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Nedkoff L, Briffa T, Zemedikun D, Herrington S, Wright FL. Global Trends in Atherosclerotic Cardiovascular Disease. Clin Ther 2023; 45:1087-1091. [PMID: 37914585 DOI: 10.1016/j.clinthera.2023.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/10/2023] [Accepted: 09/26/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE Cardiovascular disease (CVD) is the leading cause of morbidity and mortality, affecting over 523 million people globally. Atherosclerotic diseases, particularly ischemic heart disease (IHD) and stroke, are the primary mediators of CVD burden and trends, with half of CVD deaths attributed to IHD, and another quarter to ischemic stroke. The aim of this review was to provide an overview of world-wide trends in the burden of atherosclerotic CVD. METHODS A literature review of published studies reporting regional or global trends or burden of CVD was undertaken, with a specific focus on atherosclerotic-mediated CVDs. FINDINGS While long-term trends in age-standardized rates of CVD mortality and incidence indicate substantial declines in disease burden, the impact of population growth and ageing has contributed to a continued increase in the absolute number of people living with CVD. Additionally, when data are restricted to the most recent decade, there are indications that even declines in age-standardized CVD rates may have attenuated. Trends are also heterogeneous across countries and regions, with a relative increase in CVD burden in developing countries and differing trends within countries. The impact of the COVID-19 pandemic resulted in substantial short-term reductions in hospitalization rates for major atherosclerotic CVDs including acute coronary syndromes and heart failure in some countries. IMPLICATIONS Recent attenuation of declines in atherosclerotic CVDs with increasing absolute burden has significant implications for health systems and resource availability, with the impact of the COVID-19 pandemic on longer-term trends in CVD yet to be clearly established.
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Affiliation(s)
- Lee Nedkoff
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia; Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.
| | - Tom Briffa
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Dawit Zemedikun
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Saranne Herrington
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - F Lucy Wright
- Nuffield Department of Population Health, and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
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Okoth K, Crowe F, Marshall T, Thomas GN, Nirantharakumar K, Adderley NJ. Sex-specific temporal trends in the incidence and prevalence of cardiovascular disease in young adults: a population-based study using UK primary care data. Eur J Prev Cardiol 2022; 29:1387-1395. [PMID: 35139185 DOI: 10.1093/eurjpc/zwac024] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/15/2022] [Accepted: 02/02/2022] [Indexed: 11/13/2022]
Abstract
AIMS There is concern that cardiovascular disease (CVD) in young adults is rising. However, current trends in the UK are unknown. We investigated sex-specific trends in the incidence and prevalence of CVD in young UK adults. METHODS AND RESULTS A series of annual (1998-2017) cohort and cross-sectional studies were conducted to estimate incidence rates and prevalence in men and women aged 16-50. Joinpoint regression models were fitted to evaluate changes in trends. From 1998 to 2017, incidence and prevalence had an overall downward trend for ischaemic heart disease (IHD) and angina, while coronary revascularization, stroke/transient ischaemic attack (TIA), and heart failure (HF) had an upward trend in both sexes. Myocardial infarction (MI) trends were stable in men and increased in women. For incidence, the average annual percentage change (AAPC) for men vs. women, respectively, was IHD -2.6% vs. -3.4%; angina -7.0% vs. -7.3%; MI 0.01% vs. 2.3%; revascularization 1.1% vs. 3.9%; stroke/TIA 1.9% vs. 0.6%; HF 5.6% vs. 5.0% (P for trend <0.05 for all except MI and revascularization in men and stroke/TIA in women). For prevalence, AAPCs for men vs. women, respectively, were IHD -2.8% vs. -4.9%; angina -7.2% vs. -7.8%; MI -0.2% vs. 2.0; revascularization 3.2% vs. 4.1%; stroke/TIA 3.1% vs. 3.6%; HF 5.0% vs. 3.0% (P for trend <0.05 for all except MI in men). In recent years, IHD and revascularization trends levelled off, while stroke/TIA and HF trends increased in both sexes. CONCLUSION Overall trends in incidence and prevalence of CVD are worsening in young adults. Factors behind unfavourable trends warrant investigation and public health intervention.
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Affiliation(s)
- Kelvin Okoth
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Francesca Crowe
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Institute of Metabolism and Systems Research, Edgbaston, Birmingham B15 2TT, UK
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Sato Y, Kawakami R, Sakamoto A, Cornelissen A, Mori M, Kawai K, Ghosh S, Romero ME, Kolodgie FD, Finn AV, Virmani R. Sex Differences in Coronary Atherosclerosis. Curr Atheroscler Rep 2022. [PMID: 35175547 DOI: 10.1007/s11883-022-00980-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW The importance of cardiovascular disease (CVD) in women has long been underestimated. Therefore, we need to understand the impact of sex differences on CVD. RECENT FINDINGS Traditional risk factors contribute to coronary artery disease (CAD) differently in women and men. There are female-specific risk factors and comorbid conditions that affect the risk of CAD. Plaque erosion is frequently seen in younger women who smoke, while plaque rupture is common in older women and men who have elevated blood cholesterol. Coronary artery calcification is also different in both sexes. Thus, coronary artery calcification score-based risk stratification in women is challenging. A deeper understanding of the sex differences in the risk factors and plaque morphology of coronary atherosclerosis may lead to improved outcomes of CVD in women.
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Valdés G. Focus on today's evidence while keeping an eye on the future: lessons derived from hypertension in women. J Hum Hypertens 2022. [PMID: 35082377 DOI: 10.1038/s41371-021-00652-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 12/17/2022]
Abstract
While evidence-based medicine has contributed enormously to the uniformity and rationale of patient care, it is necessary that we anticipate changes in order to implement their rapid translation to practice. The purpose of this review is to expose three issues regarding cardiovascular health in women, including milestones to reflect the pace at which these are incorporated into public policies. Two of these matters, as changes in the thresholds of normal blood pressure in gestation and in nonpregnant women, need further evidence and deserve to be retrospectively analyzed in high-quality databases. The third subject derives from the association of remote cardiovascular complications of hypertensive pregnancies, an example of the unnecessary delay of more than two decades to install a wide prevention strategy when the health system is not on the watch.
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Wright FL, Townsend N, Greenland M, Goldacre MJ, Smolina K, Lacey B, Nedkoff L. Long-term trends in population-based hospitalisation rates for myocardial infarction in England: a national database study of 3.5 million admissions, 1968-2016. J Epidemiol Community Health 2022; 76:45-52. [PMID: 34253559 PMCID: PMC8666807 DOI: 10.1136/jech-2021-216689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/28/2021] [Indexed: 11/29/2022]
Abstract
AIM To analyse the timing and scale of temporal changes in rates of hospitalised myocardial infarction (MI) in England by age and sex from 1968 to 2016. METHODS MI admissions for adults aged 15-84 years were identified from electronic hospital data. We calculated age-standardised and age-specific rates, and examined trends using joinpoint. RESULTS From 1968 to 2016, there were 3.5 million admissions for MI in England (68% men). Rates increased in the early years of the study in both men and women, peaked in the mid-1980s (355 per 100 000 population in men; 127 in women) and declined by 38.8% in men and 37.4% in women from 1990 to 2011. From 2012, however, modest increases were observed in both sexes. Long-term trends in rates over the study period varied by age and sex, with those aged 70 years and older having the greatest and most sustained increases in the early years (1968-1985). During subsequent years, rates decreased in most age groups until 2010-2011. The exception was younger women (35-49 years) and men (15-34 years) who experienced significant increases from the mid-1990s to 2007 (range +2.1%/year to 4.7%/year). From 2012 onwards, rates increased in all age groups except the oldest, with the most marked increases in men aged 15-34 years (7.2%/year) and women aged 40-49 (6.9%-7.3%/year) . CONCLUSION Despite substantial declines in hospital admission rates for MI in England since 1990, the burden of annual admissions remains high. Continued surveillance of trends and coronary disease preventive strategies are warranted.
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Affiliation(s)
- F Lucy Wright
- Unit of Health-Care Epidemiology, Nuffield Department of Population Health and Big Data Institute, University of Oxford, Oxford, UK
| | | | - Melanie Greenland
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Michael J Goldacre
- Unit of Health-Care Epidemiology, Nuffield Department of Population Health and Big Data Institute, University of Oxford, Oxford, UK
| | - Kate Smolina
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ben Lacey
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health and Big Data Institute, University of Oxford, Oxford, UK
| | - Lee Nedkoff
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Weber C, Hung J, Hickling S, Li I, Murray K, Briffa T. Changing age-specific trends in incidence, comorbidities and mortality of hospitalised heart failure in Western Australia between 2001 and 2016. Int J Cardiol 2021; 343:56-62. [PMID: 34520794 DOI: 10.1016/j.ijcard.2021.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/09/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Incident heart failure (HF) hospitalisation rates in most high-income countries are stable or declining. However, HF incidence may be increasing in younger people linked to changing risk factor profiles in the general population. We examined age and sex-specific patterns of incidence, comorbidities and mortality of hospitalised HF in Western Australia (WA) between 2001 and 2016. METHODS AND RESULTS All WA residents aged 25-94 years, with an incident (first-ever) principal HF discharge diagnosis between 2001 and 2016 were included (n = 22,476). Poisson regression derived annual age and sex-standardised rates of incident HF and 1-year mortality overall, and by age groups (25-54, 55-74, 75-94), across the study period. Overall, the age and sex-standardised rates of incident HF increased marginally by 0.6% per year (95% confidence interval (CI), 0.3, 0.8) whereas incidence increased by 3.1% per year (95% CI, 2.2, 4.0) in the 25-54 year age-group (trend p < 0.0001). There was a high prevalence (≥15%) of obesity, diabetes mellitus, cardiomyopathy, hypertension, ischemic heart disease, atrial fibrillation, and chronic kidney disease in younger HF patients. Overall standardised 1-year mortality declined by -1.0% per year (95%CI, -0.4, -1.6), driven largely by the mortality decline in the 55-74 year age group. CONCLUSION Incident HF hospitalisation rates have been rising in WA since 2006, notably in individuals under 55 years. The underlying reasons require further investigation, particularly the population-attributable risk related to increasing obesity and diabetes mellitus in the general population. Rising HF incidence along with declining mortality rates portends to an increasing HF burden in the community.
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Affiliation(s)
- Courtney Weber
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia.
| | - Joseph Hung
- Medical School, Faculty of Medicine and Health Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Siobhan Hickling
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Ian Li
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Tom Briffa
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
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Dugani SB, Hydoub YM, Ayala AP, Reka R, Nayfeh T, Ding JF, McCafferty SN, Alzuabi M, Farwati M, Murad MH, Alsheikh-Ali AA, Mora S. Risk Factors for Premature Myocardial Infarction: A Systematic Review and Meta-analysis of 77 Studies. Mayo Clin Proc Innov Qual Outcomes 2021; 5:783-94. [PMID: 34401655 DOI: 10.1016/j.mayocpiqo.2021.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the magnitude of the association between risk factors and premature myocardial infarction (MI) (men aged 18-55 years; women aged 18-65 years). Patients and Methods We searched MEDLINE and other databases from inception through April 30, 2020, as well as bibliography of articles selected for data extraction. We selected observational studies reporting the magnitude of the association of at least 1 risk factor (demographic characteristics, lifestyle factors, clinical risk factors, or biomarkers) with premature MI and a control group. Pooled risk estimates (random effects) from all studies unadjusted and adjusted for risk factors were reported as summary odds ratios (ORs) with 95% CIs. Results From 35,320 articles of 12.7 million participants, we extracted data on 19 risk factors from 77 studies across 58 countries. Men had a higher risk of premature MI (OR, 2.39; 95% CI, 1.71 to 3.35) than did women. Family history of cardiac disease was associated with a higher risk of premature MI (OR, 2.67; 95% CI, 2.29 to 3.27). Major modifiable risk factors associated with higher risk were current smoking (OR, 4.34; 95% CI, 3.68 to 5.12 vs no/former), diabetes mellitus (OR, 3.54; 95% CI, 2.69 to 4.65), dyslipidemia (OR, 2.94; 95% CI, 1.76 to 4.91), and hypertension (OR, 2.85; 95% CI, 2.48 to 3.27). Higher body mass index carried higher risk (OR, 1.46; 95% CI, 1.24 to 1.71 for ≥25 kg/m2 vs <25 kg/m2). Biomarkers associated with 2- to 3-fold higher risk were total cholesterol levels greater than 200 mg/dL, triglyceride levels higher than 150 mg/dL, and high-density lipoprotein cholesterol levels less than 60 mg/dL (to convert to mmol/L, multiply by 0.0259). Conclusion Major risk factors for premature MI are mostly amenable to patient, population, and policy level interventions. Mild elevations in body mass index and triglyceride levels were associated with higher risk, which has implications for the growing worldwide epidemic of cardiometabolic diseases.
