Trends in cardiovascular diseases burden and vascular risk factors in Italy: The Global Burden of Disease study 1990-2017

Monospecies Bacteria-Induced Chronic Apical Periodontitis Triggers the Aortic Inflammatory Response Via Modulation of Systemic Inflammation and Lipid Metabolism

Cardiovascular disease (CVD) is the leading cause of death worldwide and has been confirmed to be associated with a common oral bacterial infection-chronic apical periodontitis (CAP). However, the detailed mechanisms remain controversial. CAP can potentially alter systemic inflammation, lipid metabolism, and gut microbiota, all of which contribute to the progression of the aortic inflammatory response. This study aimed to explore the differential effects between Enterococcus faecalis and Porphyromonas gingivalis-CAP on the aortic inflammatory response, which focused on changes in systemic inflammation, lipid metabolism, and gut microbiota, to explore potential mechanisms linking oral disease to CVD. Our results showed P. gingivalis-CAP could activate more serious aortic inflammatory cytokine micro RNA expression (TNF-α, MCP-1, and ICAM-1) than E. faecalis-CAP by promoting higher serum inflammation (TNF-α, IL-6, IL-1α, and MCP-1) and lipid (low-density lipoprotein cholesterol and total cholesterol) levels. Simultaneously, there was no significant change in gut microbiota between them. Furthermore, all serum inflammatory cytokines showed substantial correlations with aortic inflammatory cytokine micro RNA expression, and certain serum lipid indicators showed significant correlations, but only 2 gut microorganisms (Ruminococcaceae and Prevotellaceae) showed significant correlations. The combined results suggest that CAP might activate the aortic inflammatory response in association with changes in the 3 potential mechanisms. However, the promotion of gut microbiota might be relatively weak. Using experimental CAP induced by specific bacteria, in which bacteria are sequestered in the medullary cavity, avoids the direct influence of blood or intestinal pathways and provides new perspectives for studying the mechanism of CVD associated with oral disease. Overall, these findings suggest that CAP may exacerbate systemic inflammation and serum lipid levels in patients with CVD, highlighting the importance of educating such patients on oral hygiene.

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.

The impact of budget cuts on individual patient health: Causal evidence from hospital closures

Public finance constraints following the 2008 financial crisis in Europe often affected the hospital sector. This paper investigates i) the causal health impacts of reduced hospital supply, and ii) possible mechanisms to explain these. Using a staggered difference-in-differences framework, we study the effects of hospital closures on outcomes of all heart attack patients admitted to an Italian hospital between 2008 and 2015. Results show that closures increased in-hospital mortality by 10 % and length-of-stay by 0.3 days, but had no impact on readmissions. We explore potential mechanisms using different estimation approaches, and show that increased travel time following closures explains most of the mortality effect.

Mangiferin and EGCG Compounds Fight Against Hyperlipidemia by Promoting FFA Oxidation via AMPK/PPARα

Background: Hyperlipidemia is a critical risk factor for obesity, diabetes, cardiovascular diseases, and other chronic diseases. Our study was to determine the effects and mechanism of mangiferin (MF) and epigallocatechin gallate (EGCG) compounds on improving hyperlipidemia in HepG2 cells. Methods: HepG2 cells were treated with 0.25 mM palmitic acid (PA) and then incubated with MF (12.5, 25, and 50 μM) or EGCG (25, 50, and 100 μM) or MF:EGCG (0:0, 6.25:12.5, 25:50, and 50:100 μM:μM) for 24 h. The improvement of hyperlipidemia was verified by Oil Red O staining, changes in triglyceride (TG) and free fatty acid (FFA) levels, and the expression of lipid metabolizing proteins in western blotting. Results: MF (12.5, 25, and 50 μM) or EGCG (25, 50, and 100 μM) markedly lowered lipid accumulations by lipid index levels. Furthermore, we found that the optimum concentration of MF and EGCG compounds was 25:50 (μM:μM), which significantly reduced the FFA level, TG, and total cholesterol (TC) accumulations and increased FFA uptake in HepG2 cells, and the effect was better than that of single phytochemicals. The adenosine 5⁣'-monophosphate (AMP)-activated protein kinase (AMPK) protein and its downstream proteins sirtuin 1 (SIRT1), peroxisome proliferator-activated receptor α (PPARα), and those involved in fatty acid translocase (CD36) and carnitine palmitoyltransferase 1 (CPT1) were also markedly increased in HepG2 cells. The upregulation of protein expression was reversed when AMPK-specific inhibitor Compound C was added. Conclusions: MF and EGCG (25:50 μM) compounds protect against hyperlipidemia by promoting the FFA oxidation, alleviating TG and TC accumulations via the AMPK/PPARα pathway in PA-treated HepG2 cells.

The Economic Burden of Atherosclerotic Cardiovascular Disease in Italy

BACKGROUND

Atherosclerotic cardiovascular diseases remain the primary cause of mortality in Italy. Individuals with a history of acute coronary syndrome, peripheral arterial disease, and ischemic stroke/transient ischemic attack face an elevated risk of recurrent major adverse cardiovascular events, including mortality. The population aging, coupled with increasing risk factors such as diabetes mellitus and obesity, exacerbates the disease's economic impact.

OBJECTIVES

This study aims to comprehensively assess the economic burden of atherosclerotic cardiovascular diseases in Italy, specifically focusing on direct healthcare costs.

METHODS

We analyzed real-world data from administrative databases in the Marche region and Local Health Unit Umbria 2. The economic burden of patients discharged with acute coronary syndrome, peripheral arterial disease, and ischemic stroke/transient ischemic attack was evaluated, with a focus on direct costs associated with hospitalizations, drugs, and outpatient visits. Results were stratified by age, sex, comorbidities at baseline, and adherence to lipid-lowering therapy and antihypertensive agents.

