Search Results (134)

Burden of diseases measured as disability-adjusted life years (DALYs) per 100,000 people can be mined from public domain data, when they are made available by population health surveillance systems. This can be analysed to allow insightful comparisons with the national average, and to understand differences in trends between the sexes, age groups, time periods, geographic regions, and sub-regions. In this illustrative case study, we have analysed the Scottish burden of disease database to understand what ailed the population of the Grampian region before the COVID-19 pandemic. We have identified that selected cancers, ischaemic heart disease, Alzheimer’s disease and other dementias are amongst the highest contributors to the burden; that drug use disorders and colorectal cancer are showing worsening trends and require health promotion and disease prevention measures from ages 15 and 25, respectively, especially in Aberdeen City; and that males are more vulnerable to atrial fibrillation and flutter, diabetes mellitus, oesophageal cancer, and self-harm, while females are more vulnerable to cerebrovascular and chronic obstructive pulmonary diseases. We demonstrate the usefulness of our analysis and methodology for the wider health system, allowing targeted medical research investments and coordinated response from public health and health service delivery. We also show the need for up-to-date surveillance data, forecasts, and evidence on the impact of interventions to be made available widely. Full article

Background and Aims: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of mortality worldwide, with lipid abnormalities playing a central role in disease development. While the causal role of low-density lipoprotein cholesterol (LDL-C) in ASCVD is well-established, the long-term population impact of combined lipid profiles, particularly the HDL-C/LDL-C ratio, remains less clearly quantified. This study aimed to estimate the lifetime burden of cardiovascular outcomes associated with different lipid risk profiles using a patient-level simulation framework. Methods: The authors analyzed projected lifetime ASCVD events across four HDL-C/LDL-C risk strata, ranging from low (≥0.45) to very high (<0.25), using the National Health Model Database of Projected and Estimated Outcomes (NHM-DPEO)—a digital twin of national healthcare systems built from multiple data sources, including national health and demographic statistics and estimates from the relevant literature. The framework is structured as a patient-level simulation model that projects individual health trajectories over a lifetime horizon. Model outputs were assessed for plausibility by comparison with published epidemiological estimates. Results: The NHM simulation revealed a strong, graded relationship between lipid profiles and cardiovascular survival. Life expectancy declined from 80.2 years in the lowest risk group (HDL-C/LDL-C ≥ 0.45) to 63.0 years in the very-high-risk group (HDL-C/LDL-C < 0.25), a reduction of 17.2 years, with 13.7 fewer QALYs. Similarly, participants with LDL-C > 5.0 mmol/L had a life expectancy 13.4 years shorter than those with LDL-C < 3.1 mmol/L. The burden of ASCVD increased exponentially with worsening lipid ratios: MI events rose from 5000 to 73,090 per 100,000 births, with onset in the highest risk group occurring as early as age 20. Ischaemic heart disease followed a similar pattern, showing up to 92% of events attributable to elevated lipid risk. While ischaemic stroke risk displayed a more complex pattern due to earlier MI mortality in high-risk groups, overall cardiovascular mortality and lifetime event burden were dominated by LDL-driven disease. These findings demonstrate that sustained LDL-C reduction and balanced HDL-C/LDL-C ratios confer substantial survival benefits across both sexes and all age groups. Conclusions: This study shows that lipid balance has a decisive influence on cardiovascular survival. Sustained LDL-C reduction and favourable HDL-C/LDL-C ratios markedly extend life expectancy and delay the onset of MI and IHD. The magnitude of this survival benefit highlights the need for early and continuous lipid control as a cornerstone of ASCVD prevention. The NHM quantifies these lifetime effects, offering valuable insights for targeted strategies that improve both longevity and quality of life. Full article

