Age-standardized mortality rates (ASMR) for cardiovascular diseases (CVD) have decreased in Brazil in the last decades due to better control of risk factors and access to healthcare. However, how this reduction is distributed across the country's municipalities is unknown. We aimed to evaluate changes in CVD mortality rates across Brazilian municipalities from 2000 to 2018 using estimates from the Global Burden of Disease (GBD) study.

In this ecological study, ASMR for CVD were estimated using GBD methodology for 5564 Brazilian municipalities from 5 regions in the triennials: 2000-2002, 2009-2011, 2016-2018. A visuospatial analysis was applied to create clusters in ASMR with Moran Local analysis. Municipalities were stratified by population size in <30,000, 30,000-300,000, and >300,000 inhabitants per region. The % changes in ASMR from 2000-2002 to 2016-2018 were calculated.

In 2000-2002, ASMR for CVD were higher in more developed regions and in larger municipalities of all regions, except for the South. In 2016-2018, CVD ASMR increased in the least developed Northern regions. The % reduction in CVD ASMR was lower in small vs large municipalities within all 5 regions, varying from -3% in small Northern municipalities to -43% in large Southern municipalities.

The reduction in CVD mortality in Brazil was lower in municipalities from the most vulnerable regions and smaller populations. Public policies tailored to these smaller municipalities, particularly on the least developed regions, must be considered a priority.

Brazilian Ministry of Health [grant 148/2018] and Pan American Health Organization [Letter of Agreement SCON2021-00288].

Lower extremity peripheral arterial disease (PAD) is a significant health concern among older adults globally, affecting both mortality and quality of life.

To evaluate the temporospatial trends and its risk factors in lower extremity PAD-related burden among adults aged 60 years and older from 1990 to 2021.

This repeated cross-sectional study utilized data from the Global Burden of Disease Study 2021, encompassing 204 countries and territories. The study population included adults aged 60 years and older.

Lower extremity PAD among older adults from January 1990 to December 2021.

Primary outcomes included age-standardized prevalence rates (ASPR), mortality rates (ASMR), disability-adjusted life-years (DALYs), and average annual percentage changes (AAPCs). Trends were analyzed by age, sex, and sociodemographic index (SDI). Joinpoint regression analysis was used to identify significant trend changes.

From 1990 to 2021, global trends showed decreases in lower extremity PAD-related prevalence, mortality, and DALYs. Significant geographical disparities were observed: high-SDI regions had the highest prevalence (11,171.66 per 100,000 in 2021) but showed declining trends (AAPC, -0.74; 95% CI, -0.80 to -0.68), while low-SDI regions had the lowest prevalence (4,842.40 per 100,000) but demonstrated increasing trends (AAPC, 0.22; 95% CI, 0.21 to 0.24). Regionally, although lower extremity PAD-related prevalence showed a decreasing trend in most regions from 1990 to 2021, there were still some regions with an increasing trend (North Africa and Middle East AAPC, 0.57; 95% CI, 0.55 to 0.59). Temporal analysis showed sex-specific divergent trends in recent years, with males exhibiting an upward trend since 2015 (APC, 0.15; 95% CI, 0.07 to 0.24), while females showed a slowed decline since 2014 (APC, -0.06; 95% CI, -0.12 to -0.01). Decomposition analysis identified population growth as the primary driver of PAD burden increase, with epidemiological changes showing contrasting effects across SDI regions. Among risk factors, high fasting glucose emerged as the leading contributor, while smoking's contribution decreased.

This study revealed significant disparities in lower extremity PAD burden across different SDI levels and regions, with low-SDI countries facing an increasing burden. The contrasting trends between high- and low-SDI regions, coupled with varying risk factor patterns (particularly the rise in high fasting glucose and decline in smoking), suggest the need for targeted interventions in resource-limited settings to address this growing health challenge among older adults.

Ischemic stroke is an important public health problem. However, comprehensive data on its burden in aging populations is limited. The aim of this study is to provide an up-to-date assessment of the prevalence, incidence, mortality, disability-adjusted life years, and risk factors for ischemic stroke globally in adults aged 60 years and older from 1990 to 2021 based on population changes.

The Global Burden of Diseases, Injuries, and Risk Factors Study 2021 served as the data source for this study. Average annual percentage changes were estimated over the study period to quantify temporal patterns and assess trends in age-standardized rates of the prevalence, incidence, mortality, and disability-adjusted life-years of ischemic stroke.

The significant increase in the prevalence and incidence of ischemic stroke is mainly related to population ageing and the significant increase in the number of people over 60 years of age, with the significant increase in the population over 60 years of age being the main driving force, while epidemiological changes have had the opposite effect. Critically, using the entire age population for calculations will prompt us to underestimate the burden of ischemic stroke. The burden of ischemic stroke disease is highest in older men than in older women, and the age-standardized prevalence rates, incidence rates, mortality rates, and disability-adjusted life-years rates are 26-35% higher in men than in women. High-middle sociodemographic index and Sub-Saharan Africa regions suffer the heaviest burden. Ischemic stroke health inequities widen, with less developed regions bearing a heavier ischemic stroke burden and the disparity in that burden becoming more pronounced over time.

Population aging is the primary driver of the growing burden of ischemic stroke. Our findings indicate that prevention and control of this disease remain critical public health challenges. Targeted interventions addressing modifiable risk factors could significantly reduce the global burden of ischemic stroke.

Background/Objectives: Depression is associated with an increased risk for the development and progression of cardiovascular disease. This research investigated the association between depressive symptoms and inflammation in the development of atherosclerotic coronary events. Methods: This retrospective observational study included 276 patients who were not previously diagnosed with atherosclerotic coronary artery disease at the beginning of the research. Participants were categorized using the Hamilton Depression Rating Scale (HDRS) and the Structured Clinical Interview for DSM-5 (SCID) into two groups: the depression group and the control group. Inflammatory biomarkers (C-reactive protein (CRP), fibrinogen, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and cortisol) were measured at the beginning of the study, as well as at six months, one year, and two years. Results: Among patients with mild depression (17.3% vs. 4.2%) or moderate depression (15.4% vs. 6.7%), there were significantly more men than women, while among patients with very severe depression, there were significantly more women than men (21.7% vs. 11.5%). Participants with depression showed significantly higher increases at 2 years compared to baseline for all investigated parameters (p < 0.001). Depressed patients were significantly associated with an acute coronary syndrome (p = 0.038). Conclusions: This research highlights that individuals with depression face a greater risk of developing an acute coronary syndrome than those without depression.

The burden of non-communicable diseases is rising in low-and-middle-income countries, with diet being a key risk factor. This study aimed to assess the patterns, socioeconomic inequalities and determinants of eating healthy in Kenya. The study is the first in Kenya to use a healthy diet index to assess dietary patterns.

We analysed cross-sectional data from the 2015/16 Kenya Integrated Household Budget Survey. The study's outcome variable was a continuous healthy diet index (HDI) constructed using principal component analysis from nine WHO/Food and Agriculture Organization (FAO) healthy diet recommendations. The HDI score and WHO/FAO healthy diet recommendations met were summarised for Kenyan households. Using the concentration index, we examined the socioeconomic disparities in healthy eating. In addition, multivariable linear regression was used to determine factors that influence healthy eating in Kenya.

A total of 21 512 households in Kenya were included, of which 60% were rural and about two-thirds headed by males. The HDI score ranged between -1.13 and 1.70, with a higher value indicating healthier eating. Overall, the average HDI score was 0.24 (95% CI: 0.24 to 0.25), interpreted as moderate. We identified key determinants including socioeconomic status and urban-rural residency differences. Healthy eating was concentrated among higher socioeconomic households, regardless of gender or location. Higher socioeconomic status (β=0.28, 95% CI 0.26 to 0.30), rural residence (β=0.18, 95% CI 0.15 to 0.20), household head being in union (β=0.04, 95% CI 0.02 to 0.06) or employed (β=0.05, 95% CI 0.02 to 0.08) were significantly associated with increased HDI scores, whereas male-headed households and lack of education were associated with significant decreases in HDI scores on average.