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Tang X, Liu L, Yang J, Gao Z, Zhao X, Qiao S, Gao R, Wang Z, Yuan J, Yang Y. Evidence-based oral antiplatelet therapy among hospitalized Chinese patients with acute myocardial infarction: results from the Chinese acute myocardial infarction registry. BMC Cardiovasc Disord 2021; 21:299. [PMID: 34126921 PMCID: PMC8204547 DOI: 10.1186/s12872-021-02115-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background Oral antiplatelet therapy is the cornerstone of treatment for acute myocardial infaction (AMI). However, detailed usage data on oral antiplatelet therapy are lacking. Methods Using data from a nationally representative sample of patients with AMI, the detailed usage of oral antiplatelet therapy was analyzed in 40,202 consecutive eligible patients. Results The proportions of patients with AMI taking loading doses of aspirin and P2Y12 inhibitors were relatively low (62.2% and 63.6%, respectively), whereas approximately 90% of patients received maintenance doses of aspirin, P2Y12 inhibitors, and dual antiplatelet therapy. The proportions of patients taking loading doses of aspirin and P2Y12 inhibitors gradually decreased with age. Male sex, an educational level of at least college, an interval from onset to treatment of < 24 h, and primary PCI use were associated with a higher proportion of patients taking a loading dose of antiplatelet therapy, whereas those receiving conservative treatment had a lower rate of antiplatelet use (all P < 0.05). The proportion of patients taking loading doses of aspirin was highest in the western region, and that of patients taking loading doses of P2Y12 inhibitors was highest in the eastern region (P < 0.05). In addition, 76.7% of patients with ST-elevation MI and 91% of patients with non-ST-elevation MI received 300-mg loading dose of clopidogrel. Conclusions The proportion of patients with AMI receiving loading doses of aspirin and P2Y12 inhibitors during hospitalization was relatively low, and this rate was affected by many factors, such as age, sex, educational level, region of residence, and the interval from onset to treatment. The underutilization of guideline-based P2Y12 inhibitors was also problematic. Hence, quality improvement initiatives are needed to enhance adherence to guidelines to improve consistent use of oral antiplatelet therapy. Trial registration The Chinese Acute Myocardial Infarction Registry; Trial registration number: ChiCTR-ONC-12002636; Registered 31 October 2012; http://www.chictr.org.cn/showproj.aspx?proj=6916 Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02115-1.
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Affiliation(s)
- Xiaofang Tang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Lifu Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Jingang Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Zhan Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Xueyan Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Shubin Qiao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Runlin Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Zhifang Wang
- Department of Cardiology, The Central Hospital of Xinxiang, Xinxiang, Henan Province, China
| | - Jinqing Yuan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China.
| | - Yuejin Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China.
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Ogata S, Marume K, Nakai M, Kaichi R, Ishii M, Ikebe S, Mori T, Komaki S, Kusaka H, Toida R, Kurogi K, Iwanaga Y, Yano T, Yamamoto N, Miyamoto Y. Incidence Rate of Acute Coronary Syndrome Including Acute Myocardial Infarction, Unstable Angina, and Sudden Cardiac Death in Nobeoka City for the Super-Aged Society of Japan. Circ J 2021; 85:1722-1730. [PMID: 34121054 DOI: 10.1253/circj.cj-20-1207] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study aimed to calculate incidence rates (IR) of acute coronary syndrome (ACS) including acute myocardial infarction (AMI), unstable angina (UAP), and sudden cardiac death (SCD) in Nobeoka city, Japan.Methods and Results:This was an observational study based on a city-wide comprehensive registration between 2015 and 2017 in Nobeoka city, Japan, using 2 databases: all patients with cardiogenic out-of-hospital cardiac arrest in Nobeoka city and hospitalized ACS patients from Miyazaki Prefectural Nobeoka Hospital in which all ACS patients in Nobeoka city were hospitalized except for possible rare cases of patients highly unlikely to be hospitalized elsewhere. The IRs of ACS based on the population size of Nobeoka city (125,000 persons), and their age-adjusted IRs by using the direct method and the 2015 model population of Japan were calculated. There were 260 eligible patients hospitalized with first-onset ACS (age [SD]=71.1 [12.4], 34.2% women) and 107 eligible SCD patients. Crude IRs of hospitalized ACS and SCD patients, and hospitalized AMI and SCD patients, respectively, were 130.2 (183.3 for men, 85.6 for women) and 107.5 (148.4 for men, 73.2 for women) per 100,000. Crude IRs of hospitalized ACS, AMI, and UAP patients, respectively, were 92.3 (132.8 for men, 58.1 for women), 69.6 (97.9 for men, 45.7 for women), and 22.7 (35.0 for men, 12.4 for women) per 100,000. CONCLUSIONS The calculated IRs can be useful in building a health strategy for treating ACS.
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Affiliation(s)
- Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center
| | - Kyohei Marume
- Miyazaki Prefectural Nobeoka Hospital.,Department of Sport Science, University of Innsbruck
| | - Michikazu Nakai
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
| | | | | | - Sou Ikebe
- Miyazaki Prefectural Nobeoka Hospital
| | | | | | | | | | | | - Yoshitaka Iwanaga
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
| | | | | | - Yoshihiro Miyamoto
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
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10
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Aziz A, Thompson J, Gyamfi-Bannerman C, D’Alton M, Wapner R, Bello NA. The Evidence of Aspirin Use in Prevention of Adverse Pregnancy Outcomes (APOs): Should It Be Continued Long Term After an APO? Curr Treat Options Cardio Med 2021. [DOI: 10.1007/s11936-021-00936-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kringeland E, Tell GS, Midtbø H, Igland J, Haugsgjerd TR, Gerdts E. Stage 1 hypertension, sex, and acute coronary syndromes during midlife: the Hordaland Health Study. Eur J Prev Cardiol 2021; 29:147-154. [PMID: 33993298 DOI: 10.1093/eurjpc/zwab068] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/15/2021] [Accepted: 04/11/2021] [Indexed: 12/17/2022]
Abstract
AIMS Hypertension has been suggested as a stronger risk factor for acute coronary syndromes (ACS) in women than men. Whether this also applies to stage 1 hypertension [blood pressure (BP) 130-139/80-89 mmHg] is not known. METHODS AND RESULTS We tested associations of stage 1 hypertension with ACS in 12 329 participants in the Hordaland Health Study (mean baseline age 41 years, 52% women). Participants were grouped by baseline BP category: Normotension (BP < 130/80 mmHg), stage 1 and stage 2 hypertension (BP ≥140/90 mmHg). ACS was defined as hospitalization or death due to myocardial infarction or unstable angina pectoris during 16 years of follow-up. At baseline, a lower proportion of women than men had stage 1 and 2 hypertension, respectively (25 vs. 35% and 14 vs. 31%, P < 0.001). During follow-up, 1.4% of women and 5.7% of men experienced incident ACS (P < 0.001). Adjusted for diabetes, smoking, body mass index, cholesterol, and physical activity, stage 1 hypertension was associated with higher risk of ACS in women [hazard ratio (HR) 2.18, 95% confidence interval (CI) 1.32-3.60], while the association was non-significant in men (HR 1.30, 95% CI 0.98-1.71). After additional adjustment for systolic and diastolic BP, respectively, stage 1 diastolic hypertension was associated with ACS in women (HR 2.79 [95% CI 1.62-4.82]), but not in men (HR 1.24 [95% CI 0.95-1.62]), while stage 1 systolic hypertension was not associated with ACS in either sex. CONCLUSION Among subjects in their early 40s, stage 1 hypertension was a stronger risk factor for ACS during midlife in women than in men.
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Affiliation(s)
- Ester Kringeland
- Department of Clinical Science, University of Bergen, PO Box 7804, 5020 Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020 Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, PO Box 973 Sentrum, 5808 Bergen, Norway
| | - Helga Midtbø
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020 Bergen, Norway
| | - Teresa R Haugsgjerd
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020 Bergen, Norway
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, PO Box 7804, 5020 Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
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Dugani SB, Moorthy MV, Li C, Demler OV, Alsheikh-Ali AA, Ridker PM, Glynn RJ, Mora S. Association of Lipid, Inflammatory, and Metabolic Biomarkers With Age at Onset for Incident Coronary Heart Disease in Women. JAMA Cardiol 2021; 6:437-447. [PMID: 33471027 PMCID: PMC7818181 DOI: 10.1001/jamacardio.2020.7073] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Risk profiles for premature coronary heart disease (CHD) are unclear. Objective To examine baseline risk profiles for incident CHD in women by age at onset. Design, Setting, and Participants A prospective cohort of US female health professionals participating in the Women's Health Study was conducted; median follow-up was 21.4 years. Participants included 28 024 women aged 45 years or older without known cardiovascular disease. Baseline profiles were obtained from April 30, 1993, to January 24, 1996, and analyses were conducted from October 1, 2017, to October 1, 2020. Exposures More than 50 clinical, lipid, inflammatory, and metabolic risk factors and biomarkers. Main Outcomes and Measures Four age groups were examined (<55, 55 to <65, 65 to <75, and ≥75 years) for CHD onset, and adjusted hazard ratios (aHRs) were calculated using stratified Cox proportional hazard regression models with age as the time scale and adjusting for clinical factors. Women contributed to different age groups over time. Results Of the clinical factors in the women, diabetes had the highest aHR for CHD onset at any age, ranging from 10.71 (95% CI, 5.57-20.60) at CHD onset in those younger than 55 years to 3.47 (95% CI, 2.47-4.87) at CHD onset in those 75 years or older. Risks that were also noted for CHD onset in participants younger than 55 years included metabolic syndrome (aHR, 6.09; 95% CI, 3.60-10.29), hypertension (aHR, 4.58; 95% CI, 2.76-7.60), obesity (aHR, 4.33; 95% CI, 2.31-8.11), and smoking (aHR, 3.92; 95% CI, 2.32-6.63). Myocardial infarction in a parent before age 60 years was associated with 1.5- to 2-fold risk of CHD in participants up to age 75 years. From approximately 50 biomarkers, lipoprotein insulin resistance had the highest standardized aHR: 6.40 (95% CI, 3.14-13.06) for CHD onset in women younger than 55 years, attenuating with age. In comparison, weaker but significant associations with CHD in women younger than 55 years were noted (per SD increment) for low-density lipoprotein cholesterol (aHR, 1.38; 95% CI, 1.10-1.74), non-high-density lipoprotein cholesterol (aHR, 1.67; 95% CI, 1.36-2.04), apolipoprotein B (aHR, 1.89; 95% CI, 1.52-2.35), triglycerides (aHR, 2.14; 95% CI, 1.72-2.67), and inflammatory biomarkers (1.2- to 1.8-fold)-all attenuating with age. Some biomarkers had similar CHD age associations (eg, physical inactivity, lipoprotein[a], total high-density lipoprotein particles), while a few had no association with CHD onset at any age. Most risk factors and biomarkers had associations that attenuated with increasing age at onset. Conclusions and Relevance In this cohort study, diabetes and insulin resistance, in addition to hypertension, obesity, and smoking, appeared to be the strongest risk factors for premature onset of CHD. Most risk factors had attenuated relative rates at older ages.
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Affiliation(s)
- Sagar B Dugani
- Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - M Vinayaga Moorthy
- Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chunying Li
- Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Olga V Demler
- Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alawi A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Paul M Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert J Glynn
- Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Samia Mora
- Center for Lipid Metabolomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Wyld MLR, De La Mata NL, Masson P, O'Lone E, Kelly PJ, Webster AC. Cardiac Mortality in Kidney Transplant Patients: A Population-based Cohort Study 1988-2013 in Australia and New Zealand. Transplantation 2021; 105:413-422. [PMID: 32168042 DOI: 10.1097/tp.0000000000003224] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transplant recipients experience excess cardiac mortality. We compared circulatory death rates in Australian and New Zealand kidney transplant recipients to the general population and identified risk factors for circulatory death in kidney transplant recipients. METHODS The primary cause of death for kidney transplant recipients aged ≥18 was established through ICD-10-AM codes using data linkage between the Australia and New Zealand dialysis and transplant registry and national death registers. We estimated standardized mortality ratios (SMRs) and developed a Fine-Gray competing risks model to determine risk factors for cardiac mortality. RESULTS Of 5089 deaths in 16 329 kidney transplant recipients (158 325 person-years), 918 (18%) were cardiac. An increased risk of circulatory death was associated with older age (P < 0.001), male sex (P < 0.001), longer dialysis duration (P = 0.004), earlier era of transplantation (P < 0.001), ever graft failure (P < 0.001), known coronary artery disease (P = 0.002), and kidney failure from diabetes or hypertension (P < 0.001). The cardiac SMR was 5.4 [95% confidence interval (CI): 5.0-5.8], falling from 8.0 (95% CI: 4.9-13.1) in 1988 to 5.3 (95% CI: 4.0-7.0) in 2013 (P < 0.001). Females, particularly young ones, had significantly higher relative cardiac mortality than men. In recipients aged 40 years, the cardiac SMR was 26.5 (95% CI: 15.0-46.6) in females and 7.5 (95% CI: 5.0-11.1) for males. CONCLUSIONS Cardiac risks remain elevated in kidney transplant recipients and may be under-recognized, and prevention and treatment interventions less accessed, less effective or even harmful in female recipients.