Peripheral artery disease (PAD) is found in 10.9% of patients with ischaemic stroke (IS). This cross-sectional study was performed to investigate the prevalence of PAD and its risk factors among acute IS patients in Singapore. Patients admitted for IS were recruited. Data was collected on sex, age, body mass index (BMI), history of hypertension, diabetes mellitus (DM), hypercholesterolaemia, cigarette smoking, prior stroke (PS) and ischaemic heart disease (IHD). IS was classified as a lacunar infarct (LI) or non-lacunar infarct (NLI) based on neuroimaging. Carotid intima–medial thickening (IMT) and carotid plaques (CP) were determined by ultrasonography. The ankle–brachial Index (ABI) was calculated in both lower limbs; PAD was diagnosed if the ABI was ≤0.9 in any limb. The estimated sample size was 150 subjects. In total, 150 subjects were recruited; the mean age was 62.7 ± 10.2 years, 44.7% were female, and the mean BMI was 24.1 ± 4.1. A total of 63.3% reported hypertension, 42.7% DM, 30.0% hypercholesterolaemia, 38.0% smoking, 18.7% PS, and 6.0% IHD. A total of 30.7% had IMT, 77.3% had CP, and 8.0% had carotid stenosis ≥50%. LI occurred in 64.7%. PAD was diagnosed in 22.0% (95% CI 16.1–29.3). On univariate analysis, based on vascular risk factors alone, PAD was associated with age (p = 0.03), hypercholesterolaemia (p = 0.03), and IHD (p = 0.004). On logistic regression, PAD was only associated with IHD (aOR 6.42, 95% CI 1.25–32.84; p = 0.03). When IMT and CP were added to the model, the association with IHD remained (aOR 5.45, 95% CI 1.03–28.71; p = 0.045). When the results of neuroimaging were added, the association was only with NLI (aOR 2.78, 95% CI 1.09–7.14; p = 0.03). This study found a high prevalence of PAD among Asian patients with IS. It was associated with a non-lacunar infarction. Full article

Background: Cardiometabolic diseases are a leading cause of premature mortality globally, yet longitudinal national mortality patterns remain insufficiently characterised in Gulf Cooperation Council settings. This study examines national trends in cardiometabolic mortality alongside health system financing, capacity, and utilization in Kuwait between 2010 and 2022. Methods: A national ecological time-series analysis used Ministry of Health administrative data covering mortality, cardiac care unit (CCU) capacity and discharges, cardiovascular procedural volumes, and MOH expenditure. Cause-specific outcomes included circulatory disease, ischaemic heart disease (IHD), cerebrovascular disease, hypertensive disease, and diabetes mellitus. Ordinary least squares regression estimated annual trends; pre-COVID restricted models (2010–2019) separated secular from pandemic-period effects. Results: All-cause deaths rose significantly from 5448 (2010) to 8041 (2022; β = +373.5/year; p = 0.001), peaking at 10,938 in 2021. Circulatory disease mortality rates increased over the full series but not pre-COVID, indicating pandemic-era acceleration. IHD death counts rose significantly in both models (β = +68.4 and +67.0/year; p < 0.01); IHD rates showed no significant trend, implicating demographic growth. Diabetes demonstrated the strongest signal: significant increases in death counts (β = +36.5/year; p < 0.001) and mortality rates (β = +0.689/100,000/year; p = 0.002), rising progressively across all time blocks. Hypertensive mortality declined significantly (β = −0.113/year; p = 0.002). MOH expenditure, CCU capacity, and CCU discharges increased significantly, demonstrating sustained structural expansion of cardiovascular services. Conclusions: Rising cardiometabolic mortality—driven prominently by diabetes—occurred alongside sustained health system expansion in Kuwait, indicating that tertiary capacity growth alone is insufficient to offset underlying epidemiological pressures. These findings underscore the urgency of strengthening upstream cardiometabolic prevention, integrated diabetes surveillance, and long-term metabolic risk control as central pillars of sustainable NCD policy. Full article

Background and Objectives: To assess whether country-level changes in major cardiometabolic risk factors were associated with concurrent changes in age-standardized death rates (ASDR) from ischaemic heart disease (IHD) and stroke between 2000 and 2015. Materials and Methods: We conducted a multinational ecological analysis using harmonized data from WHO, NCD-RisC, and the World Bank across 157 countries (n = 157). Absolute changes in systolic blood pressure, obesity, diabetes, and total cholesterol were standardized to z-scores. Linear regression models examined change–change associations, adjusting for income group and behavioral factors. Income-stratified and quartile-based analyses were performed. Results: Between 2000 and 2015, IHD and stroke mortality declined, while obesity and diabetes increased. In adjusted models, change in total cholesterol showed the most consistent association with change in IHD ASDR (β = 13.09, 95% CIs = 4.58–21.60, p = 0.003), whereas the other risk factors did not show consistent independent associations. Significant associations were confined to high- and upper middle-income countries, where change in total cholesterol was associated with IHD mortality. Conclusions: Changes in total cholesterol showed the most consistent correspondence with concurrent changes in IHD mortality at the country level, whereas other cardiometabolic risk factors showed less consistent patterns. These patterns were observed mainly in high- and upper–middle-income countries, suggesting heterogeneity by socioeconomic context. Full article

