The Global Burden of Cardiovascular Disease in Women

Purpose of review

Cardiovascular disease (CVD) is the leading cause of mortality worldwide, accounting for one third of all deaths in 2015. Alarmingly, there has been slowing of the decline in age-standardized CVD mortality over the last 5 years compared to the previous 25 years.

Recent findings

Given the increasing global CVD burden, in 2011, the United Nations declared the goal to reduce premature mortality from the four main non-communicable diseases by 25% from 2010 to 2025, abbreviated as the 25?×?25 goal. The United Nations has further created nine targets to achieve the 25?×?25 goal. These targets emphasize risk factor modification and strengthening of healthcare delivery systems.

Summary

Achieving the nine targets and 25?×?25 goal set by the United Nations will undoubtedly benefit the world as a whole. However, women face additional, unacceptable, disproportionate CVD risk factors that need to be addressed, including psychological stressors contributing to ischemic heart disease, pregnancy-related CVD, environmental and infectious exposures in low socioeconomic settings, and limited healthcare access and delivery. This paper highlights global CVD gender disparities in order to stimulate awareness and discussion of potential interventions to address the rapidly growing burden of heart disease in women.

     

The Combined Burden of Diabetes and Cardiovascular Disease in Indigenous Australians

Type 2 diabetes mellitus (T2DM), cardiovascular disease, and chronic kidney disease are significant contributors to the 17-year disparity in life expectancy between Indigenous and non-Indigenous Australians. These three conditions are prevalent from a young age in Indigenous Australians and clearly contribute to their premature mortality. Risk factors that both exacerbate and promote these conditions include central obesity, dyslipidemia, cigarette smoking, albuminuria, inflammation, and poor socio-economic status. Although rates of screening for T2DM are higher in Indigenous Australians than in non-Indigenous Australians, gaps in clinical management of both T2DM and cardiovascular disease exist. To enhance survival and quality of life, prevention strategies are required at a population level and from a young age in Indigenous Australians.     

Addressing the Global Burden of Cardiovascular Diseases; Need for Scalable and Sustainable Frameworks

Only 14 countries are on track to attain the Sustainable Development Goal (SDG) target of reducing premature mortality from Noncommunicable Diseases (NCDs) by one-third by 2030. This target cannot be reached without reducing the burden of cardiovascular diseases (CVDs) which is the major contributor to premature mortality from NCDs. Sustainable and scalable national responses to address both CVDs and their risk factors are urgently needed. Although smoking rates have decreased globally, consumption of alcohol and physical inactivity are on the rise. No country is on course to achieve the target to halt the rise in obesity or to reduce salt intake: targets critical for reducing the diabetes related cardiovascular burden and for hypertension control. Although very cost-effective scalable interventions are available, they are underutilized. Unless pathways selected to tackle CVDs prioritize prevention, primary health care and universal health coverage, countries will fall further behind in the attainment of the SDG target.     

溶血磷脂酸与心血管系统

溶血磷脂酸是一种具有细胞间信号传导作用的脂类小分子物质,通过G蛋白偶联受体介导多种生物学功能,在心血管系统中具有重要作用。本文主要对LPA的合成释放与运输、G蛋白偶联受体及LPA在心血管系统的病理生理作用进行综述。     

Cardiovascular Disease in Developing Countries: Myths, Realities, and Opportunities

Summary. The burden of cardiovascular disease (CVD), especially ischemic heart disease and stroke, varies remarkably between regions of the world, with declining rates in Europe, North America, and Australia/New Zealand, burgeoning epidemics in the former socialist economies and India, and relatively lower impact in developing regions such as sub-Saharan Africa. The basis for a prediction of a global CVD epidemic lies in the epidemiologic transition, in which control of infectious, parasitic, and nutritional diseases allows most of the population to reach the ages in which CVD manifests itself. In fact, CVD is already the leading cause of death not only in developed countries but, as of the mid-1990s, in developing countries as well. A variety of myths have attempted to minimize the rationale for CVD control in developing countries. In reality, CVD affects men, not only the elderly, and the rich, but rather a broad spectrum of the population. Moreover, as a cause of disability it will be a world leader by 2020. Finally, there is evidence that the epidemic can be curtailed. Projections to the year 2020 predict an expansion of the CVD epidemic to the developing world, with CVD exceeding infectious and parasitic diseases in all regions except sub-Saharan Africa. These estimates, in fact, may be conservative, because several factors may allow multiplication of risk. In utero or early childhood deprivation, the use of disposable income for deleterious health behaviors (such as tobacco and a high fat/cholesterol diet), interactions between multiple coexisting risk factors, and the interaction between newly acquired health behaviors and genes may all inflate the risk to levels above those predicted. Efforts to control CVD should invest strategically in research to understand the prevalence of, and risks associated with, CVD risk factors, as well as in studies of new risk factors, measures to prevent or modify risk, and clinical trials to demonstrate the efficacy of these interventions. In lieu of this improved research base, a number of initiatives should go forward to prevent the dissemination of risk factors, to treat risk factors appropriately in high-risk subjects, and to develop case-management strategies shown to be both efficacious and cost effective. A global epidemic of CVD in developing countries may be inevitable unless there is a better understanding of its origins, a prediction of its magnitude, and the organization of preventive and case-management strategies early enough to control it.     

The Global Burden of Cardiovascular Disease: The Role of Endothelial Function and Arterial Elasticity in Cardiovascular Disease as Novel and Emerging Biomarkers

Some consider the measurements of arterial elasticity and flow-mediated dilation to be an indirect “biomarker” of endothelial dysfunction. As such, we describe the various uses of these techniques in the evaluation of the natural history of vascular disease. These measures are potential markers of disease, as abnormalities reflect changes in the integrity of vascular structure but occur prior to the manifestation of symptomatic cardiovascular events. In this review, the natural history of arterial elasticity is discussed, and the effects of aging and inflammation are reviewed. The role that arterial elasticity and flow-mediated dilation have in predicting future cardiovascular disease, and the effects of pharmacologic agents on these measures, is also reviewed.     