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Affiliation(s)
- Melanie L R Wyld
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
- Renal Department, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Philip Masson
- School of Public Health, University of Sydney, Australia
| | - Emma O'Lone
- School of Public Health, University of Sydney, Australia
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Patrick J Kelly
- Renal Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Angela C Webster
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
- School of Public Health, University of Sydney, Australia
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Adilova IG, Abdurakhmanov MM, Abdurakhmanov ZM. [Influence of age factor and age-associated predictors on remote results of coronary artery bypass grafting]. Angiol Sosud Khir 2020; 26:161-167. [PMID: 33332319 DOI: 10.33529/angio2020414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study was undertaken to analyse long-term survival and its predictors, depending on age of patients who underwent isolated coronary aortic bypass grafting. Our study included a total of 177 consecutive patients operated on during 2014. For the purpose of statistical analysis, the patients were divided into two groups according to their age at the time of surgery: <60 years (n=96) and >60 years (n=81). The mean age in the groups <60 years and >60 years amounted to 54.5±2.9 years and 63.5±2.5 years, respectively. All data were obtained from the patients' medical histories, outpatient follow-up records, and operative reports. The average duration of follow-up in the overall cohort amounted to 5.1±1.7 years. Chronic obstructive pulmonary disease, peripheral artery disease, and acute impairment of cerebral circulation were of significantly less common occurrence in the younger patient cohort. However, the frequency of a body mass index of ≥30 kg/m2, unstable angina, previously endured myocardial infarction and left ventricular systolic dysfunction in the preoperative period appeared to be significantly higher in this population. At 5 years after surgery, freedom from survival amounted to 94.8% in patients younger than 60 years (5 patients) and to 90.1% (8 patients) in those aged 60 years and older (p<0.001). Based on the findings of a multivariate analysis, independent predictors of mortality turned out to be a history of myocardial infarction, chronic kidney disease, diabetes mellitus, chronic obstructive pulmonary disease, lesions of peripheral arteries and the trunk of the left coronary artery. The area under the receiver operating characteristic curve was 0.834 (p<0.001, 95% CI: 0.724-0.902). Despite the fact that coronary artery bypass grafting is an effective method of treatment of ischaemic heart disease for both groups, special attention should be paid to the development and improvement of preventive strategies aimed at decreasing the impact of specific risk factors for cardiovascular diseases such as diet, lifestyle, weight control, and more aggressive medical therapy in younger patients. It is necessary to elaborate a reasonable strategy and optimization of the choice of an optimal approach to myocardial revascularization for elderly patients with multivessel and truncal lesions of coronary arteries, which are potential risk factors of death in the postoperative period.
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Affiliation(s)
- I G Adilova
- Department of Cardiology, Tashkent Institute of Advanced Medical Training, Tashkent, Uzbekistan
| | - M M Abdurakhmanov
- Department of Surgical Diseases and Resuscitation, Bukhara State Medical Institute, Bukhara, Uzbekistan
| | - Z M Abdurakhmanov
- Department of Surgical Diseases and Resuscitation, Bukhara State Medical Institute, Bukhara, Uzbekistan
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Okoth K, Chandan JS, Marshall T, Thangaratinam S, Thomas GN, Nirantharakumar K, Adderley NJ. Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review. BMJ 2020; 371:m3502. [PMID: 33028606 PMCID: PMC7537472 DOI: 10.1136/bmj.m3502] [Citation(s) in RCA: 167] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To consolidate evidence from systematic reviews and meta-analyses investigating the association between reproductive factors in women of reproductive age and their subsequent risk of cardiovascular disease. DESIGN Umbrella review. DATA SOURCES Medline, Embase, and Cochrane databases for systematic reviews and meta-analyses from inception until 31 August 2019. REVIEW METHODS Two independent reviewers undertook screening, data extraction, and quality appraisal. The population was women of reproductive age. Exposures were fertility related factors and adverse pregnancy outcomes. Outcome was cardiovascular diseases in women, including ischaemic heart disease, heart failure, peripheral arterial disease, and stroke. RESULTS 32 reviews were included, evaluating multiple risk factors over an average follow-up period of 7-10 years. All except three reviews were of moderate quality. A narrative evidence synthesis with forest plots and tabular presentations was performed. Associations for composite cardiovascular disease were: twofold for pre-eclampsia, stillbirth, and preterm birth; 1.5-1.9-fold for gestational hypertension, placental abruption, gestational diabetes, and premature ovarian insufficiency; and less than 1.5-fold for early menarche, polycystic ovary syndrome, ever parity, and early menopause. A longer length of breastfeeding was associated with a reduced risk of cardiovascular disease. The associations for ischaemic heart disease were twofold or greater for pre-eclampsia, recurrent pre-eclampsia, gestational diabetes, and preterm birth; 1.5-1.9-fold for current use of combined oral contraceptives (oestrogen and progesterone), recurrent miscarriage, premature ovarian insufficiency, and early menopause; and less than 1.5-fold for miscarriage, polycystic ovary syndrome, and menopausal symptoms. For stroke outcomes, the associations were twofold or more for current use of any oral contraceptive (combined oral contraceptives or progesterone only pill), pre-eclampsia, and recurrent pre-eclampsia; 1.5-1.9-fold for current use of combined oral contraceptives, gestational diabetes, and preterm birth; and less than 1.5-fold for polycystic ovary syndrome. The association for heart failure was fourfold for pre-eclampsia. No association was found between cardiovascular disease outcomes and current use of progesterone only contraceptives, use of non-oral hormonal contraceptive agents, or fertility treatment. CONCLUSIONS From menarche to menopause, reproductive factors were associated with cardiovascular disease in women. In this review, presenting absolute numbers on the scale of the problem was not feasible; however, if these associations are causal, they could account for a large proportion of unexplained risk of cardiovascular disease in women, and the risk might be modifiable. Identifying reproductive risk factors at an early stage in the life of women might facilitate the initiation of strategies to modify potential risks. Policy makers should consider incorporating reproductive risk factors as part of the assessment of cardiovascular risk in clinical guidelines. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019120076.
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Affiliation(s)
- Kelvin Okoth
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Shakila Thangaratinam
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Dirgawati M, Hinwood A, Nedkoff L, Hankey GJ, Yeap BB, Flicker L, Nieuwenhuijsen M, Brunekreef B, Heyworth J. Long-term Exposure to Low Air Pollutant Concentrations and the Relationship with All-Cause Mortality and Stroke in Older Men. Epidemiology 2019; 30 Suppl 1:S82-9. [PMID: 31181010 DOI: 10.1097/EDE.0000000000001034] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Long-term air pollution exposure has been associated with increased risk of mortality and stroke. Less is known about the risk at lower concentrations. The association of long-term exposure to PM2.5, PM2.5 absorbance, NO2, and NOx with all-cause mortality and stroke was investigated in a cohort of men aged ≥ 65 years who lived in metropolitan Perth, Western Australia. METHODS Land use regression models were used to estimate long-term exposure to air pollutants at participant's home address (n = 11,627) over 16 years. Different metrics of exposure were assigned: baseline; year before the outcome event; and average exposure across follow-up period. The Mortality Register and Hospital Morbidity Data from the Western Australia Data Linkage System were used to ascertain mortality and stroke cases. Hazard ratios (HRs) and 95% confidence intervals were estimated using Cox proportional hazard models, adjusting for age, smoking, education, and body mass index for all-cause mortality. For fatal and hospitalized stroke, the models included variables controlled for all-cause mortality plus hypertension. RESULTS Fifty-four percent of all-participants died, 3% suffered a fatal stroke, and 14% were hospitalized stroke cases. PM2.5 absorbance increased the risk of all-cause mortality with adjusted HR of 1.12 (1.02-1.23) for baseline and average exposures, and 1.14 (1.02-1.24) for past-year exposure. There were no associations between PM2.5 absorbance, NO2, and NOx and stroke outcomes. However, PM2.5 was associated with reduced risks of fatal stroke. CONCLUSION Long-term exposure to PM2.5 absorbance was associated with all-cause mortality among older men exposed to low concentrations; and exposure to PM2.5 was associated with reduced risk of fatal stroke.
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Sun Y, Feng L, Li X, Gao R, Wu Y. The sex difference in 6-month MACEs and its explaining variables in acute myocardial infarction survivors: Data from CPACS-3 study. Int J Cardiol 2020; 311:1-6. [PMID: 32223960 DOI: 10.1016/j.ijcard.2020.03.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/09/2020] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND We aimed to assess sex difference in developing major adverse cardiovascular events (MACEs) after discharge and factors associated with the gender disparity among AMI survivors. METHODS We selected the patients hospitalized with either NSTEMI or STEMI from 101 Chinese centers in the CPACS 3 study. We compared sex differences in MACEs and mortality in 6 months after discharge using a Cox proportional hazards model, following sequential adjustment for covariates. RESULTS 8958 patients with AMI were included and 30.3% were women. Overall, the crude rate of MACEs at 6 month for women were significantly higher than men (6.5% vs 4.5%; hazard ratio (HR) =1.47; 95% CI, 1.21-1.77). Women also had significantly higher total mortality compared to men (4.4% vs 2.7%; HR = 1.65; 95% CI, 1.30-2.09). Among possible explanatory factors, patients' cardiovascular risk profile might explain 53%, age 38%, low level of education and socioeconomic status 32%. Interestingly, medications at discharge did not contribute to the sex disparity in 6-month risk of MACEs. These factors could explain a similar proportion of the gender disparity in total death. All together, these factors could explain all the disparity in the risk of both MACEs (HR = 1.05,95% CI, 0.85-1.31) and total death (HR = 1.00,95% CI,0.76-1.30). CONCLUSIONS The gender disparity in MACEs and total death among AMI patients continues at 6 months after discharged surviving. Multiple factors could explain the higher risk for women, including poorer cardiovascular risk factor profile, older age and lower socioeconomic status. TRIAL REGISTRATION CPACS-3 was registered on www.clinicaltrails.gov, and the registration number is NCT01398228.
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Affiliation(s)
- Yihong Sun
- China-Japan Friendship Hospital, Beijing, China
| | - Lin Feng
- Peking University Clinical Research Institute, Beijing, China.
| | - Xian Li
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China; Faculty of Medicine, University of New South Wales, Australia.
| | - Runlin Gao
- The Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Beijing, China; The George Institute for Global Health at Peking University Health Science Center, Beijing, China; Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China.
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Wang TKM, Grey C, Jiang Y, Jackson R, Kerr A. Contrasting Trends in Acute Coronary Syndrome Hospitalisation and Coronary Revascularisation in New Zealand 2006-2016: A National Data Linkage Study (ANZACS-QI 27). Heart Lung Circ 2020; 29:1375-1385. [PMID: 31974025 DOI: 10.1016/j.hlc.2019.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/28/2019] [Accepted: 11/18/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Evaluating trends in acute coronary syndrome (ACS) and invasive coronary procedures, including coronary angiography, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) can identify areas for improvement in clinical care and inform future health planning. This national data-linkage study reports trends in ACS hospitalisations and procedure rates in New Zealand between 2006 and 2016. METHODS All adult ACS hospitalisations and associated angiography and revascularisation procedures were identified from hospital discharge codes. Crude and age-standardised ACS incidence and procedure rates were calculated for each calendar year. RESULTS Between 2006 and 2016 there were 188,264 ACS admissions. During this time, there was a steady decline in hospitalisation rates, from 685 to 424 per 100,000 per year. This decline was observed in both sexes and in all age groups. There were also significant increases in coronary angiography and revascularisation rates, from 29.8% to 54.3% and 20.6% to 37.3%, respectively, between 2006 and 2016. The rate of revascularisation by PCI increased from 16.0% to 31.0%, a greater increase than revascularisation by CABG, which increased from 4.6% to 6.5%. Increases in procedures were observed in all age groups and both sexes. The proportions of coronary angiograms that resulted in revascularisation each year consistently ranged from 67 to 70% throughout the period. CONCLUSIONS Acute coronary syndrome hospitalisation rates in New Zealand decreased by nearly 40% between 2006 and 2016, while the use of coronary angiography and revascularisation after ACS nearly doubled. The similar proportions of angiograms that resulted in revascularisation each year suggests that, despite the doubling of angiograms over the 10-year study period, they are not over-utilised.
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Affiliation(s)
- Tom Kai Ming Wang
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand; Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Corina Grey
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Rod Jackson
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Andrew Kerr
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand; School of Population Health, University of Auckland, Auckland, New Zealand.
