic potential assay in several hypercoagulable states including cardiovascular disease, haematological disorders and influence of hormone status as well as healthy controls. We provide a review of the use and limitations of global coagulation assays in healthy controls as well as hypercoagulable conditions.
Collapse
Affiliation(s)
- Hui Yin Lim
- Department of Haematology, Northern Pathology Victoria, Northern Health, Northern Hospital, 185 Cooper St, Epping, VIC, 3076, Australia.
- Australian Centre for Blood Diseases, Monash University - Monash AMREP Building, Level 1 Walkway via the Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
- Department of Medicine, Northern Health, University of Melbourne, Studley Road, Heidelberg, VIC, 3084, Australia.
| | - Geoffrey Donnan
- The Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, 4/300 Grattan St, Parkville, VIC, 3050, Australia
| | - Harshal Nandurkar
- Australian Centre for Blood Diseases, Monash University - Monash AMREP Building, Level 1 Walkway via the Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Prahlad Ho
- Department of Haematology, Northern Pathology Victoria, Northern Health, Northern Hospital, 185 Cooper St, Epping, VIC, 3076, Australia
- Australian Centre for Blood Diseases, Monash University - Monash AMREP Building, Level 1 Walkway via the Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Department of Medicine, Northern Health, University of Melbourne, Studley Road, Heidelberg, VIC, 3084, Australia
| |
Collapse
|
14
|
Peng CQ, Lawson KD, Heffernan M, McDonnell G, Liew D, Lybrand S, Pearson SA, Cutler H, Kritharides L, Trieu K, Huynh Q, Usherwood T, Occhipinti JA. Gazing through time and beyond the health sector: Insights from a system dynamics model of cardiovascular disease in Australia. PLoS One 2021; 16:e0257760. [PMID: 34591888 PMCID: PMC8483334 DOI: 10.1371/journal.pone.0257760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 09/09/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To construct a whole-of-system model to inform strategies that reduce the burden of cardiovascular disease (CVD) in Australia. METHODS A system dynamics model was developed with a multidisciplinary modelling consortium. The model population comprised Australians aged 40 years and over, and the scope encompassed acute and chronic CVD as well as primary and secondary prevention. Health outcomes were CVD-related deaths and hospitalisations, and economic outcomes were the net benefit from both the healthcare system and societal perspectives. The eight strategies broadly included creating social and physical environments supportive of a healthy lifestyle, increasing the use of preventive treatments, and improving systems response to acute CVD events. The effects of strategies were estimated as relative differences to the business-as-usual between 2019-2039. Probabilistic sensitivity analysis produced uncertainty intervals of interquartile ranges (IQR). FINDINGS The greatest reduction in CVD-related deaths was seen in strategies that improve systems response to acute CVD events (8.9%, IQR: 7.7-10.2%), yet they resulted in an increase in CVD-related hospitalisations due to future recurrent admissions (1.6%, IQR: 0.1-2.3%). This flow-on effect highlighted the importance of addressing underlying CVD risks. On the other hand, strategies targeting the broad environment that supports a healthy lifestyle were effective in reducing both hospitalisations (7.1%; IQR: 5.0-9.5%) and deaths (8.1% reduction; IQR: 7.1-8.9%). They also produced an economic net benefit of AU$43.3 billion (IQR: 37.7-48.7) using a societal perspective, largely driven by productivity gains. Overall, strategic planning to reduce the burden of CVD should consider the varying effects of strategies over time and beyond the health sector.
