IMPORTANCE: Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions. OBJECTIVE: To estimate ...the association between SBP of at least 110 to 115 mm Hg and SBP of 140 mm Hg or higher and the burden of different causes of death and disability by age and sex for 195 countries and territories, 1990-2015. DESIGN: A comparative risk assessment of health loss related to SBP. Estimated distribution of SBP was based on 844 studies from 154 countries (published 1980-2015) of 8.69 million participants. Spatiotemporal Gaussian process regression was used to generate estimates of mean SBP and adjusted variance for each age, sex, country, and year. Diseases with sufficient evidence for a causal relationship with high SBP (eg, ischemic heart disease, ischemic stroke, and hemorrhagic stroke) were included in the primary analysis. MAIN OUTCOMES AND MEASURES: Mean SBP level, cause-specific deaths, and health burden related to SBP (≥110-115 mm Hg and also ≥140 mm Hg) by age, sex, country, and year. RESULTS: Between 1990-2015, the rate of SBP of at least 110 to 115 mm Hg increased from 73 119 (95% uncertainty interval UI, 67 949-78 241) to 81 373 (95% UI, 76 814-85 770) per 100 000, and SBP of 140 mm Hg or higher increased from 17 307 (95% UI, 17 117-17 492) to 20 526 (95% UI, 20 283-20 746) per 100 000. The estimated annual death rate per 100 000 associated with SBP of at least 110 to 115 mm Hg increased from 135.6 (95% UI, 122.4-148.1) to 145.2 (95% UI 130.3-159.9) and the rate for SBP of 140 mm Hg or higher increased from 97.9 (95% UI, 87.5-108.1) to 106.3 (95% UI, 94.6-118.1). Loss of disability-adjusted life-years (DALYs) associated with SBP of at least 110 to 115 mm Hg increased from 148 million (95% UI, 134-162 million) to 211 million (95% UI, 193-231 million), and for SBP of 140 mm Hg or higher, the loss increased from 95.9 million (95% UI, 87.0-104.9 million) to 143.0 million (95% UI, 130.2-157.0 million). The largest numbers of SBP-related deaths were caused by ischemic heart disease (4.9 million 95% UI, 4.0-5.7 million; 54.5%), hemorrhagic stroke (2.0 million 95% UI, 1.6-2.3 million; 58.3%), and ischemic stroke (1.5 million 95% UI, 1.2-1.8 million; 50.0%). In 2015, China, India, Russia, Indonesia, and the United States accounted for more than half of the global DALYs related to SBP of at least 110 to 115 mm Hg. CONCLUSIONS AND RELEVANCE: In international surveys, although there is uncertainty in some estimates, the rate of elevated SBP (≥110-115 and ≥140 mm Hg) increased substantially between 1990 and 2015, and DALYs and deaths associated with elevated SBP also increased. Projections based on this sample suggest that in 2015, an estimated 3.5 billion adults had SBP of at least 110 to 115 mm Hg and 874 million adults had SBP of 140 mm Hg or higher.
Background
Vasa vasorum (VV) vessels are critical in the genesis of atherosclerosis. Therefore, we assessed measures of carotid VV, intima–media thickness (CIMT), and patient risk factors in a ...primary prevention population.
Methods
We used multivariable linear models to evaluate the relationship between baseline covariates and a measure of carotid VV (VV ratio) and CIMT among 324 diabetics and 141 nondiabetics.
Results
Median CIMT (in mm) and VV ratio among nondiabetics were 0.82 ± 0.22 and 0.80 ± 0.19, respectively, and 1.06 ± 0.19 and 1.21 ± 0.26 among diabetics (P < 0.0001). Diabetes was associated with 36% (95% CI: 24.3–48.0, P < 0.001) higher VV ratio whereas a unit change in BMI was associated with ≈1% (95% CI: 0.5–1.4, P < 0.001) change in VV ratio. A 10‐year increase in age was associated with 4% (95% CI: 1–7, P = 0.005) higher CIMT. Each 10 mmHg increase in mean systolic blood pressure was associated with 2% (95% CI: 1–4, P = 0.003) higher CIMT whereas diabetes conferred 31% (95% CI: 19.1–42.1, P < 0.001) higher CIMT. Female sex was associated with a 9% (95% CI: −12.9 to −4.1, P < 0.001) lower CIMT. Low density lipoprotein (LDL) cholesterol, blood pressure, and CIMT were not significantly associated with VV ratio.
Conclusion
In this cohort of patients with low CIMT, VV ratio, and CIMT were distinctly unrelated, but each independently associated with diabetes. VV ratio and CIMT relationships warrant further investigation in large‐scale studies and across a spectrum of atherosclerostic states.