Most Kenyan households do not meet all the healthy dietary recommendations, and socioeconomic inequalities exist in eating healthy. Targeted interventions that promote healthy eating based on key determinants in Kenya are required.

We investigated the relationship between loneliness and cardiovascular disease (CVD) in older adults from the USA and South Korea. We conducted counterfactual mediation analyses to explore the potential mediation of this relationship by health behaviors.

We used the Health and Retirement Study (HRS; n = 13 073) from the USA and the Korean Longitudinal Study of Aging (KLoSA; n = 8311) from South Korea. In both cohorts, baseline loneliness was assessed using one item from the Center for Epidemiologic Studies Depression Scale. Incident CVD was defined as reporting new-onset CVD on the biennial questionnaire or CVD death reported by proxies. Within each cohort, we estimated adjusted hazard ratios (aHRs) of incident CVD according to loneliness (yes/no) over 12-14 years of follow-up, adjusting for baseline covariates: social isolation, sociodemographic factors, health conditions, and health behaviors.

Feeling lonely was associated with an increased likelihood of developing CVD in the USA (aHR: 1.15, 95% CI: 1.04, 1.27) and South Korea (aHR: 1.16, 95% CI: 1.00, 1.34). Several behaviors accounted for a proportion of the association: physical activity (14.3%, P = 0.03 in HRS; 1.3%, P = 0.04 in KLoSA) and alcohol (3.9%, P < 0.001 in HRS; 1.3%, P < 0.001 in KLoSA) in both countries, smoking only in HRS (4.7%, P < 0.001).

The magnitude of the impact of loneliness on CVD was similar in both countries, but behavioral pathways differed. Loneliness may be a risk factor for CVD regardless of culture; however, different prevention strategies in clinical settings may be required.

Peripheral artery disease (PAD) can develop into critical limb ischemia (CLI), which is characterized by resting pain at rest, ulcerations, or gangrene, with a high risk of amputation. The optimum course of treatment at this point is arterial revascularization, although this has a significant financial cost and is not always feasible or successful in reducing pain, healing ulcers, or preventing amputations. In situations where traditional alternatives for treating PAD have been exhausted, recent developments in cell therapy may offer a viable substitute.

The purpose of this study is to assess the safety and effectiveness of using expanded autologous adipose-derived stem cells (ASCs) in cellular therapy for the treatment of PAD patients who developed chronic artery ulcers.

An open randomized clinical trial will be carried out with two groups of twenty patients with CLI: In group 1, 2g of abdominal adipose tissue will be taken to produce ASCs. These cells will then be expanded in a lab (cell processing center) for 14-21 days before being applied to the lesion using bio-dressings and perilesional subcutaneous injections. Group 2 will receive conventional treatment with hydrogel-based dressing. There will be regular clinical assessments, supplementary tests, and photo documentation. The main efficacy outcome will be partial or complete healing of the wound. Safety outcomes will be monitored for infections, gangrene, amputations, and death. Participants will be monitored for 90 days. Cases of major amputation of the studied limb will not be included. The results will be evaluated by an independent external evaluator who is blind to the groups. Considering the high prevalence and socioeconomic consequences related to CLI and limb amputation, this study is expected to provide a positive social and financial impact on the Brazilian Unified Health System. ClinicalTrials.gov: NCT06326203.

The systemic immune-inflammation index (SII) has been used effectively to effectively assess the prognosis of patients with a variety of diseases. But few evidence on the relationship between SII and long-term prognosis of myocardial infarction. We thus aimed to evaluate the relationships of cumulative exposure to SII and its accumulation time course with major adverse cardiovascular events (MACE) events in patients with acute myocardial infarction after percutaneous coronary intervention. To evaluate the predictive value of SII in MACE events in patients with acute myocardial infarction. A total of 480 patients with acute ST-elevation myocardial infarction who underwent emergency coronary angiography at the Department of Cardiology, Affiliated Hospital of Hebei University from August 2022 to August 2023 were enrolled in this study. Eighteen patients were lost to follow-up, with a loss rate of 3.8%. Time-weighted cumulative SII was calculated as the weighted sum of the mean SII value for each time interval, then normalized by total exposure duration, the exposure duration was from hospitalization to 1-year follow-up. Duration of high SII exposure was defined as the duration with high SII and ranged from hospitalization to 1-year follow-up. The time course of SII accumulation was categorized by the combination of time-weighted cumulative SII < or ≥ median and SII slope. At 1-year follow-up, after adjusting for potential confounders, the time-weighted cumulative SII was divided into 2 groups. The S2 group which is above the median had a higher risk of MACE (hazard ratio, 1.090; 95% confidence interval 1.035-1.149), the high time-weighted cumulative SII group with a positive slope had a higher risk of MACE (hazard ratio, 4.096; 95% confidence interval 1.851-9.065). Long-term cumulative exposure to SII increases the risk of MACE in patients with acute ST-elevation myocardial infarction undergoing coronary angiography, and late high SII results in a higher risk of MACE events at the same time-weighted cumulative SII, underscoring the importance of late inflammation control.

Dyslipidaemia is a significant risk factor for cardiovascular diseases, which can manifest early in life. Despite its importance, the prevalence of dyslipidaemia in the paediatric population of Pakistan remains poorly understood. This study uses laboratory data to determine the prevalence of dyslipidaemia and lipid testing practices among Pakistani children and adolescents.

This retrospective cohort study analysed the laboratory data from children and adolescents, aged up to 19 years, who underwent lipid testing. The data was obtained from two centres with collection points all over Pakistan for five years (March 2019-March 2024). Logistic regression models were used to assess relationships between demographic factors (age, sex and regions/provinces) and lipid profile parameters.

Over five years, 9,787 children and adolescents with a mean age of 13.8 ± 5.1 years underwent lipid testing. Boys accounted for 59.7% of those tested compared to 40.3% of girls (p = 0.09). Most tests were conducted in Punjab (81.2%), with minimal representation from Balochistan (0.5%) and Gilgit Baltistan (0.3%). Among tested children and adolescents, 33.3% had elevated total cholesterol, 25.4% high low-density lipoprotein cholesterol, 46.6% low high-density lipoprotein cholesterol, 48.0% abnormal non- high-density lipoprotein cholesterol and 41.7% hypertriglyceridemia. Compared to boys, girls had significantly lower odds of abnormal high-density lipoprotein cholesterol (Odds Ratio 0.556, 95% CI 0.511-0.607, p < 0.001) and triglyceride levels (Odds Ratio 0.702, 95% CI 0.642-0.767, p < 0.001).

This study highlights a high prevalence of dyslipidaemia among Pakistani children, with boys more affected than girls. The study also highlights a gender-based inequality in lipid testing where girls appear to be less frequently tested compared to boys.

Mounting evidence indicates that gut microbial metabolites are central hubs linking the gut microbiota to atherosclerosis (AS). Gut microbiota enriched with pathobiont bacteria responsible for producing metabolites like trimethylamine N-oxide and phenylacetylglutamine are related to an increased risk of cardiovascular events. Furthermore, gut microbiota enriched with bacteria responsible for producing short-chain fatty acids, indole, and its derivatives, such as indole-3-propionic acid, have demonstrated AS-protective effects. This study described AS-related gut microbial composition and how microbial metabolites affect AS. Summary findings revealed gut microbiota and their metabolites-targeted diets could benefit AS treatment. In conclusion, dietary interventions centered on the gut microbiota represent a promising strategy for AS treatment, and understanding diet-microbiota interactions could potentially be devoted to developing novel anti-AS therapies.