Background/Objective: Acute myocardial infarction (AMI) is a common, life-threatening condition and represents a substantial disease burden in Hungary. The aim of this study was to estimate the incidence of AMI in Hungary. Methods: This nationwide, retrospective, longitudinal study used data from the National Health Insurance Fund and included patients aged ≥15 years who were newly diagnosed with AMI (ICD-10 codes I21 or I22) between 1 January 2019 and 31 December 2023. Age-standardized incidence rates and their regional distributions were calculated using the European Standard Population from 2013. Results: A total of 16,171 and 14,797 patients with AMI were identified in 2019 and 2023, respectively, showing a declining trend (−1.60%; 95% CI: −2.10% to −1.10%; p < 0.0001). Age-standardized incidence rates varied between 144.22 and 166.63/100,000 person-years (PYs) during the analyzed period. The highest age-standardized incidence was detected among men (235.75/100,000 PYs) in 2019. The annual decrease in AMI incidence was significantly greater (p = 0.003) among women (−2.60%; 95% CI: −3.39% to −1.80%) than among men (−1.06%; 95% CI: −1.71% to −0.41%). Conclusions: The incidence of AMI in Hungary was in line with findings from other studies conducted in Central and Eastern European countries. AMI incidence showed a decreasing trend during the analyzed period. Men had higher incidence rates, and the declining trend was more pronounced among women. Full article

Background: Coronary artery disease (CAD) commonly coexists with chronic obstructive pulmonary disease (COPD), but may be under-recognised, since symptoms such as dyspnoea and chest discomfort are often attributed to lung disease. We hypothesised that coronary artery disease is highly prevalent in patients with COPD, even in the absence of typical angina symptoms. Methods: This study aimed to detect CAD in patients with COPD. We conducted a single-centre observational study, including 76 patients with no known previous cardiovascular events. To detect ischaemic heart disease, three methods were used, according to standard clinical indications: coronary angiography, coronary CT, and calcium score analysis on chest CT. The findings were categorised according to lesion severity and vessel involvement. Results: A substantial proportion of patients with COPD harboured previously undiagnosed atherosclerotic coronary disease (78%). However, most detected disease was non-obstructive atherosclerosis (56%), whereas severe stenosis was present in approximately one-third of patients (32%). Single-vessel disease accounted for 37% of cases, while the remaining patients exhibited multi-vessel involvement. Nevertheless, only a small proportion of patients had typical angina symptoms (11.8%), and the most frequent complaint was effort dyspnoea (50%). Patients not receiving inhaled corticosteroid therapy were more likely to have extensive coronary artery disease (χ² (6)= 14.228, p = 0.027). Conclusions: These findings support our hypothesis that atherosclerotic coronary disease is often under-recognised in patients with COPD. ICS-containing therapy appeared to be associated with less extensive coronary artery involvement; however, this observation should be interpreted cautiously. Full article