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Affiliation(s)
- Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
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Dugani SB, Ayala Melendez AP, Reka R, Hydoub YM, McCafferty SN, Murad MH, Alsheikh-Ali AA, Mora S. Risk factors associated with premature myocardial infarction: a systematic review protocol. BMJ Open 2019; 9:e023647. [PMID: 30755446 PMCID: PMC6377544 DOI: 10.1136/bmjopen-2018-023647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Premature myocardial infarction (MI) generally refers to MI in men ≤55 years or women ≤65 years. Premature MI is a major contributor to cardiovascular disease (CVD), which claimed 17.6 million lives globally in 2016. Reducing premature MI and CVD is a key priority for all nations; however, there is sparse synthesis of information on risk factors associated with premature MI. To address this knowledge gap, we are conducting a systematic review to describe the association between risk factors (demographics, lifestyle factors and biomarkers) and premature MI. METHODS AND ANALYSIS The following databases were searched from inception to June 2018: CENTRAL, CINAHL, Clinical Trials, EMBASE and MEDLINE. We will include original research articles (case-control, cohort and cross-sectional studies) that report a quantitative relationship between at least one risk factor and premature MI. Two investigators will use predetermined selection criteria and independently screen articles based on title and abstract (primary screening). Articles that meet selection criteria will undergo full-text screening based on criteria used for primary screening (secondary screening). Data will be extracted using predetermined data extraction forms. The Newcastle-Ottawa Scale for case-control and cohort studies will be used to evaluate the risk of bias and will be adapted for cross-sectional studies. Whenever feasible, data will be summarised into a random-effects meta-analysis. ETHICS AND DISSEMINATION To our knowledge, this will be the first study to synthesise results on the relationship between risk factors and premature MI. These findings will inform healthcare providers on factors associated with risk of premature MI and potentially improve primary prevention efforts by guiding development of interventions. These findings will be summarised and presented at conferences and through publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018076862.
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Affiliation(s)
- Sagar B Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Center for Lipid Metabolomics, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Roger Reka
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | | | | | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Alawi A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Samia Mora
- Center for Lipid Metabolomics, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
- Division of Preventive Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
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21
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Sarink D, Nedkoff L, Briffa T, Shaw JE, Magliano DJ, Stevenson C, Mannan H, Knuiman M, Hung J, Hankey GJ, Norman P, Peeters A. Trends in age- and sex-specific prevalence and incidence of cardiovascular disease in Western Australia. Eur J Prev Cardiol 2018; 25:1280-1290. [PMID: 30012003 DOI: 10.1177/2047487318786585] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Temporal trends in incidence and mortality of cardiovascular disease (CVD) have been well described, with recent data suggesting declining improvements in those aged under 55 years. However, little is known about the combined impact of incidence and mortality trends on disease prevalence, an important indicator of disease burden and cost. We analysed changes in age-specific and age-standardised temporal trends in prevalence and incidence of CVD subtypes. Methods Annual prevalence and incidence rates of coronary heart disease, cerebrovascular disease and peripheral arterial disease for the Western Australian population for 1995-2010 were calculated using data from the Western Australian Data Linkage System. Joinpoint regression analyses were used to identify joinpoints in trends in age-specific and age-standardised annual prevalence and incidence rates for each CVD subtype. Results Between 1995 and 2010, age- and sex-specific incidence and prevalence of the CVD subtypes generally decreased among middle-aged and older adults, but were stable or increased among younger adults. In < 55 year olds, increases in incidence tended to occur from 2003, while increases in prevalence were from 2007/2008. Declines in age-standardised incidence were greater than those in crude incidence, with changes in population structure having a greater impact among men than women. Conclusions The majority of CVDs occurs in older adults. Our findings of generally worsening trends in prevalence in younger adults across most CVD subtypes were in contrast to generally declining trends in older age groups. These data highlight the importance of monitoring prevalence and incidence, particularly in younger adults.
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Affiliation(s)
- Danja Sarink
- 1 Baker IDI Heart and Diabetes Institute, Melbourne, Australia.,2 Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - Lee Nedkoff
- 3 School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Tom Briffa
- 3 School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Jonathan E Shaw
- 1 Baker IDI Heart and Diabetes Institute, Melbourne, Australia.,4 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Dianna J Magliano
- 1 Baker IDI Heart and Diabetes Institute, Melbourne, Australia.,4 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christopher Stevenson
- 5 School of Health and Social Development, Faculty of Health, Deakin University, Melbourne, Australia
| | - Haider Mannan
- 6 Translational Health Research Institute, School of Medicine, Western Sydney University, Australia
| | - Matthew Knuiman
- 3 School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Joseph Hung
- 7 School of Medicine, The University of Western Australia, Perth, Australia
| | - Graeme J Hankey
- 7 School of Medicine, The University of Western Australia, Perth, Australia
| | - Paul Norman
- 7 School of Medicine, The University of Western Australia, Perth, Australia
| | - Anna Peeters
- 1 Baker IDI Heart and Diabetes Institute, Melbourne, Australia.,4 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,8 Deakin University, Geelong, Australia
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Wellings J, Kostis JB, Sargsyan D, Cabrera J, Kostis WJ. Risk Factors and Trends in Incidence of Heart Failure Following Acute Myocardial Infarction. Am J Cardiol 2018; 122:1-5. [PMID: 29685572 DOI: 10.1016/j.amjcard.2018.03.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/05/2018] [Accepted: 03/13/2018] [Indexed: 12/25/2022]
Abstract
Patients who develop heart failure (HF) after an acute myocardial infarction (AMI) are at higher risk of adverse fatal and nonfatal outcomes. Published studies on the incidence and associations of HF after infarction have been contradictory, with some reporting increasing and others decreasing incidence. Between 2000 and 2015, 109,717 patients admitted for a first AMI in New Jersey were discharged alive. In the 15 years from 2000 to 2015, the rates of admission for HF in AMI patients who were discharged alive decreased by 60%, from 3.48% to 1.4%, at 1-year follow-up. At 5 years of follow-up, the decline was more pronounced, from 7.21% to 1.4%, an 80% decline. All-cause death, and the combined end point of admission for HF or death, showed decreasing trends. Cox regression indicated a decrease in the risk of admission for HF over time (hazard ratio [HR] 0.955, 95% confidence interval [CI] 0.949 to 0.961). Younger age, male gender, and commercial insurance were associated with lower HRs for HF (p <0.001), whereas history of hypertension, diabetes, kidney, or lung disease were associated with higher HRs (p <0.001). There was no significant difference in the rate of HF between subendocardial and transmural AMI (adjusted OR was 0.96, CI 0.90 to 1.03, p = 0.241). Revascularization was associated with a marked decrease in HF admissions (adjusted OR 0.22, 95% CI 0.19 to 0.25, p <0.001 for percutaneous coronary intervention and OR 0.44, 95% CI 0.38 to 0.51, p <0.001 for CABG). In conclusion, the rate of admission for HF after discharge for a first myocardial infarction as well as all-cause death decreased markedly from 2000 to 2015.
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Affiliation(s)
- Jennifer Wellings
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute, New Brunswick, New Jersey
| | - John B Kostis
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute, New Brunswick, New Jersey.
| | - Davit Sargsyan
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute, New Brunswick, New Jersey
| | - Javier Cabrera
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute, New Brunswick, New Jersey
| | - William J Kostis
- Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute, New Brunswick, New Jersey
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Nicolini F, Fortuna D, Contini GA, Pacini D, Gabbieri D, Zussa C, De Palma R, Vezzani A, Gherli T. The Impact of Age on Clinical Outcomes of Coronary Artery Bypass Grafting: Long-Term Results of a Real-World Registry. Biomed Res Int 2017; 2017:9829487. [PMID: 29423414 DOI: 10.1155/2017/9829487] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 09/26/2017] [Accepted: 10/19/2017] [Indexed: 11/17/2022]
Abstract
The aim of this retrospective multicenter registry study was to investigate age-dependent trends in mortality, long-term survival, and comorbidity over time in patients who underwent isolated CABG from 2003 to 2015. The percentage of patients < 60 years of age was 18.9%. Female sex, chronic pulmonary disease, extracardiac arteriopathy, and neurologic dysfunction disease were significantly less frequent in this younger population. The prevalence of BMI ≥ 30, previous myocardial infarction, preoperative severe depressed left ventricular ejection fraction, and history of previous PCI were significantly higher in this population. After PS matching, at 5 years, patients < 60 years of age reported significantly lower overall mortality (p < 0.0001), cardiac-related mortality (p < 0.0001), incidence of acute myocardial infarction (p = 0.01), and stroke rates (p < 0.0001). Patients < 60 years required repeated revascularization more frequently than older patients (p = 0.05). Patients < 60 who underwent CABG had a lower risk of adverse outcomes than older patients. Patients < 60 have a different clinical pattern of presentation of CAD in comparison with more elderly patients. These issues require focused attention in order to design and improve preventive strategies aiming to reduce the impact of specific cardiovascular risk factors for younger patients, such as diet, lifestyle, and weight control.
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Saner H, Mollet JD, Berlin C, Windecker S, Meier B, Räber L, Zwahlen M, Stute P. No significant gender difference in hospitalizations for acute coronary syndrome in Switzerland over the time period of 2001 to 2010. Int J Cardiol 2017; 243:59-64. [DOI: 10.1016/j.ijcard.2017.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/21/2017] [Accepted: 05/09/2017] [Indexed: 11/29/2022]
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Grey C, Jackson R, Wells S, Wu B, Poppe K, White H, Chan WC, Kerr AJ. First and recurrent ischaemic heart disease events continue to decline in New Zealand, 2005-2015. Heart 2017; 104:51-57. [PMID: 28663363 DOI: 10.1136/heartjnl-2017-311613] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/25/2017] [Accepted: 05/30/2017] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To examine recent trends in first and recurrent ischaemic heart disease (IHD) deaths and hospitalisations. METHODS Using anonymous patient-linkage of routinely collected data, all New Zealanders aged 35-84 years who experienced an International Statistical Classification of Diseases and Related Health Problems I(CD)-coded IHD hospitalisation and/or IHD death between 1 January 2005 and 31 December 2015 were identified. A 10-year look-back period was used to differentiate those experiencing first from recurrent events. Age-standardised hospitalisation and mortality rates were calculated for each calendar year and trends compared by sex and age. RESULTS 160 109 people experienced at least one IHD event (259 678 hospitalisations and 35 548 deaths) over the 11-year study period, and there was a steady decline in numbers (from almost 24 000 in 2005 to just over 16 000 in 2015) and in age-standardised rates each year. With the exception of deaths in younger (35-64 years) women with prior IHD, there was a significant decline in IHD events in men and women of all ages, with and without a history of IHD. The decline in IHD mortality was greater for those experiencing a first rather than recurrent IHD event (3.8%-5.2% vs 0%-3.7% annually on average). In contrast, the decline in IHD hospitalisations was greater for those experiencing a recurrent compared with a first IHD event (5.6%-7.3% vs 3.2%-5.7% annually on average). CONCLUSIONS The substantial decline in IHD hospitalisations and mortality observed in New Zealanders with and without prior IHD between 2005 and 2015 suggests that primary and secondary prevention efforts have been effective in reducing the occurrence of IHD events.
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Affiliation(s)
- Corina Grey
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Rod Jackson
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Susan Wells
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Billy Wu
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Katrina Poppe
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Harvey White
- Greenlane Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand
| | - Wing Cheuk Chan
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Andrew J Kerr
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.,Counties Manukau District Health Board, Auckland, New Zealand
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Davies AJ, Naudin C, Al-Omary M, Khan A, Oldmeadow C, Jones M, Bastian B, Bhagwandeen R, Fletcher P, Leitch J, Boyle A. Disparities in the incidence of acute myocardial infarction: long-term trends from the Hunter region. Intern Med J 2017; 47:557-562. [DOI: 10.1111/imj.13399] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/14/2017] [Accepted: 02/09/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Allan J. Davies
- Cardiovascular Department; John Hunter Hospital; Newcastle New South Wales Australia
| | - Crystal Naudin
- School of Medicine and Public Health; University of Newcastle; Newcastle New South Wales Australia
| | - Mohammed Al-Omary
- Cardiovascular Department; John Hunter Hospital; Newcastle New South Wales Australia
- School of Medicine and Public Health; University of Newcastle; Newcastle New South Wales Australia
- Hunter Medical Research Institute; Newcastle New South Wales Australia
| | - Arshad Khan
- Cardiovascular Department; John Hunter Hospital; Newcastle New South Wales Australia
| | - Chris Oldmeadow
- School of Medicine and Public Health; University of Newcastle; Newcastle New South Wales Australia
- Hunter Medical Research Institute; Newcastle New South Wales Australia
| | - Mark Jones
- School of Medicine and Public Health; University of Newcastle; Newcastle New South Wales Australia
- Hunter Medical Research Institute; Newcastle New South Wales Australia
| | - Bruce Bastian
- Cardiovascular Department; John Hunter Hospital; Newcastle New South Wales Australia
| | - Rohan Bhagwandeen
- Cardiovascular Department; John Hunter Hospital; Newcastle New South Wales Australia
| | - Peter Fletcher
- Cardiovascular Department; John Hunter Hospital; Newcastle New South Wales Australia
- Hunter Medical Research Institute; Newcastle New South Wales Australia
| | - James Leitch
- Cardiovascular Department; John Hunter Hospital; Newcastle New South Wales Australia
- Hunter Medical Research Institute; Newcastle New South Wales Australia
| | - Andrew Boyle
- Cardiovascular Department; John Hunter Hospital; Newcastle New South Wales Australia
- School of Medicine and Public Health; University of Newcastle; Newcastle New South Wales Australia
- Hunter Medical Research Institute; Newcastle New South Wales Australia
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Ramirez FD, Chen Y, Di Santo P, Simard T, Motazedian P, Hibbert B. Association Between Self-Reported Potentially Modifiable Cardiac Risk Factors and Perceived Need to Improve Physical Health: A Population-Based Study. J Am Heart Assoc 2017; 6:JAHA.117.005491. [PMID: 28468783 PMCID: PMC5524095 DOI: 10.1161/jaha.117.005491] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background An individual's perceived need to improve their physical health (PNIPH) is an essential precursor to adopting healthy behaviors. Nine potentially modifiable risk factors (PMRFs) for myocardial infarction collectively account for ≥90% of the population attributable risk. Though widely recognized, their impact on individuals’ health perceptions is unclear. Methods and Results Residents from 6 provinces were administered a module on changes to improve health as part of the 2011–2012 Canadian Community Health Survey, yielding relevant data for 8 of the 9 PMRFs sought. The potential effects of PMRFs individually and cumulatively on PNIPH were examined using modified Poisson regression. In total, 45 443 respondents were included, representing 11 006 123 individuals and corresponding to 96.8% of the adult population of the sampled provinces. The sum of PMRFs was positively associated with PNIPH (adjusted prevalence ratio, 1.08; 95% CI, 1.07–1.09 per additional PMRF) with 82.3% of individuals with ≥5 PMRFs reporting this perception. Smoking, obesity, and low physical activity were most strongly associated with PNIPH, whereas hypertension and diabetes mellitus exhibited no association with this outcome after adjusting for potential confounders. Barriers to adopting healthy behaviors were reported by 55.9% of individuals endorsing PNIPH. Conclusions The cumulative burden of PMRFs is positively associated with PNIPH; however, individual PMRFs differentially contribute to this perception. Among those at highest cardiac risk, ≈1 in 5 denied PNIPH. A better understanding of factors underlying health perceptions and behaviors is needed to capitalize on cardiovascular preventive efforts.