The cluster of cardiovascular risk factors, referred to as metabolic syndrome (MetS), represents a substantial risk factor for cardiovascular diseases and presents a significant public health challenge. However, previous epidemiological investigations exploring the link between sleep duration and MetS lack experimental evidence to establish a causal relationship. Hence, he objective of this study is to examine the association between sleep duration and MetS by employing the Mendelian randomization (MR) approach.

A cross-sectional study was conducted utilizing the Taiwan Biobank database, which comprised 33,270 predominantly Han Chinese individuals aged 30-70 years with no history of cancer and enrolled between 2008 and 2020. This study was conducted using Taiwan Biobank database. In MR analysis, we constructed weighted and unweighted genetic risk scores by calculating the SNP alleles significantly associated with sleep duration. Two-stage regression analysis was used to estimate odds ratio (OR) and 95% confidence interval (CI).

In the observational epidemiologic study, after multivariate adjustment, the OR for sleep durations of < 5, 8-9 and > 9 h compared to those with a sleep duration of 7 h were 1.23 (95% CI: 1.07, 1.43), 1.15 (95% CI: 1.06, 1.24) and 1.84 (95% CI: 1.43, 2.36), respectively. In the MR analyses after multivariate adjustment, the ORs of MetS per 1 standard deviation increase in the estimated sleep duration and the probability of long and short sleep durations derived from weighted genetic risk scores were 0.64 (95% CI: 0.63, 0.66), 1.55 (95% CI: 1.51, 1.59), and 1.66 (95% CI: 1.62, 1.70), respectively.

Observational and MR analyses demonstrated that short and long sleep durations are potential causal risk factors for MetS. Therefore, long and short sleep durations should be considered as risk factors in MetS-prevention strategies.

Coronary artery disease (CAD) has become a major health challenge across the globe and is one of the major causes of mortality and morbidity in several countries. In Saudi Arabia, recent studies have emphasized the burden of CAD. Therefore, in this study, we aim to assess the risk factors associated with CAD in Saudi Arabia. The Population, Intervention, Comparison, and Outcome (PICO) model was used to refine the research question, which defined patients with CAD and identified risk factors and prevention strategies. PubMed, Web of Science, and Google Scholar were searched from January 1, 2010, until December 1, 2024. The common risk factors were diabetes, hypertension, obesity, and smoking, indicating their significant impact on health outcomes and the urgency for focus prevention strategies such as education and routine clinical screening. The risk factors contributing to CAD emphasize the need for targeted public health intervention and improvement in the management of risk factors in addition to specific health education content to improve healthy habits in the community.

While, many interventions can prevent cardiovascular disease (CVD), and its resulting morbidity or mortality, these are used sub-optimally in most countries. Therefore, health systems need to develop new approaches to ensure that proven CVD therapies are delivered widely. In this review, we describe five impactful implementation strategies which include: (1) Task shifting, (2) Use of mobile-Health (mHealth) support and virtual access to care, (3) simplified diagnostic and management algorithms for the prevention of CVD, (4) improving the use of combinations of medicines (i.e., polypill), and (5) patient engagement and role of patient-nominated peer support (i.e., treatment supporters). Adapting and tailoring these strategies to the local context in different settings in various countries in the Americas and the Caribbean can reduce the morbidity and mortality of CVD substantially.

Against the backdrop of alarming obesity rates and growing concerns about access to specialist care across Australia, this study aims to assess the utility of the nation's largest digital weight-loss service (DWLS) in regional Australia.

This study focuses on patients of the Eucalyptus DWLS who live in regional Australia (Monash Modified Model classification 3-6).

Thirty-two adults living with overweight or obesity who have been subscribed to the Eucalyptus DWLS for at least 3 weeks were invited to participate in phone-based interviews.

Interviewers prompted discussion around 6 questions, pertaining to reasons for Eucalyptus subscription, previous attempts at weight loss, views on the service's comprehensiveness, access to face-to-face alternatives, areas for program improvement and general program satisfaction. Investigators conducted a Braun and Clarke thematic analysis of all interview transcripts.

Six key themes were identified in the analysis, including unmanageable travel times to face-to-face obesity services; inadequate Eucalyptus app functionality; satisfaction with Eucalyptus care continuity; frustration with previously attempted standalone lifestyle interventions; aversion to or dissatisfaction with surgical interventions; and early weight loss increases confidence and exercise motivation.

Comprehensive DWLSs such as Eucalyptus have the potential to significantly increase access and adherence to continuous obesity care for regional Australians. However, platforms need to contain special provisions for users with lower literacy and integrate advanced lifestyle trackers to ensure patients are not simply using the DWLS to access weight-loss medications.

This study aims to assess the global burden and trends in cardiovascular diseases (CVDs) prevalence, stratified by sociodemographic index (SDI) categories and age groups, across 204 countries and territories.

Utilizing data from the Global Burden of Disease Study 2019, this study analyzed trends in the age-standardized prevalence rate of overall and type-specific CVDs, including rheumatic heart disease, ischemic heart disease, stroke, hypertensive heart disease, non-rheumatic valvular heart disease, cardiomyopathy and myocarditis, atrial fibrillation and flutter, peripheral artery disease, endocarditis, and other cardiovascular and circulatory diseases. Age-standardized prevalence rates were stratified by SDI categories (low, low-middle, middle, high-middle, and high) and age groups (0-14, 15-49, 50-69, and ≥ 70 years). The corresponding average annual percentage change was calculated to assess temporal trends.

From 1990 to 2019, the global age-standardized prevalence rate per 100,000 population for CVD decreased from 6728.04 (95% UI 6394.55 to 7059.66) to 6431.57 (95% UI 6109.95 to 6759.8), with an average annual percent change of -0.15% (95% CI -0.17 to -0.13). When stratified by SDI category, the age-standardized prevalence rate of CVD decreased significantly in high-middle and high SDI countries but increased in middle, low-middle, and low SDI countries. By age group, the age-standardized prevalence rate of CVD declined in the 50-69 and ≥ 70 years groups but increased in the 0-14 and 15-49 years groups. SDI levels were negatively associated with faster increases in the age-standardized prevalence rate of CVD across all ages and age groups. Low SDI countries consistently showed the highest age-standardized prevalence rates of CVD in the younger age groups (0-14 and 15-49 years), while high-middle SDI countries had the highest rates in the older age groups (50-69 and ≥ 70 years). The age-standardized prevalence rate of CVD was negatively associated with SDI levels in the 0-14 and 15-49 years groups and positively associated with SDI levels in the 50-69 and ≥ 70 years groups. Type-specific CVDs such as rheumatic heart disease, other cardiovascular and circulatory diseases, non-rheumatic valvular heart disease, and hypertensive heart disease showed increased age-standardized prevalence rates from 1990 to 2019.

This study highlights significant disparities in CVD prevalence across sociodemographic and age groups. While the global prevalence of CVD has generally decreased, the rise in CVD prevalence in lower SDI countries and younger populations calls for tailored intervention strategies. Addressing these disparities is crucial to mitigating the growing burden of CVD and promoting cardiovascular health on a global scale.

In Latin America and the Caribbean (LAC), sociodemographic context, socioeconomic disparities and the high level of urbanization provide a unique entry point to reflect on the burden of cardiometabolic disease in the region. Cardiovascular diseases are the main cause of death in LAC, precipitated by population growth and ageing together with a rapid increase in the prevalence of cardiometabolic risk factors, predominantly obesity and diabetes mellitus, over the past four decades. Strategies to address this growing cardiometabolic burden include both population-wide and individual-based initiatives tailored to the specific challenges faced by different LAC countries, which are heterogeneous. The implementation of public policies to reduce smoking and health system approaches to control hypertension are examples of scalable strategies. The challenges faced by LAC are also opportunities to foster innovative approaches to combat the high burden of cardiometabolic diseases such as implementing digital health interventions and team-based initiatives. This Review provides a summary of trends in the epidemiology of cardiometabolic diseases and their risk factors in LAC as well as context-specific disease determinants and potential solutions to improve cardiometabolic health in the region.

