Socioeconomic status, cardiac risk factors, and cardiovascular disease: A novel approach to determination of this association

Thymus atlanticus (Ball) Roussine Aqueous Extract Exerts Lipid-lowering and Anti-atherosclerotic Effects in Hyperlipidemic Guinea Pigs

BACKGROUND

Thymus atlanticus (Ball) Roussine (T. atlanticus) is traditionally used in the Moroccan high Atlas Mountains to treat several disorders, including cardiovascular disease. In the present study, the lipid-lowering and anti-atherosclerotic activities of the traditionally used aqueous extract of T. atlanticus were evaluated on guinea pigs subjected to chronic hyperlipidemia.

METHODS

Animals were given a diet containing 2% cholesterol and 20% lard for 12 weeks. Moreover, thyme extract was given daily at 400 mg/kg. At the end of the experiment, lipid levels and paraoxonase arylesterase activity were measured, and aorta histology was studied.

RESULTS

Our findings revealed that there was an important elevation of blood lipids in the HFD group along with a significant decrease in paraoxonase arylesterase activity (-40.06%). Moreover, the consumption of fat altered the histology of aorta by thickening the intima media and forming atherosclerotic lesions and foam cells in these tissues. However, the administration of thyme extract attenuated HFD-caused alterations by decreasing blood lipids, elevating paraoxonase activity (+24.04%), and limiting the progression of atherosclerotic lesions.

CONCLUSION

We conclude that the supplementation with the aqueous extract of T. atlanticus could potentially protect against hyperlipidemia and consequently, the development of atherosclerosis.

Impact of Socioeconomic Status on Heart Failure

Heart failure has emerged as a substantial health burden in the United States in the last few decades. This study examined the hypothesis that socioeconomic factors such as education level, social position, employment status, and poverty have a strong confounding influence on the risk for heart failure. To access relevant data, 12 published studies were retrieved from MEDLINE, Google Scholar, and Web of Science. A cross-sectional analysis of the identified studies confirmed that the four socioeconomic factors predisposed individuals to an elevated risk of heart failure-related complications. Despite their interdependencies, educational level, employment status, social position, and poverty independently confounded cardiovascular risk among individuals. Notably, individuals from households with low education were at a higher risk of these diseases. At the same time, households without employed family members were less likely to report cases of heart failure than those with low socioeconomic status. Additionally, individuals from disadvantaged backgrounds faced a greater risk for heart failure complications. The findings from this study found a strong association between socioeconomic status and heart failure risks.

The Influence of Socioeconomic Status on the Prognosis and Profile of Patients Admitted for Acute Heart Failure during COVID-19 Pandemic: Overestimated Aspects or a Multifaceted Hydra of Cardiovascular Risk Factors?

Background: Heart failure (HF) is a complex clinical syndrome that represents a great burden on public health systems due to its increased prevalence, disability and mortality rates. There are multiple triggers that can induce or aggravate a preexisting HF, socioeconomic status (SES) emerging as one of the most common modifiable risk factors. Our study aimed to analyze the influence of certain SES indicators on the outcome, clinical aspects and laboratory parameters of patients with HF in North-Eastern Romania, as well as their relationship with other traditional cardiovascular risk factors. Methods: We conducted a prospective, single-center study comprising 120 consecutively enrolled patients admitted for acute HF. The evaluation of individual SES was based upon a standard questionnaire and evidence from official documents. Results: the patients’ age ranged between 18 and 94 years; Out of 120 patients, 49 (40.8%) were women and 71 (59.2%) were men, residing in rural 59 (49.2%) or urban 61 (50.8%) areas. 14.2% were university graduates, while 15.8% had only attended primary school. The majority of the patients are or were employed in the service sector (54.5%), followed by industry (29.2%) and agriculture (20%). The mean monthly income was 306.1 ± 177.4 euro, while the mean hospitalization cost was 2471.8 ± 2073.8 euro per patient. The individual income level was positively correlated with urban area of residence, adequate household sanitation facilities and healthcare access, and negatively associated with advanced age and previous hospitalizations due to HF. However, the individual financial situation was also positively correlated with the increased prevalence of certain cardiovascular risk factors, such as arterial hypertension, anemia or obesity, but not with total cholesterol or male gender. Concerning the direct impact of a poor economic status upon prognosis in the setting of acute HF, our results showed no statistically significant differences concerning the in-hospital or at 1-month follow-up mortality rates. Rather than inducing a direct impact on the short-term outcome, these findings concerning SES indicators are meant to enhance the implementation of policies aimed to provide adequate healthcare for people from all social layers, with a primary focus on modifiable cardiovascular risk factors.