RESULTS

Annually, nearly 350,000 patients were hospitalized for peripheral arterial disease, acute coronary syndrome, or ischemic stroke/transient ischemic attack. Direct health costs averaged €7190 per patient over a 2-year follow-up, with hospitalizations accounting for nearly 70% of the total. Male patients incurred significantly higher costs (€7467) than female patients (€6625). Costs correlated positively with age and with the number of baseline comorbidities, with a range from €5259 (0-1 comorbidities) to €17,095 (4+ comorbidities). Costs were significantly lower in adherent subjects (€6813) compared with non-adherent subjects (€7757).

CONCLUSIONS

This study provides valuable insights into the economic implications of atherosclerotic cardiovascular diseases in Italy, emphasizing the necessity of a comprehensive approach to preventive measures, optimal medication adherence, and lifestyle modifications to mitigate its impact.

Temporal trends in temperature-related mortality and evidence for maladaptation to heat and cold in the Eastern Mediterranean region

The eastern Mediterranean region is characterized by rising temperature trends exceeding the corresponding global averages and is considered a climate change hot-spot. Although previous studies have thoroughly investigated the impact of extreme heat and cold on human mortality and morbidity, both for the current and future climate change scenarios, the temporal trends in temperature-related mortality or the potential historical adaptation to heat and cold extremes has never been studied in this region. This study focuses on cardiovascular mortality and assesses the temporal evolution of the Minimum Mortality Temperature (MMT), as well as the disease-specific cold- and heat-attributable fraction of mortality in three typical eastern Mediterranean environments (Athens, Thessaloniki and Cyprus). Data on daily cardiovascular mortality (ICD-10 code: I00-I99) and meteorological parameters were available between 1999 and 2019 for Athens, 1999 to 2018 for Thessaloniki and 2004 to 2019 for Cyprus. Estimation of cardiovascular MMT and mortality fractions relied on time-series Poisson regressions with distributed lag nonlinear models (DLNM) controlling for seasonal and long-term trends, performed over a series of rolling sub-periods at each site. The results indicated that in Athens, the MMT decreased from 23 °C (67.5th percentile) in 1999-2007 to 21.8 °C (62nd percentile) in 2011-2019, while in Cyprus the MMT decreased from 26.3 °C (79th percentile) in 2004-2012 to 23.9 °C (66.5th percentile) in 2011-2019. In Thessaloniki, the decrease in MMT was rather negligible. In all regions under study, the fractions of mortality attributed to both cold and heat followed an upward trend throughout the years. In conclusion, the demonstrated increase in cold attributable fraction and the decreasing temporal trend of MMT across the examined sites are suggestive of maladaptation to extreme temperatures in regions with warm climate and highlight the need for relevant public health policies and interventions.

Accuracy of duplex ultrasonography versus angiotomography for the diagnosis of extracranial internal carotid stenosis

INTRODUCTION

Internal carotid artery (ICA) stenosis causes about 15% of ischemic strokes. Duplex ultrasonography (DUS) is the first line of investigation of ICA stenosis, but its accuracy varies in the literature and it is usual to complement the study with another more accurate exam when faced with significant stenosis. There is a lack of studies that compare DUS with angiotomography (CTA) in the present literature.

METHODS

we performed an accuracy study, which compared DUS to CTA of patients in a tertiary hospital with a maximum interval of three months between tests. Patients were selected retrospectively, and two independent and certified vascular surgeons evaluated each image in a masked manner. When there was discordance, a third evaluator was summoned. We evaluated the diagnostic accuracy of ICA stenosis of 50-94% and 70-94%.

RESULTS

we included 45 patients and 84 arteries after inclusion and exclusion criteria applied. For the 50-94% stenosis range, DUS accuracy was 69%, sensitivity 89%, and specificity 63%. For the 70-94% stenosis range, DUS accuracy was 84%, sensitivity 61%, and specificity 93%. There was discordance between CTA evaluators with a change from clinical to surgical management in at least 37.5% of the conflicting reports.

CONCLUSION

DUS had an accuracy of 69% for stenoses of 50-94% and 84% for stenoses of 70-94% of the ICA. The CTA analysis depended directly on the evaluator with a change in clinical conduct in more than 37% of cases.

Atrial Fibrillation and Other Cardiovascular Factors and the Risk of Dementia: An Italian Case-Control Study

Dementia is a major neurologic syndrome characterized by severe cognitive decline, and it has a detrimental impact on overall physical health, leading to conditions such as frailty, changes in gait, and fall risk. Depending on whether symptoms occur before or after the age of 65, it can be classified as early-onset (EOD) or late-onset (LOD) dementia. The present study is aimed at investigating the role of cardiovascular factors on EOD and LOD risk in an Italian population. Using a case-control study design, EOD and LOD cases were recruited at the Modena Cognitive Neurology Centers in 2016-2019. Controls were recruited among caregivers of all the dementia cases. Information about their demographics, lifestyles, and medical history were collected through a tailored questionnaire. We used the odds ratio (OR) and 95% confidence interval (CI) to estimate the EOD and LOD risk associated with the investigated factors after adjusting for potential confounders. Of the final 146 participants, 58 were diagnosed with EOD, 34 with LOD, and 54 were controls. According to their medical history, atrial fibrillation was associated with increased disease risk (ORs 1.90; 95% CI 0.32-11.28, and 3.64; 95% CI 0.32-41.39 for EOD and LOD, respectively). Dyslipidemia and diabetes showed a positive association with EOD, while the association was negative for LOD. We could not evaluate the association between myocardial infarction and EOD, while increased risk was observed for LOD. No clear association emerged for carotid artery stenosis or valvular heart disease. In this study, despite the limited number of exposed subjects and the high imprecision of the estimates, we found positive associations between cardiovascular disease, particularly dyslipidemia, diabetes, and atrial fibrillation, and EOD.