Hyperlipidaemia is considered one of the most common risk factors for ischemic heart disease. Severely elevated triglyceride levels may lead to hyperviscosity which may contribute to endothelial dysfunction, tissue ischemia and chylomicronaemia. This case report features a 39-year-old, non-smoker male with a past medical history of hypertension and no family history of coronary artery disease, who presented to the clinic with angina. The electrocardiogram and echocardiogram were normal. Laboratory tests were normal except for severely elevated triglyceride levels. A dobutamine stress echocardiogram was positive, so the patient underwent coronary angiography which revealed normal coronary arteries with slow flow in all of the coronary arteries (TIMI 2 flow grade). The patient was then discharged on high-intensity statin, fenofibrate, isosorbide mononitrate, nebivolol, and was given lifestyle modification instructions. After 3 months the patient came back to the clinic for follow-up. He was in good general condition and symptom free. Laboratory tests (including lipid profile) were within normal limits.

Understanding the effects of severely elevated triglyceride levels on coronary endothelial function.Prevention of harmful effects resulting from severely elevated triglyceride levels.

Insulin resistance (IR) is a recognized contributor to stroke association, and the estimated glucose disposal rate (eGDR) is a dependable indicator of IR. However, the specific connections between eGDR, stroke prevalence, and overall mortality have not been thoroughly investigated. This study aimed to examine how eGDR correlates with stroke and overall death rate.

The study leveraged information from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2016. To unravel the data, the team utilized logistic regression, cox proportional hazards models, and restricted cubic splines (RCS) Sensitivity analyses excluded participants with a stroke history within the previous two years. Results were validated through analysis of the China Health and Retirement Longitudinal Study (CHARLS).

A higher eGDR is like a protective shield against strokes, with those in the top eGDR quartile exhibited a 60% reduction in stroke association (OR = 0.40, 95% CI, 0.22-0.73, P = 0.003). Additionally, a higher eGDR correlates with a lower overall death rate (HR = 0.71, 95% CI, 0.52-0.98, P = 0.037), particularly in individuals without a history of stroke. RCS analysis demonstrated that eGDR's influence on stroke association follows a non-linear pattern. Subgroup analysis revealed that the protective effect of eGDR was stronger in non-diabetic and non-hypertensive individuals.

eGDR is inversely related to both stroke association and mortality, affirming its utility as a predictive marker of stroke.

This study aimed to determine the average intake of CoQ10 from dietary sources and explore the dose-response relationships between the dietary-derived CoQ10 intake and lipid profiles.

We performed a cross-sectional study based on the China Health and Nutrition Survey, which included 7,938 adults. The dietary intake assessment used three consecutive 24-h recalls combined with a household inventory. Serum was used for lipid profiling.

The average dietary-derived CoQ10 intake was 5.4 mg/day in Chinese adults. The dietary CoQ10 intake of the highest quartile (Q4 ≥ 6.96 mg/day) was negatively associated with total cholesterol (TC) [-0.12 (-0.19, -0.06) mmol/L], low-density lipoprotein cholesterol (LDL-C) [-0.17 (-0.23, -0.10) mmol/L], and non-high-density lipoprotein cholesterol (non-HDL-C) [-0.12 (-0.18, -0.05) mmol/L], while positively associated with apolipoprotein A-1 (ApoA1) [0.10 (0.08, 0.13) g/L] and triglycerides (TG) [0.14 (0.05, 0.23) mmol/L], compared to the lowest quartile (Q1 < 1.88 mg/day). Besides, dietary CoQ10 intake showed nonlinear dose-response associations with the above lipid variables (all P nonlinear < 0.05).

Dietary-derived CoQ10 intake may be associated with some lipid profiles, such as TG, ApoA1, TC, LDL-C, and non-HDL-C. However, CoQ10 from dietary sources may not be a good choice for individuals who need to CoQ10 supplement.

Coronary artery disease (CAD) is associated with a large clinical and economic burden. However, consensus on the optimal approach to CAD diagnosis is lacking. This study sought to compare downstream healthcare resource utilisation following different cardiac imaging modalities, to inform test selection for CAD diagnosis.

Claims and electronic health records data from the Decision Resources Group Real-World Evidence US Data Repository were analysed for 2.5 million US patients who underwent single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI), positron emission tomography myocardial perfusion imaging (PET MPI), coronary computed tomography angiography (cCTA), or stress echocardiography between January 2016 and March 2018. Patients were stratified into nine cohorts based on suspected or existing CAD diagnosis, pre-test risk, and prior events or interventions. Downstream healthcare utilisation, including additional diagnostic imaging, coronary angiography, and cardiac-related health system encounters, was compared by cohort and index imaging modality.

Among patients with suspected CAD diagnosed within 3 months of the index test, PET MPI was associated with lower downstream utilisation; 25-37% of patients who underwent PET MPI required additional downstream healthcare resources compared with 40-49% of patients who received SPECT MPI, 35-41% of patients who underwent cCTA, and 44-47% of patients who received stress echocardiography. Patients who underwent PET MPI experienced fewer acute cardiac events (5.3-9.4%) and generally had lower rates of healthcare encounters (0.8-4.1%) and invasive coronary angiography (ICA, 15.4-24.2%) than those who underwent other modalities. SPECT MPI was associated with more downstream ICA (31.3-38.2%) and a higher rate of cardiac events (9.5-13.2%) compared with PET MPI (5.3-9.4%) and cCTA (6.9-9.9%). Across all cohorts, additional diagnostic imaging was 1.6 to 4.7 times more frequent with cCTA compared with PET MPI.

Choice of imaging modality for CAD diagnosis impacts downstream healthcare utilisation. PET MPI was associated with lower utilisation across multiple metrics compared with other imaging modalities studied.

Rapid urbanisation without concomitant infrastructure development has led to the creation of urban slums throughout sub-Saharan Africa. People living in urban slums are particularly vulnerable to food insecurity due to the lack of physical and economic accessibility to food. Hence, it is important to explore how vulnerable groups living in slums interact with the food environment. This study assessed the relationships between food insecurity, including restrictive coping strategies, food purchasing patterns and perceptions about the food environment among dwellers of selected urban slums in Ibadan, Nigeria.

This community-based cross-sectional study was conducted with people responsible for food procurement from 590 randomly selected households in two urban slums in Ibadan. Food insecurity and restrictive coping strategies were assessed using the Household Food Insecurity Access Scale and the Coping Strategy Index, respectively. We examined purchasing patterns of participants by assessing the procurement of household foodstuffs in different categories, as well as by vendor type. Participants' perceptions of the food environment were derived through a five-item composite score measuring food availability, affordability and quality. Chi-square tests and logistic regression models analysed associations between food insecurity, purchasing patterns and perceptions of the food environment.

The prevalence of food insecurity in the sample was 88%, with 40.2% of the households experiencing severe food insecurity. Nearly a third (32.5%) of the households used restrictive coping strategies such as limiting the size of food portions at mealtimes, while 28.8% reduced the frequency of their daily meals. Participants purchased food multiple times a week, primarily from formal and informal food markets rather than from wholesalers and supermarkets. Only a few households grew food or had livestock (3.2%). Food insecure households had a lower perceived access to the food environment, with an approximate 10% increase in access score per one-unit decrease in food insecurity (AOR = 0.90, 95% CI: 0.84, 0.96). The most procured foods among all households were fish (72.5%), bread (60.3%), rice (56.3%), yam and cassava flours (50.2%). Food-secure households procured fruit, dairy and vegetable proteins more frequently.