Effects of sociodemographic and socioeconomic factors on stroke development in Lebanese patients with atrial fibrillation: a cross-sectional study

Background: Non-communicable diseases, the major cause of death and disability, are susceptible to modifiable and non-modifiable risk factors. Atrial fibrillation (AF) increases the risk of stroke by 4 to 5 times and can lead to cardiovascular mortality. This study was conducted to assess the effects of different sociodemographic and socioeconomic factors on stroke development in patients with AF.

Methods: A cross-sectional study was conducted between January and June 2018 on patients recruited from Lebanese community pharmacies. The CHA ₂DS ₂-VASc scoring system is utilized as a stroke risk stratification tool in AF patients. Participants with a previous physician diagnosis of AF, documented on medical records, were included in this study. Data was collected through a survey that was distributed to all eligible patients.

Results: A total of 524 patients were enrolled in the study with a mean age (± SD) of 58.75 ± 13.59 years with hypertension (78.4%) being the most predominant disease. The results showed that obesity (Beta=0.61, p-value =0.011), retirement and unemployment compared to employment (Beta=1.44 and 1.44, p-value=0.001 respectively), divorced/widow compared to married (Beta=1.38, p-value =0.001) were significantly associated with higher CHA ₂DS ₂-VASc scores whereas high versus low socio-economic status (Beta=-1.03, p=0.009) and high school education versus primary education level (Beta=-0.49, p-value=0.025) were significantly associated with lower CHA ₂DS ₂-VASc scores.

Conclusions: The study highlights that the CHA ₂DS ₂-VASc score is affected by the presence of various sociodemographic and socioeconomic characteristics in patients with AF. Thus, screening for those factors may predict the progression of cardiovascular disease and may provide an optimal intervention.

A Novel Paradigm Based on ST2 and Its Contribution towards a Multimarker Approach in the Diagnosis and Prognosis of Heart Failure: A Prospective Study during the Pandemic Storm

Background: Acute heart failure (HF) represents an increasingly common and challenging presentation in the emergency room, also inducing a great socio-economic burden. Extensive research was conducted toward finding an ideal biomarker of acute HF, both in terms of sensitivity and specificity, but today practicians’ interest has shifted towards a more realistic multimarker approach. Natriuretic peptides (NPs) currently represent the gold standard for diagnosing HF in routine clinical practice, but novel molecules, such as sST2, emerge as potentially useful biomarkers, providing additional diagnostic and prognostic value. Methods: We conducted a prospective, single-center study that included 120 patients with acute HF and 53 controls with chronic HF. Of these, 13 patients (eight with acute HF, five from the control group) associated the coronavirus-19 disease (COVID-19). The diagnosis of HF was confirmed by a complete clinical, biological and echocardiographic approach. Results: The serum levels of all studied biomarkers (sST2, NT-proBNP, cardiac troponin) were significantly higher in the group with acute HF. By area under the curve (AUC) analysis, we noticed that NT-proBNP (AUC: 0.976) still had the best diagnostic performance, closely followed by sST2 (AUC: 0.889). However, sST2 was a significantly better predictor of fatal events, showing positive correlations for both in-hospital and at 1-month mortality rates. Moreover, sST2 was also associated with other markers of poor prognosis, such as the use of inotropes or high lactate levels, but not with left ventricle ejection fraction, age, body mass index or mean arterial pressure. sST2 levels were higher in patients with a positive history of COVID-19 as compared with non-COVID-19 patients, but the differences were statistically significant only within the control group. Bivariate regression showed a positive and linear relationship between NT-proBNP and sST2 (r(120) = 0.20, p < 0.002). Conclusions: we consider that sST2 has certain qualities worth integrating in a future multimarker test kit alongside traditional biomarkers, as it provides similar diagnostic value as NT-proBNP, but is emerging as a more valuable prognostic factor, with a better predictive value of fatal events in patients with acute HF.