Collapse
Affiliation(s)
- Cindy Q. Peng
- Decision Analytics, The SAX Institute, Sydney, Australia
- * E-mail:
| | - Kenny D. Lawson
- Adjunct, Western Sydney University, Sydney, Australia
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Mark Heffernan
- Adjunct, Western Sydney University, Sydney, Australia
- Dynamic Operations, Sydney, Australia
| | | | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Henry Cutler
- Centre for the Health Economy, Macquarie University, Sydney, Australia
| | - Leonard Kritharides
- Concord Repatriation General Hospital, University of Sydney, Sydney, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Jo-An Occhipinti
- Decision Analytics, The SAX Institute, Sydney, Australia
- Brain and Mind Centre, University of Sydney, Sydney, Australia
- Computer Simulation & Advanced Research Technology (CSART), Sydney, Australia
| |
Collapse
|
15
|
Choi M, Raeside R, Hyun K, Partridge SR, Thiagalingam A, Redfern J. Understanding Preferences for Lifestyle-Focused Visual Text Messages in Patients With Cardiovascular and Chronic Respiratory Disease: Discrete Choice Experiment. J Med Internet Res 2021; 23:e26224. [PMID: 34542413 PMCID: PMC8491117 DOI: 10.2196/26224] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/15/2021] [Accepted: 07/21/2021] [Indexed: 12/04/2022] Open
Abstract
Background Supporting healthy lifestyle changes is a key aim of cardiovascular and pulmonary rehabilitation programs. SMS text messaging programs have demonstrated effectiveness in cardiovascular disease risk reduction, weight loss, increasing physical activity, and smoking cessation. The optimization of SMS text messaging programs may deliver greater population benefits as mobile phone use becomes ubiquitous. Visual messaging (ie, image-based messages) has the potential to communicate health messages via digital technology and result in enhanced engagement. Objective This study aims to determine and understand patient preferences for lifestyle-focused visual text messages that support cardiovascular and pulmonary rehabilitation. Methods A discrete choice experiment was conducted in a 4-stage iterative process to elicit patient preferences for visual message features. Attribute and level development yielded 3 attributes (purpose, image type, and web address), and 16 choice sets were subsequently constructed according to a full factorial design. Patients participating in cardiovascular and pulmonary rehabilitation were surveyed (on the web) for their preferences regarding the visual message choice sets. Respondents were asked to choose among 16 pairs of visual messages regarding key lifestyle behaviors, namely, physical activity and nutrition. The data were analyzed using a conditional logit model. Results There was a total of 1728 observations from 54 unique respondents. Two factors that were associated with patient preference were gain-framed purpose compared with no purpose (odds ratio [OR] 1.93, 95% CI 1.40-2.65) and real images compared with cartoon images (OR 1.26, 95% CI 1.04-1.54). A loss-framed purpose was less preferred than no purpose (OR 0.55, 95% CI 0.42-0.74). Overall, patients preferred positive images that were colorful and engaged with text that supported the image and had a preference for images of real people rather than cartoons. Conclusions A discrete choice experiment is a scientific method for eliciting patient preferences for a visual messaging intervention that is designed to support changes in lifestyle behaviors. SMS text messaging programs that use visual aids may result in greater patient satisfaction by using a gain frame, using real images, and avoiding a loss frame. Further research is needed to explore the feasibility of implementation and the health and behavioral outcomes associated with such visual messaging programs.
Collapse
Affiliation(s)
- Michael Choi
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Rebecca Raeside
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Consumer Engagement and Codesign Research Hub, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Karice Hyun
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Consumer Engagement and Codesign Research Hub, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia
| | - Stephanie R Partridge
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Consumer Engagement and Codesign Research Hub, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Prevention Research Collaboration, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Cardiology, Westmead Hospital, Sydney, Australia.,George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Julie Redfern
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Consumer Engagement and Codesign Research Hub, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,George Institute for Global Health, University of New South Wales, Sydney, Australia.,Research Education Network, Western Sydney Local Health District, Sydney, Australia
| |
Collapse
|
16
|
Paratz ED, Smith K, Ball J, van Heusden A, Zentner D, Parsons S, Morgan N, Thompson T, James P, Pflaumer A, Semsarian C, Stub D, Liew D, La Gerche A. The economic impact of sudden cardiac arrest. Resuscitation 2021; 163:49-56. [PMID: 33865963 DOI: 10.1016/j.resuscitation.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/15/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There are 20,000 sudden cardiac arrests (SCAs) in Australia annually, with 90% case-fatality. OBJECTIVE The present study calculated both the health and economic impact of SCAs in Victoria, Australia. METHODS Data on all SCAs attended by Ambulance Victoria from July 2017 to June 2018 were collected regarding age, gender, and survival to hospital, discharge and 12 months. Pre-SCA employment status of all patients was modelled using age and gender-matched Australian economic data. A Markov state-transition model with a five-year horizon calculated health and economic impact in years of life lived (YLL), productivity-adjusted life years (PALYs) and gross domestic product (GDP) lost. A counterfactual Markov state-transition model assessed outcomes of an identical cohort of patients who did not experience SCA. All values were discounted by 5%. RESULTS In 12 months, 4637 people suffered SCAs in Victoria, of whom 1516 (32.7%) were working at the time. 695 patients (15.0%) survived to hospital, 325 (7.0%) to discharge, and 303 (6.5%) to 12 months. In five years following their SCA, the cohort lost 15,922 years of life and 2327 PALYs. Reduced productivity led to GDP losses of AUD$448 million (92.8% relative reduction). Extrapolated to the 20,000 SCAs occurring across all of Australia, total GDP losses approached AUD$2 billion. CONCLUSION The health and economic burden of SCAs is high, predominantly underpinned by very high mortality. Annual national losses approach AUD$2 billion (USD$1.42 billion) and are comparable to productivity losses from all cancers combined. Prioritising research and state-of-the-art care for SCA patients appears economically sound.