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Affiliation(s)
- F Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
| | - Yue Chen
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
| | - Pietro Di Santo
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Trevor Simard
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pouya Motazedian
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada .,CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Ghazi L, Oparil S, Calhoun DA, Lin CP, Dudenbostel T. Distinctive Risk Factors and Phenotype of Younger Patients With Resistant Hypertension: Age Is Relevant. Hypertension 2017; 69:827-835. [PMID: 28348010 DOI: 10.1161/hypertensionaha.116.08632] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 11/04/2016] [Accepted: 02/04/2017] [Indexed: 01/11/2023]
Abstract
Resistant hypertension, defined as blood pressure >140/90 mm Hg despite using ≥3 antihypertensive medications, is a well-recognized clinical entity. Patients with resistant hypertension are at an increased risk of cardiovascular disease compared with those with more easily controlled hypertension. Coronary heart disease mortality rates of younger adults are stagnating or on the rise. The purpose of our study was to characterize the phenotype and risk factors of younger patients with resistant hypertension, given the dearth of data on cardiovascular risk profile in this cohort. We conducted a cross-sectional analysis with predefined age groups of a large, ethnically diverse cohort of 2170 patients referred to the Hypertension Clinic at the University of Alabama at Birmingham. Patients (n=2068) met the inclusion criteria and were classified by age groups, that is, ≤40 years (12.7% of total cohort), 41 to 55 years (32.1%), 56 to 70 years (36.1%), and ≥71 years (19.1%). Patients aged ≤40 years compared with those aged ≥71 years had significantly earlier onset of hypertension (24.7±7.4 versus 55.0±14.1 years; P<0.0001), higher rates of obesity (53.4% versus 26.9%; P<0.0001), and significantly higher levels of plasma aldosterone (11.3±9.8 versus 8.9±7.4 ng/dL; P=0.005), plasma renin activity (4.9±10.2 versus 2.5±5.0 ng/mL per hour; P=0.001), 24-hour urinary aldosterone (13.4±10.0 versus 8.2±6.2 µg/24 h; P<0.0001), and sodium excretion (195.9±92.0 versus 146.8±67.1 mEq/24 h; P<0.0001). Among patients with resistant hypertension, younger individuals have a distinct phenotype characterized by overlapping risk factors and comorbidities, including obesity, high aldosterone, and high dietary sodium intake compared with elderly.
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Affiliation(s)
- Lama Ghazi
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (L.G.); Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O., D.A.C., T.D.); Alabama Medicine (S.O., D.A.C., T.D.) and Center for Clinical and Translational Science (C.P.L.), University of Birmingham at Alabama.
| | - Suzanne Oparil
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (L.G.); Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O., D.A.C., T.D.); Alabama Medicine (S.O., D.A.C., T.D.) and Center for Clinical and Translational Science (C.P.L.), University of Birmingham at Alabama
| | - David A Calhoun
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (L.G.); Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O., D.A.C., T.D.); Alabama Medicine (S.O., D.A.C., T.D.) and Center for Clinical and Translational Science (C.P.L.), University of Birmingham at Alabama
| | - Chee Paul Lin
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (L.G.); Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O., D.A.C., T.D.); Alabama Medicine (S.O., D.A.C., T.D.) and Center for Clinical and Translational Science (C.P.L.), University of Birmingham at Alabama
| | - Tanja Dudenbostel
- From the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (L.G.); Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (S.O., D.A.C., T.D.); Alabama Medicine (S.O., D.A.C., T.D.) and Center for Clinical and Translational Science (C.P.L.), University of Birmingham at Alabama
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Feng JL, Nedkoff L, Knuiman M, Semsarian C, Ingles J, Briffa T, Hickling S. Temporal Trends in Sudden Cardiac Death From 1997 to 2010: A Data Linkage Study. Heart Lung Circ 2017; 26:808-16. [PMID: 28190759 DOI: 10.1016/j.hlc.2016.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/21/2016] [Accepted: 11/29/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Community-wide trends data for sudden cardiac death (SCD) are scarce, unlike widely reported declines in cardiovascular disease (CVD) mortality. Using administrative data, we aimed to examine population-level trends in SCD, stratified by sex, age and prior CVD hospitalisation. METHODS Person-linked mortality and hospital morbidity data were used to identify SCD and determine hospitalisation and comorbidity using a 10-year hospitalisation lookback period. Log-linear Poisson regression was used to calculate annual rate changes and rate ratios. RESULTS In Western Australia, 7160 SCD cases were identified from 1997 to 2010 with males comprising 69%. Overall age-standardised SCD rates decreased by 17% in men and 31% in women from 1997-2001 to 2007-2010. The annual rate reduction was higher in women than men (-4.0%/year versus -2.3%/year; p=0.0039). Significant reductions were observed for 55-69 year-old and 70-84 year-old men and women but not for the 35-54 year-olds. The overall relative risk comparing men to women increased slightly from 2.4 in 1997 to 3.0 in 2010 (trend p=0.0039) but differed across age groups. The relative risk declined in 35-54 year-olds from 5.1 to 3.2 whereas it increased from 2.9 to 3.9 in 55-69 year-olds and 1.9 to 2.3 in 70-84 year-olds. Declining trends in SCD rates were observed in those with and without prior CVD and were similar to CVD mortality trends (-4.9%/year in men and -5.5%/year in women). CONCLUSIONS Trends in rates of SCD fell in middle to older aged men and women, with and without CVD, and mirrored the fall in fatal CVD. Limited improvement in 35-54 year-olds requires further investigation.
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Waters DD. The Rise and Fall of Tuberculosis and Atherosclerosis: First There Is a Mountain…. Can J Cardiol 2017; 33:295-297. [PMID: 28081868 DOI: 10.1016/j.cjca.2016.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 11/17/2016] [Accepted: 11/17/2016] [Indexed: 01/03/2023] Open
Affiliation(s)
- David D Waters
- Division of Cardiology, San Francisco General Hospital, and the Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
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Vakili H, Sadeghi R, Toofaninejad N, SadeAkbarighi T, Kachoueian N. One- and Six-month Outcomes of Patients with Non-ST Elevation Myocardial Infarction. ijcp 2016. [DOI: 10.21859/ijcp-010303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Pelletier R, Choi J, Winters N, Eisenberg MJ, Bacon SL, Cox J, Daskalopoulou SS, Lavoie KL, Karp I, Shimony A, So D, Thanassoulis G, Pilote L. Sex Differences in Clinical Outcomes After Premature Acute Coronary Syndrome. Can J Cardiol 2016; 32:1447-1453. [PMID: 27683172 DOI: 10.1016/j.cjca.2016.05.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Over past decades, the incidence of acute coronary syndrome (ACS) has increased in young women, and greater mortality rates after discharge were observed among young women vs men. We revisited this issue with contemporary data from the Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome (GENESIS-PRAXY), a multicentre prospective cohort study. METHODS One thousand two hundred thirteen patients were enrolled in GENESIS-PRAXY from 26 centres across Canada, the United States, and Switzerland between January 2009 and April 2013. We assessed major adverse cardiac events (MACE) and mortality over 12 months after ACS. The role of sex as a predictor of outcomes was determined with Cox proportional hazard regression analysis. RESULTS We included 1163 patients with complete data. The occurrence of MACE was 9% and 8% in women and men, respectively (P = 0.75), and 1% of women and men died during follow-up. In adjusted models, there was no sex difference in the risk of MACE or mortality. The proportion of patients with all-cause rehospitalization was higher in women (13%) compared with men (9%; P = 0.006), but cardiac rehospitalization rates were similar in both sexes regardless of ACS type. Among first rehospitalizations, the majority was classified as cardiac related (69%), with chest pain or angina (28%) and myocardial infarction (19%) reported as the most common reasons for first rehospitalization. CONCLUSIONS Women were more likely than men to be rehospitalized for all causes but not for a cardiac cause. In contrast to earlier studies, men and women had similar mortality and MACE outcomes at 1 year.
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Affiliation(s)
- Roxanne Pelletier
- Divisions of Clinical Epidemiology and General Internal Medicine, The Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Jin Choi
- Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicholas Winters
- Divisions of Clinical Epidemiology and General Internal Medicine, The Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Mark J Eisenberg
- Divisions of Cardiology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, Montréal, Québec, Canada
| | - Jafna Cox
- Division of Cardiology, Department of Medicine and Department of Community Health and Epidemiology, Halifax, Nova Scotia, Canada
| | - Stella S Daskalopoulou
- Division of General Internal Medicine, Department of Medicine, McGill University, McGill University Health Centre, Montréal, Québec, Canada
| | - Kim L Lavoie
- Department of Psychology, University of Québec in Montréal, Montréal, Québec, Canada
| | - Igor Karp
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Avi Shimony
- Division of Cardiology, Soroka Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Derek So
- Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - George Thanassoulis
- Division of Cardiology, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Louise Pilote
- Divisions of Clinical Epidemiology and General Internal Medicine, The Research Institute of the McGill University Health Centre, Montréal, Québec, Canada.
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Nedkoff L, Knuiman M, Hobbs MST, Hung J, Mathur S, Beilby J, Reynolds A, Briffa TG, Lopez D, Sanfilippo FM. Is the incidence of heart attack still decreasing in Australia? Developing reliable methods for monitoring trends in myocardial infarction and coronary heart disease (AUS-MOCHA): a study protocol. BMJ Open 2016; 6:e012180. [PMID: 27558904 PMCID: PMC5013363 DOI: 10.1136/bmjopen-2016-012180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/30/2016] [Accepted: 08/01/2016] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Accurate monitoring of acute coronary heart disease (CHD) is essential for understanding the effects of primary and secondary prevention and for planning of healthcare services. The ability to reliably monitor acute CHD has been affected by new diagnostic tests for myocardial infarction (MI) and changing clinical classifications and management of CHD. Our study will develop new and reliable methods for monitoring population trends in incidence, outcomes and health service usage for acute CHD and chest pain. METHODS AND ANALYSIS The study cohort of all CHD will be identified from the Western Australian Data Linkage System using state-wide data sets for emergency department presentation, hospitalisations and mortality data for 2002-2014. This core linked data set will be supplemented with data from hospital medical record reviews, pathology data and hospital pharmacy dispensing databases. The consistency over time of the coding of the different subgroups of CHD/chest pain (ST-elevation MI, non-ST elevation MI, unstable angina, stable angina, other CHD, non-CHD chest pain) in linked data will be assessed using these data sources, and an algorithm developed detailing groups in which temporal trends can be reliably measured. This algorithm will be used for measurement of trends in incidence and outcomes of acute CHD, and to develop further methods for monitoring acute CHD using unlinked and linked data with varying availability of hospitalisation history. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Human Research Ethics Committees of the WA Department of Health (#2016/23) and The University of Western Australia (RA/4/1/7230). Findings will be disseminated via publication in peer-reviewed journals, and presentation at national and international conferences. There will also be a strong platform for dissemination of new monitoring methods via collaboration with the Australian Institute of Health and Welfare which will assist with promotion of these methods at state and national levels.