Effects of sociodemographic and socioeconomic factors on stroke development in Lebanese patients with atrial fibrillation: a cross-sectional study

Background: Non-communicable diseases, the major cause of death and disability, are susceptible to modifiable and non-modifiable risk factors. Atrial fibrillation (AF) increases the risk of stroke by 4-5 times and can lead to cardiovascular mortality. This study was conducted to assess the effects of different sociodemographic factors on stroke development in patients with AF. Methods: A cross-sectional study was conducted between January and June 2018 on patients recruited from Lebanese community pharmacies. The CHA ₂DS ₂-VASc scoring system is utilized as a stroke risk stratification tool in AF patients. Participants with a previous physician diagnosis of AF, documented on medical records, were included in this study. Results: A total of 524 patients were enrolled in the study with a mean age of 58.75 (± SD) ± 13.59 years with hypertension (78.38%) being the most predominant disease. The results showed that obesity (Beta=0.610, p-value =0.011), retirement and unemployment compared to employment (Beta=1.440 and 1.440, p-value=0.001 respectively), divorced/widow compared to married (Beta=1.380, p-value =0.001) were significantly associated with higher CHA ₂DS ₂-VASc scores whereas high versus low socio-economic status (Beta=-1.030, p=0.009) and high school education versus primary education level (Beta=-0.490, p-value=0.025) were significantly associated with lower CHA ₂DS ₂-VASc scores. Conclusions: The study highlights that the CHA ₂DS ₂-VASc score is affected by the presence of various sociodemographic and socioeconomic characteristics in patients with AF. Thus, screening for those factors may predict the progression of cardiovascular disease and may provide an optimal intervention.

Comparison of the effect of cognitive-behavioral therapy and dialectical behavioral therapy on perceived stress and coping skills in patients after myocardial infarction

BACKGROUND

Among the cardiovascular diseases (CVDs), myocardial infraction (MI) is one of the main causes of mortality around the world. A diagnosis of MI may be followed by psychological problems, such as depression, anxiety, and stress. Therefore, psychological interventions can be beneficial in routine treatment. The purpose of this study was to compare the effect of cognitive-behavioral therapy (CBT) and dialectical behavioral therapy (DBT) on perceived stress and coping skills in patients after MI.

METHODS

This study was a randomized clinical trial with a pretest-posttest design and control group. The statistical population consisted of 45 patients after MI who referred to Noor Heart Clinic in Rasht, Iran, between 2018 and 2019. They were randomly divided into 3 groups of 15 individuals (2 interventions including CBT and DBT, and 1 control group). In the intervention groups, participants underwent 8 weekly 90-minute sessions. Data were collected using a 3 part self-report questionnaire including a demographic information form, the Ways of Coping Questionnaire (WCQ), and the Perceived Stress Scaleý-14 (PSS-14). The statistical methods used for data analysis included chi-square test, one-way ANOVA, repeated-measures ANOVA, and post hoc Bonferroni test.

RESULTS

We found significant main effects of group (F(2,42)=6.11; P=0.005) and time (F(2,84)=28.48; P<0.001), and a significant group-by-time interaction (F(4,84)=8.97; P<0.001) on perceived stress scores. For problem-focused coping scores, findings indicated significant main effects of group (F(2,42)=7.33; P=0.002) and time (F(2,84)=30.71; P<0.001), and a significant group-by-time interaction (F(4,84)=12.86; P<0.001). For emotion-focused coping scores, the results also indicated significant main effects of group (F(2,42) = 17.41; P < 0.001) and time (F(2,84)=31.74; P<0.001), and a significant group-by-time interaction (F(4,84)=14.90; P<0.001).

CONCLUSION

The current study revealed that DBT was more effective in improving emotion-focused coping than CBT.