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Indian Journal of Dermatology,... May 2024
PubMed: 38841948
DOI: 10.25259/IJDVL_980_2023 -
Circulation Jun 2024Quantifying the economic burden of cardiovascular disease and stroke over the coming decades may inform policy, health system, and community-level interventions for... (Review)
Review
BACKGROUND
Quantifying the economic burden of cardiovascular disease and stroke over the coming decades may inform policy, health system, and community-level interventions for prevention and treatment.
METHODS
We used nationally representative health, economic, and demographic data to project health care costs attributable to key cardiovascular risk factors (hypertension, diabetes, hypercholesterolemia) and conditions (coronary heart disease, stroke, heart failure, atrial fibrillation) through 2050. The human capital approach was used to estimate productivity losses from morbidity and premature mortality due to cardiovascular conditions.
RESULTS
One in 3 US adults received care for a cardiovascular risk factor or condition in 2020. Annual inflation-adjusted (2022 US dollars) health care costs of cardiovascular risk factors are projected to triple between 2020 and 2050, from $400 billion to $1344 billion. For cardiovascular conditions, annual health care costs are projected to almost quadruple, from $393 billion to $1490 billion, and productivity losses are projected to increase by 54%, from $234 billion to $361 billion. Stroke is projected to account for the largest absolute increase in costs. Large relative increases among the Asian American population (497%) and Hispanic American population (489%) reflect the projected increases in the size of these populations.
CONCLUSIONS
The economic burden of cardiovascular risk factors and overt cardiovascular disease in the United States is projected to increase substantially in the coming decades. Development and deployment of cost-effective programs and policies to promote cardiovascular health are urgently needed to rein in costs and to equitably enhance population health.
PubMed: 38832515
DOI: 10.1161/CIR.0000000000001258 -
Circulation Jun 2024Cardiovascular disease and stroke are common and costly, and their prevalence is rising. Forecasts on the prevalence of risk factors and clinical events are crucial. (Review)
Review
Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050-Prevalence of Risk Factors and Disease: A Presidential Advisory From the American Heart Association.
BACKGROUND
Cardiovascular disease and stroke are common and costly, and their prevalence is rising. Forecasts on the prevalence of risk factors and clinical events are crucial.
METHODS
Using the 2015 to March 2020 National Health and Nutrition Examination Survey and 2015 to 2019 Medical Expenditure Panel Survey, we estimated trends in prevalence for cardiovascular risk factors based on adverse levels of Life's Essential 8 and clinical cardiovascular disease and stroke. We projected through 2050, overall and by age and race and ethnicity, accounting for changes in disease prevalence and demographics.
RESULTS
We estimate that among adults, prevalence of hypertension will increase from 51.2% in 2020 to 61.0% in 2050. Diabetes (16.3% to 26.8%) and obesity (43.1% to 60.6%) will increase, whereas hypercholesterolemia will decline (45.8% to 24.0%). The prevalences of poor diet, inadequate physical activity, and smoking are estimated to improve over time, whereas inadequate sleep will worsen. Prevalences of coronary disease (7.8% to 9.2%), heart failure (2.7% to 3.8%), stroke (3.9% to 6.4%), atrial fibrillation (1.7% to 2.4%), and total cardiovascular disease (11.3% to 15.0%) will rise. Clinical CVD will affect 45 million adults, and CVD including hypertension will affect more than 184 million adults by 2050 (>61%). Similar trends are projected in children. Most adverse trends are projected to be worse among people identifying as American Indian/Alaska Native or multiracial, Black, or Hispanic.
CONCLUSIONS
The prevalence of many cardiovascular risk factors and most established diseases will increase over the next 30 years. Clinical and public health interventions are needed to effectively manage, stem, and even reverse these adverse trends.
PubMed: 38832505
DOI: 10.1161/CIR.0000000000001256 -
BMC Musculoskeletal Disorders Jun 2024Current evidence suggests that metabolic dysregulation is inextricably linked to both hypertension and osteoporosis, but the correlation between hypertension and...
BACKGROUND
Current evidence suggests that metabolic dysregulation is inextricably linked to both hypertension and osteoporosis, but the correlation between hypertension and osteoporosis is still unclear. Therefore, in this study, we explored the correlation between hypertension and osteoporosis.
METHODS
A total of 37,807 participants from the National Health and Nutrition Examination Survey (1999-2010, 2013-2014, 2017-2018) were enrolled in this population-based cross-sectional study. Hypertension was considered an exposure factor and osteoporosis was considered an outcome factor. Logistic regression and subgroup analysis were used to assess the association between hypertension and osteoporosis.