Food insecurity remains a serious public health challenge in the urban slums of Ibadan. Perceptions of greater access to the food environment was associated with increasing food security. Interventions should focus on creating more robust social and financial protections, with efforts to improve livelihoods to ensure food security among urban slum-dwellers.

Background Type 2 diabetes mellitus (T2DM) is characterized by low insulin production or resistance. Adiponectin, a hormone produced by adipocytes, is essential for regulating glucose metabolism and is correlated with insulin decrease. Aim The aim of this study is to estimate the levels of adiponectin in T2DM patients and their relationship with various metabolic markers (glycated hemoglobin (HbA1c), fasting blood sugar (FBS), fasting insulin, lipid profile, and anthropometric variables in an Indian cohort. Methods This study was conducted at King George's Medical University (KGMU), India, from October 2022 to October 2024. The study (case-control) included 234 subjects: T2DM patients and age-sex-matched healthy controls. Diagnosis of T2DM followed American Diabetes Association criteria. Data collection involved medical history, anthropometric measurements, blood pressure, and biochemical assessments including FBS, HbA1c, lipid profiles, insulin levels, and insulin resistance. Serum adiponectin levels were estimated using an ELISA kit. Results T2DM patients had a significantly higher HbA1c value (7.82±0.96%) compared to controls (5.31±0.39%, p<0.001). Insulin resistance was also significantly higher in T2DM patients (4.31±0.95) than in controls (3.62±0.82, p=0.002). Adiponectin levels were significantly lower in T2DM patients (6.87±3.73 µg/mL) compared to controls (10.18±5.16 µg/mL, p<0.001). Low levels of adiponectin were correlated with HbA1c (r=-0.58, p<0.001), FBS (r=-0.51, p<0.001), and total cholesterol (r=0.38, p<0.001). Adiponectin levels also were correlated with BMI (r=-0.33, p<0.001). Conclusion Lower adiponectin levels in T2DM patients correlate with HbA1c and increased insulin resistance, suggesting that adiponectin may be a biomarker for diabetes management and risk assessment.

Communicable diseases have been the primary cause of morbidity and mortality, affecting populations for decades. However, in recent times, noncommunicable diseases (NCDs) have emerged as the primary cause of illness and premature death due to factors such as urbanization, longer life expectancy, and unhealthy lifestyles. In recent years, noncommunicable illnesses have emerged as the primary cause of morbidity and premature mortality, replacing infectious diseases as the leading cause of illness and death. Among the top five causes of NCD, cardiovascular disease (CVD) is the most important factor, comprising the major diseases with maximum mortality and morbidity. The burden of CVD is greatly increased by modifiable risk factors, such as smoking, high blood pressure, type 2 diabetes, low-density lipoprotein cholesterol, and excess body weight. CVD occurs particularly in certain occupational risk groups, such as doctors, police personnel, and persons working for prolonged hours, predisposing them to unhealthy dietary practices, improper sleeping patterns, and increased psychological stress. As members of this occupational group, police personnel are particularly at risk for cardiovascular diseases, making it imperative to implement preventive measures to reduce the burden of these diseases in this population. The primary objective was to assess the impact of yoga and health education interventions on cardiovascular health outcomes among police personnel in South India, and the secondary objective was to examine the changes in blood pressure levels and lipid profiles following yoga and health education programs among police personnel.

Previous studies have found a solid correlation between payment problems and health, and a large body of literature has recognised the impact of debt burden on ill health. However, few have looked at the reversed causality-the impact of health on over-indebtedness and payment problems. In this article, we investigate whether or not a person with mental and physical health challenges is more likely to experience debt enforcement, and we take a step further to explore the role of health status on receiving debt settlement for those with severe payment problems. The article uses register data from Statistics Norway, the Norwegian Patient Registry and the Mortgages Registry from 2009 to 2018. When using conditional logistic models and fixed-effects Poisson regressions with a one-year lagged effect, we find that mental disorders significantly contribute to individuals' financial strains, while physical health does not play a substantial role. When integrating the models with dynamic health effects, all health indicators turned out to have substantial impacts, indicating an extended delayed physical health effect on financial outcomes. Poor health leads to increased payment problems, yet individuals facing health challenges have a lower likelihood of receiving necessary assistance in debt settlement. These findings emphasise the need for tailored services to address the financial challenges of debtors with diverse health conditions.

In developing countries, including China, solid-fuel-based heating and cooking is common. For older people, the multimorbidity prevalence is exceptionally high. Nevertheless, studies on the associations of indoor solid fuels use, especially switching fuels types, on multimorbidity in middle-aged and older people is scarce.

Data from five waves of the China Health and Retirement Longitudinal Study were used in this study. Indoor fuels were classified as solid or clean fuels. Physical-psychological-cognitive multimorbidity (PPC-multimorbidity) was defined as the simultaneous presence of three disease types (physical illness, psychological disorders, cognitive impairment). Using Cox proportional risk models, hazard ratios (HRs) and 95 % confidence intervals (95 % CI) were calculated to investigate the associations of heating- and cooking-related baseline indoor fuels and switching indoor fuels with PPC-multimorbidity incidence.

In the heating (n=3121, mean age=56.55 years, male proportion=54.25 %) and cooking (n=3574, mean age=56.67 years, male proportion=52.94 %) analyses, 75.07 % and 45.64 % of the participants used solid fuels at baseline, and 564 (18.07 %) and 613 (17.15 %) PPC-multimorbidity cases were diagnosed during follow-up, respectively. Participants with baseline heating- and cooking-based solid fuels use had greater PPC-multimorbidity incidences [HRs (95 % CIs): 1.23 (0.98, 1.55) and 1.44 (1.21, 1.73)], respectively. Additionally, combined baseline heating- and cooking-based solid fuels use was associated with even greater PPC-multimorbidity incidence [HR (95 % CI): 1.55 (1.18, 2.04)]. Persistent solid fuels use obviously increased the PPC-multimorbidity incidence [HRs (95 % CIs): 2.43 (1.67, 3.55) for heating and 2.63 (2.03, 3.40) for cooking]. Moreover, switching from solid to clean fuels was associated with a significantly decreased PPC-multimorbidity incidence [HRs (95 % CIs): 0.27 (0.20, 0.35) for heating and 0.36 (0.28, 0.46) for cooking].

Long-term solid-fuels use is associated with an increased PPC-multimorbidity incidence, and switching to cleaner fuels is associated with a decreased PPC-multimorbidity incidence in adults aged ≥45 years.

Evidence-based International clinical practice guidelines, universally recommend secondary prevention medications for those with previous cardiovascular disease (CVD). There is limited data on the community use of these medications in the Middle East (ME).

This study assesses the use and predictors of evidence based secondary prevention medications in individuals with a history of CVD [coronary heart disease (CHD) or stroke].

Between 2005 and 2015, we enrolled 11,228 individuals aged between 35-70 years from 52 urban and 35 rural communities from four ME countries, United Arab Emirates (n = 1499), Kingdom of Saudi Arabia (n = 2046), Occupied Palestinian Territory (n = 1668) and Islamic Republic of Iran (n = 6013). With standardized questionnaires, we report estimates of medication use in those with CVD at national level and the independent predictors of their utilization through a multivariable analysis model. Results: Of the total ME cohort, 614 (5.5%) had CVD, of which 115 (1.0%) had stroke, 523 (4.7%) had CHD and 24 (0.2%) had both. The mean age of those with CVD was 56.6 ± 8.8 years and 269 (43.8%) were female. Overall, only 23.5% of those with CVD reported using three or more proven secondary prevention medications, and a substantial proportion (stroke 27.8%, CHD 25.8%) did not take any of these medications. In a fully adjusted analysis, increasing age, female gender, higher education, higher wealth in individual household, residence in a higher income country as well as being obese, hypertensive or diabetic were independent predictors of medication use.