There is a growing gap between available science and evidence and the ability of service providers to deliver high-quality care in a cost-effective way to the entire population. We believe that the ...chasm between knowledge and action is due to a lack of concerted effort among all organizations that deliver health care services across the life span of patients. Broad participation is needed and necessitates a far more explicit and concerted public-private partnership focused on large-scale transformation. In this context, the National Heart, Lung, and Blood Institute convened a panel made up of leaders of corporate health care entities, including academic health centers, and government agency representatives to inform contemporary strategic partnerships with health care companies. This article provides insights from the meeting on how to execute a transformative innovation research agenda that will foster improvements in health care service delivery by leveraging the translation of biomedical research evidence in real-world settings.
Because heart failure (HF) is the final common pathway for most heart diseases, we examined its 10-year prevalence trend by race, sex, and age in Tennessee.
HF hospitalization data from the Tennessee ...Hospital Discharge Data System were analyzed by race, sex, and age. Rates were directly age-adjusted using the Year 2000 standard population. Adult (age 20+ years) inpatient hospitalization for primary diagnosis of HF (HFPD) increased from 4.2% in 1997 to 4.5% in 2006. Age-adjusted hospitalization for HF (per 10 000 population) rose by 11.3% (from 29.3 in 1997 to 32.6 in 2006). Parallel changes in secondary HF admissions were also noted. Age-adjusted rates were higher among blacks than whites and higher among men than women. The ratios of black to white by sex admitted with HFPD in 2006 were highest (9:1) among the youngest age categories (20 to 34 and 35 to 44 years). Furthermore, for each age category of black men below 65 years, there were higher HF admission rates than for white men in the immediate older age category. In 2006, the adjusted rate ratios for HFPD in black to white men ages 20 to 34 and 35 to 44 years were odds ratio, 4.75; 95% confidence interval, 3.29 to 6.86 and odds ratio, 5.10; 95% confidence interval, 4.15 to 6.25, respectively. Hypertension was the independent predictor of HF admissions in black men ages 20 to 34 years.
The higher occurrence of HF among young adults in general, particularly among young black men, highlights the need for prevention by identifying modifiable biological and social determinants to reduce cardiovascular health disparities in this vulnerable group.
Abstract Background and aims Consumption of polyunsaturated fatty acids (PUFA), especially the n3-series, may protect against cardiovascular disease (CVD), but recent randomized studies have failed ...to demonstrate these benefits. One of the prevailing hypotheses is that PUFA intake may not confer benefits beyond those provided by statins, but studies comparing statin users to non-users with regard to effects of PUFA are lacking. Methods and results Black and white men and women (n = 69,559) in the Southern Community Cohort Study were studied. Cox regression models adjusting for age, sex, race, BMI, recruitment site, education, income, smoking, diabetes, and dietary variables were used. Results At baseline the mean ± SD age was 52 ± 9 years, 60% of participants were women, 54% had hypertension and 16% used statins. We observed modest inverse associations between n3-PUFA and n6-PUFA intake with mortality among non-statin users but not among statin users. In adjusted analyses, the HRs (95% CIs) for all-cause mortality (6,396 deaths over a median of 6.4 years) comparing the highest to the lowest quintile were 0.90 (0.82–1.00) for n3-PUFA and 0.80 (0.70–0.92) for n6-PUFA among non-statin users, whereas they were 1.06 (0.87–1.28) and 0.96 (0.78–1.19) for n3-PUFA and n6-PUFA, respectively, among statin users. Conclusions Our results suggest potential benefits of PUFA consumption on mortality which are only apparent in the absence of statin therapy. It seems prudent to consider the potential benefit of PUFA consumption in the primary prevention of CVD among patients who are not candidates for statin therapy but are at increased risk for CVD and mortality.
Diagnostic Accuracy of Rubidium-82 Myocardial Perfusion Imaging With Hybrid Positron Emission Tomography/Computed Tomography in the Detection of Coronary Artery Disease Uchechukwu K. Sampson, ...Sharmila Dorbala, Atul Limaye, Raymond Kwong, Marcelo F. Di Carli We evaluated the diagnostic performance of rest-stress rubidium-82 myocardial perfusion positron emission tomography-computed tomography (PET-CT) imaging in the detection of obstructive coronary artery disease (CAD) in 64 patients with suspected CAD and 38 patients with a low likelihood for CAD. The overall sensitivity, specificity, and diagnostic accuracy of rubidium-82 PET-CT were 93%, 83%, and 87% respectively. All patients with a low likelihood for CAD showed normal scans, for a normalcy rate of 100%. The sensitivity for detecting CAD was equally high in patients with single and multivessel disease, in men and women, and in obese and nonobese individuals.
We sought to determine whether there are signs of improvement in the rates of heart failure (HF) hospitalizations given the recent reports of improvement in national trends.
HF admissions data from ...the Tennessee Hospital Discharge Data System were analyzed.