Collapse
Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia; St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia.
| | - Karen Smith
- Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC, 3108, Australia; Department of Paramedicine, Monash University, Melbourne, VIC, Australia; Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | - Jocasta Ball
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia; Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC, 3108, Australia; Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | | | - Dominica Zentner
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia; Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC, 3006, Australia; Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, VIC, 3006, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC, 3006, Australia
| | - Tina Thompson
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - Paul James
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - Andreas Pflaumer
- Royal Children's Hospital, 50 Flemington Rd Parkville, Melbourne, VIC, 3052, Australia; Department of Paediatrics, Melbourne University, Parkville, VIC, 3010, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC, 3052, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, The University of Sydney, Missenden Rd, Sydney, NSW, 2050, Australia
| | - Dion Stub
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia; Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC, 3108, Australia; Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | - Danny Liew
- Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia; Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC, 3181, Australia; Alfred Hospital, 55 Commercial Rd, Prahran, VIC, 3181, Australia; St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia
| |
Collapse
|
17
|
Tabassum R, Ripatti S. Integrating lipidomics and genomics: emerging tools to understand cardiovascular diseases. Cell Mol Life Sci 2021; 78:2565-2584. [PMID: 33449144 PMCID: PMC8004487 DOI: 10.1007/s00018-020-03715-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023]
Abstract
Cardiovascular diseases (CVDs) are the leading cause of mortality and morbidity worldwide leading to 31% of all global deaths. Early prediction and prevention could greatly reduce the enormous socio-economic burden posed by CVDs. Plasma lipids have been at the center stage of the prediction and prevention strategies for CVDs that have mostly relied on traditional lipids (total cholesterol, total triglycerides, HDL-C and LDL-C). The tremendous advancement in the field of lipidomics in last two decades has facilitated the research efforts to unravel the metabolic dysregulation in CVDs and their genetic determinants, enabling the understanding of pathophysiological mechanisms and identification of predictive biomarkers, beyond traditional lipids. This review presents an overview of the application of lipidomics in epidemiological and genetic studies and their contributions to the current understanding of the field. We review findings of these studies and discuss examples that demonstrates the potential of lipidomics in revealing new biology not captured by traditional lipids and lipoprotein measurements. The promising findings from these studies have raised new opportunities in the fields of personalized and predictive medicine for CVDs. The review further discusses prospects of integrating emerging genomics tools with the high-dimensional lipidome to move forward from the statistical associations towards biological understanding, therapeutic target development and risk prediction. We believe that integrating genomics with lipidome holds a great potential but further advancements in statistical and computational tools are needed to handle the high-dimensional and correlated lipidome.
Collapse
Affiliation(s)
- Rubina Tabassum
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, PO Box 20, 00014, Helsinki, Finland.
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, PO Box 20, 00014, Helsinki, Finland.
- Department of Public Health, Clinicum, University of Helsinki, Helsinki, Finland.
