Economic Burden of Myocardial Infarction Combined With Dyslipidemia

The influence of habitual tooth brushing frequency on individuals diagnosed with coronary artery disease

Coronary artery disease (CAD) is a prevalent and high-mortality condition globally. The awareness regarding adequate oral care in China was insufficient. This study investigates the outcomes of CAD patients in southwest China based on their tooth brushing frequency. A total of 841 CAD patients were selected from a cohort of 32,709 residents. Over a four-year follow-up period, the incidence of three-point major adverse cardiovascular events (3P-MACEs) was evaluated. The results indicated that the hazard ratios (HR) with 95% confidence intervals (CIs) for 3P-MACEs among the three groups of tooth brushing frequency (twice, once, and thrice daily) were: reference, 1.61 (1.09-2.37) (p = 0.017), and 0.49 (0.15-1.62) (p = 0.241). Patients who brushed their teeth only once a day had a 1.71 (1.18-2.46) times higher risk compared to those who brushed twice or more daily (p = 0.004). In conclusion, insufficient tooth brushing frequency appears to be associated with a higher risk of adverse outcomes among CAD patients.

The association between short-term exposure to ambient PM2.5 and hospitalization costs in patients with myocardial infarction: a hospital-based study

Myocardial infarction (MI) ranks as one of the primary causes of global disabilities and disease deaths. The association between fine particulate matter (PM2.5) and MI has gained attention in recent years. In this study, we assessed the relationship between short-term PM2.5 exposure and MI inpatient hospitalization costs using multiple linear regression, and estimated the attributable MI burden. Stratified analyses were done by gender, age, season, and hyperlipidemia. The economic burden of PM2.5 was assessed using WHO (25 μg/m³) and China's (75 μg/m³) criteria. PM2.5 concentration positively correlated with MI hospitalization costs. A 10 μg/m³ increase in Lag015 PM2.5 led to a 940.05 CNY (95% CI: 141.87-1463.23) increase in costs. Furthermore, the association was stronger in males, those <65 years old, and patients with hyperlipidemia. This study first indicates that short-term PM2.5 levels can be positively associated with MI's economic burden, especially in cool seasons.

Global comparison of the economic costs of coronary heart disease: a systematic review and meta-analysis

OBJECTIVES

Coronary heart disease (CHD) is the leading cause of global morbidity and mortality, yet no comprehensive evaluation of its global economic costs exists. We conducted a systematic review with meta-analysis to examine the costs of CHD treatment by region and CHD subtypes, examine whether there are cost difference by sex, and examine costing methodologies.

DESIGN

We conducted a systematic review and meta-analysis of non-randomised studies.

DATA SOURCES

We searched Medline, Embase, CINAHL, EconLit and Google Scholar from 1 January 2000 to February 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included observational studies reporting economic costs of CHD treatment and outcomes for adults that were published in English.

DATA EXTRACTION AND SYNTHESIS

Data extraction and quality assessment were independently undertaken by two reviewers. Costs were converted to percentage of gross domestic product (GDP) per capita of corresponding country. A random-effects model was used for meta-analysis using StataSE V.18 to calculate the pooled percentage. Heterogeneity was assessed using the I2 statistic. Meta-regression and bias assessment were performed.

RESULTS

Out of 20 100 records identified, 37 studies (including 2 564 189 individuals) from 22 countries were included in the qualitative synthesis and the quantitative meta-analysis. In most countries, the annual cost of CHD exceeds many times the total health expenditure per capita. The pooled direct annual cost of CHD per patient varied from 4.9% to 137.8% of GDP per capita (Int$ purchasing power parity), with pooled percentage of 21.7% (95% CI 15.3, 28.1) for those with CHD. Slight difference in the annual pooled cost of CHD was observed, with a 2% of GDP per capita higher cost in men (95% CI 0.8, 3.2). Most studies applied a top-down costing approach (n=21).

CONCLUSIONS

The review illustrates the expense associated with CHD, which is varied by region and CHD subtypes. The observed cost difference by sex warrants further exploration of sex-specific factors influencing cost disparities. Exploring advanced costing methods such as time-driven activity-based costing can optimise resource allocation and identify opportunities to reduce unnecessary costs and cost disparities.

PROSPERO REGISTRATION NUMBER

CRD42023412044.

Genetically predicted smoking and body mass index mediate the relationship between insomnia and myocardial infarction

Objective

This study aimed to investigate the causal relationship between insomnia and the risk of myocardial infarction (MI) and explore potential mediators such as smoking initiation, alcohol consumption and body mass index (BMI) using mendelian randomization (MR) analysis.