RESULTS
A total of 2,523 participants, with a mean age of 68.65 ± 12.21 years, suffered from osteoporosis, and 86.2% were female. Participants with osteoporosis had a greater prevalence of hypertension than participants without osteoporosis (p < 0.001). Participants with hypertension also had a greater prevalence of osteoporosis than participants without hypertension (p < 0.001). Univariate logistic regression analysis indicated that hypertension was associated with osteoporosis (OR: 2.693, 95% CI: 2.480-2.924, p < 0.001). Multivariate logistic regression analysis with a fully adjusted model indicated that hypertension was strongly associated with osteoporosis (OR: 1.183, 95% CI: 1.055-1.327, p = 0.004). Subgroup analysis revealed that the associations between hypertension and osteoporosis were significant in the younger than 60 years, male sex, diabetes subgroup and hypercholesterolemia subgroup (p < 0.05).
CONCLUSION
Hypertension was independently associated with osteoporosis in the general population.
Topics: Humans; Female; Cross-Sectional Studies; Male; Hypertension; Osteoporosis; Aged; Middle Aged; Prevalence; Nutrition Surveys; Risk Factors; Aged, 80 and over
PubMed: 38831414
DOI: 10.1186/s12891-024-07553-4 -
American Journal of Preventive... Jun 2024Assess the yield of genetic testing for pathogenic variants in and in individuals with personal and family histories suggestive of familial hypercholesterolemia.
OBJECTIVE
Assess the yield of genetic testing for pathogenic variants in and in individuals with personal and family histories suggestive of familial hypercholesterolemia.
METHODS
Retrospective review of patients seen in the Advanced Lipid Disorders Clinic at Johns Hopkins.
RESULTS
In the lipid clinic at a single center during the years 2015-2023, 607 patients underwent genetic testing for familial hypercholesterolemia, of which 263 underwent the expanded genetic testing for sitosterolemia. Eighty-eight patients had genetic testing which included and 22 patients had testing which included Among these, one patient was identified to have a pathogenic variant in and another patient with a pathogenic variant in (0.7 % yield). The frequency of a positive result was double that of a variant of uncertain significance.
CONCLUSION
These data suggest in rare cases expanded testing can provide answers for patients and families with a minimal likelihood of a variant of uncertain significance.
PubMed: 38828125
DOI: 10.1016/j.ajpc.2024.100683 -
Clinical Epidemiology 2024The study aimed to analyze the associations between estimated pulse wave velocity (ePWV) and 5-year mortality in atherosclerotic cardiovascular disease (ASCVD) patients...
Associations Between Estimated Pulse Wave Velocity and Five-Year All-Cause Mortality in Patients with Atherosclerotic Cardiovascular Disease with and without Standard Modifiable Risk Factors: Evidence From NHANES 1999-2016.
AIM
The study aimed to analyze the associations between estimated pulse wave velocity (ePWV) and 5-year mortality in atherosclerotic cardiovascular disease (ASCVD) patients with and without standard modifiable risk factors (SMuRFs), which included smoking status, hypertension, diabetes, and hypercholesterolemia.
METHODS
The present retrospective cohort study utilized data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016. Patients with ASCVD who completed both the questionnaire survey and serum testing were included. Patients were categorized into the ≥1 SMuRF group if they had at least one SMuRF, while those without any SMuRFs were classified into the SMuRF-less group. The ePWV, which was calculated using the age and mean blood pressure, was evenly divided into three categories: low (Q1), medium (Q2), and high (Q3). Multivariable weighted Cox proportional-hazard regression analyses were utilized to explore the risk factors associated with 5-year mortality in patients with and without SMuRFs. And restricted cubic spline curve (RCS) was used to assess their nonlinear correlation.
RESULTS
A total of 1901 patients with ASCVD were included in the study. For the patients in ≥1 SMuRF group, the Q3 group included patients who were older, with a higher proportion of males, more comorbidities, and a lower body mass index than the Q1 group (P<0.05). The Cox proportional-hazard regression model results revealed, the Q3 group had a higher risk of 5-year mortality than the Q1 group [hazard ratio (HR) 4.30, 95% confidence interval (CI) (2.66, 6.95), P<0.001]. RCS demonstrated a linear trend between high level of ePWV and decreased risks of mortality. Similar results were observed in the SMuRF-less group [HR 10.62, 95% CI (1.22, 92.06), P=0.032].