Genetic, lifestyle and metabolic factors contributing to cardiovascular disease in the Italian population: a literature review

Cardiovascular diseases (CVD) represent a major health problem worldwide. In Italy, despite the decline in CVD mortality and disability-adjusted life years recently observed, CVD remains the leading cause of death. The development of CVD has a complex and multifactorial etiology that involves environmental, lifestyle/behavioral (e.g., unhealthy diet, physical inactivity, smoking, and alcohol abuse), metabolic, and genetic factors. Although a large number of CVD susceptibility genetic variants have been identified, some seem to confer risk according to the genetic background or ethnicity of the population. Some CVD-associated polymorphisms with appreciable frequency in the Italian population may be important contributors to the development and progression of the most prevalent CVD in the population. This literature review aims to provide an overview of the epidemiology of CVD in Italy, as well as to highlight the main genetic, lifestyle/behavioral, and metabolic factors contributing to CVD risk in this population.

Parental cardiometabolic multimorbidity and subsequent cardiovascular incidence in middle-aged adults: A prospective cohort study

Background

The prevalence of cardiometabolic multimorbidity, defined as the coexistence of two or three cardiometabolic diseases (CMDs), including coronary heart disease (CHD), diabetes, and stroke, has increased rapidly in recent years, but the additive association between parental cardiometabolic multimorbidity and cardiovascular incidence in middle-aged adults remains unclear.

Methods

All the data analysed in this study were derived from the UK Biobank, and a total of 71,923 participants aged 40-55 years old without CVD were included in the main analyses. A weighted score was developed and grouped participants into four parental CMDs patterns: non-CMD, low burden, middle burden, and high burden. Cox proportional hazard models were used to estimate the associations between parental CMDs pattern and CVD incidence before 65 years old. Improvement in CVD risk prediction by adding parental CMDs pattern to a basic model was evaluated.

Results

Among the 71,923 participants, 3070 CVD events were observed during a median 12.04 years of follow-up. Compared to non-CMD groups, adults in high burden group had a 94% (73-117%) increased risk of CVD. The restricted cubic spline analysis revealed an exposure-response association between parental CMDs burden and risk of CVD (Pnonlinear = 0.24). Additionally, models involving parental CMDs pattern showed slightly improvements in CVD risk prediction, especially for CHD.

Conclusion

An increased burden of parental CMDs was associated with an increased risk of CVD incidence in middle-aged adults. Parental CMDs pattern may provide valuable information in primary prevention of CVD in middle-aged adults.

Trends in sudden cardiac death mortality in Italy, 2013-2019

We sought to analyse the incidence of sudden cardiac deaths (SCDs) amongst subjects aged less than 39 years in Italy and its time trend between 2013 and 2019. Data regarding cause-specific mortality and population size by sex in 5-year age groups were extracted from the World Health Organization (WHO) mortality database. Decedents reporting the codes I46.1, I45.6, I47.2, I41.9, R09.2 and R96.0 of the International Classification of Disease-10 (ICD-10) coding system, were extracted. The age-adjusted mortality rates (AAMRs), with relative 95% confidence intervals (CIs) stratified by sex, were determined using the direct method. Joinpoint regression analyses were used to identify periods with statistically distinct log linear trends in SCD-related death rates. To calculate nationwide annual trends in SCD-related mortality, we assessed the annual and average annual per cent change (AAPC) and relative 95% CIs. Over the study period, 314 deaths [220 males (70.0%) and 94 females] were due to SCD corresponding to a 0.06 per 100,000 per year (0.10 per 100,000 in males and 0.04 per 100,000 in females, respectively). Proportional mortality slightly increased, without reaching the statistical significance (p = 0.82) from 3.06 to 3.56 per 100 deaths, with a similar trend in both sexes. Joinpoint regression analysis revealed a plateau in age-standardised SCD-related mortality over the period [AAPC: -4.2 (95% CI: -24.0 to 20.8, p = 0.71], which was consistent between males and females. In Italy, SCD remains a public health issue of concern in the last decade after adjusting for age.

A Mobile App-based Approach in Cardiovascular Disease Prevention: A Prospective Randomized Study

Cardiovascular risk factors are prevalent in the Italian population, and cardiovascular diseases remain a leading cause of mortality in the Western world. As the incidence of risk factors and cardiovascular diseases increases with age, effective and early prevention and management strategies are crucial. This study aims to evaluate the feasibility and potential benefits of using the Heartaway® mobile application as an additional intervention to standard clinical care for patients with hypertension. The study will explore improvements in blood pressure control, medication adherence, cardiovascular risk factors, lifestyle habits, and cardiovascular outcomes. The results of this study may contribute to a broader integration of telemedicine into cardiovascular disease prevention in the clinical practice.