The use of secondary prevention medication is low in ME and has not reached the modest recommended WHO target of 50% use of 3 or more medications. Independent factors of higher use were, better socioeconomic status (household wealth, country wealth and education) and better contact and accessibility to health care (increasing age, female gender, obesity, diabetes and hypertension).

The prevalence of cardiovascular disease is burgeoning in low- and middle-income countries (LMICs). In sub-Saharan Africa, the prevalence of cardiovascular risk factors is increasing, though rates of CVD diagnosis and management remain low. Awareness of the influence of social determinants of health (SDOH) on cardiovascular outcomes is growing, however, most work focuses on high-income countries. Material needs security is a measure of SDOH that may be particularly relevant for LMICs. This study investigated the relationship between material needs security and cardiovascular risk in older adults living in South Africa.

The analysis included 5059 respondents age ≥ 40 in the Health and Aging in Africa survey, an observational cohort study administered in 2014 in Mpumalanga Province, South Africa. Linear regression models tested the association between material needs and eight cardiovascular risk factors (waist-to-hip ratio, body mass index, blood pressure, glucose, cholesterol, LDL, and triglycerides). Adjusted linear regression models controlled for sociodemographic confounders.

There were significant adjusted associations found between increased material needs security and four cardiovascular risk factors, including waist-to-hip ratio (β = 0.001; 95% CI [0.00002,0.002]), BMI (β = 0.19; 95%CI=[0.14,0.24]), glucose (β = 0.46; 95%CI=[0.02,0.90]), and triglycerides (β = 0.26; 95%CI=[0.02,0.49]).

Increased material needs security was associated with significantly increased cardiovascular risk in older adults in rural South Africa. These findings can inform the approach to treatment and management of cardiovascular disease in South Africa and similar LMICs. Future investigations should evaluate the implementation and efficacy of interventions that recognize the role of material needs security in cardiovascular risk.

Cardiac imaging is crucial for diagnosing heart disorders. Methods like X-rays, ultrasounds, CT scans, and MRIs provide detailed anatomical and functional heart images. AI can enhance these imaging techniques with its advanced learning capabilities.

In this scoping review, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Guidelines, we searched PubMed, Scopus, Web of Science, and Google Scholar using related keywords on 16 April 2024. From 3679 articles, we first screened titles and abstracts based on the initial inclusion criteria and then screened the full texts. The authors made the final selections collaboratively.

The PRISMA chart shows that 3516 articles were initially selected for evaluation after removing duplicates. Upon reviewing titles, abstracts, and quality, 24 articles were deemed eligible for the review. The findings indicate that AI enhances image quality, speeds up imaging processes, and reduces radiation exposure with sensitivity and specificity comparable to or exceeding those of qualified radiologists or cardiologists. Further research is needed to assess AI's applicability in various types of cardiac imaging, especially in rural hospitals where access to medical doctors is limited.

AI improves image quality, reduces human errors and radiation exposure, and can predict cardiac events with acceptable sensitivity and specificity.

Many recent studies have examined the impact of predicted changes in temperature and precipitation patterns on infectious diseases under different greenhouse gas emissions scenarios. But these emissions scenarios symbolize more than altered temperature and precipitation regimes; they also represent differing levels of change in energy, transportation, and food production at a global scale to reduce the effects of climate change. The ways humans respond to climate change, either through adaptation or mitigation, have underappreciated, yet hugely impactful effects on infectious disease transmission, often in complex and sometimes nonintuitive ways. Thus, in addition to investigating the direct effects of climate changes on infectious diseases, it is critical to consider how human preventative measures and adaptations to climate change will alter the environments and hosts that support pathogens. Here, we consider the ways that human responses to climate change will likely impact disease risk in both positive and negative ways. We evaluate the evidence for these impacts based on the available data, and identify research directions needed to address climate change while minimizing externalities associated with infectious disease, especially for vulnerable communities. We identify several different human adaptations to climate change that are likely to affect infectious disease risk independently of the effects of climate change itself. We categorize these changes into adaptation strategies to secure access to water, food, and shelter, and mitigation strategies to decrease greenhouse gas emissions. We recognize that adaptation strategies are more likely to have infectious disease consequences for under-resourced communities, and call attention to the need for socio-ecological studies to connect human behavioral responses to climate change and their impacts on infectious disease. Understanding these effects is crucial as climate change intensifies and the global community builds momentum to slow these changes and reduce their impacts on human health, economic productivity, and political stability.

Background Acute coronary syndrome (ACS) is a significant cause of mortality and morbidity globally, necessitating effective intervention strategies. Early invasive procedures such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are often recommended for high-risk patients. However, their cost-effectiveness in low-income regions remains uncertain, particularly in Pakistan, where healthcare resources are limited. Objective This study aims to evaluate the cost-effectiveness of early invasive procedures compared to standard care for ACS in low-income regions of Pakistan. Methods We conducted a prospective cohort study from January 1, 2021, to January 31, 2021, at four major hospitals in Pakistan: Army Cardiac Center Combined Military Hospital (CMH) Lahore, National Institute of Cardiovascular Diseases in Karachi, Lady Reading Hospital in Peshawar, and Mardan Medical Complex. The participants included 436 patients diagnosed with ACS aged 18 years or older and presenting within 24 hours of symptom onset. The patients were divided into two groups: the early invasive procedure group (n = 218) and the standard care group (n = 218). The primary outcome was the 30-day mortality rate. Secondary outcomes included recurrent myocardial infarctions, hospital readmissions, healthcare costs, and procedural complications. Data were analyzed using SPSS version 25.0 (IBM SPSS Statistics, Armonk, NY), employing descriptive statistics, chi-square tests, independent t-tests, and Kaplan-Meier survival analysis. Results The early invasive procedure group showed a mortality rate of 18 (8%) compared to 33 (15%) in the standard care group, demonstrating a significant reduction in mortality (p = 0.01). Additionally, the average healthcare cost was significantly lower in the early invasive group, with mean costs of Pakistani rupee (PKR) 187,200 (US dollar {USD} 1,200) compared to PKR 280,800 (USD 1,800) in the standard care group (p < 0.01). Recurrent myocardial infarctions occurred in 11 (5%) of the early invasive group versus 26 (12%) in the standard care group (p < 0.05). Hospital readmission rates were lower in the early invasive group, 22 (10%) compared to 39 (18%) in the standard care group (p < 0.05). Healthcare costs were significantly lower in the early invasive group, with mean costs of PKR 187,200 (USD 1,200) compared to PKR 280,800 (USD 1,800) in the standard care group (p < 0.01). Conclusion Early invasive procedures for ACS significantly improve survival rates, reduce complications, and lower healthcare costs in low-income regions of Pakistan. These findings suggest that such strategies should be considered in resource-limited settings to optimize patient outcomes and healthcare resource utilization.

While individuals who were separated from their biological family and placed into the care of the state during childhood (out-of-home care) are more prone to developing selected adverse health problems in adulthood, their risk of cardiovascular disease is uncertain. Our aim was to explore this association by pooling published and unpublished results from prospective cohort studies.

We used two approaches to identifying relevant data on childhood care and adult cardiovascular disease (PROSPERO registration CRD42021254665). First, to locate published studies, we searched PubMed (Medline) until November 2023. Second, with the objective of identifying unpublished studies with the potential to address the present research question, we scrutinised retrieved reviews on childhood out-of-home care and other adult health outcomes. Included studies were required to satisfy three criteria: a cohort study in which the assessment of care was made prospectively pre-adulthood (in the avoidance of recall bias); data on an unexposed comparator group were available (for the computation of relative risk); and a diagnosis of adult cardiovascular disease events (coronary heart disease, stroke, or their combination) had been made (as opposed to risk factors only). Collaborating investigators provided study-specific estimates which were aggregated using random-effects meta-analysis. The Newcastle-Ottawa Scale was used to assess individual study quality.