CONCLUSION
A high level of ePWV signified a higher risk of 5-year mortality in ASCVD patients with and without SMuRFs.
PubMed: 38827433
DOI: 10.2147/CLEP.S457054 -
Journal of Lipid and Atherosclerosis May 2024The development of advanced technologies in artificial intelligence (AI) has expanded its applications across various fields. Machine learning (ML), a subcategory of AI,... (Review)
Review
The development of advanced technologies in artificial intelligence (AI) has expanded its applications across various fields. Machine learning (ML), a subcategory of AI, enables computers to recognize patterns within extensive datasets. Furthermore, deep learning, a specialized form of ML, processes inputs through neural network architectures inspired by biological processes. The field of clinical lipidology has experienced significant growth over the past few years, and recently, it has begun to intersect with AI. Consequently, the purpose of this narrative review is to examine the applications of AI in clinical lipidology. This review evaluates various publications concerning the diagnosis of familial hypercholesterolemia, estimation of low-density lipoprotein cholesterol (LDL-C) levels, prediction of lipid goal attainment, challenges associated with statin use, and the influence of cardiometabolic and dietary factors on the discordance between apolipoprotein B and LDL-C. Given the concerns surrounding AI techniques, such as ethical dilemmas, opacity, limited reproducibility, and methodological constraints, it is prudent to establish a framework that enables the medical community to accurately interpret and utilize these emerging technological tools.
PubMed: 38826186
DOI: 10.12997/jla.2024.13.2.111 -
Social Science & Medicine (1982) May 2024Divorce is often considered a major and stressful life transition. Given that divorcees are overrepresented in primary care and there is a association between... (Review)
Review
Divorce is often considered a major and stressful life transition. Given that divorcees are overrepresented in primary care and there is a association between individuals' physical health and psychological adjustment, potential post-divorce health problems are of concern. Yet, empirical evidence is lacking on the magnitude of the overall physical health risk after divorce, on possible differences across specific pathologies, and on factors that may increase or reduce this risk. The current meta-analysis addresses these issues. We identified 94 studies including u = 248 relevant effect sizes, based on N = 1,384,507 participants. Generally, compared to married individuals, divorcees showed significantly worse self-reported health (OR = 1.20, [1.08-1.33]), experienced more physical symptoms (OR = 1.34, [1.17-1.53]), and had a higher risk for diabetes (OR = 1.18 [1.05-1.33]), joint pathologies (OR = 1.24, [1.14-1.34]), cardiovascular (OR = 1.24, [1.09-1.41]) and cerebrovascular conditions (OR = 1.31, [1.14-1.51]), and sexually transmitted diseases (OR = 2.48, [1.32-4.64]). However, they had no increased risk of hypertension, hypercholesterolemia, cancer and cancer development, disabilities or limitations, or cognitive pathologies. Nor did divorcees significantly differ from married individuals when aggregating all pathologies to measure overall physical health problems (OR = 1.14, [0.85 to 1.54]). Yet, moderation analyses revealed that being female, unemployed, childless, or having a lower education constitutes a higher risk for overall physical health problems after divorce. The same applied to having a heavy alcohol consumption, lack of exercise, and being overweight. Our meta-analysis shows that divorcees are at heightened risk of certain pathologies, with sexually transmitted diseases as a particular post-divorce hazard. These findings call for more awareness among counsellors and physicians on divorcees' health conditions and the characteristics that make divorcees even more vulnerable to health problems.
PubMed: 38824838
DOI: 10.1016/j.socscimed.2024.117005 -
Cancer Medicine Jun 2024Obesity and hypercholesterolemia are linked to unfavor clinical outcomes. Recent studies declared the paradox that high body mass index (BMI) and serum cholesterol were...
Effect of body mass index and cholesterol-rich apolipoprotein-B-containing lipoproteins on clinical outcome in NSCLC patients treated with immune checkpoint inhibitors-based therapy: A retrospective analysis.
OBJECTIVES
Obesity and hypercholesterolemia are linked to unfavor clinical outcomes. Recent studies declared the paradox that high body mass index (BMI) and serum cholesterol were independently connected to better clinical outcome of immune checkpoint inhibitors (ICIs) monotherapy in non-small cell lung cancer (NSCLC). The aim of the study is to investigate the prognosis of BMI and serum cholesterol in ICIs-based therapy.