Multi-Criterial Model for Weighting Biological Risk Factors in Multiple Sclerosis: Clinical and Health Insurance Implications

The etiology of Multiple Sclerosis (MS) remains undetermined. Its pathogenic risk factors are thought to play a negligible role individually in the development of the disease, instead assuming a pathogenic role when they interact with each other. Unfortunately, the statistical weighting of this pathogenic role in predicting MS risk is currently elusive, preventing clinical and health insurance applications. Here, we aim to develop a population-based multi-criterial model for weighting biological risk factors in MS; also, to calculate the individual MS risk value useful for health insurance application. Accordingly, among 596 MS patients retrospectively assessed at the time of diagnosis, the value of vitamin D < 10 nm/L, BMI (Body Mass Index) < 15 Kg/m2 and >30 Kg/m2, female sex, degree of family kinship, and the range of age at onset of 20-45 years were considered as biological risk factors for MS. As a result, in a 30-year-old representative patient having a BMI of 15 and second degree of family kinship for MS, the major developmental contributor for disease is the low vitamin D serum level of 10 nm/L, resulting in an MS risk of 0.110 and 0.106 for female and male, respectively. Furthermore, the Choquet integral applied to uncertain variables, such as biological risk factors, evidenced the family kinship as the main contributor, especially if coincident with the others, to the MS risk. This model allows, for the first time, for the risk stratification of getting sick and the application of the health insurance in people at risk for MS.

Executive Attentional Dyscontrol as a Core Cognitive and Behavioral Feature of Individuals with Obesity and Cardiovascular Disease: A Cross-Sectional Investigation

Executive attention as a frontal domain ability that is effective in potentially blocking distracting information, reconciling conflicts among simultaneous attentional demands, and regulating impulsive behavior may be impaired in individuals with obesity and cardiovascular disease (CVD). This study aimed (i) to explore the presence of selected cognitive (global cognitive impairment, sensitivity to interference, and attention) and psychological (quality of life, depression, anxiety, and impulsivity) dimensions and (ii) to examine the interactive relationship between attentional dyscontrol-both as a psychological and as a cognitive measure-and the above-mentioned variables in a sample of patients with CVD attending a cardiac rehabilitation program across different body mass index (BMI) levels. Clinical information of 104 patients with CVD was retrospectively collected. Participants were classified into three groups according to their BMI as follows: normal weight (NW = 30), overweight (OW = 19), and obese (OB = 55). Individuals with CVD and a higher BMI showed problems in controlling executive attention-through both neuropsychological and behavioral measures. Specifically, OB patients demonstrated reduced sensitivity to cognitive interference, lower capabilities in divided attention during visual-tracking tasks, and greater impulsivity compared to NW patients. This behavioral characteristic was also found to be correlated with higher levels of anxiety and depression and a lower quality of life. Implications for cognitive rehabilitation were discussed to offer directions for better management of patients with CVD and obesity.

Global burden of disease attributable to high systolic blood pressure in older adults, 1990-2019: an analysis for the Global Burden of Disease Study 2019

AIMS

High systolic blood pressure (HSBP), a significant public health challenge, has not been systematically studied in the elderly population in the context of global aging. Understanding the temporal trends of the disease burden associated with HSBP in the elderly population is essential to control and mitigate the harm caused by HSBP.

METHODS AND RESULTS

We used the estimated data derived from the Global Burden of Disease Study to analyse the disease burden of HSBP among the elderly population by region, sex, and temporal changes from 1990 to 2019. We found that the number of deaths due to HSBP increased to 7.86 (95% UI: 6.89-8.82) million, with an increase of 54.1%, and the number of disability-adjusted life years (DALYs) increased to 146 (95% UI: 130-162) million, with an increase of 52.4%. Conversely, the death and DALY rates of HSBP decreased by -27.0 and -27.8%, respectively. At the national and regional levels, Australasia and other high socio-demographic index regions have made significant improvements in the burden of HSBP, while it remains high in other regions of the world. Additionally, the burden of HSBP in older men is greater than that in older women.

CONCLUSION

Our findings indicate that the current prevention and control of HSBP in older adults is poor, with the total burden increasing significantly. There is an urgent need to implement feasible measures to resist HSBP and lessen the disparity of the global HSBP burden for older adults.

The ratio of monocyte count and high-density lipoprotein cholesterol mediates the association between urinary tungsten and cardiovascular disease: a study from NHANES 2005-2018

Tungsten (W) is an emerging contaminant that can damage multiple systems in humans. However, studies of its effects on cardiovascular disease (CVD) are limited. The monocyte count to high-density lipoprotein cholesterol ratio (MHR) is a composite inflammatory index of great concern in recent years, derived from lipid and cell inflammation parameters, that is used to indicate the risk of CVD. This study aimed to investigate the association between urinary W and CVD in the general population and compare the mediating effects of lipids, cell inflammatory parameters, and MHR to find a better target for intervention. We analyzed data from 9137 (≥ 20 years) participants in the National Health and Nutrition Examination Survey (NHANES), from 2005 to 2018. Restricted cubic splines (RCS) and survey-weighted generalized linear models (SWGLMs) were used to assess the relationship between W and CVD. Mediated analyses were used to explore lipids, cell inflammatory parameters, and MHR in the possible mediating pathways between W and CVD. In SWGLM, we found that W enhances the risk of CVD, especially congestive heart failure (CHF), coronary heart disease (CHD), and angina pectoris (AP). Women, higher age groups (≥ 55 years), and those with hypertension were vulnerable to W in the subgroup analysis. Mediation analysis showed that monocyte count (MC), white blood cell count (WBC), high-density lipoprotein cholesterol (HDL), and MHR played a mediating role between W and CVD in proportions of 8.49%, 3.70%, 5.18%, and 12.95%, respectively. In conclusion, our study shows that urinary W can increase the risk of CVD, especially for CHF, CHD, and AP. Women, older age groups, and people with hypertension seem to be more vulnerable to W. In addition, MC, WBC, HDL, and MHR mediated the association between W and CVD, especially MHR, which suggests that we should consider it as a priority intervention target in the future.