Background/Objectives: Ventricular repolarization abnormalities (VRA) represent a grey area in athlete screening: some patterns are physiological, while others are precursors to heart disease. Objective: to clarify the natural history of VRA and the associated factors of structural diagnosis. Methods: Retrospective observational single-center study of athletes with resting or stress VRA at the first evaluation, with normal echocardiography; minimum follow-up of 2 years. Clinical data, resting and stress ECG, echocardiography, and selective advanced imaging throughout follow-up were collected. Primary outcome: cardiovascular diagnosis at follow-up; time-to-event analysis and associations between ECG characteristics and diagnosis. Results: Fifty-three athletes (mean age 22.2 ± 9.2 years; 92.5% male) were included; 60.4% had resting VRA, and 100% had exercise-induced VRA at baseline. Over 7.3 ± 4.5 years, 28/53 (52.8%) received a diagnosis; median time-to-detection was 7.0 years (95% CI 6.0–not reached); RMST10 was 6.7 years (95% CI 5.7–7.7). Diagnoses included hypertrophic cardiomyopathy (24.5%), non-ischaemic left-ventricular scar (11.3%), myocardial bridging (7.5%), hypertensive remodelling (5.7%), coronary anomaly (1.9%), and ventricular pre-excitation (1.9%). Persistence of resting VRA from baseline to follow-up was more frequent in athletes with a final diagnosis (p = 0.01), whereas topography and exercise-induced abnormalities did not discriminate groups. Advanced imaging contributed substantially to case ascertainment. No major adverse cardiovascular events have been identified throughout follow-up. Conclusions: In athletes with screening-detected VRA and normal echocardiography, persistence of resting VRA was associated with higher detection of a cardiovascular diagnosis, while exercise-induced changes alone show limited diagnostic yield. The long median time-to-detection supports prolonged, pre-planned surveillance, with priority for advanced imaging in profiles with persistent abnormalities. These findings align with a risk-adapted, personalized management strategy in sports cardiology. Full article

KCa3.1 encodes the intermediate-conductance calcium-activated potassium channel KCa3.1, a regulator of membrane potential and calcium-dependent signalling in cardiovascular and immune cells. Increasing evidence indicates that KCa3.1 is a shared driver of vascular remodelling, inflammation, fibrosis, and electrical instability across multiple cardiovascular diseases. In ischaemic heart disease (IHD), KCa3.1 is upregulated in endothelial cells, vascular smooth muscle cells, macrophages, and T lymphocytes, where it promotes smooth muscle proliferation, neointimal formation, and chronic vascular inflammation. Genetic deletion or pharmacological blockade of KCa3.1 reduces atherosclerotic plaque burden and restenosis in animal models. In atrial fibrillation (AF), KCa3.1 contributes to electrical remodelling by shortening atrial action potential duration and to structural remodelling by driving fibroblast activation and collagen deposition. KCa3.1 also regulates macrophage polarisation and pro-inflammatory cytokine release in atrial tissue, linking immune activation to arrhythmogenic substrate formation. Inhibition of KCa3.1 prolongs atrial refractoriness, attenuates atrial fibrosis, and reduces AF inducibility in multiple preclinical models. Emerging data in valvular heart disease suggest that KCa3.1 is upregulated in valvular interstitial cells and regions of active calcification, where it supports myofibroblast differentiation, osteogenic signalling, and inflammatory crosstalk, implicating the channel in fibrocalcific valve degeneration. Collectively, these findings position KCa3.1 as a central molecular integrator of electrical, fibrotic, and inflammatory pathways in cardiovascular disease. The availability of selective KCa3.1 inhibitors with established human safety profiles supports the feasibility of therapeutic translation. Targeting KCa3.1 may enable disease-modifying strategies that extend beyond symptom control to suppress maladaptive cardiovascular remodelling. Full article

Coronavirus disease 2019 (COVID-19) has caused substantial global health and economic disruption, and identifying factors associated with adverse outcomes remains essential. This study is a first-wave observational study and examined risk factors and outcomes among patients admitted with COVID-19 to a non-acute hospital during the first wave of the pandemic, with particular focus on social deprivation and frailty. We conducted a retrospective review of clinical notes for 205 patients admitted between December 2019 and June 2020. Frailty was assessed using the Clinical Frailty Score and the Charlson Comorbidity Index, and social deprivation was evaluated using the Welsh Index of Multiple Deprivation. Although more women than men were admitted, mortality rates were similar across sexes. Older age was associated with increased mortality, and ischaemic heart disease was the most common comorbidity, occurring more frequently among patients who died. Those who died also demonstrated greater frailty, reflected in higher frailty and comorbidity scores. Most patients, irrespective of survival, were from less deprived areas, and greater social deprivation was not associated with increased admission or mortality. These findings indicate that older age, frailty, and ischaemic heart disease are important predictors of mortality in non-acute hospital settings, while social deprivation did not appear to influence admission risk or outcomes in this cohort. As this cohort predates widespread vaccination and antiviral therapy, these findings provide insight into baseline risk factors for COVID-19 mortality in frail populations during the first pandemic wave. Full article