Twelve studies (2 published, 10 unpublished) met the inclusion criteria, and investigators from nine provided viable results, including updated analyses of the published studies. Studies comprised 611,601 individuals (301,129 women) from the US, UK, Sweden, Finland, and Australia. Five of the nine studies were judged to be of higher methodological quality. Relative to the unexposed, individuals with a care placement during childhood had a 51% greater risk of cardiovascular disease in adulthood (summary rate ratio after age- and sex-adjustment [95% confidence interval]: 1.51 [1.22, 1.86]; range of study-specific estimates: 1.07 to 2.06; I 2  = 69%, p = 0.001). This association was attenuated but persisted after adjustment for socioeconomic status in childhood (8 studies; 1.41 [1.15, 1.72]) and adulthood (9 studies, 1.29 [1.11, 1.51]).

Our findings show that individuals with experience of out-of-home care in childhood have a moderately raised risk of cardiovascular disease in adulthood.

Medical Research Council; National Institute on Aging; Wellcome Trust.

Mortality data and comparative risk assessments from sub-Saharan Africa are limited. There is an urgent need for high quality population health surveys to be conducted, to improve the national health surveillance system. Our aim was to perform a comparative risk assesment and report on the mortality status and cause of death data of participants from a South African site of the international Prospective Urban Rural Epidemiology study.

1 921 Black participants were included, with a median observational time of 13 years resulting in 21 525 person-years. We performed a comparative risk assessment considering four health status domains: locality (rural vs. urban), socio-economic status (SES) (education and employment), lifestyle factors (physical activity, smoking and alcohol consumption) and prevalent diseases (human immunodeficiency virus (HIV), type 2 diabetes mellitus and hypertension). Next, population-attributable fractions (PAFs) were calculated to determine the mortality risk attributable to modifiable determinants.

577 all-cause deaths occurred. Infectious diseases (28.1% of all deaths) were the most frequent cause of death, followed by cardiovascular disease (CVD) (22.4%), respiratory diseases (11.6%) and cancer (11.1%). The three main contributors to all-cause mortality were HIV infection, high SES and being underweight. HIV infection and underweight were the main contributors to infectious disease mortality and hypertension, the urban environment, and physical inactivity to CVD mortality. HIV had the highest PAF, followed by physical inactivity, alcohol and tobacco use and hypertension (for CVD mortality).

This African population suffers from a quadruple burden of disease. Urban locality, high SES, prevalent disease (HIV and hypertension) and lifestyle factors (physical inactivity, tobacco and alcohol use) all contributed in varying degrees to all-cause and cause-specific mortalities. Our data confirm the public health importance of addressing HIV and hypertension, but also highlights the importance of physical inactivity, tobacco use and alcohol consumption as focal points for public health strategies to produce the most efficient mortality reduction outcomes.

Growing evidence suggests that cardiovascular disease develops over the lifetime, often beginning in childhood. Metal exposures have been associated with cardiovascular disease and important risk factors, including dyslipidemia, but prior studies have largely focused on adult populations and single metal exposures.

To investigate the individual and joint impacts of multiple metal exposures on lipid levels during childhood.

This cross-sectional study included 291 4-year-old children from the Rhea Cohort Study in Heraklion, Greece. Seven metals (manganese, cobalt, selenium, molybdenum, cadmium, mercury, and lead) were measured in whole blood using inductively coupled plasma mass spectrometry. Serum lipid levels included total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol. To determine the joint and individual impacts of child metal exposures (log2-transformed) on lipid levels, Bayesian kernel machine regression (BKMR) was employed as the primary multi-pollutant approach. Potential effect modification by child sex and childhood environmental tobacco smoke exposure was also evaluated.

BKMR identified a positive association between the metal mixture and both total and LDL cholesterol. Of the seven metals examined, selenium (median 90.6 [IQR = 83.6, 96.5] µg/L) was assigned the highest posterior inclusion probability for both total and LDL cholesterol. A difference in LDL cholesterol of 8.22 mg/dL (95% CI = 1.85, 14.59) was observed when blood selenium was set to its 75th versus 25th percentile, holding all other metals at their median values. In stratified analyses, the positive association between selenium and LDL cholesterol was only observed among boys or among children exposed to environmental tobacco smoke during childhood.

Growing evidence indicates that cardiovascular events in adulthood are the consequence of the lifelong atherosclerotic process that begins in childhood. Therefore, public health interventions targeting childhood cardiovascular risk factors may have a particularly profound impact on reducing the burden of cardiovascular disease. Although growing evidence supports that both essential and nonessential metals contribute to cardiovascular disease and risk factors, such as dyslipidemia, prior studies have mainly focused on single metal exposures in adult populations. To address this research gap, the current study investigated the joint impacts of multiple metal exposures on lipid concentrations in early childhood.

To evaluate using a biocellulose-based hydrogel as an adjuvant in the healing process of arterial ulcers.

A prospective single group quasi-experimental study was carried out with chronic lower limb arterial ulcer patients. These patients received biocellulose-based hydrogel dressings and outpatient guidance on dressing and periodic reassessments. The primary outcomes were the ulcer-healing rate and product safety, which were assessed by ulcer area measured in photographic records of pre-treatment and posttreatment after 7, 30, and 60 days. Secondary outcomes were related to clinical assessment by the quality-of-life scores (SF-36 and EQ-5D) and pain, evaluated by the visual analogue scale (VAS).

Seventeen participants were included, and one of them was excluded. Six patients (37%) had complete wound healing, and all patients had a significant reduction in the ulcer area during follow-up (233.6mm2 versus 2.7mm2) and reduction on the score PUSH 3.0 (p < 0.0001). The analysis of the SF-36 and EQ-5D questionnaires showed a statistically significant improvement in almost all parameters analyzed and with a reduction of pain assessed by the VAS.

The biocellulose-based hydrogel was safe and showed a good perspective to promoting the necessary conditions to facilitate partial or complete healing of chronic arterial ulcers within a 60-day follow-up. Quality of life and pain were positively affected by the treatment.

Longitudinal study.

To explore whether individuals with traumatic spinal cord injury (TSCI) and non-traumatic SCI (NTSCI) experience different trajectories in changes of cardiometabolic disease (CMD) factors during initial rehabilitation stay.

Multicenter Swiss Spinal Cord Injury Cohort (SwiSCI) study.

Individuals without history of cardiovascular diseases were included. CMD factors and Framingham risk score (FRS) were compared between TSCI and NTSCI. Linear mixed models' analysis was employed to explore the trajectory in CMD factors changes over rehabilitation period and a multivariate linear regression analysis was used at discharge from inpatient rehabilitation to explore factors associated with CMD risk profile in TSCI and NTSCI. We performed age and sex-stratified analyses.

We analyzed 530 individuals with SCI (64% with TSCI and 36% NTSCI). The median age was 53 years (IQR:39-64) with 67.9% (n = 363) of the study cohort being male. The median rehabilitation duration was 4.4 months (IQR 2.4-6.4). At admission to rehabilitation, FRS (9.61 vs. 5.89) and prevalence of hypertension (33.16% vs. 13.62%), diabetes (13.68% vs. 4.06%), and obesity (79.05% vs. 66.67%) were higher in NTSCI as compared to TSCI, No difference was observed in cardiometabolic syndrome between the groups (around 40% in both groups). Overall, we observed longitudinal increases in total cholesterol, HDL-C and HDL/total cholesterol ratio, and a decrease in fasting glucose over the rehabilitation period. No differences in longitudinal changes in cardiovascular risk factors were observed between TSCI and NTSCI.