- Broad Institute of the Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA.
| |
Collapse
|
18
|
Nghiem S, Afoakwah C, Byrnes J, Scuffham P. Lifetime Costs of Hospitalised Cardiovascular Disease in Australia: An Incidence-Based Estimate. Heart Lung Circ 2021; 30:1207-1212. [PMID: 33632592 DOI: 10.1016/j.hlc.2020.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/17/2020] [Accepted: 10/24/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To estimate the incidence-based, lifetime costs of health care and productivity losses associated with cardiovascular disease (CVD) using hospital admission data from Queensland, Australia. METHODS Retrospective analysis of data on CVD health care use sourced from Queensland Hospital Admitted Patient Data Collection (QHAPDC), Emergency Department Data Collection (EDDC), Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS). Costs were estimated from the societal perspective. Study participants included patients who were first admitted to any Queensland hospital in 2010 for a CVD-related treatment. Subsequent admissions of these patients were followed until December 2015. The present value of incidence-based lifetime costs per patient were used to estimate the total costs for Australia. All costs were presented in Australian dollars at 2019 prices. RESULTS The estimated lifetime health care cost of CVD was AUD$65,700 per person. Productivity loss cost was higher at AUD$75,200 per person, and total indirect lifetime costs were $140,900 per person. Scaling these costs up for the Australian population, the estimated incidence-based lifetime CVD costs for Australia were $60.5 billion ($28.2 billion in direct costs and $32.3 billion in indirect costs). CONCLUSIONS Incidence-based lifetime indirect costs of CVD were higher than the direct costs. The life-time cost structure suggests that economic benefits of health care interventions for cardiovascular diseases from a societal perspective should be at least twice as large than that from a health service perspective.
Collapse
Affiliation(s)
- Son Nghiem
- Centre for Applied Health Economics, Griffith University, Brisbane, Qld, Australia.
| | - Clifford Afoakwah
- Centre for Applied Health Economics, Griffith University, Brisbane, Qld, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Brisbane, Qld, Australia
| | - Paul Scuffham
- Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia. https://twitter.com/MenziesHealth
| |
Collapse
|
19
|
Chen Q, Yin Q, Song J, Liu C, Chen H, Li S. Identification of monocyte-associated genes as predictive biomarkers of heart failure after acute myocardial infarction. BMC Med Genomics 2021; 14:44. [PMID: 33563285 PMCID: PMC7871627 DOI: 10.1186/s12920-021-00890-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/31/2021] [Indexed: 12/21/2022] Open
Abstract
Background Acute myocardial infarction (AMI) is a major contributor of heart failure (HF). Peripheral blood mononuclear cells (PBMCs), mainly monocytes, are the essential initiators of AMI-induced HF. The powerful biomarkers for early identification of AMI patients at risk of HF remain elusive. We aimed to identify monocyte-related critical genes as predictive biomarkers for post-AMI HF. Methods We performed weighted gene co-expression network analysis (WGCNA) on transcriptomics of PBMCs from AMI patients who developed HF or did not. Functional enrichment analysis of genes in significant modules was performed via Metascape. Then we obtained the single-cell RNA-sequencing data of recruited monocytes/macrophages from AMI and control mice using the Scanpy and screened 381 differentially expressed genes (DEGs) between the two groups. We validated the expression changes of the 25 genes in cardiac macrophages from AMI mice based on bulk RNA-sequencing data and PBMCs data mentioned above. Results In our study, the results of WGCNA showed that two modules containing 827 hub genes were most significantly associated with post-AMI HF, which mainly participated in cell migration, inflammation, immunity, and apoptosis. There were 25 common genes between DEGs and hub genes, showing close relationship with inflammation and collagen metabolism. CUX1, CTSD and ADD3 exhibited consistent changes in three independent studies. Receiver operating characteristic curve analysis showed that each of the three genes had excellent performance in recognizing post-AMI HF patients. Conclusion Our findings provided a set of three monocyte-related biomarkers for the early prediction of HF development after AMI as well as potential therapeutic targets of post-AMI HF.