Declining trends of premature mortality from ischemic heart disease and regional differences in Italy from 2011 to 2017

AIMS

Data regarding the premature mortality (<65 years of age) due to ischemic heart disease (IHD) in Italy are scant. We sought to analyze the incidence of premature death due to IHD in Italy and its time trend between years 2011 and 2017.

METHODS AND RESULTS

We used the free publicly available EUROSTAT death certificate database to examine premature age-adjusted IHD mortality rates (per 100.000) and relative average annual percentage change (AAPC) in Italy from 2011 to 2017 using ICD-codes I20-I25. Over the study period, the proportional IHD-related mortality rates decline from 8.09% to 7.1% in the entire population (p for trend 0.012), showing a significant reduction in women (from 4.06% to 3.40%, p for trend: 0.02) but not in men (from 10.3% to 9.3%, p for trend 0.062). The age-adjusted IHD mortality rate decreased with an AAPC of -4.1 per year [(95% CI, -5.1 to -3.0), p < 0.001], resulting more pronounced in women [AAPC: -4.4 per year (95% CI: -6.4 to -2.3,), p = 0.001)] than in men [AAPC: -3.7 per year (95% CI: -5.4 to -2.0, p = 0.003)]. Age-adjusted IHD premature death rates above the 90th percentile were distributed in Italian southern regions and islands of Italy while premature death rates below the 10th percentile were clustered in the western and northeastern regions of the country.

CONCLUSIONS

In Italy, premature IHD-related mortality remains an important contributor to overall mortality. Age-adjusted mortality declined in the last decade, especially in the northern regions and among women. Moreover, a marked region-level variations were observed.

The Efficacy of Vision, Aphasia, Neglect Assessment in Predicting Emergent Large Vessel Occlusion in Patients Presenting with a Cerebrovascular Accident to the Emergency Department

Background

Early identification of patients with an emergent large vessel occlusion (ELVO) ischemic stroke is crucial in the Emergency Department (ED), as they are the ideal candidates for endovascular therapy.With this study, we have attempted to use Vision, Aphasia, Neglect (VAN) screening tool in the ED for rapid identification of ELVO ischemic stroke and compared its performance with the National Institute of Health Stroke Severity (NIHSS) scale.

Materials and methods

A prospective observational study was conducted in the ED of a tertiary care hospital over 18 months among all suspected stroke patients. Vision, aphasia, neglect and NIHSS scores were calculated on arrival. Magnetic resonance imaging + magnetic resonance angiography (MRI + MRA) were taken as gold standard.

Results

This study found that VAN identified ELVO with 85.19% sensitivity (p-value < 0.0001), 88.64% specificity (p-value < 0.0001), and 87% diagnostic accuracy, with respect to the gold standard test. Vision, aphasia, neglect had a positive predictive value (PPV) and negative predictive value (NPV) of 82.14% and 90.7%, respectively. Time taken to perform VAN score in the ED was on average 2 minutes. National Institute of Health Stroke Severity detected ELVO with a sensitivity of 88%, specificity of 51.11%, a PPV of 53.33%, and a NPV of 88.4%. Diagnostic accuracy was 66%, and it took approximately 5 minutes to perform. When both scores were applied together for ELVO detection, NPV was 100%.

Conclusion

Vision, Aphasia, Neglect score as well as NIHSS scale are both tools for clinical prediction of ELVO with VAN having a better diagnostic accuracy and utility as a screening tool in the ED.

How to cite this article

Krishnan A, Srinivasarangan M, Jagadish S, Bheemanna AS, Sivasankar A. The Efficacy of Vision, Aphasia, Neglect Assessment in Predicting Emergent Large Vessel Occlusion in Patients Presenting with a Cerebrovascular Accident to the Emergency Department. Indian J Crit Care Med 2023;27(7):475-481.

Time-Trends in Air Pollution Impact on Health in Italy, 1990-2019: An Analysis From the Global Burden of Disease Study 2019

Objectives: We explored temporal variations in disease burden of ambient particulate matter 2.5 μm or less in diameter (PM2.5) and ozone in Italy using estimates from the Global Burden of Disease Study 2019. Methods: We compared temporal changes and percent variations (95% Uncertainty Intervals [95% UI]) in rates of disability adjusted life years (DALYs), years of life lost, years lived with disability and mortality from 1990 to 2019, and variations in pollutant-attributable burden with those in the overall burden of each PM2.5- and ozone-related disease. Results: In 2019, 467,000 DALYs (95% UI: 371,000, 570,000) were attributable to PM2.5 and 39,600 (95% UI: 18,300, 61,500) to ozone. The crude DALY rate attributable to PM2.5 decreased by 47.9% (95% UI: 10.3, 65.4) from 1990 to 2019. For ozone, it declined by 37.0% (95% UI: 28.9, 44.5) during 1990-2010, but it increased by 44.8% (95% UI: 35.5, 56.3) during 2010-2019. Age-standardized rates declined more than crude ones. Conclusion: In Italy, the burden of ambient PM2.5 (but not of ozone) significantly decreased, even in concurrence with population ageing. Results suggest a positive impact of air quality regulations, fostering further regulatory efforts.

Relationship between bisphenol A and the cardiovascular disease metabolic risk factors in American adults: A population-based study

BACKGROUND

Bisphenol A (BPA) is widely used in personal care and consumer products. However, no study has reported a specific relationship between BPA concentrations and metabolic hazardous elements for cardiovascular diseases (CVDs). Consequently, in this study, we used six years of population-based NHANES data (2011-2016) to analyse the association between BPA concentrations and metabolic risk factors for CVDs.