There was no deterioration in cardiometabolic risk factors over rehabilitation period, at discharge from initial rehabilitation stay. Both TSCI and NTSCI experienced high burden of cardiometabolic syndrome components with NTSCI experiencing more disadvantageous risk profile. The effectiveness of therapeutic and lifestyle/behavioral strategies to decrease burden of cardiometabolic disease and its components in early phase should be explored in future studies.

Pedometer-based walking programs hold promise as a health promotion strategy for stroke prevention in community-dwelling older adults, particularly when targeted at physical activity-related modifiable risk factors. The question arises: What is the effectiveness of pedometer-based walking program interventions in improving modifiable stroke risk factors among community-dwelling older adults?

Eight databases were searched up to December 2nd, 2023, following the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol. Inclusion criteria focused on randomized controlled trials (RCTS) involving community-dwelling older adults and reported in English. Two independent reviewers utilized Physiotherapy Evidence Database (PEDro) tool to extract data, assess eligibility, evaluate study quality, and identify potential bias. Standardized mean difference (SMD) was employed as summary statistics for primary -physical activity level -and secondary outcomes related to cardiovascular function (blood pressure) and metabolic syndrome, including obesity (measured by body mass index and waist circumference), fasting blood sugar, glycated hemoglobin, high-density lipoprotein cholesterol (HDL-C), and triglycerides. A random-effects model was used to generate summary estimates of effects.

The review analyzed eight studies involving 1546 participants aged 60-85 years, with 1348 successfully completing the studies. Across these studies, pedometer-based walking programs were implemented 2-3 times per week, with sessions lasting 40-60 minutes, over a duration of 4-26 weeks. The risk of bias varied from high to moderate. Our narrative synthesis revealed positive trends in HDL-C levels, fasting blood sugar, and glycated hemoglobin, suggesting improved glycemic control and long-term blood sugar management. However, the impact on triglycerides was only marginal. Primary meta-analysis demonstrated significantly improved physical activity behavior (SMD=0.44,95%CI:0.26, 0.61,p=<0.00001;I2=0%;4 studies; 532 participants) and systolic blood pressure (SMD=-0.34,95%CI:-0.59,-0.09;p=<0.008;I2=65%,2 studies;249 participants), unlike diastolic blood pressure (SMD=0.13,95%CI:-0.13,-0.38,p=0.33; I2=91%; 2 studies; 237 participants). Interventions based on social cognitive, self-efficacy, and self-efficiency theory(ies), and social cognitive theory applied in an ecological framework, were linked to successful physical activity behavior outcomes.

Pedometer-based walking programs, utilizing interpersonal health behavior theory/ecological framework, enhance physical activity behavior and have antihypertensive effects in community-dwelling older adults. While they do not significantly affect diastolic blood pressure, these programs potentially serve as a primary stroke prevention strategy aligning with global health goals.

Registration Number: INPLASY202230118.

There is limited evidence on the prevalence of ischaemic heart disease (IHD) and its association with risk factors and socioeconomic status (SES) in low- and middle-income countries (LMICs). Given the relatively high levels of access to healthcare in Sri Lanka, the association of IHD with SES may be different from that observed in other LMICs.

To estimate the prevalence of IHD in Sri Lanka, determine its associated risk factors and its association with SES.

We analysed data from 6,513 adults aged ≥18 years examined in the 2018/19 Sri Lanka Health and Ageing Study. We used the Rose angina questionnaire to classify participants as having angina (Angina+) and used self-report or medical records to identify participants with a history of IHD (History+). The association of Angina+ and History+ with age, ethnicity, sector of residence, education level, household SES wealth quintile, area SES wealth quintile, hypertension, diabetes, smoking, total cholesterol, cholesterol-to-HDL ratio, waist-to-hip ratio and body mass index were analysed in unadjusted and adjusted models. Additional analyses were performed to investigate sensitivity to correction for missing data and to benchmark estimates against evidence from other studies.

We estimated prevalence of History+ of 3.9% (95% CI 3.3%-4.4%) and Angina+ of 3.0% (95% CI 2.4%-3.5%) in adults aged 18 years and over. The prevalence of Angina+ was higher in women than men (3.9% vs. 1.9%, p < 0.001) whilst prevalence of History+ was lower (3.8% vs. 4.0%, p = 0.8), which may suggest a higher rate of undiagnosed IHD in women. A history of IHD was strongly associated with age, hypertension and diabetes status even after adjusting for sociodemographic factors. Though the prevalence of History+ was higher in the most developed area SES tertile and urban areas, History+ was also associated with less education but not household SES, consistent with patterns emerging from other LMICs.

There is an upward trend in the key cardiovascular risk factors in Iraq. Accordingly, the current study was initiated to address the changing epidemiology of acute coronary heart disease in Iraq.

In this cross-sectional study, a total of 600 patients diagnosed with acute coronary syndrome (ACS) in the period between October 2020 and September 2022, and admitted to the Heart Center at Azadi Teaching Hospital, Duhok, Iraq, were recruited. All patients had detailed histories, clinical examinations, and relevant investigations, with particular scrutiny of the major cardiovascular risk factors at enrollment. Patients were categorized as having ST-segment elevation myocardial infarction (STEMI) or non-ST elevation myocardial infarction (NSTEMI) following the American Society of Cardiology guidelines.

The patients had a mean age of 56.2 (SD: 10.5) years, with a male-to-female ratio of 2.5:1. The study included 185 (30.8%) patients with NSTEMI and 415 (69.2%) patients with STEMI. The frequency of regular smokers, those with hyperlipidemia, hypertension, and diabetes mellitus were 57.0%, 56.2%, 47%, and 40.7%, respectively. Family history of coronary heart disease and being overweight were encountered in a further 24.8% and 29.8%, respectively. Females were significantly older, with higher frequencies of hypertension, diabetes, hyperlipidemia, and overweight, while they were less likely to be smokers than males. Patients with hypertension, diabetes, and hyperlipidemia were significantly older, while smokers and those with a family history of ischemic heart disease were significantly younger. STEMI patients were significantly younger, more likely to be males, smokers, and overweight, but less likely to be diabetic than NSTEMI patients.

Iraqi patients with ACS were eight to 10 years younger than their Western counterparts. Males were more frequently involved and were younger than females. Hyperlipidemia and smoking were the most frequent risk factors, with the former's frequency exceeding reports from neighboring countries and the West. STEMI was more frequent and occurred at younger ages than NSTEMI. The results of the study support the need to institute effective targeted preventive and educational programs to reduce the risk of ACS in this part of the world.

Kenya has adopted the WHO target of halting the rise of overweight, including obesity, by 2025. This paper assesses the potential impact of achieving the set target on health, healthcare cost and productivity.

We used a proportional multistate life table model (Kenya Obesity Model) to simulate the 2019 population of Kenya over their lifetime. We compared a scenario in which body mass index (BMI) distributions stabilise in 2025 against one whose BMI distributions stabilise in 2044, and quantified changes in disease-specific health outcomes, healthcare costs and productivity. We searched the literature to identify the best estimates of the total and disease-specific healthcare costs in Kenya. We used the Human Capital Approach to estimate productivity gains.

If BMI distributions stabilised in 2025, an estimated 6.8 million health-adjusted life years (HALYs) (95% uncertainty interval (UI) 5.8-7.9 million) would be saved over the lifetime of the 2019 Kenyan population (135 HALYs per 1000 persons). A total of US$755 million in body mass-related healthcare costs could be saved by 2044 (US$15 per capita). For context, this equates to 16% of Kenya's annual healthcare expenditure. Over the lifetime, ~US$3 billion healthcare costs could be saved (US$62 per capita). By 2044, the total productivity gain resulting from a reduction in high BMI-related mortality and morbidity (combined) was ~US$5.8 billion (~US$237 per capita).

Achieving Kenya's overweight and obesity reduction target could improve health outcomes and also yield substantial healthcare cost savings and productivity gains.