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Affiliation(s)
- Lee Nedkoff
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Matthew Knuiman
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Michael S T Hobbs
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Joseph Hung
- Sir Charles Gairdner Hospital Unit, School of Medicine and Pharmacology (M503), The University of Western Australia, Crawley, Western Australia, Australia
| | - Sushma Mathur
- Australian Institute of Health and Welfare, Canberra, Australian Capital Territory, Australia
| | - John Beilby
- PathWest Laboratory Medicine WA, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- School of Pathology and Laboratory Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Anna Reynolds
- Australian Institute of Health and Welfare, Canberra, Australian Capital Territory, Australia
| | - Tom G Briffa
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Derrick Lopez
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Frank M Sanfilippo
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
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Ren S, Hure A, Peel R, D'Este C, Abhayaratna W, Tonkin A, Hopper I, Thrift AG, Levi C, Sturm J, Durrheim D, Hung J, Briffa T, Chew DP, Anderson P, Moon L, McEvoy M, Hansbro P, Newby D, Attia J; AUSPICE study group. Rationale and design of a randomized controlled trial of pneumococcal polysaccharide vaccine for prevention of cardiovascular events: The Australian Study for the Prevention through Immunization of Cardiovascular Events (AUSPICE). Am Heart J 2016; 177:58-65. [PMID: 27297850 DOI: 10.1016/j.ahj.2016.04.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 04/12/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Research has shown that vaccination with Streptococcus pneumoniae reduced the extent of atherosclerosis in experimental animal models. It is thought that phosphorylcholine lipid antigens in the S. pneumoniae cell wall induce the production of antibodies that cross-react with oxidized low-density lipoprotein, a component of atherosclerotic plaques. These antibodies may bind to and facilitate the regression of the plaques. Available data provide evidence that similar mechanisms also occur in humans, leading to the possibility that pneumococcal vaccination protects against atherosclerosis. A systematic review and meta-analysis, including 8 observational human studies, of adult pneumococcal polysaccharide vaccination for preventing cardiovascular disease in people older than 65 years, showed a 17% reduction in the odds (odds ratio 0.83, 95% CI 0.71-0.97) of having an acute coronary syndrome event. METHODS/DESIGN The AUSPICE is a multicenter, randomized, placebo-controlled, double-blind, clinical trial to formally test whether vaccination with the pneumococcal polysaccharide vaccine protects against cardiovascular events (fatal and nonfatal acute coronary syndromes and ischemic strokes). Cardiovascular outcomes will be obtained during 4 to 5 years of follow-up, through health record linkage with state and national administrative data sets. CONCLUSION This is the first registered randomized controlled trial (on US, World Health Organization, Australia and New Zealand trial registries) to be conducted to test whether vaccination with the pneumococcal polysaccharide vaccine will reduce cardiovascular events. If successful, vaccination can be readily extended to at-risk groups to reduce the risk of cardiovascular diseases.
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Andriolo RB, Ponte Jr JR, Gomes Gutierrez E, Andriolo BNG, Ramos LR. Glycaemic control for patients with acute coronary syndrome. Hippokratia 2016. [DOI: 10.1002/14651858.cd010811.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Regis B Andriolo
- Universidade do Estado do Pará; Department of Public Health; Travessa Perebebuí, 2623 Belém Pará Brazil 66087-670
| | | | - Erickson Gomes Gutierrez
- Universidade Federal do Para; Department of Medicine; Avenida Governador Jose Malchar 1192 Belem Para Brazil 660055260
| | - Brenda NG Andriolo
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde; Brazilian Cochrane Centre; Rua Borges Lagoa, 564 cj 63 São Paulo São Paulo Brazil 04038-000
| | - Luiz Roberto Ramos
- Escola Paulista de Medicina, Universidade Federal de São Paulo; Department of Preventive Medicine; Rua dos Otonis, 731 Vila Clementino São Paulo São Paulo Brazil 04025-002
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Xanthos PD, Gordon BA, Begg S, Nadurata V, Kingsley MIC. A comparison of age-standardised event rates for acute and chronic coronary heart disease in metropolitan and regional/remote Victoria: a retrospective cohort study. BMC Public Health 2016; 16:391. [PMID: 27169563 PMCID: PMC4865014 DOI: 10.1186/s12889-016-3081-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/04/2016] [Indexed: 11/11/2022] Open
Abstract
Background Acute and chronic coronary heart disease (CHD) pose different burdens on health-care services and require different prevention and treatment strategies. Trends in acute and chronic CHD event rates can guide service implementation. This study evaluated changes in acute and chronic CHD event rates in metropolitan and regional/remote Victoria. Methods Victorian hospital admitted episodes with a principal diagnosis of acute CHD or chronic CHD were identified from 2005 to 2012. Acute and chronic CHD age-standardised event rates were calculated in metropolitan and regional/remote Victoria. Poisson log-link linear regression was used to estimate annual change in acute and chronic CHD event rates. Results Acute CHD age-standardised event rates decreased annually by 2.9 % (95 % CI, −4.3 to −1.4 %) in metropolitan Victoria and 1.7 % (95 % CI, −3.2 to −0.1 %) in regional/remote Victoria. In comparison, chronic CHD age-standardised event rates increased annually by 4.8 % (95 % CI, +3.0 to +6.5 %) in metropolitan Victoria and 3.1 % (95 % CI, +1.3 to +4.9 %) in regional/remote Victoria. On average, age-standardised event rates for regional/remote Victoria were 30.3 % (95 % CI, 23.5 to 37.2 %) higher for acute CHD and 55.3 % (95 % CI, 47.1 to 63.5 %) higher for chronic CHD compared to metropolitan Victoria from 2005 to 2012. Conclusion Annual decreases in acute CHD age-standardised event rates might reflect improvements in primary prevention, while annual increases in chronic CHD age-standardised event rates suggest a need to improve secondary prevention strategies. Consistently higher acute and chronic CHD age-standardised event rates were evident in regional/remote Victoria compared to metropolitan Victoria from 2005 to 2012.
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Affiliation(s)
- Paul D Xanthos
- Discipline of Exercise Physiology, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Brett A Gordon
- Discipline of Exercise Physiology, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Stephen Begg
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Voltaire Nadurata
- Department of Cardiology, Bendigo Health Care Group, Bendigo, Victoria, Australia
| | - Michael I C Kingsley
- Discipline of Exercise Physiology, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia.
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Abstract
OBJECTIVE To evaluate gender-specific and age-specific differences in the occurrence of unstable angina pectoris (UAP) caused admissions. DESIGN Population-based retrospective registry study in Finland. PARTICIPANTS All consecutive patients aged ≥30 years hospitalised with a primary diagnosis of UAP in 22 hospitals with a coronary catheterisation laboratory during 5/2000-10/2009. PRIMARY OUTCOME MEASURES Gender-specific and age-specific differences and trends in occurrence of UAP admissions. RESULTS The study period included 27 282 admissions caused primarily by UAP. Of these, 61.9% occurred to men and 38.1% to women with age-adjusted relative risk (RR) of 1.85 (CI 1.61 to 2.14) for the male gender (p<0.0001). The standardised incidence rate of UAP during the whole study was 92.8 (CI 91.8 to 93.9)/100,000 person-years. The incidence rate increased gradually from 1.3 in the population aged 30-34 years to 268.0/100,000 in the population aged 75-84 years. Men had a 2.4-fold risk for UAP admission compared with women in the general population (incidence rate ratio 2.39; CI 2.24 to 2.56; p<0.0001). Gender difference was present in all age groups. UAP caused 22.4% of acute coronary syndrome admissions and 4.7% of all cardiovascular admissions. UAP was more likely to be the cause of cardiovascular admission in male patients (RR=1.25; CI 1.21 to 1.30, p<0.0001 compared with female patients), but there was no gender difference in acute coronary syndrome admissions. The incidence rate of UAP hospitalisations in the general population declined by an estimated 8% per study-year (p<0.0001). Declining incidence was evident regardless of gender and age. CONCLUSIONS Men have a 2.4-fold overall RR for UAP admission compared to women in the general population. Admissions due to UAP have a declining incidence trend across the adult Finnish population.
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Affiliation(s)
- Ville Kytö
- Heart Center, Turku University Hospital, Turku, Finland
- Department of Medicine, Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Jussi Sipilä
- Division of Clinical Neurosciences, Neurology, Turku University Hospital, Turku, Finland
- Department of Neurology, University of Turku, Turku, Finland
| | - Päivi Rautava
- Clinical Research Center, Turku University Hospital, Turku, Finland
- Department of Public Health, University of Turku, Turku, Finland
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Wilmot KA, O'Flaherty M, Capewell S, Ford ES, Vaccarino V. Coronary Heart Disease Mortality Declines in the United States From 1979 Through 2011: Evidence for Stagnation in Young Adults, Especially Women. Circulation 2015; 132:997-1002. [PMID: 26302759 DOI: 10.1161/circulationaha.115.015293] [Citation(s) in RCA: 350] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 07/06/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary heart disease (CHD) mortality rates have fallen dramatically over the past 4 decades in the Western world. However, recent data from the United States and elsewhere suggest a plateauing of CHD incidence and mortality among young women. We therefore examined recent trends in CHD mortality rates in the United States according to age and sex. METHODS AND RESULTS We analyzed mortality data between 1979 and 2011 for US adults ≥25 years of age. We calculated age-specific CHD mortality rates and compared estimated annual percentage changes during 3 approximate decades of data (1979-1989, 1990-1999, and 2000-2011). We then used Joinpoint regression modeling to assess changes in trends over time on the basis of inflection points of the mortality rates. Adults ≥65 years of age showed consistent mortality declines, which became even steeper after 2000 (women, -5.0%; men, -4.4%). In contrast, young men and women (<55 years of age) initially showed a clear decline in CHD mortality from 1979 until 1989 (estimated annual percentage change, -5.5% in men and -4.6% in women). However, the 2 subsequent decades saw stagnation with minimal improvement. Notably, young women demonstrated no improvements between 1990 and 1999 (estimated annual percentage change, 0.1%) and only -1% estimated annual percentage change since 2000. Joinpoint analyses provided consistent results. CONCLUSIONS The dramatic decline in CHD mortality since 1979 conceals major heterogeneities. CHD death rates in older groups are now falling steeply. However, young adults have experienced frustratingly small decreases in CHD mortality rates since 1990. The drivers of these major differences in CHD mortality trends by age and sex merit urgent study.
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Affiliation(s)
- Kobina A Wilmot
- From the Department of Medicine, Division of Cardiology (K.A.W., V.V.), Department of Epidemiology, Rollins School of Public Health (V.V.), Emory University School of Medicine, Atlanta, GA; Department of Public Health & Policy, Institute of Psychology, Health & Society, University of Liverpool, UK (M.O., S.C.); and Centers for Disease Control and Prevention, Atlanta, GA (E.S.F.)
| | - Martin O'Flaherty
- From the Department of Medicine, Division of Cardiology (K.A.W., V.V.), Department of Epidemiology, Rollins School of Public Health (V.V.), Emory University School of Medicine, Atlanta, GA; Department of Public Health & Policy, Institute of Psychology, Health & Society, University of Liverpool, UK (M.O., S.C.); and Centers for Disease Control and Prevention, Atlanta, GA (E.S.F.)
| | - Simon Capewell
- From the Department of Medicine, Division of Cardiology (K.A.W., V.V.), Department of Epidemiology, Rollins School of Public Health (V.V.), Emory University School of Medicine, Atlanta, GA; Department of Public Health & Policy, Institute of Psychology, Health & Society, University of Liverpool, UK (M.O., S.C.); and Centers for Disease Control and Prevention, Atlanta, GA (E.S.F.)
| | - Earl S Ford
- From the Department of Medicine, Division of Cardiology (K.A.W., V.V.), Department of Epidemiology, Rollins School of Public Health (V.V.), Emory University School of Medicine, Atlanta, GA; Department of Public Health & Policy, Institute of Psychology, Health & Society, University of Liverpool, UK (M.O., S.C.); and Centers for Disease Control and Prevention, Atlanta, GA (E.S.F.)
| | - Viola Vaccarino
- From the Department of Medicine, Division of Cardiology (K.A.W., V.V.), Department of Epidemiology, Rollins School of Public Health (V.V.), Emory University School of Medicine, Atlanta, GA; Department of Public Health & Policy, Institute of Psychology, Health & Society, University of Liverpool, UK (M.O., S.C.); and Centers for Disease Control and Prevention, Atlanta, GA (E.S.F.).