Collapse
Affiliation(s)
- Qixin Chen
- Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Peking University People's Hospital, No 11. Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Qijin Yin
- Ministry of Education Key Laboratory of Bioinformatics, Research Department of Bioinformatics at the Beijing National Research Center for Information Science and Technology, Center for Synthetic and Systems Biology, Department of Automation, Tsinghua University, Beijing, 100084, China
| | - Junxian Song
- Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Peking University People's Hospital, No 11. Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Chuanfen Liu
- Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Peking University People's Hospital, No 11. Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Hong Chen
- Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Peking University People's Hospital, No 11. Xizhimen South Street, Xicheng District, Beijing, 100044, China.
| | - Sufang Li
- Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Center for Cardiovascular Translational Research, Peking University People's Hospital, No 11. Xizhimen South Street, Xicheng District, Beijing, 100044, China.
| |
Collapse
|
20
|
Myokines and Heart Failure: Challenging Role in Adverse Cardiac Remodeling, Myopathy, and Clinical Outcomes. DISEASE MARKERS 2021; 2021:6644631. [PMID: 33520013 PMCID: PMC7819753 DOI: 10.1155/2021/6644631] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/08/2020] [Accepted: 01/06/2021] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) is a global medical problem that characterizes poor prognosis and high economic burden for the health system and family of the HF patients. Although modern treatment approaches have significantly decreased a risk of the occurrence of HF among patients having predominant coronary artery disease, hypertension, and myocarditis, the mortality of known HF continues to be unacceptably high. One of the most important symptoms of HF that negatively influences tolerance to physical exercise, well-being, social adaptation, and quality of life is deep fatigue due to HF-related myopathy. Myopathy in HF is associated with weakness of the skeletal muscles, loss of myofibers, and the development of fibrosis due to microvascular inflammation, metabolic disorders, and mitochondrial dysfunction. The pivotal role in the regulation of myocardial and skeletal muscle rejuvenation, attenuation of muscle metabolic homeostasis, and protection against ischemia injury and apoptosis belongs to myokines. Myokines are defined as a wide spectrum of active molecules that are directly synthesized and released by both cardiac and skeletal muscle myocytes and regulate energy homeostasis in autocrine/paracrine manner. In addition, myokines have a large spectrum of pleiotropic capabilities that are involved in the pathogenesis of HF including cardiac remodeling, muscle atrophy, and cardiac cachexia. The aim of the narrative review is to summarize the knowledge with respect to the role of myokines in adverse cardiac remodeling, myopathy, and clinical outcomes among HF patients. Some myokines, such as myostatin, irisin, brain-derived neurotrophic factor, interleukin-15, fibroblast growth factor-21, and growth differential factor-11, being engaged in the regulation of the pathogenesis of HF-related myopathy, can be detected in peripheral blood, and the evaluation of their circulating levels can provide new insights to the course of HF and stratify patients at higher risk of poor outcomes prior to sarcopenic stage.
Collapse
|
21
|
Aminde LN, Cobiac L, Veerman JL. Cost-effectiveness analysis of population salt reduction interventions to prevent cardiovascular disease in Cameroon: mathematical modelling study. BMJ Open 2020; 10:e041346. [PMID: 33234652 PMCID: PMC7689085 DOI: 10.1136/bmjopen-2020-041346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/15/2020] [Accepted: 10/18/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Reducing dietary sodium (salt) intake has been proposed as a population-wide strategy to reduce blood pressure and cardiovascular disease (CVD). The cost-effectiveness of such strategies has hitherto not been investigated in Cameroon. METHODS A multicohort multistate life table Markov model was used to evaluate the cost-effectiveness of three population salt reduction strategies: mass media campaign, school-based salt education programme and low-sodium salt substitute. A healthcare system perspective was considered and adults alive in 2016 were simulated over the life course. Outcomes were changes in disease incidence, mortality, health-adjusted life years (HALYs), healthcare costs and incremental cost-effectiveness ratios (ICERs) over the lifetime. Probabilistic sensitivity analysis was used to quantify uncertainty. RESULTS Over the life span of the cohort of adults alive in Cameroon in 2016, substantial numbers of new CVD events could be prevented, with over 10 000, 79 000 and 84 000 CVD deaths that could be averted from mass media, school education programme and salt substitute interventions, respectively. Population health gains over the lifetime were 46 700 HALYs, 348 800 HALYs and 368 400 HALYs for the mass media, school education programme and salt substitute interventions, respectively. ICERs showed that all interventions were dominant, with probabilities of being cost-saving of 84% for the school education programme, 89% for the mass media campaign and 99% for the low sodium salt substitute. Results were largely robust in sensitivity analysis. CONCLUSION All the salt reduction strategies evaluated were highly cost-effective with very high probabilities of being cost-saving. Salt reduction in Cameroon has the potential to save many lives and offers good value for money.