Hospitalization for primary diagnosis of HF (HFPD) in adults (aged 20 years old or older) decreased from 4.5% in 2006 to 4.2% in 2008. Similarly, age-adjusted HF hospitalization (per 10,000 population) declined by 19.1% (from 45.5 in 2006 to 36.8 in 2008). The age-adjusted rates remain higher among blacks than whites and higher among men than women. Notably, the rate ratio of black-to-white men ages 20 to 34 years admitted with HFPD increased from 8.5 in 2006 to 11.1 in 2008; similarly, the adjusted odds ratios for HFPD were 4.75 (95% confidence interval 3.29-6.86) and 5.61 (95% confidence interval 3.70-8.49), respectively. There was, however, a significant improvement in odds ratio for HF rates among young black women, as evidenced by a decrease from 4.60 to 3.97 (aged 20-34 years) and 4.21 to 3.12 (aged 35-44 years) between 2006 and 2008, respectively. Among patients aged 20 to 34 and 35 to 44 years, hypertension was the strongest independent predictor for HF. Diabetes and myocardial infarction emerged as predictors for HF among patients aged 35 years and older.
The overall rate of HF hospitalization declined during the period surveyed, but the persistent disproportionate involvement of blacks with evidence of worsening among younger black men, requires close attention.
Are statins diabetogenic? Sampson, Uchechukwu K; Linton, MacRae F; Fazio, Sergio
Current opinion in cardiology,
2011-July, 2011-Jul, 2011-07-00, 20110701, Letnik:
26, Številka:
4
Journal Article
Recenzirano
Odprti dostop
PURPOSE OF REVIEWStatins are widely utilized for low-density lipoprotein lowering and for prevention of atherosclerotic cardiovascular disease. Although these drugs have a good safety record, ...increased risk of developing diabetes during extended use has recently garnered attention. Here we review clinical trial evidence related to statin use and incident diabetes, and the potential mechanisms for this association.
RECENT FINDINGSThe increased incidence of diabetes with rosuvastatin treatment in Justification for the Use of Statins in Primary Preventionan intervention Trial Evaluating Rosuvastatin (JUPITER) reignited attention on the link between statin therapy and diabetes. The JUPITER findings are supported by two recent meta-analyses of large-scale placebo-controlled and standard care-controlled trials, which, respectively, observed a 9% odds ratio 1.09; 95% confidence interval (CI) 1.02–1.17 and 13% (risk ratio 1.13; 95% CI 1.03–1.23) increased risk for incident diabetes associated with statin therapy. However, the underlying mechanisms for this association remain unclear. Experimental evidence supports a paradigm implicating inhibition of β-cell glucose transporters, delayed ATP production, pro-inflammatory and oxidative β-cell effects of plasma-derived cholesterol, inhibition of calcium channel-dependent insulin secretion, and β-cell apoptosis.
SUMMARYThe aggregate of large clinical trials supports the notion that statins modestly increase the risk of incident diabetes. Because diabetes is a risk equivalent condition for coronary and peripheral arterial diseases, these findings create a paradox whereby needed statin therapy may be withheld to avoid excess risk of diabetes while representing the strongest cardiovascular risk reduction tool in diabetics. We simply recommend regular glucose monitoring in patients taking statins.
ObjectiveDepression and anxiety are frequently observed in heart failure (HF) patients; however, the effect of such factors on hospitalization costs of HF patients, and whether such costs vary by ...race and gender remain poorly understood. This analysis delineated the prevalence of depression/anxiety among HF patients and estimated the effect of race and gender on hospitalization costs.MethodsWe examined the 2008 files of the Tennessee Hospital Discharge Data System (HDDS) on patients (≥20 years of age) with a primary diagnosis of HF (ICD-9 codes 402, 404, and 428) along with demographic data, depression/anxiety diagnoses, hospital costs, and comorbidities. Among the HF sample (n=16,889) 53% were female and 23% were black. Race and gender differences in hospital costs were evaluated for the following three groups: (1) HF patients with depression/anxiety (HF+D); (2) HF-only patients without depression/anxiety (HFO); and (3) HF patients with other mental diagnoses (HF+M).ResultsHF was significantly (p<0.000) higher among blacks compared to whites, and higher among males than females. Nearly 25% of HF patients had depression/anxiety (more whites and females were depressed). HF patients averaged more than 3 comorbidities (blacks had a greater number of comorbidities and hospitalization cost for the year). Costs were higher among HF+D patients compared to HFO patients. Among HF+D patients, costs were higher for black males compared with white males. These cost patterns prevailed largely because of higher comorbidities that required more re-admissions and longer hospital stays.ConclusionRace and depression/anxiety are associated with increased hospitalization costs of HF patients. The higher costs among blacks reflect the higher burden of comorbidities, such as hypertension and diabetes, which calls for widespread dissemination, adoption, and implementation of proven interventions for the control of these comorbidities.
Background Compared with whites, blacks have a higher prevalence of hypertension (HTN) for which lifestyle and socioeconomic status (SES) have been implicated as contributory factors. ...our ...objective was to evaluate factors associated with HTN in a cohort with well-documented SES characteristics.
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