Methods

Data from 1,207,228 individuals of European ancestry were obtained from the UK Biobank and 23andMe for insomnia-related genetic associations. Genetic instruments for MI, smoking initiation, alcohol consumption, and BMI were derived from large-scale genome-wide association studies. Univariate MR analysis mainly utilized the inverse variance weighting method, and multivariable MR analysis assessed the mediation effects of smoking initiation and BMI.

Results

The univariate MR analysis revealed a 96% increased risk of MI in individuals with insomnia [odds ratio (OR) = 1.96; 95% CI: 1.67, 2.31]. Smoking initiation and BMI were identified as potential mediators. The multivariable MR analysis indicated smoking initiation accounted for 29% of the total effect (95% CI: 13%, 61%), while BMI accounted for 15% (95% CI: 7%, 27%), with a combined mediation proportion of 54% (95% CI: 31%, 91%).

Conclusions

The results of this MR analysis demonstrate that insomnia increases the risk of MI. Quitting smoking and losing weight may reduce this risk; however, there is still a portion of the impact of insomnia on MI that cannot be explained. Therefore, further investigation into other potentially modifiable intermediate factors is necessary.

The Effect of a Program to Improve Adherence to the Mediterranean Diet on Cardiometabolic Parameters in 7034 Spanish Workers

BACKGROUND

Cardiovascular and metabolic diseases include a large group of pathologies and constitute one of the most serious chronic health problems facing the 21st century, with high rates of morbidity and mortality worldwide. Unhealthy diets influence the development of these pathologies. The Mediterranean diet can be an important part in the treatment of these diseases. The objective of this study was to assess the effect of a program that aims to increase adherence to the Mediterranean diet on the improvement of different cardiometabolic risk parameters.

METHODS

A prospective intervention study was carried out on 7034 Spanish workers. Prior to the intervention, 22 cardiometabolic risk scales were evaluated. Participants in this study were informed both orally and in writing of the characteristics and benefits of the Mediterranean diet and were given the website of the Ministry of Health, Consumption and Social Welfare of Spain, which provides advice on nutrition. Adherence to the Mediterranean diet was reinforced by sending a monthly SMS to their mobile phones. After six months of follow-up, the 22 risk scales were re-evaluated to assess changes. Means and standard deviations were calculated using Student's t test to analyse quantitative variables. Prevalence was calculated using the Chi-square test when the variables were qualitative.

RESULTS

All the cardiometabolic risk scales studied decreased after implementing a program to improve and enhance adherence to the Mediterranean diet. The number of losses in the sample was very low, standing at 4.31%.

CONCLUSIONS

The Mediterranean diet is effective in reducing all cardiovascular risk scales evaluated. The mean values and prevalence of high values of the different cardiometabolic risk scales analysed led to lower values after the implementation of the program to increase adherence to the Mediterranean diet. We observed a significant positive difference in metabolic age in both sexes. We have obtained a significant improvement in the insulin resistance index, especially in the SPISE-IR index, data that we have not found in previous publications. Easy access to the Internet and new information and communication technologies facilitate adherence to a diet and can reduce the number of losses.

Prevalence, awareness, treatment, and control of dyslipidemia in Chinese adults: a systematic review and meta-analysis

Background

Researchers have conducted a considerable number of epidemiological studies on dyslipidemia in China over recent years. Nevertheless, a representative study to comprehensively appraise for the epidemiological status of dyslipidemia is still lacked. This meta-analysis is intended to explore the pooled prevalence, rates of awareness, treatment, and control of dyslipidemia among adults in Chinese Mainland.

Materials and methods

A systematic review was performed on relevant cross-sectional studies published since January 2012 by searching six authoritative literature databases. Meta-analyses were conducted in included studies based on a random-effect model to summarize the epidemiological status of dyslipidemia in China. A potential source of heterogeneity was detected by subgroup analysis and meta-regression. Publication bias was assessed by Egger's test and funnel plots. A sensitivity analysis was conducted to examine the study quality's influence on the pooled estimate of prevalence and rates of awareness, treatment, and control.

Results

Forty-one original researches with a total of 1,310,402 Chinese participants were finally included in the meta-analysis. The prevalence, rates of awareness, treatment, and control of dyslipidemia were 42.1%, 18.2%, 11.6%, and 5.4%, respectively. With a pooled prevalence estimate at 24.5%, low HDL-C was the most prevalent among various dyslipidemia types, followed by hypertriglyceridemia (TG) (15.4%), hypercholesterolemia (TC) (8.3%), and high LDL-C (7.1%). The pooled prevalence of elevated serum lipoprotein(a) [Lp(a)] was 19.4%. By gender, the prevalence of dyslipidemia was 47.3% in males and 38.8% in females. Subgroup analyses revealed that the prevalence in southern and urban areas were higher than their counterparts. Females and population in urban areas tended to possess higher rates of awareness, treatment, and control. Meta-regression analyses suggested that the year of screening influenced prevalence estimates for dyslipidemia. The impact of the study's quality on the pooled estimates is insignificant.