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Safdar B, Dziura J, Bathulapalli H, Leslie DL, Skanderson M, Brandt C, Haskell SG. Chest pain syndromes are associated with high rates of recidivism and costs in young United States Veterans. BMC Fam Pract 2015. [PMID: 26202799 PMCID: PMC4511555 DOI: 10.1186/s12875-015-0287-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Recurrent chest pain is common in patients with and without coronary artery disease. The prevalence and burden of these symptoms on healthcare is unknown. Objectives To compare chest pain return visits (recidivism) in patients with unexplained chest pain (UCP) against reference group of patients with coronary artery disease (CAD) and estimate the annual cost of recurrent chest pain. Methods In a retrospective cohort study, a Veteran Affairs (VA) administrative and clinical database of Veterans who were deployed to or served in support of the wars in Iraq or Afghanistan was queried for first disease specific ICD-9 code to form two cohorts (UCP or CAD). Patients were followed between 09/2001-09/2010 for the first and cumulative return visits for UCP or cardiac pain (ACS or angina) to clinic, emergency department or admission; or for all-cause death. Time to return was analyzed using Cox regression and negative binomial models and adjusted for age, gender, race, marital status, and risk factors (hypertension, hyperlipidemia, diabetes, smoking and obesity). Direct total costs included inpatient, outpatient and fee basis (non-VA) costs. Results Of 749,036 patients, 20,521 had UCP and 5303 had CAD. UCP patients were young and had a lower burden of risk factors than CAD cohort (p < .01). Yet, these patients were likely to return earlier with any chest pain (adjusted Hazard Ratio [aHR] = 1.76; 95 % CI 1.65-1.88); or unexplained chest pain than CAD patients (aHR: 1.89; 95 % CI 1.77-2.01). UCP patients were also likely to return more frequently for any chest pain (aRate Ratio = 1.54; 95 % CI 1.43-1.64) or UCP than CAD patients (aRR =2.63; 95 % CI 2.43-2.87). Per 100 patients, the 1-year cumulative returns were 37 visits for reference group and 45 visits for UCP cohort. The annual costs for chest pain averaged $69,009 for CAD and $57,336 for UCP patients (log geometric mean ratio=1.25; 95 % CI 1.18-1.32). Conclusion Chest pain recidivism is common and costly even in patients without known CAD. We need evidence-based guidelines for these patients to minimize returns. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0287-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Basmah Safdar
- Department of Emergency Medicine, 464 Congress Ave, New Haven, CT, USA. .,VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, USA.
| | - James Dziura
- Department of Emergency Medicine, 464 Congress Ave, New Haven, CT, USA. .,VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, USA. .,Yale Center for Analytical Sciences, 300 George Street, Suite 555, New Haven, CT, USA.
| | - Harini Bathulapalli
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, USA. .,Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA.
| | - Douglas L Leslie
- Penn State College of Medicine, A210, 600 Centerview Drive, Hershey, PA, USA.
| | - Melissa Skanderson
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, USA.
| | - Cynthia Brandt
- Department of Emergency Medicine, 464 Congress Ave, New Haven, CT, USA. .,VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, USA.
| | - Sally G Haskell
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, USA. .,Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT, USA.
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Sulo G, Igland J, Vollset SE, Nygård O, Egeland GM, Ebbing M, Sulo E, Tell GS. Effect of the Lookback Period's Length Used to Identify Incident Acute Myocardial Infarction on the Observed Trends on Incidence Rates and Survival: Cardiovascular Disease in Norway Project. Circ Cardiovasc Qual Outcomes 2015; 8:376-82. [PMID: 26058719 DOI: 10.1161/circoutcomes.114.001703] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 05/11/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND In studies using patient administrative data, the identification of the first (incident) acute myocardial infarction (AMI) in an individual is based on retrospectively excluding previous hospitalizations for the same condition during a fixed time period (lookback period [LP]). Our aim was to investigate whether the length of the LP used to identify the first AMI had an effect on trends in AMI incidence and subsequent survival in a nationwide study. METHODS AND RESULTS All AMI events during 1994 to 2009 were retrieved from the Cardiovascular Disease in Norway project. Incident AMIs during 2004 to 2009 were identified using LPs of 10, 8, 7, 5, and 3 years. For each LP, we calculated time trends in incident AMI and subsequent 28-day and 1-year mortality rates. Results obtained from analyses using the LP of 10 years were compared with those obtained using shorter LPs. In men, AMI incidence rates declined by 4.2% during 2004 to 2009 (incidence rate ratio, 0.958; 95% confidence interval, 0.935-0.982). The use of other LPs produced similar results, not significantly different from the LP of 10 years. In women, AMI incidence rates declined by 7.3% (incidence rate ratio, 0.927; 95% confidence interval, 0.901-0.955) when an LP of 10 years was used. The decline was statistically significantly smaller for the LP of 5 years (6.2% versus 7.3%; P=0.02) and 3 years (5.9% versus 7.3%; P=0.03). The choice of LP did not influence trends in 28-day and 1-year mortality rates. CONCLUSIONS The length of LP may influence the observed time trends in incident AMIs. This effect is more evident in older women.
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Affiliation(s)
- Gerhard Sulo
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.).
| | - Jannicke Igland
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
| | - Stein Emil Vollset
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
| | - Ottar Nygård
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
| | - Grace M Egeland
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
| | - Marta Ebbing
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
| | - Enxhela Sulo
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
| | - Grethe S Tell
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
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Manemann SM, Gerber Y, Chamberlain AM, Dunlay SM, Bell MR, Jaffe AS, Weston SA, Killian JM, Kors J, Roger VL. Acute coronary syndromes in the community. Mayo Clin Proc 2015; 90:597-605. [PMID: 25794453 PMCID: PMC4420654 DOI: 10.1016/j.mayocp.2015.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To measure the incidence of acute coronary syndrome (ACS), defined as first-ever myocardial infarction (MI) or unstable angina (UA); evaluate recent temporal trends; and determine whether survival after ACS has changed over time and differs by type. PATIENTS AND METHODS This was a population surveillance study conducted in Olmsted County, Minnesota (population: 144,248). All persons hospitalized with incident ACS between January 1, 2005, and December 31, 2010, were identified using International Classification of Diseases, Ninth Revision codes, natural language processing of the medical records, and biomarkers. Myocardial infarction was validated by epidemiologic criteria and UA by the Braunwald classification. Patients were followed through June 30, 2013, for death. RESULTS Of 1244 incident ACS cases, 35% (n=438) were UA and 65% (n=806) were MI. The standardized rates (per 100,000) of ACS were 284 (95% CI, 248-319) in 2005 and 184 (95% CI, 157-210) in 2010 (2010 vs 2005: rate ratio, 0.62; 95% CI, 0.53-0.73), indicating a 38% decline (similar for MI and UA). The 30-day case fatality rates did not differ by year of diagnosis but were worse for MI (8.9%; 95% CI, 6.9%-10.9%) compared with UA (1.9%; 95% CI, 0.6%-3.1%). Among 30-day survivors, the risk of death did not differ by ACS type or diagnosis year. CONCLUSION In the community, UA constitutes 35% of ACS. The incidence of ACS has declined in recent years, and trends were similar for UA and MI, reaffirming a substantial decline in all acute manifestations of coronary disease. Survival after ACS did not change over time, but 30-day survival was worse for MI compared with UA.
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Affiliation(s)
| | - Yariv Gerber
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Shannon M Dunlay
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Malcolm R Bell
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Allan S Jaffe
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Susan A Weston
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Jill M Killian
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Jan Kors
- Department of Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
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Nedkoff L, Atkins E, Knuiman M, Sanfilippo FM, Rankin J, Hung J. Age-specific gender differences in long-term recurrence and mortality following incident myocardial infarction: a population-based study. Heart Lung Circ 2015; 24:442-9. [PMID: 25618449 DOI: 10.1016/j.hlc.2014.11.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 11/23/2014] [Accepted: 11/27/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Higher mortality following myocardial infarction (MI) is reported in women compared with men with short-term follow-up. Our study aim was to compare long-term gender- and age-specific outcomes following incident MI. METHODS 30-day survivors of incident MI from 2003-2009 were identified from linked administrative data in Western Australia. Outcomes identified were recurrent MI, and cardiovascular and all-cause mortality. Follow-up data was available until 30(th) June 2011. Unadjusted risk out to eight-years was estimated from Kaplan-Meier survival curves, and multivariate Cox regression models were used to estimate relative risk in women compared with men by age group. RESULTS There were 12,420 30-day survivors of incident MI from 2003-2009 (males 71.2%). Women had higher levels of comorbidities across all age groups compared with men. Unadjusted event risks were higher in women than men overall, underpinned by higher risk of recurrent MI in 55-69 year-old women and of cardiovascular mortality across all age groups in women. Gender differences were generally attenuated after adjustment for demographic factors and comorbidities. CONCLUSIONS This study highlights the elevated risk of cardiovascular events in women compared with men with long-term follow-up, and demonstrates the need for improved long-term secondary prevention in this patient group.
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Affiliation(s)
- Lee Nedkoff
- School of Population Health, The University of Western Australia, Crawley, Western Australia 6009.
| | - Emily Atkins
- School of Population Health, The University of Western Australia, Crawley, Western Australia 6009
| | - Matthew Knuiman
- School of Population Health, The University of Western Australia, Crawley, Western Australia 6009
| | - Frank M Sanfilippo
- School of Population Health, The University of Western Australia, Crawley, Western Australia 6009
| | - Jamie Rankin
- Cardiology Department, Royal Perth Hospital, Perth, Western Australia, 6000
| | - Joseph Hung
- School of Population Health, The University of Western Australia, Crawley, Western Australia 6009; School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Crawley, Western Australia, 6009
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Ha NT, Hendrie D, Moorin R. Impact of population ageing on the costs of hospitalisations for cardiovascular disease: a population-based data linkage study. BMC Health Serv Res 2014; 14:554. [PMID: 25392132 PMCID: PMC4236486 DOI: 10.1186/s12913-014-0554-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 10/24/2014] [Indexed: 11/25/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the most costly disease in Australia. Measuring the impact of ageing on its costs is needed for planning future healthcare budget. The aim of this study was to measure the impact of changes in population age structure in Western Australia (WA) on the costs of hospitalisation for CVD. Methods All hospitalisation records for CVD occurring in WA in 1993/94 and 2003/04 inclusive were extracted from the WA Hospital Morbidity Data System (HMDS) via the WA Data Linkage System. Inflation adjusted hospitalisation costs using 2012 as the base year was assigned to all episodes of care using Australian Refined Diagnosis Related Group (AR-DRG) costing information. The component decomposition method was used to measure the contribution of ageing and other factors to the increase of hospitalisation costs for CVD. Results Between 1993/94 and 2003/04, population ageing contributed 23% and 30% respectively of the increase in CVD hospitalisation costs for men and women. The impact of ageing on hospitalisation costs was far greater for chronic conditions than acute coronary syndrome (ACS) and stroke. Conclusions Given the impact of ageing on hospitalisation costs, and the disparity between chronic and acute conditions, disease-specific factors should be considered in planning for future healthcare expenditure. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0554-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ninh Thi Ha
- Department of Community Health, Institute of Public Health at Ho Chi Minh City, 159 Hung Phu street, District 8, Ho Chi Minh City, Vietnam.
| | - Delia Hendrie
- School of Public Health, Curtin University, Bentley, Perth, Western Australia.
| | - Rachael Moorin
- Faculty of Health Science, Curtin University, Bentley, Perth, Western Australia.
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Kouvonen A, Koskinen A, Varje P, Kokkinen L, De Vogli R, Väänänen A. National trends in main causes of hospitalization: a multi-cohort register study of the finnish working-age population, 1976-2010. PLoS One 2014; 9:e112314. [PMID: 25379723 PMCID: PMC4224429 DOI: 10.1371/journal.pone.0112314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 10/13/2014] [Indexed: 11/26/2022] Open
Abstract
Background The health transition theory argues that societal changes produce proportional changes in causes of disability and death. The aim of this study was to identify long-term changes in main causes of hospitalization in working-age population within a nation that has experienced considerable societal change. Methodology National trends in all-cause hospitalization and hospitalizations for the five main diagnostic categories were investigated in the data obtained from the Finnish Hospital Discharge Register. The seven-cohort sample covered the period from 1976 to 2010 and consisted of 3,769,356 randomly selected Finnish residents, each cohort representing 25% sample of population aged 18 to 64 years. Principal Findings Over the period of 35 years, the risk of hospitalization for cardiovascular diseases and respiratory diseases decreased. Hospitalization for musculoskeletal diseases increased whereas mental and behavioral hospitalizations slightly decreased. The risk of cancer hospitalization decreased marginally in men, whereas in women an upward trend was observed. Conclusions/Significance A considerable health transition related to hospitalizations and a shift in the utilization of health care services of working-age men and women took place in Finland between 1976 and 2010.