Cooperative Cardiovascular Disease Research Network (RECAVA)

Today, cardiovascular disease is the principal cause of death and hospitalization in Spain, and accounts for an annual healthcare budget of more than 4000 million euros. Consequently, early diagnosis, effective prevention, and the optimum treatment of cardiovascular disease present a significant social and healthcare challenge for the country. In this context, combining all available resources to increase the efficacy and healthcare benefits of scientific research is a priority. This rationale prompted the establishment of the Spanish Cooperative Cardiovascular Disease Research Network, or RECAVA (Red Temática de Investigación Cooperativa en Enfermedades Cardiovasculares), 5 years ago. Since its foundation, RECAVA's activities have focused on achieving four objectives: a) to facilitate contacts between basic, clinical and epidemiological researchers; b) to promote the shared use of advanced technological facilities; c) to apply research results to clinical practice, and d) to train a new generation of translational cardiovascular researchers in Spain. At present, RECAVA consists of 41 research groups and seven shared technological facilities. RECAVA's research strategy is based on a scientific design matrix centered on the most important cardiovascular processes. The level of RECAVA's research activity is reflected in the fact that 28 co-authored articles were published in international journals during the first six months of 2007, with each involving contributions from at least two groups in the network. Finally, RECAVA also participates in the work of the Spanish National Center for Cardiovascular Research, or CNIC (Centro Nacional de Investigación Cardiovascular), and some established Biomedical Research Network Centers, or CIBER (Centros de Investigación Biomédica en RED), with the aim of consolidating the development of a dynamic multidisciplinary research framework that is capable of meeting the growing challenge that cardiovascular disease will present in the future.     

Resource Needs for Addressing Noncommunicable Disease in Low- and Middle-Income Countries: Current and Future Developments

Low and middle income countries are faced with a range of challenges related to providing efficient and affordable health care. With non-communicable diseases (NCD) on the rise, there is a growing need to be able to estimate resource requirements, costs and expected impact associated with various investment strategies related to prevention and control of NCD. In this article, recently developed costing and health impact models for non-communicable disease are reviewed, with a view to drawing out their main findings as well as methodological limitations. A key shortcoming is that earlier modelling efforts have taken a vertical approach to costing, when in reality a more integrated, horizontal approach is needed in order to effectively plan for scaled-up investment and system development. We subsequently describe how the integration of an NCD module into the joint United Nations OneHealth tool will enable low- and middle-income countries to bring NCD into an integrated process for national strategic health planning.     

Management of Cardiovascular Disease During Coronavirus Disease (COVID-19) Pandemic

Patients with pre-existing cardiovascular disease and risk factors are more likely to experience adverse outcomes associated with the novel coronavirus disease-2019 (COVID-19). Additionally, consistent reports of cardiac injury and de novo cardiac complications, including possible myocarditis, arrhythmia, and heart failure in patients without prior cardiovascular disease or significant risk factors, are emerging, possibly due to an accentuated host immune response and cytokine release syndrome. As the spread of the virus increases exponentially, many patients will require medical care either for COVID-19 related or traditional cardiovascular issues. While the COVID-19 pandemic is dominating the attention of the healthcare system, there is an unmet need for a standardized approach to deal with COVID-19 associated and other traditional cardiovascular issues during this period. We provide consensus guidance for the management of various cardiovascular conditions during the ongoing COVID-19 pandemic with the goal of providing the best care to all patients and minimizing the risk of exposure to frontline healthcare workers.     

Fibrotic Burden Determines Cardiovascular Risk among Subjects with Metabolic Dysfunction-Associated Fatty Liver Disease

Background/AimsMetabolic dysfunction associated fatty liver disease (MAFLD) has recently been introduced to compensate for the conventional concept of nonalcoholic fatty liver disease (NAFLD). We explored whether fibrotic burden determines the risk of atherosclerotic cardiovascular disease (ASCVD) among subjects with MAFLD.MethodsWe recruited 9,444 participants from the Korea National Health and Nutrition Examination Survey (2008 to 2011). Liver fibrosis was identified using the fibrosis-4 (FIB-4) index and NAFLD fibrosis score. The 10-year ASCVD risk score (>10%) was used to determine a high probability ASCVD risk. For sensitivity analysis, propensity score matching was assessed to subjects with aged 40 to 75 years free from ASCVD.ResultsThe prevalence of MAFLD was 38.0% (n=3,592). The ASCVD risk scores stratified in quartile were positively correlated to MAFLD and FIB-4 defined-significant liver fibrosis (p for trend <0.001). Individuals with both MAFLD and FIB-4 defined-significant liver fibrosis had a greater chance of high probability ASCVD risk (odds ratio [OR]=2.40; p<0.001) than those without MAFLD. The impact of MAFLD on high probability ASCVD risk was greater than that of significant liver fibrosis (OR=4.72 for MAFLD vs OR=1.88 for FIB-4 defined-significant liver fibrosis; all p<0.001). Among participants with MAFLD, low muscle mass enhanced the risk of significant liver fibrosis (OR=1.56 to 2.43; p<0.001). When NAFLD fibrosis score was applied to define significant liver fibrosis, similar findings were observed.ConclusionsIndividuals with MAFLD had a substantial ASCVD risk compared to those without MAFLD. Accompanying significant liver fibrosis further enhanced the risk of ASCVD among subjects with MAFLD.