Collapse
Affiliation(s)
| | - Linda Cobiac
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - J Lennert Veerman
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| |
Collapse
|
22
|
Adverse Cardiac Remodelling after Acute Myocardial Infarction: Old and New Biomarkers. DISEASE MARKERS 2020; 2020:1215802. [PMID: 32626540 PMCID: PMC7306098 DOI: 10.1155/2020/1215802] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 01/06/2020] [Accepted: 05/22/2020] [Indexed: 12/15/2022]
Abstract
The prevalence of heart failure (HF) due to cardiac remodelling after acute myocardial infarction (AMI) does not decrease regardless of implementation of new technologies supporting opening culprit coronary artery and solving of ischemia-relating stenosis with primary percutaneous coronary intervention (PCI). Numerous studies have examined the diagnostic and prognostic potencies of circulating cardiac biomarkers in acute coronary syndrome/AMI and heart failure after AMI, and even fewer have depicted the utility of biomarkers in AMI patients undergoing primary PCI. Although complete revascularization at early period of acute coronary syndrome/AMI is an established factor for improved short-term and long-term prognosis and lowered risk of cardiovascular (CV) complications, late adverse cardiac remodelling may be a major risk factor for one-year mortality and postponded heart failure manifestation after PCI with subsequent blood flow resolving in culprit coronary artery. The aim of the review was to focus an attention on circulating biomarker as a promising tool to stratify AMI patients at high risk of poor cardiac recovery and developing HF after successful PCI. The main consideration affects biomarkers of inflammation, biomechanical myocardial stress, cardiac injury and necrosis, fibrosis, endothelial dysfunction, and vascular reparation. Clinical utilities and predictive modalities of natriuretic peptides, cardiac troponins, galectin 3, soluble suppressor tumorogenicity-2, high-sensitive C-reactive protein, growth differential factor-15, midregional proadrenomedullin, noncoding RNAs, and other biomarkers for adverse cardiac remodelling are discussed in the review.
Collapse
|
23
|
Berezin AE, Berezin AA. Extracellular Endothelial Cell-Derived Vesicles: Emerging Role in Cardiac and Vascular Remodeling in Heart Failure. Front Cardiovasc Med 2020; 7:47. [PMID: 32351973 PMCID: PMC7174683 DOI: 10.3389/fcvm.2020.00047] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/10/2020] [Indexed: 12/19/2022] Open
Abstract
Extracellular vesicles play a pivotal role in numerous physiological (immune response, cell-to-cell cooperation, angiogenesis) and pathological (reparation, inflammation, thrombosis/coagulation, atherosclerosis, endothelial dysfunction) processes. The development of heart failure is strongly associated with endothelial dysfunction, microvascular inflammation, alteration in tissue repair, and cardiac and vascular remodeling. It has been postulated that activated endothelial cell-derived vesicles are not just transfer forms of several active molecules (such as regulatory peptides, coagulation factors, growth factors, active molecules, hormones that are embedded onto angiogenesis, tissue reparation, proliferation, and even prevention from ischemia/hypoxia), but are instead involved in direct myocardial and vascular damage due to regulation of epigenetic responses of the tissue. These responses are controlled by several factors, such as micro-RNAs, that are transferred inside extracellular vesicles from mother cells to acceptor cells and are transductors of epigenetic signals. Finally, it is not a uniform opinion whether different phenotypes of heart failure are the result of altered cardiac and vascular reparation due to certain epigenetic responses, which are yielded by co-morbidities, such as diabetes mellitus and obesity. The aim of the review is to summarize knowledge regarding the role of various types of extracellular endothelial cell-derived vesicles in the regulation of cardiac and vascular remodeling in heart failure.
