Browsing by Subject "Cardiovascular disease"

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    Cardiovascular magnetic resonance in women with cardiovascular disease: position statement from the Society for Cardiovascular Magnetic Resonance (SCMR)
    (2021-05-10) Ordovas, Karen G; Baldassarre, Lauren A; Bucciarelli-Ducci, Chiara; Carr, James; Fernandes, Juliano L; Ferreira, Vanessa M; Frank, Luba; Mavrogeni, Sophie; Ntusi, Ntobeko; Ostenfeld, Ellen; Parwani, Purvi; Pepe, Alessia; Raman, Subha V; Sakuma, Hajime; Schulz-Menger, Jeanette; Sierra-Galan, Lilia M; Valente, Anne M; Srichai, Monvadi B
    Abstract This document is a position statement from the Society for Cardiovascular Magnetic Resonance (SCMR) on recommendations for clinical utilization of cardiovascular magnetic resonance (CMR) in women with cardiovascular disease. The document was prepared by the SCMR Consensus Group on CMR Imaging for Female Patients with Cardiovascular Disease and endorsed by the SCMR Publications Committee and SCMR Executive Committee. The goals of this document are to (1) guide the informed selection of cardiovascular imaging methods, (2) inform clinical decision-making, (3) educate stakeholders on the advantages of CMR in specific clinical scenarios, and (4) empower patients with clinical evidence to participate in their clinical care. The statements of clinical utility presented in the current document pertain to the following clinical scenarios: acute coronary syndrome, stable ischemic heart disease, peripartum cardiomyopathy, cancer therapy-related cardiac dysfunction, aortic syndrome and congenital heart disease in pregnancy, bicuspid aortic valve and aortopathies, systemic rheumatic diseases and collagen vascular disorders, and cardiomyopathy-causing mutations. The authors cite published evidence when available and provide expert consensus otherwise. Most of the evidence available pertains to translational studies involving subjects of both sexes. However, the authors have prioritized review of data obtained from female patients, and direct comparison of CMR between women and men. This position statement does not consider CMR accessibility or availability of local expertise, but instead highlights the optimal utilization of CMR in women with known or suspected cardiovascular disease. Finally, the ultimate goal of this position statement is to improve the health of female patients with cardiovascular disease by providing specific recommendations on the use of CMR.
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    Community-driven citizen science approach to explore cardiovascular disease risk perception, and develop prevention advocacy strategies in sub-Saharan Africa: a programme protocol
    (2021-02-26) Okop, Kufre J; Murphy, Kathy; Lambert, Estelle V; Kedir, Kiya; Getachew, Hailemichael; Howe, Rawleigh; Niyibizi, Jean B; Ntawuyirushintege, Selemani; Bavuma, Charlotte; Rulisa, Stephen; Kasenda, Stephen; Chipeta, Effie; Bunn, Christopher; Crampin, Amelia C; Chapotera, Gertrude; King, Abby C; Banchoff, Ann; Winter, Sandra J; Levitt, Naomi S
    Background In sub-Saharan Africa (SSA), which experiences a disproportionately high cardiovascular disease (CVD) burden, population-based screening and prevention measures are hampered by low levels of knowledge about CVD and associated risk factors, and inaccurate perceptions of severity of risk. Methods This protocol describes the planned processes for implementing community-driven participatory research, using a citizen science method to explore CVD risk perceptions and to develop community-specific advocacy and prevention strategies in the rural and urban SSA settings. Multi-disciplinary research teams in four selected African countries will engage with and train community members living in rural and urban communities as citizen scientists to facilitate conceptualization, co-designing of research, data gathering, and co-creation of knowledge that can lead to a shared agenda to support collaborative participation in community-engaged science. The emphasis is on robust community engagement, using mobile technology to support data gathering, participatory learning, and co-creation of knowledge and disease prevention advocacy. Discussion Contextual processes applied and lessons learned in specific settings will support redefining or disassembling boundaries in participatory science to foster effective implementation of sustainable prevention intervention programmes in Low- and Middle-income countries.