Conclusion

Our study suggested a severe epidemic situation of dyslipidemia among adults in Chinese Mainland. More importantly, the awareness, treatment, and control rates were extremely low, revealing that dyslipidemia is a grave health issue. Consequently, we should attach more importance to the management of dyslipidemia, especially in economically underdeveloped areas.

Systematic review registration

PROSPERO [CRD42022366456].

Habitual physical activity improves outcomes among patients with myocardial infarction

Purpose

This study evaluates the association between habitual physical activity (HPA) and the outcomes of patients with myocardial infarction (MI).

Methods

Patients newly diagnosed with MI were divided into two groups based on whether they engaged in HPA, defined as an aerobic activity with a duration of no less than 150 min/week, before the index admission. The primary outcomes included major adverse cardiovascular events (MACEs), cardiovascular (CV) mortality, and cardiac readmission rate 1 year following the index date of admission. A binary logistic regression model was applied to analyze whether HPA was independently associated with 1-year MACEs, 1-year CV mortality, and 1-year cardiac readmission rate.

Results

Among the 1,266 patients (mean age 63.4 years, 72% male), 571 (45%) engaged in HPA, and 695 (55%) did not engage in HPA before MI. Patients who participated in HPA were independently associated with a lower Killip class upon admission (OR = 0.48: 95% CI, 0.32-0.71, p < 0.001) and a lower prevalence of 1-year MACEs (OR = 0.74: 95% CI, 0.56-0.98, p = 0.038) and 1-year CV mortality (OR = 0.50: 95% CI, 0.28-0.88, p = 0.017) than those who did not participate in HPA. HPA was not associated with cardiac-related readmission (OR = 0.87: 95% CI, 0.64-1.17, p = 0.35).

Conclusions

HPA before MI was independently associated with a lower Killip class upon admission, 1-year MACEs, and 1-year CV mortality rate.

Burden of ischemic heart disease in Spain: incidence, hospital mortality and costs of hospital care

BACKGROUND

Ischemic heart disease (IHD) is the leading global cause of death and is assumed to entail a significant social and economic burden globally. This study aimed to evaluate incidence and mortality trends of IHD in Spain and to estimate direct medical costs.

METHODS

Admission files corresponding to patients with IHD registered between 2011 and 2019 were obtained from a Spanish hospital discharge database and analyzed in a retrospective study.

RESULTS

Admission data corresponding to 814,740 patients with IHD was analyzed. The majority of patients were males, and about half of the hospitalizations were due to an acute myocardial infarction. Incidence decreased significantly in most age groups over time, while hospital mortality rate remained stable (4.4%). Additionally, mortality rate was significantly higher among females (6.6%). Median admission cost was €5175; the higher costs per admission were found in patients with an acute myocardial infarction and in admissions with an ICU stay. The annual cost of hospital care was €693.8 million.

CONCLUSIONS

Despite the decreasing trends described in the general population, hospital mortality rate was constant among hospitalized patients during the study period. The higher hospital mortality rate described among females should be considered in further studies and protocol revisions.

Association of Tooth Scaling with Acute Myocardial Infarction and Analysis of the Corresponding Medical Expenditure: A Nationwide Population-Based Study

Accumulating evidence has shown a significant correlation between periodontal diseases and systemic diseases. In this study, we investigated the association between the frequency of tooth scaling and acute myocardial infarction (AMI). Here, a group of 7164 participants who underwent tooth scaling was compared with another group of 7164 participants without tooth scaling through propensity score matching to assess AMI risk by Cox’s proportional hazard regression. The results show that the hazard ratio of AMI from the tooth scaling group was 0.543 (0.441, 0.670) and the average expenses of AMI in the follow up period was USD 265.76, while the average expenses of AMI in follow up period for control group was USD 292.47. The tooth scaling group was further divided into two subgroups, namely A and B, to check the influence of tooth scaling frequency on AMI risk. We observed that (1) the incidence rate of AMI in the group without any tooth scaling was 3.5%, which is significantly higher than the incidence of 1.9% in the group with tooth scaling; (2) the tooth scaling group had lower total medical expenditures than those of the other group because of the high medical expenditure associated with AMI; and (3) participants who underwent tooth scaling had a lower AMI risk than those who never underwent tooth scaling had. Therefore, the results of this study demonstrate the importance of preventive medicine.