METHODS

A total of 1467 participants were enrolled in our project. The participants in the study were divided into quartiles based on BPA levels (Q1: ≤0.6 ng/ml, Q2: 0.7-1.2 ng/ml, Q3: 1.3-2.3 ng/ml, Q4: ≥2.4 ng/ml). This study used multiple linear and multivariate logistic regression models to determine the association among BPA concentrations and CVD metabolic risk factors.

RESULTS

When the concentration of BPA was in Q3, fasting glucose concentrations were decreased by 3.87 mg/dl, and 2-h glucose concentrations were decreased by 16.24 mg/dl. When the concentration of BPA was in Q4, fasting glucose concentrations were decreased by 12.15 mg/dl, and diastolic blood pressure was increased by 2.08 mmHg. At the same time, compared to participants in the first quartile (Q1), those from the fourth quartile (Q4) of BPA concentrations had 21% higher odds of hypertension, 30% higher odds of obesity, 30.2% higher odds of central obesity, 4.5% higher odds of elevated HbA₁c, 17% higher odds of elevated non-HDL cholesterol, and 60.8% higher odds of diabetes (compared to the lowest quartile, Q1).

CONCLUSIONS

We found that higher concentrations of BPA were linked with a higher metabolic risk for CVDs. Further regulation of BPA may need to be considered for the prevention of CVDs in adults.

Projected Global Trends in Ischemic Stroke Incidence, Deaths and Disability-Adjusted Life Years From 2020 to 2030

BACKGROUND

We projected global trends in ischemic stroke from 2020 to 2030 according to age, sex, and socio-demographic index (SDI) quintile.

METHODS

Estimated annual percentage changes (EAPCs) were used to project trends in the incidence of deaths from and disability-adjusted life years (DALYs) due to ischemic stroke between 2020 and 2030. EAPCs were computed using generalized additive models and data from the Global Burden of Disease study during the 1990 to 2019 period.

RESULTS

The global age-standardized incidence rate of ischemic stroke was projected to increase to 89.32 per 100 000 population in 2030 (EAPC=0.89), whereas the associated global age-standardized death and DALY rates were projected to decrease to 18.28 (EAPC, -3.58) and 500.37 per 100 000 (EAPC=-1.75), respectively, in 2030. The projections indicated a higher age-standardized incidence rate of ischemic stroke among women than among men in 2030 (90.70 versus 87.64 per 100 000). The incidence rate of ischemic stroke was projected to increase across all age groups and SDI quintiles between 2020 and 2030. At the national level, the greatest increase in the age-standardized incidence rate of ischemic stroke between 2020 and 2030 was projected to occur in Cyprus (EAPC=4.16), followed by Palestine (EAPC=3.50) and South Africa (EAPC=2.64). Additionally, the projections suggested increases in the age-standardized death and DALY rates due to ischemic stroke for countries in low-SDI quintiles (EAPC=3.68 and EAPC=5.30, respectively).

CONCLUSIONS

The projections indicated that the incidence rate of ischemic stroke will increase both sexes, all age groups, and all SDI quintiles and in some countries between 2020 and 2030. Furthermore, countries with a low SDI should be aware of potential increases in the age-standardized death and DALY due to ischemic stroke.

Effects of Meteo-Climatic Factors on Hospital Admissions for Cardiovascular Diseases in the City of Bari, Southern Italy

The objective of this study was to determine the relationship between weather conditions and hospital admissions for cardiovascular diseases (CVD). The analysed data of CVD hospital admissions were part of the database of the Policlinico Giovanni XXIII of Bari (southern Italy) within a reference period of 4 years (2013-2016). CVD hospital admissions have been aggregated with daily meteorological recordings for the reference time interval. The decomposition of the time series allowed us to filter trend components; consequently, the non-linear exposure-response relationship between hospitalizations and meteo-climatic parameters was modelled with the application of a Distributed Lag Non-linear model (DLNM) without smoothing functions. The relevance of each meteorological variable in the simulation process was determined by means of machine learning feature importance technique. The study employed a Random Forest algorithm to identify the most representative features and their respective importance in predicting the phenomenon. As a result of the process, the mean temperature, maximum temperature, apparent temperature, and relative humidity have been determined to be the most suitable meteorological variables as the best variables for the process simulation. The study examined daily admissions to emergency rooms for cardiovascular diseases. Using a predictive analysis of the time series, an increase in the relative risk associated with colder temperatures was found between 8.3 °C and 10.3 °C. This increase occurred instantly and significantly 0-1 days after the event. The increase in hospitalizations for CVD has been shown to be correlated to high temperatures above 28.6 °C for lag day 5.

Astaxanthin Alleviates Foam Cell Formation and Promotes Cholesterol Efflux in Ox-LDL-Induced RAW264.7 Cells via CircTPP2/miR-3073b-5p/ABCA1 Pathway

Atherosclerosis (AS) is a common cardiovascular disease and remains the leading cause of death in the world. It is generally believed that the deposition of foam cells in the arterial wall is the main cause of AS. Moreover, promoting cholesterol efflux and enhancing the ability of reverse cholesterol transport (RCT) can effectively inhibit the formation of foam cells, thereby preventing the occurrence and development of AS. Astaxanthin, with a powerful antioxidant ability, has a potential role in the prevention of atherosclerosis, but how it works in preventing atherosclerosis remains unknown. Here, our experimental results suggest that astaxanthin can upregulate the expression of circular RNA tripeptidyl-peptidase II (circTPP2) and eventually promote cholesterol efflux by modulating ATP-binding cassette subfamily A member 1 (ABCA1). The expression of ABCA1 was significantly suppressed after knocking down circTPP2 in macrophage-derived foam cells. In addition, the experimental results showed that circTPP2 could downregulate the expression of microRNA-3073b-5p (miR-3073b-5p), and ABCA1 was identified as the target gene of miR-3073b-5p. In conclusion, the circTPP2/miR-3073b-5p/ABCA1 axis may be the specific mechanism of astaxanthin promoting cholesterol efflux.