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    The converging burdens of infectious and non-communicable diseases in rural-to-urban migrant Sub-Saharan African populations: a focus on HIV/AIDS, tuberculosis and cardio-metabolic diseases
    (Biomed Central Ltd, 2015) Peer, Nasheeta
    Africa has the unenviable challenge of dealing with a double burden of disease: infectious diseases (IDs) such as HIV/AIDS and tuberculosis are high while non-communicable diseases (NCDs) are rapidly rising in the region. Populations with increased susceptibility to both include migrants. This review highlights the susceptibility of rural-to-urban migrants in Sub-Saharan Africa to the IDs of HIV/AIDS and tuberculosis, and to NCDs, particularly cardiovascular diseases. The disruption that occurs with migration is often accompanied by unhealthy exposures and environments. These include partaking in risky sexual practices and a subsequent greater risk for HIV infection in migrants than the general populations which contributes to the spread of the disease. Migrants frequently work and live in conditions that are poorly ventilated and overcrowded with suboptimal sanitation which increases their risk for tuberculosis. Considering that migrants have an increased risk of acquiring both HIV/AIDS and tuberculosis, and in view of the interaction between these diseases, they are likely to be at high risk for co-infection. They are also likely to facilitate the geographical spread of these infections and serve as conduits of disease dissemination to rural areas. Changes in lifestyle behaviours that accompany migration and urbanisation are exemplified primarily by shifts in physical activity and dietary patterns which promote the development of obesity, diabetes, hypertension and cardiovascular diseases. Urban living and employment is generally less physically exerting than rural routines; when migrants relocate from their rural residence they adapt to their new environment by significantly reducing their physical activity levels. Also, nutritional patterns among migrants in urban centres change rapidly with a shift to diets higher in fat, sugar and salt. Consequently, increases in weight, blood pressure and glucose levels have been reported within a year of migration. Interactions between IDs and NCDs are common; considering that migrants have an increased susceptibility to IDs and demonstrate a rapid rise in their risk for NCDs, the concurrent prevalence of both is likely in this population. There is a need for a combined strategy to combat IDs and NCDs with screening and treatment programmes geared towards this high risk group.
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    Delivery of health care for cardiovascular and metabolic diseases among people living with HIV/AIDS in African countries: a systematic review protocol
    (BioMed Central, 2016) Watkins, David A; Tulloch, Nathaniel L; Anderson, Molly E; Barnhart, Scott; Steyn, Krisela; Levitt, Naomi S
    Background: People living with HIV (PLHIV) in African countries are living longer due to the rollout of antiretroviral drug therapy programs, but they are at increasing risk of non-communicable diseases (NCDs). However, there remain many gaps in detecting and treating NCDs in African health systems, and little is known about how NCDs are being managed among PLHIV. Developing integrated chronic care models that effectively prevent and treat NCDs among PLHIV requires an understanding of the current patterns of care delivery and the major barriers and facilitators to health care. We present a systematic review protocol to synthesize studies of healthcare delivery for an important subset of NCDs, cardiovascular and metabolic diseases (CMDs), among African PLHIV. Methods/design: We plan to search electronic databases and reference lists of relevant studies published in African settings from January 2003 to the present. Studies will be considered if they address one or both of our major objectives and focus on health care for one or more of six interrelated CMDs (ischemic heart disease, stroke, heart failure, hypertension, diabetes, and hyperlipidemia) in PLHIV. Our first objective will be to estimate proportions of CMD patients along the “cascade of care”—i.e., screened, diagnosed, aware of the diagnosis, initiated on treatment, adherent to treatment, and with controlled disease. Our second objective will be to identify unique barriers and facilitators to health care faced by PLHIV in African countries. For studies deemed eligible for inclusion, we will assess study quality and risk of bias using previously published criteria. We will extract study data using standardized instruments. We will meta-analyze quantitative data at each level of the cascade of care for each CMD (first objective). We will use meta-synthesis techniques to understand and integrate qualitative data on health-related behaviors (second objective). Discussion: CMDs and other NCDs are becoming major health concerns for African PLHIV. The results of our review will inform the development of research into chronic care models that integrate care for HIV/AIDS and CMDs among PLHIV. Our findings will be highly relevant to health policymakers, administrators, and practitioners in African settings.
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    Endovascular cerebral aneurysm treatment : Long-term outcomes
    (2008) Le Feuvre, David; Taylor, Allan
    Endovascular treatment was confirmed by the International Subarachnoid aneurysm Trial1 as the treatment of choice for intracranial “berry” aneurysms. The durability of coiling and the relevance of stable neck remnants next needed to be addressed. Methods We retrospectively assessed the follow-up angiograms of patients, who presented with subarachnoid haemorrhages or IIIrd nerve palsies and had berry aneurysms treated endovascularly between 2002 and 2003, Patients were phoned to assess their wellbeing and to see whether they were back at work or not. Angiograms were assessed to ascertain percentage of aneurysm coiled at initial procedure and then stability was assessed by percentage change in the residual on later angiograms. Results Over a 1-year period 75 patients were treated endovascularly. 100% occlusion was attainable in 52% at the initial procedure and although the number of patients who attended their 3-month and 1year follow-up angiograms were 40 and 34 respectively there was a trend toward progressive thrombosis to 65% and then 82% respectively. In only 1 of the neck remnants was there growth at the 3-month angiogram. One patient bled having missed his 3-month follow-up angiogram. Although only 40% of the patients were contactable at 4 years there was no re-bleeds amongst them. Conclusion Coiling is durable as shown by our results over a 4 year period and while neck remnants may be observed any growth should be viewed as unstable and treated either endovascularly or surgically if required.