Background: Acute coronary syndromes (ACSs) remain a leading cause of death and disability. Since the publication of the 2023 ESC ACS guidelines, multiple studies and an ESC/EAS dyslipidaemia update have refined how clinicians diagnose, revascularize, and treat ACS across the care continuum. Content: This state-of-the-art review synthesizes advances from 2023 to 2025 across five domains. Diagnosis: High-sensitivity troponin-based accelerated pathways remain foundational; GRACE 3.0 improves calibration for early vs. delayed angiography, while selective use of CCTA and routine use of intracoronary imaging/physiology help define the mechanism and optimize PCI. Revascularization: complete revascularization continues to underpin care in multivessel disease, with recent data favouring culprit-only PCI acutely and staged non-culprit treatment during the index stay in most STEMI presentations, particularly with heart-failure physiology. Antithrombotic therapy: Aspirin remains critical early after ACS-PCI; emerging evidence supports shorter DAPT and aspirin withdrawal after 1 month in carefully selected, low-ischaemic-risk patients, whereas day-0 aspirin-free strategies in unselected ACS are not non-inferior. Secondary prevention: A “strike early and strong” approach to LDL-cholesterol—often with combination therapy in hospital—is emphasized, alongside nuanced roles for SGLT2 inhibitors and GLP-1 receptor agonists. Special populations and implementation: Sex- and age-aware tailoring (including MINOCA/SCAD evaluation), pragmatic bleeding-risk mitigation, digitally enabled cardiac rehabilitation, and registry-driven quality improvement translate evidence into practice. Summary: Contemporary ACS care is moving from uniform protocols toward risk-stratified, mechanism-informed pathways. We offer practical algorithms and checklists to align interventional timing, antithrombotic intensity/duration, and secondary prevention with individual patient risk—bridging new evidence to bedside decisions. Full article

Background: While the 2024 ESC Guidelines provide guidance on utilising incidental CAC findings from non-gated CT scans to enhance risk stratification and guide treatment decisions, there remain gaps in detailed protocols for managing such incidental findings, particularly in inpatient settings. An incidental finding of CAC in a patient without known atherosclerosis provides an opportunity to assess cardiac risk, promote risk factor optimisation and evaluate need for further cardiac work up. The aim of this study was to assess the prevalence of incidental coronary artery calcification on non-cardiac dedicated gated CT thorax scans among general medical inpatients and to evaluate the subsequent management of these findings. Methods: This was a single-centre retrospective observational study of consecutive general medical inpatients aged 40–75, who had undergone a non-cardiac gated CT thorax during their admission, between February and March 2025. Data were collected using local electronic health records. Exclusion criteria were patients with known ischaemic heart disease (IHD). Risk factor assessment was noted by documentation of smoking status, hypertension, diabetes and low-density lipoprotein (LDL) values. Results: A total of 186 patients with thoracic CT scans were identified. On review of all CT reports, 53 (28.4%) patients had CAC reported, of whom 17 had known IHD. Therefore 36 (19.4%) patients were identified for further analysis. An exercise stress test was booked in none of the patients. A coronary angiogram was booked in 1 patient. Conclusions: One fifth of medical inpatients in our study had a new finding of CAC on thoracic imaging. Cardiovascular risk factors of LDL and HbA1c were checked in less than half of patients. None of these patients went on to have functional testing. There is a valuable opportunity to optimise cardiac risk factors and evaluate the need for functional testing in a subset of patients with CAC reported on non-cardiac CTs. This can be facilitated by raising awareness and implementing a flowchart tool for hospital physicians to reference. Full article

It is well established that vascular dysfunction is common in people with diabetes mellitus and is associated with increased risk of heart attack, ischaemic stroke and peripheral vascular disease. Although our understanding of the molecular mechanisms responsible is incomplete, persistent hyperglycaemia observed in poorly controlled diabetes has long been thought to be a critical factor. Multiple studies have, therefore, investigated the effects of poor glycaemic control on vascular function in multiple experimental settings, from in vitro and ex vivo models of primary human cells and tissues through to pre-clinical models. This review consolidates our current understanding of how metabolic and cell signalling pathways triggered by poor glycaemic control, impact vascular function in diabetes. We also evaluate how these pathways could be exploited to develop targeted therapeutic approaches to improve cardiovascular outcomes specifically in people with diabetes. Full article