Analysis of the heat- and cold-related cardiovascular mortality in an urban mediterranean environment through various thermal indices

During the last decades the effects of thermal stress on public health have been a great concern worldwide. Thermal stress is determined by air temperature in combination with other meteorological parameters, such as relative humidity and wind speed. The present study is focused on the Mediterranean city of Thessaloniki, Greece and it aims to explore the association between thermal stress and mortality from cardiovascular diseases, using both air temperature and other thermal indices as indicators. For that, an over-dispersed Poisson regression function was used, in combination with distributed lag non-linear models, in order to capture the delayed and nonlinear effects of temperature. Our results revealed a reverse J-shaped exposure-response curve for the total population and females and a U-shaped association for males. In all cases examined, the minimum mortality temperature was identified around the 80th percentile of each distribution. It is noteworthy that despite the fact that the highest risks of cardiovascular mortality were estimated for exposure to extreme temperatures, moderate temperatures were found to cause the highest burden of mortality. On the whole, our estimations demonstrated that the population in Thessaloniki is more susceptible to cold effects and in regard with gender, females seem to be more vulnerable to ambient thermal conditions.

Triglyceride-glucose index trajectory and stroke incidence in patients with hypertension: a prospective cohort study

Background

It has been suggested that the baseline triglyceride-glucose (TyG) index, a simple surrogate measure for insulin resistance, is significantly associated with the occurrence of stroke. Nevertheless, the impact of longitudinal patterns of TyG on the stroke risk in hypertensive patients is still unknown. Hence, this study aimed to investigate the association between TyG index trajectory and stroke risk among hypertensive patients.

Methods

This prospective study included 19,924 hypertensive patients from the Kailuan Study who underwent three waves survey and were free of myocardial infarction, cancer and stroke before or during 2010. The TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting plasma glucose (mg/dL)/2], and latent mixed modelling was used to identify the trajectory of TyG during the exposure period (2006–2010). Furthermore, the Cox proportional hazard models were applied to estimate the hazard ratio (HR) and 95% confidence interval (CI) for incident stroke of different trajectory groups.

Results

Five distinct TyG trajectory were identified during 2006–2010: low-stable (n = 2483; range, 8.03–8.06), moderate low-stable (n = 9666; range, 8.58–8.57), moderate high-stable (n = 5759; range, 9.16–9.09), elevated-stable (n = 1741; range, 9.79–9.75), and elevated-increasing (n = 275; range, 10.38–10.81). During the median follow-up of 9.97 years, 1,519 cases of incident stroke were identified, including 1,351 with ischemic stroke and 215 with hemorrhage stroke. After adjusting for confounding variables, the HR and 95% CI of stroke were 2.21 (1.49,3.28) for the elevated-increasing group, 1.43 (1.13,1.83) for the elevated-stable group, 1.35 (1.10,1.64) for the moderate high-stable group, 1.26 (1.06,1.52) for the moderate low-stable group, respectively, when compare with the low-stable group. Similar results were observed in ischemic stroke, but a significant association was not found between TyG trajectory and risk of hemorrhage stroke.

Conclusion

A long-term elevated TyG index in hypertensive patients is associated with an increased risk of stroke, especially ischemic stroke. This finding implies that regular monitoring of TyG index may assist in identifying individuals at a higher risk of stroke among patients with hypertension.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12933-022-01577-7.

Association between urinary environmental phenols and the prevalence of cardiovascular diseases in US adults

Environmental phenols, as endocrine disruptors, are used widely in personal care and consumer products. However, few studies have examined the association between phenol exposure, including bisphenol A (BPA), benzophenone-3 (BP-3), and triclosan, and the prevalence of cardiovascular diseases (CVD). This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (2003-2012). Urinary BPA, BP-3, and triclosan were measured with liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The CVD was defined as a composite of 5 self-reported cardiovascular outcomes, including congestive heart failure, coronary heart disease, angina pectoris, heart attack or stroke. Multivariable logistic regression models were used to examine the association between phenols and the prevalence of CVD. A total of 8164 participants were enrolled, and 740 (9.1%) were diagnosed of CVD. The average levels of BPA, BP-3, and triclosan concentrations were 3.38, 202.63, and 99.27 ng/mL respectively. Per 1-unit increasement in log-transformed urinary BPA was associated with increased risk of CVD after adjusting all covariates (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.01 to 1.18, P < 0.05). Compared with the lowest quartile (< 0.9), the multivariable-adjusted OR was 1.30 (1.03 to 1.65, P < 0.05) in the highest quartile (> 3.8). Restricted spline models confirmed that the association between BPA and the risk of CVD was non-linear (P = 0.045). Only BPA was associated with the risk of CVD, following a J-curve shaped relationship.

Relationship of cumulative exposure to the triglyceride-glucose index with ischemic stroke: a 9-year prospective study in the Kailuan cohort

BACKGROUND

A single measurement of the triglyceride-glucose (TyG) index, a simple and reliable surrogate marker of insulin resistance, is associated with ischemic stroke. However, evidence for an effect of a long-term elevation in TyG index on ischemic stroke is limited. Therefore, we evaluated the relationship between cumulative TyG index exposure and the risk of ischemic stroke.