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Affiliation(s)
- Anne Kouvonen
- Department of Social Research, University of Helsinki, Helsinki, Finland
- University of Social Sciences and Humanities, Faculty in Wroclaw, Wroclaw, Poland
- UKCRC Centre of Excellence for Public Health (Northern Ireland), Queen's University Belfast, Belfast, United Kingdom
- * E-mail:
| | - Aki Koskinen
- Finnish Institute of Occupational Health, Helsinki and Tampere, Finland
| | - Pekka Varje
- Finnish Institute of Occupational Health, Helsinki and Tampere, Finland
- Department of Philosophy, History, Culture and Art Studies, University of Helsinki, Helsinki, Finland
| | - Lauri Kokkinen
- Finnish Institute of Occupational Health, Helsinki and Tampere, Finland
| | - Roberto De Vogli
- Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, United States of America
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Ari Väänänen
- Finnish Institute of Occupational Health, Helsinki and Tampere, Finland
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Nedkoff L, Knuiman M, Hung J, Briffa TG. Comparative trends in the incidence of hospitalized myocardial infarction and coronary heart disease in adults with and without diabetes mellitus in Western Australia from 1998 to 2010. Circ Cardiovasc Qual Outcomes 2014; 7:708-17. [PMID: 25160842 DOI: 10.1161/circoutcomes.114.000952] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The risk of myocardial infarction (MI) is elevated in people with diabetes mellitus (DM) compared with non-DM counterparts. The aim of this study was to compare population trends in the incidence of hospitalized MI and coronary heart disease (CHD) in adults with and without DM. METHODS AND RESULTS All incident hospitalized MI and CHD events were identified from whole-population hospital data in Western Australia for 1998 to 2010. Annual age-standardized MI and CHD incidence rates were calculated for people with and without DM aged 35 to 84 years and age-adjusted trends estimated from Poisson regression. There were 26 610 incident MI and 56 142 incident CHD cases during the study period. MI incidence rates fell in men (-2.9%/y; 95% confidence interval [CI], -3.7 to -2.1) and women (-3.8%/y; 95% CI, -4.8 to -2.1) with DM, representing overall reductions of 35% and 43% respectively, with comparable reductions in incident CHD. Downward trends in MI incidence in those with DM were most apparent in 55- to 84-year olds. In adults without DM, there was no decline in MI incidence but a small significant decrease in incident CHD (men, -1.5%/y; 95% CI, -1.8 to -1.2 and women, -1.3%/y; 95% CI, -1.8 to -0.9). Incidence rate ratios for MI in men with versus without DM declined from 4.5 (95% CI, 4.2-4.8) to 3.1 (95% CI, 2.9-3.3) and from 6.0 (95% CI, 5.4-6.6) to 3.8 (95% CI, 3.5-4.1) in women between 1998 and 2010. CONCLUSIONS There have been significant reductions in incidence rates of MI and CHD in adults with DM between 1998 and 2010; however, the excess risk of MI incidence remains 3 to 4× greater in people with DM.
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Affiliation(s)
- Lee Nedkoff
- From the School of Population Health (M431) (L.N., M.K., J.H., T.G.B.) and School of Medicine and Pharmacology (M503), Sir Charles Gairdner Hospital Unit (J.H.), The University of Western Australia, Crawley, Western Australia, Australia.
| | - Matthew Knuiman
- From the School of Population Health (M431) (L.N., M.K., J.H., T.G.B.) and School of Medicine and Pharmacology (M503), Sir Charles Gairdner Hospital Unit (J.H.), The University of Western Australia, Crawley, Western Australia, Australia
| | - Joseph Hung
- From the School of Population Health (M431) (L.N., M.K., J.H., T.G.B.) and School of Medicine and Pharmacology (M503), Sir Charles Gairdner Hospital Unit (J.H.), The University of Western Australia, Crawley, Western Australia, Australia
| | - Tom G Briffa
- From the School of Population Health (M431) (L.N., M.K., J.H., T.G.B.) and School of Medicine and Pharmacology (M503), Sir Charles Gairdner Hospital Unit (J.H.), The University of Western Australia, Crawley, Western Australia, Australia
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Lee CH, Cheng CL, Yang YHK, Chao TH, Chen JY, Liu PY, Lin CC, Chan SH, Tsai LM, Chen JH, Lin LJ, Li YH. Trends in the incidence and management of acute myocardial infarction from 1999 to 2008: get with the guidelines performance measures in Taiwan. J Am Heart Assoc 2014; 3:jah3648. [PMID: 25112555 PMCID: PMC4310397 DOI: 10.1161/jaha.114.001066] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background The American Heart Association Get With the Guidelines (GWTG) program has improved care quality of acute myocardial infarction (AMI) with important implications for other countries in the world. This study evaluated the incidence and care of AMI in Taiwan and assessed the compliance of GWTG in Taiwan. Methods and Results We used the Taiwan National Health Insurance Research Database (1999–2008) to identify hospitalized patients ≥18 years of age presenting with AMI. The temporal trends of annual incidence and care quality of AMI were evaluated. The age‐adjusted incidence of AMI (/100 000 person‐years) increased from 28.0 in 1999 to 44.4 in 2008 (P<0.001). The use of guideline‐based medications for AMI was evaluated. The use of dual antiplatelet therapy (DAPT) increased from 65% in 2004 to 83.9% in 2008 (P<0.001). Angiotensin‐converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) was used in 72.6% in 2004 and 71.7% in 2008 (P=NS) and β‐blocker was used in 60% in 2004 and 59.7% in 2008 (P=NS). Statin use increased from 32.1% to 50.1% from 2004 to 2008 (P<0.001). The in‐hospital mortality decreased from 15.9% in 1999 to 12.3% in 2008 (P<0.0001). Multivariable analysis showed that DAPT, ACE inhibitor/ARB, β‐blocker, and statin use during hospitalization were all associated with reduced in‐hospital mortality in our AMI patients. Conclusions AMI incidence was increasing, but the guideline‐based medications for AMI were underutilized in Taiwan. Quality improvement programs, such as GWTG, should be promoted to improve AMI care and outcomes in Taiwan.
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Affiliation(s)
- Cheng-Han Lee
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.)
| | - Ching-Lan Cheng
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.L.C., Y.H.K.Y.)
| | - Yea-Huei Kao Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.L.C., Y.H.K.Y.)
| | - Ting-Hsing Chao
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.)
| | - Ju-Yi Chen
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.)
| | - Ping-Yen Liu
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.)
| | - Chih-Chan Lin
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.)
| | - Shih-Hung Chan
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.)
| | - Liang-Miin Tsai
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.)
| | - Jyh-Hong Chen
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.)
| | - Li-Jen Lin
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.)
| | - Yi-Heng Li
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.)
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Koopman C, Bots ML, van Dis I, Vaartjes I. Shifts in the age distribution and from acute to chronic coronary heart disease hospitalizations. Eur J Prev Cardiol 2014; 23:170-7. [PMID: 25079238 DOI: 10.1177/2047487314544975] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/07/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Shifts in the burden of coronary heart disease (CHD) from an acute to chronic illness have important public health consequences. OBJECTIVE To assess age-sex-specific time trends in rates and characteristics of acute and chronic forms of CHD hospital admissions in the Netherlands. METHODS Using nationwide Dutch registers, we assessed time trends between 1998 and 2007 in hospitalization rates of 188,266 acute myocardial infarction (AMI, ICD-9 410), 294,374 unstable angina (ICD-9 411, 413) and 205,649 chronic forms of CHD (ICD-9 412, 414) admissions. RESULTS Between 1998 and 2007, the age-standardized CHD hospitalization rate declined from 688 to 545 per 100,000 in men and from 281 to 229 per 100,000 in women. Overall, hospitalization rates decreased at younger age (<75 years) but increased in very old age (≥85 years). The annual percentage change in hospitalization rates was larger for AMI (men:-5.1%, women:-4.4%) than for unstable angina patients (men:-2.0%, women:-2.0%). For chronic CHD, the average annual percentage change was +0.7% in men and +2.1% in women. The proportion of chronic CHD in the total of CHD admissions increased between 1998 and 2007 from 29% to 36% in men and from 23% to 30% in women. The proportion of AMI decreased from 30% to 24% in men and from 27% to 22% in women. CONCLUSIONS An increasing proportion of Dutch CHD hospital admissions was for chronic forms of CHD. The age at hospitalization was pushed towards older age: premature CHD admission declined over time and admission rates at very old age increased.
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Affiliation(s)
- Carla Koopman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands Dutch Heart Foundation, The Hague, the Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Shah AJ, Ghasemzadeh N, Zaragoza-Macias E, Patel R, Eapen DJ, Neeland IJ, Pimple PM, Zafari AM, Quyyumi AA, Vaccarino V. Sex and age differences in the association of depression with obstructive coronary artery disease and adverse cardiovascular events. J Am Heart Assoc 2014; 3:e000741. [PMID: 24943475 PMCID: PMC4309058 DOI: 10.1161/jaha.113.000741] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Young women with coronary heart disease have high rates of depression and a higher risk of adverse events than men of similar age. Whether depression has a higher prognostic value in this group than in men and older women is not known. Our objective was to assess whether depression in young women is associated with higher risk of coronary artery disease (CAD) and adverse outcomes compared with similarly aged men and older women. Methods and Results We examined 3237 patients undergoing coronary angiography for evaluation of CAD and followed them for 2.9 years (median). Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ)‐9, and CAD burden was dichotomized based on its presence or absence. After multivariable adjustment for CAD risk factors, depressive symptoms predicted CAD presence in women aged ≤55 years (odds ratio=1.07 95% confidence interval [CI] 1.02 to 1.13 per 1 point increase in PHQ‐9 score), but not in men aged ≤55 years or women aged >55 years. Depressive symptoms also predicted increased risk of death in women aged ≤55 years (adjusted hazard ratio=1.07, 95% CI 1.02 to 1.14, per 1 point increase in PHQ‐9 score), but not in men aged ≤55 years and women aged >55 years, with P=0.02 for the depression‐sex interaction and P=0.02 for depression‐sex‐age interaction. Conclusions Among patients with suspected or established CAD, depressive symptoms are associated with increased risk of death, particularly in young women. This group may be especially vulnerable to the adverse cardiovascular effects of depression.
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Affiliation(s)
- Amit J Shah
- Department of Epidemiology, Emory University, Atlanta, GA (A.J.S., P.M.P., V.V.) Department of Medicine, Emory University, Atlanta, GA (A.J.S., N.G., D.J.E., M.Z., A.A.Q., V.V.) Department of Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA (A.J.S., M.Z.)
| | - Nima Ghasemzadeh
- Department of Medicine, Emory University, Atlanta, GA (A.J.S., N.G., D.J.E., M.Z., A.A.Q., V.V.)
| | | | | | - Danny J Eapen
- Department of Medicine, Emory University, Atlanta, GA (A.J.S., N.G., D.J.E., M.Z., A.A.Q., V.V.)
| | - Ian J Neeland
- Department of Medicine, University of Texas Southwestern, Dallas, TX (I.J.N.)
| | - Pratik M Pimple
- Department of Epidemiology, Emory University, Atlanta, GA (A.J.S., P.M.P., V.V.)
| | - A Maziar Zafari
- Department of Medicine, Emory University, Atlanta, GA (A.J.S., N.G., D.J.E., M.Z., A.A.Q., V.V.) Department of Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA (A.J.S., M.Z.)
| | - Arshed A Quyyumi
- Department of Medicine, Emory University, Atlanta, GA (A.J.S., N.G., D.J.E., M.Z., A.A.Q., V.V.)
| | - Viola Vaccarino
- Department of Epidemiology, Emory University, Atlanta, GA (A.J.S., P.M.P., V.V.) Department of Medicine, Emory University, Atlanta, GA (A.J.S., N.G., D.J.E., M.Z., A.A.Q., V.V.)
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Bray JE, Di Palma S, Jacobs I, Straney L, Finn J. Trends in the incidence of presumed cardiac out-of-hospital cardiac arrest in Perth, Western Australia, 1997–2010. Resuscitation 2014; 85:757-61. [DOI: 10.1016/j.resuscitation.2014.02.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 01/24/2014] [Accepted: 02/21/2014] [Indexed: 11/21/2022]
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Kulshreshtha A, Goyal A, Dabhadkar K, Veledar E, Vaccarino V. Urban-rural differences in coronary heart disease mortality in the United States: 1999-2009. Public Health Rep 2014; 129:19-29. [PMID: 24381356 DOI: 10.1177/003335491412900105] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Coronary heart disease (CHD) mortality has declined in the past few decades; however, it is unclear whether the reduction in CHD deaths has been similar across urbanization levels and in specific racial groups. We describe the pattern and magnitude of urban-rural variations in CHD mortality in the U.S. METHODS Using data from the National Center for Health Statistics, we examined trends in death rates from CHD from 1999 to 2009 among people aged 35-84 years, in each geographic region (Northeast, Midwest, West, and South) and in specific racial-urbanization groups, including black and white people in large and medium metropolitan (urban) areas and in non-metropolitan (rural) areas. We also examined deaths from early-onset CHD in females aged <65 years and males aged <55 years. RESULTS From 1999 to 2009, there was a 40% decline in age-adjusted CHD mortality. The trend was similar in black and white people but was more pronounced in urban than in rural areas, resulting in a crossover in 2007, when rural areas began showing a higher CHD mortality than urban areas. White people in large metropolitan areas had the largest decline (43%). Throughout the study period, CHD mortality remained higher in black people than in white people, and, in the South, it remained higher in rural than in urban areas. For early-onset CHD, the mortality decline was more modest (30%), but overall trends by urbanization and region were similar. CONCLUSION Favorable national trends in CHD mortality conceal persisting disparities for some regions and population subgroups (e.g., rural areas and black people).
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Affiliation(s)
- Ambar Kulshreshtha
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA ; Emory University School of Medicine, Department of Family and Preventive Medicine, Atlanta, GA
| | - Abhinav Goyal
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA ; Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, GA
| | - Kaustubh Dabhadkar
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA ; Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, GA
| | - Emir Veledar
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA ; Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, GA
| | - Viola Vaccarino
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA ; Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, GA
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