METHODS
This is a retrospective study of 95 NSCLC patients treated with ICIs-based therapy at the Department of Oncology and Lung Cancer Center of China-Japan Friendship Hospital. Treatment efficacy was assessed using durable clinical benefit (DCB) versus nondurable benefit (NDB), best response (active vs. nonactive), and progression-free survival (PFS). The prognostic value of BMI, LDL-C, and RC was determined by multivariate regression analyses, while controlling for confounding factors including age, gender, diabetes status, smoking history, and statin usage. BMI was considered a confounding factor in the analysis when examining the impact of lipoproteins.
RESULTS
In our study, we found that in the whole group, BMI ≥25 kg/m was linked to a higher risk of poor therapeutic response (OR = 5.92, 95% CI 1.99-19.51, p.val = 0.002) and shorter progression-free survival (HR = 3.00, 95% CI 1.59-5.68, p.val = 0.001). In addition, low levels of RC were associated with better therapeutic response (OR = 0.12, 95% CI 0.02-0.64, p.val = 0.019), while low levels of serum LDL-C were found to predict longer PFS (HR = 0.40, 95% CI 0.19-0.82, p.val = 0.012). These associations were consistent in advanced NSCLC patients receiving ICIs and chemotherapy.
CONCLUSIONS
Our study suggest that BMI ≥25 kg/m and elevated levels of apoB-containing lipoproteins, including LDL-C and RC, could potentially serve as useful prognostic markers for predicting poor treatment outcomes in advanced NSCLC patients treated with the combination of chemotherapy and ICIs.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Male; Female; Retrospective Studies; Body Mass Index; Lung Neoplasms; Immune Checkpoint Inhibitors; Middle Aged; Aged; Prognosis; Treatment Outcome; Progression-Free Survival; Cholesterol; Adult; Aged, 80 and over; Obesity
PubMed: 38819098
DOI: 10.1002/cam4.7241 -
Journal of the American Heart... Jun 2024A phase 3 trial was conducted to evaluate the efficacy and safety of ongericimab, a monoclonal antibody that inhibits proprotein convertase subtilisin/kexin type 9, as... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
A phase 3 trial was conducted to evaluate the efficacy and safety of ongericimab, a monoclonal antibody that inhibits proprotein convertase subtilisin/kexin type 9, as an add-on treatment to optimized lipid-lowering therapy in Chinese patients with primary hypercholesterolemia and mixed dyslipidemia.
METHODS AND RESULTS
A total of 806 patients who were receiving stable and optimized lipid-lowering therapy but did not achieve their low-density lipoprotein cholesterol (LDL-C) targets were enrolled and randomly assigned in a 2:1:2:1 ratio to receive either ongericimab 150 mg or matching placebo every 2 weeks, or ongericimab 300 mg or matching placebo every 4 weeks for 52 weeks. Efficacy and safety were evaluated in 802 patients who received at least 1 dose of ongericimab or placebo. The primary end point was the percentage change in LDL-C from baseline to week 24. Our findings demonstrated that the least-squares mean difference of percentage change in LDL-C from baseline to week 24 was -67.7% (95% CI, -72.5% to -63.0%; <0.0001) in the ongericimab 150 mg every 2 weeks group compared with the placebo every 2 weeks group, and -61.2% (95% CI, -67.1% to -55.2%; <0.0001) in the ongericimab 300 mg every 4 weeks group compared with the placebo every 4 weeks group. These reductions were sustained up to week 52. Furthermore, treatment with ongericimab favorably altered other lipid parameters. A similar incidence of adverse events was observed in the ongericimab and placebo groups.
CONCLUSIONS
Ongericimab, as an add-on treatment to optimized lipid-lowering therapy, significantly reduced LDL-C and was well-tolerated in Chinese patients with primary hyperlipidemia and mixed dyslipidemia who did not achieve their LDL-C targets.
REGISTRATION
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04781114.
Topics: Humans; Male; Female; Middle Aged; Hypercholesterolemia; Cholesterol, LDL; China; Dyslipidemias; Treatment Outcome; Antibodies, Monoclonal, Humanized; Aged; Double-Blind Method; PCSK9 Inhibitors; Adult; Asian People; Proprotein Convertase 9; Biomarkers; Time Factors; Drug Therapy, Combination; Anticholesteremic Agents; Antibodies, Monoclonal; East Asian People
PubMed: 38818934
DOI: 10.1161/JAHA.123.033669