Background: End-stage renal disease (ESRD) patients on haemodialysis present a high burden of cardiovascular comorbidities and require anticoagulation, which increases bleeding risk. Methods: We performed a retrospective observational study (2021–2024) in the Haemodialysis Centre of The Clinical Emergency Hospital of Constanta County, Romania, including 50 adults with stage G5 CKD on haemodialysis for ≥3 months and receiving anticoagulant therapy. We collected from electronic medical records detailed demographic data (age, sex, place of residence), comorbidities (hypertension, atrial fibrillation, ischaemic heart disease, diabetes, deep-vein thrombosis, stroke, myocardial infarction, pulmonary embolism, cirrhosis), lifestyle factors (smoking and alcohol consumption), vascular access type (arteriovenous fistula or central venous catheter) and laboratory parameters (haemoglobin, haematocrit, creatinine, albumin, total protein, electrolytes, LDL- and HDL-cholesterol, total cholesterol, INR, APTT, D-dimer, BNP, CK-MB, troponin). All laboratory units were standardised and checked for plausibility. Results: Median age was 71 years; 48% were female. The most common comorbidities were: hypertension (100%), atrial fibrillation (100%) and ischaemic heart disease (62–81%). Patients exhibited severe anaemia (mean Hb ~9.7 g/dL), nephrotic-range proteinuria, hypoalbuminaemia, and impaired coagulation profiles (INR ~1.8–1.9; prolonged APTT in men). Female patients had higher platelet counts and D-dimer levels, suggesting a stronger prothrombotic profile, while males showed longer APTT. Cardiovascular strain was reflected by elevated BNP in men and also troponin/CK-MB. Correlations included smoking with leukocytosis, alcohol with increased urine density, diabetes with higher urea and lower protein, and subtherapeutic INR in cerebrovascular disease. Conclusions: Patients with ESRD on haemodialysis and anticoagulant therapy display a complex interplay of cardiovascular comorbidities, anemia, overlapping thrombotic and bleeding risks, with sex-specific differences. Therefore, systematic monitoring of proteinuria, haemoglobin, D-dimer, and coagulation markers is crucial to balance thrombotic and bleeding risks. Objective: To characterise the clinical and paraclinical profile and comorbidity–laboratory correlations of ESRD patients undergoing haemodialysis and anticoagulant therapy. Full article

Background: This novel study addresses the question of whether schizophrenia is associated with an increased risk of cardiovascular diseases (CVDs) by controlling for metabolic syndrome-related conditions through propensity score matching, using real-world primary care data from Germany. Methods: This retrospective cohort study analyzed 12,527 patients aged 18 or older with schizophrenia from 1209 general practices (GPs) in Germany between 2005 and 2023 from the IQVIA Disease Analyzer database. Patients were matched 1:5 with individuals without schizophrenia based on sex, age, index year, consultation frequency, and chronic conditions. CVDs cumulative incidence was assessed using Kaplan–Meier curves and hazard ratios (HRs) were calculated using univariable Cox regression analysis. Results: Over a 10-year follow-up, schizophrenia was associated with a higher risk of heart failure (HR: 1.33, 95% CI: 1.20–1.48) and a lower risk of atrial fibrillation and flutter (HR: 0.77, 95% CI: 0.67–0.89). No significant associations were observed for acute myocardial infarction (HR: 0.97, 95% CI: 0.76–1.25), angina pectoris (HR: 0.78, 95% CI: 0.63–0.96), or chronic ischaemic heart disease (HR: 0.91, 95% CI: 0.82–1.02). Stratified analyses showed that schizophrenia was most strongly associated with heart failure in women aged 41–50 years (HR: 3.34, 95% CI: 2.11–5.31), followed by women aged 61–70 years (HR: 1.88, 95% CI: 1.45–2.44) and men aged 51–60 years (HR: 1.81, 95% CI: 1.34–2.45). Conclusions: This study highlights significant differences in the 10-year cumulative incidence of CVDs between individuals with and without schizophrenia. While patients with schizophrenia appear less likely to be diagnosed with milder or asymptomatic CVDs, they are at increased risk for severe outcomes. The study’s findings underscore the need for sex-specific and symptom-sensitive public health strategies to improve early detection and prevention of CVDs in patients with schizophrenia. Full article