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    Non-optimal apparent temperature and cardiovascular mortality: the association in Puducherry, India between 2011 and 2020
    (2023-02-08) Shrikhande, Shreya S; Pedder, Hugo; Röösli, Martin; Dalvie, Mohammad A; Lakshmanasamy, Ravivarman; Gasparrini, Antonio; Utzinger, Jürg; Cissé, Guéladio
    Background Cardiovascular diseases (CVDs), the leading cause of death worldwide, are sensitive to temperature. In light of the reported climate change trends, it is important to understand the burden of CVDs attributable to temperature, both hot and cold. The association between CVDs and temperature is region-specific, with relatively few studies focusing on low-and middle-income countries. This study investigates this association in Puducherry, a district in southern India lying on the Bay of Bengal, for the first time. Methods Using in-hospital CVD mortality data and climate data from the Indian Meteorological Department, we analyzed the association between apparent temperature (Tapp) and in-hospital CVD mortalities in Puducherry between 2011 and 2020. We used a case-crossover model with a binomial likelihood distribution combined with a distributed lag non-linear model to capture the delayed and non-linear trends over a 21-day lag period to identify the optimal temperature range for Puducherry. The results are expressed as the fraction of CVD mortalities attributable to heat and cold, defined relative to the optimal temperature. We also performed stratified analyses to explore the associations between Tapp and age-and-sex, grouped and considered together, and different types of CVDs. Sensitivity analyses were performed, including using a quasi-Poisson time-series approach. Results We found that the optimal temperature range for Puducherry is between 30°C and 36°C with respect to CVDs. Both cold and hot non-optimal Tapp were associated with an increased risk of overall in-hospital CVD mortalities, resulting in a U-shaped association curve. Cumulatively, up to 17% of the CVD deaths could be attributable to non-optimal temperatures, with a slightly higher burden attributable to heat (9.1%) than cold (8.3%). We also found that males were more vulnerable to colder temperature; females above 60 years were more vulnerable to heat while females below 60 years were affected by both heat and cold. Mortality with cerebrovascular accidents was associated more with heat compared to cold, while ischemic heart diseases did not seem to be affected by temperature. Conclusion Both heat and cold contribute to the burden of CVDs attributable to non-optimal temperatures in the tropical Puducherry. Our study also identified the age-and-sex and CVD type differences in temperature attributable CVD mortalities. Further studies from India could identify regional associations, inform our understanding of the health implications of climate change in India and enhance the development of regional and contextual climate-health action-plans.
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    Pediatric systemic lupus erythematosus patients in South Africa have high prevalence and severity of cardiac and vascular manifestations
    (2019-11-26) Harrison, Michael J; Zühlke, Liesl J; Lewandowski, Laura B; Scott, Christiaan
    Abstract Background Pediatric onset of systemic lupus erythematosus (SLE) is associated with major organ involvement, and African patients tend to develop more aggressive disease than patients of European descent. Although cardiovascular involvement is common in pediatric SLE, there are few published reports on the subject. This study describes the frequency and characteristics of cardiac and vascular manifestations of pediatric SLE in a multi-ethnic South African cohort. Methods Demographic, clinical, and echocardiographic data were collected from pediatric SLE patients at two centers in Cape Town, South Africa. At the time of investigation, this cohort consisted of 93 participants diagnosed with SLE according to international classification criteria prior to the age of 19. Individuals with cardiac and/or vascular involvement were identified by retrospective chart review. Cardiac manifestations were defined as presence of pericardial effusion, myocarditis, cardiomyopathy, cardiac failure, Libman-Sacks endocarditis, myocardial infarction, and arrhythmia. Vascular manifestations included deep vein thrombosis, pulmonary embolism, sinus thrombosis, stroke, critical limb ischemia, cerebral vasculitis and systemic vasculitis. Statistical analysis was performed using R (v3.4.1). Results Cardiac and vascular involvement was present in 47% of the cohort. Previous studies have reported prevalence of 5%—50%. Demographic features of those with cardiac/vascular involvement did not differ from the overall cohort. Echocardiographic data were available for 23 participants. The most common cardiac manifestations were pericardial effusion (n = 24) and cardiac failure (n = 8), while the most common vascular manifestations were cerebral vasculitis (n = 9), stroke (n = 7), and pulmonary embolism (n = 7). Cardiovascular manifestations were frequently severe; one third of pericardial effusion cases required intervention, including three cases of cardiac tamponade. Cardiac and vascular involvement conferred an increased risk of mortality (31.1% versus 10.4%). Conclusions Cardiac and vascular involvement were highly prevalent in this South African cohort. The mortality rate was high, and severe manifestations were frequent. Prospective research is needed to improve knowledge of pediatric SLE in Africa and to improve outcomes for this high-risk population.