METHODS

A total of 54,098 participants in the Kailuan study who had not experienced ischemic stroke underwent three measurements of fasting blood glucose and triglycerides during 2006-2007, 2008-2009, and 2010-2011. Cumulative exposure to TyG index was calculated as the weighted sum of the mean TyG index value for each time interval (value × time). Participants were placed into four groups according to the quartile of the weighted mean: Q1 group, < 32.01; Q2 group, 32.01-34.45; Q3 group, 34.45-37.47; and Q4 group, ≥ 37.47. Cox proportional hazard models were used to assess the relationships of the cumulative TyG index with incident ischemic stroke by calculating hazard ratios (HRs) and 95% confidence intervals (95% CIs).

RESULTS

There were 2083 incident ischemic stroke events over the 9 years of follow-up. The risk of ischemic stroke increased with the quartile of cumulative TyG index. After adjustment for multiple potential confounders, participants in groups Q4, Q3, and Q2 had significantly higher risks of ischemic stroke, with HRs (95% CIs) of 1.30 (1.12-1.52), 1.26 (1.09-1.45), and 1.09 (0.94-1.27), respectively (P_trend < 0.05), compared with the Q1 group. The longer duration of high TyG index exposure was significantly associated with increased ischemic stroke.

CONCLUSIONS

High cumulative TyG index is associated with a higher risk of ischemic stroke. This finding implies that monitoring and the maintenance of an appropriate TyG index may be useful for the prevention of ischemic stroke.

Research Advances in Cardio-Cerebrovascular Diseases of Ligusticum chuanxiong Hort

Cardio-cerebrovascular diseases (CVDs) are a serious threat to human health and account for 31% of global mortality. Ligusticum chuanxiong Hort. (CX) is derived from umbellifer plants. Its rhizome, leaves, and fibrous roots are similar in composition but have different contents. It has been used in Japanese, Korean, and other traditional medicine for over 2000 years. Currently, it is mostly cultivated and has high safety and low side effects. Due to the lack of a systematic summary of the efficacy of CX in the treatment of CVDs, this article describes the material basis, molecular mechanism, and clinical efficacy of CX, as well as its combined application in the treatment of CVDs, and has been summarized from the perspective of safety. In particular, the pharmacological effect of CX in the treatment of CVDs is highlighted from the point of view of its mechanism, and the complex mechanism network has been determined to improve the understanding of CX's multi-link and multi-target therapeutic effects, including anti-inflammatory, antioxidant, and endothelial cells. This article offers a new and modern perspective on the impact of CX on CVDs.

NATIONAL TRENDS IN MORBIDITY AND MORTALITY FROM CIRCULATORY SYSTEM AND CEREBROVASCULAR DISEASES AND STROKES

OBJECTIVE

The aim: To determine national trends in morbidity and mortality from diseases of the circulatory system, cerebrovascular diseases and strokes.

PATIENTS AND METHODS

Materials and methods: Data from official sources of statistical information of Ukraine were used and systematic analysis and generalization of the obtained data was performed and trends in morbidity and mortality from diseases of the circulatory system, cerebrovascular diseases and strokes in Ukraine were calculated.

RESULTS

Results: Were found tendencies to decrease of national levels of prevalence and primary morbidity in Ukraine for DCS (-16.3 % and -28.0 %), CVD (-22.8 % and 24.1 %) and strokes (-12.2 %) with significant trends (+83.9 %) of increase in primary incidence of strokes in 2010-2017 with fairly high and threatening levels for 2017 (respectively 22199563, 2521601 and 96978 - prevalence and 1725137, 290557 and 96978 - primary incidence). National levels of reduction of deaths from DCS in Ukraine from 440369 (2013) to 389348 (2019) with a trend of -11.6 % and a decrease in mortality due to CVD from 94267 (2013) to 76232 (2019) with a trend -19.1 % were found.

CONCLUSION

Conclusions: The trends to reduce of national prevalence, primary morbidity and mortality rates in Ukraine for DCS, CVD and stroke are fully consistent with other global trends of reduction of these levels among world countries.

Change in triglyceride-glucose index predicts the risk of cardiovascular disease in the general population: a prospective cohort study

BACKGROUND

Previous studies has shown a significant relationship between baseline triglyceride-glucose (TyG) index and subsequent cardiovascular disease (CVD). However, the effect of longitudinal changes in TyG index on the risk of CVD remains uncertain. This study aimed to investigate the association between change in TyG index and the risk of CVD in the general population.

METHODS

The current study included 62,443 Chinese population who were free of CVD. The TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2], and change in TyG index was defined as the difference between the TyG index in 2010 and that in 2006. Multivariable-adjusted Cox proportional hazard models and restricted cubic spline analysis were used to examine the association between change in TyG index and the risk of CVD.

RESULTS

During a median follow-up of 7.01 years, 2530 (4.05%) incident CVD occurred, including 2018 (3.23%) incident stroke and 545 (0.87%) incident myocardial infarction (MI). The risk of developing CVD increased with the quartile of change in TyG index, after adjustment for multiple potential confounders, the hazard ratios for the Q4 group versus the Q1 group were 1.37 (95% confidence interval [CI], 1.21-1.54) for the overall CVD, 1.38 (95% CI, 1.19-1.60) for stroke, and 1.36 (95% CI, 1.05-1.76) for MI. Restricted cubic spline analysis also showed a cumulative increase in the risk of CVD with increases in the magnitude of change in TyG index. The addition of change in TyG index to a baseline risk model for CVD improved the C-statistics (P = 0.0097), integrated discrimination improvement value (P < 0.0001), and category-free net reclassification improvement value (P < 0.0001). Similar results were observed for stroke and MI.

CONCLUSIONS

Substantial changes in TyG index independently predict the risk of CVD in the general population. Monitoring long-term changes in TyG may assist with in the early identification of individuals at high risk of CVD.