Collapse
Affiliation(s)
- Alexander E Berezin
- Internal Medicine Department, State Medical University, Ministry of Health of Ukraine, Zaporozhye, Ukraine
| | - Alexander A Berezin
- Internal Medicine Department, Medical Academy of Post-graduate Education, Ministry of Health of Ukraine, Zaporozhye, Ukraine
| |
Collapse
|
24
|
Ibdah RK, Ta'an WF, Shatnawi RM, Suliman MM, Rababah JA, Rawashdeh SI. The effectiveness of early position change postcardiac catheterization on patient's outcomes: A randomized controlled trial. Nurs Forum 2020; 55:380-388. [PMID: 32020631 DOI: 10.1111/nuf.12438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Nurses play a substantial role in maintaining patient homeostasis postcardiac catheterization. Patients frequently complain of back pain and discomfort as a result of the prolonged bed rest postcatheterization. AIM This study aims to evaluate the effectiveness of early position change postcardiac catheterization on reducing patients' pain and discomfort. SETTINGS The study was conducted at two cardiac units in a university hospital in Jordan. PARTICIPANTS A total of 120 patients were used in the study, 60 patients in each of the two groups-control and intervention. METHODS The randomized controlled trial design was used. Data were initially collected 1 hour after sheath removal postcardiac catheterization. After that, the protocol was applied to the interventional group. RESULTS Early position change 1 hour after sheath removal after cardiac catheterization was found to be effective in reducing back pain as compared with the control group (P < .001). Also, the study intervention was found to be effective in reducing urinary discomfort (X2 = 50.83, P < .001), and increasing comfort level (X2 = 120, P < .001). However, although participants in the intervention group were less likely to have constipation and hematoma than those in the control group, this outcome was not statistically significant at P > .05. CONCLUSION Early position change 1 hour after sheath removal postcardiac catheterization has significant positive effects on patient outcomes by reducing the intensity of back pain and urination problems and increasing patients' comfort level without increasing incidents of vascular complications such as bleeding and hematoma.
Collapse
Affiliation(s)
- Rashid K Ibdah
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Wafa'a F Ta'an
- Department of Community and Mental Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Rawan M Shatnawi
- Nursing Department, King Abdullah University Hospital, Irbid, Jordan
| | - Mohammad M Suliman
- Department of Community and Mental Health Nursing, Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
| | - Jehad A Rababah
- Department of Adults Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Sukaina I Rawashdeh
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
25
|
Obeng-Gyasi E. Lead Exposure and Cardiovascular Disease among Young and Middle-Aged Adults. Med Sci (Basel) 2019; 7:medsci7110103. [PMID: 31698758 PMCID: PMC6915582 DOI: 10.3390/medsci7110103] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 12/26/2022] Open
Abstract
Lead and its effects on cardiovascular-related markers were explored in this cross-sectional study of young adults (18–44 years) and middle-aged adults (45–65 years) from the United States using the National Health and Nutrition Examination Survey (NHANES), 2009–2016. Degrees of exposure were created using blood lead level (BLL) as the biomarker of exposure based on the epidemiologically relevant threshold of BLL > 5 μg/dL. The mean values, in addition to the percentages of people represented for the markers of interest (systolic blood pressure [SBP], diastolic blood pressure [DBP], gamma-glutamyl transferase [GGT], non-high-density lipoprotein cholesterol [non-HDL-C]) were explored. Among those exposed to lead, the likelihood of elevated clinical markers (as defined by clinically relevant thresholds of above normal) were examined using binary logistic regression. In exploring exposure at the 5 μg/dL levels, there were significant differences in all the mean variables of interest between young and middle-aged adults. The binary logistic regression showed young and middle-aged adults exposed to lead were significantly more likely to have elevated markers (apart from DBP). In all, lead affects cardiovascular-related markers in young and middle-aged U.S. adults and thus we must continue to monitor lead exposure to promote health.
Collapse
Affiliation(s)
- Emmanuel Obeng-Gyasi
- Environmental Health and Safety Program, Department of Built Environment, North Carolina Agricultural & Technical State University, Greensboro, NC 27411, USA
| |
Collapse
|