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    Perceived cardiovascular disease risk and tailored communication strategies among rural and urban community dwellers in Rwanda: a qualitative study
    (2022-05-09) Niyibizi, Jean B.; Okop, Kufre J.; Nganabashaka, Jean P.; Umwali, Ghislaine; Rulisa, Stephen; Ntawuyirushintege, Seleman; Tumusiime, David; Nyandwi, Alypio; Ntaganda, Evariste; Delobelle, Peter; Levitt, Naomi; Bavuma, Charlotte M
    Background In Rwanda, cardiovascular diseases (CVDs) are the third leading cause of death, and hence constitute an important public health issue. Worldwide, most CVDs are due to lifestyle and preventable risk factors. Prevention interventions are based on risk factors for CVD risk, yet the outcome of such interventions might be limited by the lack of awareness or misconception of CVD risk. This study aimed to explore how rural and urban population groups in Rwanda perceive CVD risk and tailor communication strategies for estimated total cardiovascular risk. Methods An exploratory qualitative study design was applied using focus group discussions to collect data from rural and urban community dwellers. In total, 65 community members took part in this study. Thematic analysis with Atlas ti 7.5.18 was used and the main findings for each theme were reported as a narrative summary. Results Participants thought that CVD risk is due to either financial stress, psychosocial stress, substance abuse, noise pollution, unhealthy diets, diabetes or overworking. Participants did not understand CVD risk presented in a quantitative format, but preferred qualitative formats or colours to represent low, moderate and high CVD risk through in-person communication. Participants preferred to be screened for CVD risk by community health workers using mobile health technology. Conclusion Rural and urban community members in Rwanda are aware of what could potentially put them at CVD risk in their respective local communities. Community health workers are preferred by local communities for CVD risk screening. Quantitative formats to present the total CVD risk appear inappropriate to the Rwandan population and qualitative formats are therefore advisable. Thus, operational research on the use of qualitative formats to communicate CVD risk is recommended to improve decision-making on CVD risk communication in the context of Rwanda.
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    Peripheral arterial disease and intermittent claudication: Efficacy of short term upper body strength training, dynamic exercise training, and advice to exercise at home
    (2009)
    OBJECTIVE: To compare the effect of two training programmes and advice to exercise at home on physiological adaptations in patients with peripheral arterial disease (PAD). DESIGN: 30 patients with a typical history of PAD and intermittent claudication were randomised to either an upper body strength training programme (UBST), a dynamic (walking, cycling, circuit) conventional exercise rehabilitation programme (CER), or advice to 'walk as much as possible at home' (CONT). Before and after intervention groups performed a standard graded treadmill exercise test (GTET) and a 6-minute walk test (SMWT) to determine peak physiological parameters and walking distances. Maximal walking distance (MWD), pain-free walking distance (PFWD), peak oxygen uptake (VO2) , heart rate and perceived pain were measured. RESULTS: MWD on the GTET increased significantly in the CER group compared with the CONT and UBST groups (93.9 +/- 79% v. 7.0 +/- 19.8% v. 7.3 +/- 46%; CER v. UBST v. CONT p = 0.003). Similarly, peak VO2 increased with CER compared with the CONT and UBST groups (28.4 +/- 20 v. -6.2 +/- 15 v. -1.0 +/- 21%; CER v. UBST v. CONT p = 0.004). During the SMWT the CER and UBST groups improved in PFWD compared with the CONT group (37 +/- 47% v. 27 +/- 71% v. -30 +/- 29%; CER v. UBST v. CONT p = 0.03), and perceived pain decreased in the CER group compared with the UBST group (-24 +/- 39% v. 27 +/- 48%; CER v. UBST p = 0.01). CONCLUSION: CER improves physiological parameters and walking distances more than UBST does. CER is effective within 6 weeks. Verbal encouragement to exercise is an ineffective form of management.
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    Population awareness of cardiovascular disease and its risk factors in Buea, Cameroon
    (2017) Aminde, Leopold Ndemnge; Takah, Noah; Ngwasiri, Calypse; Noubiap, Jean Jacques; Tindong, Maxime; Dzudie, Anastase; Veerman, J Lennert
    Abstract Background Adequate awareness of cardiovascular diseases (CVD) and their risk factors may help reduce the population’s exposure to modifiable risk factors and thereby contribute to prevention and control strategies. There is limited data on knowledge among the general population in sub-Saharan Africa regarding CVD and risk factors. We aimed to assess the population awareness (and associated factors) of CVD types and risk factors in Buea, Cameroon. Methods This was a community-based cross-sectional study conducted in 2016 among randomly selected adults (>18 years). Data on socio-demographic characteristics, knowledge about CVD types, their risk factors and warning signs for CVD events (stroke and heart attack) were acquired using a self-administered questionnaire. Logistic regression analysis was used to investigate factors associated with moderate-to-good knowledge. Results Of the 1162 participants (61.7% women, mean age 32 years), 52.5% had overall poor knowledge (mean score 12.1 on total of 25) on CVD with only about a quarter correctly identifying types of CVD. Overall, 36, 63 and 45% were unaware of CVD risk factors, warning signs of heart attack and stroke respectively. In multivariable analysis; high level of education (aOR = 2.26 (1.69–3.02), p < 0.0001), high monthly income (aOR = 1.64 (1.07–2.51), p = 0.023), having a family history of CVD (aOR = 1.59 (1.21–2.09), p = 0.001) and being a former smoker (aOR = 1.11 (1.02–1.95), p = 0.043) were associated with moderate-to-good knowledge. Conclusions There exists a significant gap in population awareness about CVDs in Cameroon and this is similar to previous reports. Cost-effective community health education interventions taking into account socioeconomic status may be beneficial in this setting.
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    Prevalence of rheumatic heart disease in Zambian school children
    (BioMed Central, 2018-07-03) Schwaninger, Sherri; Musuku, John; Engel, Mark E; Musonda, Patrick; Lungu, Joyce C; Machila, Elizabeth; Mtaja, Agnes; Mulendele, Evans; Kavindele, Dorothy; Spector, Jonathan; Tadmor, Brigitta; Gutierrez, Marcelo M; Van Dam, Joris; Colin, Laurence; Long, Aidan; Fishman, Mark C; Mayosi, Bongani M; Zühlke, Liesl J
    Background The large global burden of rheumatic heart disease (RHD) has come to light in recent years following robust epidemiologic studies. As an operational research component of a broad program aimed at primary and secondary prevention of RHD, we sought to determine the current prevalence of RHD in the country’s capital, Lusaka, using a modern imaging-based screening methodology. In addition, we wished to evaluate the practicality of training local radiographers in echocardiography screening methods. Methods Echocardiography was conducted on a random sample of students in 15 schools utilizing a previously validated, abbreviated screening protocol. Through a task-shifting scheme, and in the spirit of capacity-building to enhance local diagnostic and research skills, general radiographers based at Lusaka University Teaching Hospital (UTH) were newly trained to use portable echocardiography devices. Students deemed as screen-positive were referred for comprehensive echocardiography and clinical examination at UTH. Cardiac abnormalities were classified according to standard World Heart Federation criteria. Results Of 1102 students that were consented and screened, 53 students were referred for confirmatory echocardiography. Three students had definite RHD, 10 had borderline RHD, 29 were normal, and 11 students were lost to follow-up. The rates of definite, borderline, and total RHD were 2.7 per 1000, 9.1 per 1000, and 11.8 per 1000, respectively. Anterior mitral valve leaflet thickening and chordal thickening were the most common morphological defects. The pairwise kappa test showed fair agreement between the local radiographers and an echocardiographer quality assurance specialist. Conclusion The prevalence of asymptomatic RHD in urban communities in Zambia is within the range of results reported in other sub-Saharan African countries using the WHF criteria. Task-shifting local radiographers to conduct echocardiography was feasible. The results of this study will be used to inform ongoing efforts in Zambia to control and eventually eliminate RHD. Trial registration The study was registered on clinicaltrials.gov ( #NCT02661763 ).