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OBJECTIVE: To assess the association between cardiovascular risk factor (CRF) profile and premature all-cause and cardiovascular disease (CVD) mortality among US adults (age < 65). METHODS: This study used data from the National Health Interview Survey from 2006 to 2014, linked to the National Death Index for non-elderly adults aged < 65 years. A composite CRF score (range = 0-6) was calculated, based on the presence or absence of six established cardiovascular risk factors: hypertension, diabetes, hypercholesterolemia, smoking, obesity, and insufficient physical activity. CRF profile was defined as "Poor" (≥ 3 risk factors), "Average" (1-2), or "Optimal" (0 risk factors). Age-adjusted mortality rates (AAMR) were reported across CRF profile categories, separately for all-cause and CVD mortality. Cox proportional hazard models were used to evaluate the association between CRF profile and all-cause and CVD mortality. RESULTS: Among 195,901 non-elderly individuals (mean age: 40.4 ± 13.0, 50% females and 70% Non-Hispanic (NH) White adults), 24.8% had optimal, 58.9% average, and 16.2% poor CRF profiles, respectively. Participants with poor CRF profile were more likely to be NH Black, have lower educational attainment and lower income compared to those with optimal CRF profile. All-cause and CVD mortality rates were three to four fold higher in individuals with poor CRF profile, compared to their optimal profile counterparts. Adults with poor CRF profile experienced 3.5-fold (aHR: 3.48 [95% CI: 2.96, 4.10]) and 5-fold (aHR: 4.76 [3.44, 6.60]) higher risk of all-cause and CVD mortality, respectively, compared to those with optimal profile. These results were consistent across age, sex, and race/ethnicity subgroups. CONCLUSIONS: In this population-based study, non-elderly adults with poor CRF profile had a three to five-fold higher risk of all-cause and CVD mortality, compared to those with optimal CRF profile. Targeted prevention efforts to achieve optimal cardiovascular risk profile are imperative to reduce the persistent burden of premature all-cause and CVD mortality in the US.
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Doenças Cardiovasculares , Diabetes Mellitus , Hipertensão , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Masculino , Doenças Cardiovasculares/prevenção & controle , Fatores de Risco , Fatores de Risco de Doenças CardíacasRESUMO
With more than 4.2 million people, Filipino Americans are the third largest Asian group in the US and the largest Southeast Asian group in the country. Despite relatively favorable average socioeconomic indicators compared to the general US population, Filipino Americans face a significant burden of traditional cardiovascular risk factors, particularly among men. Moreover, Filipino Americans have high rates of cardiovascular death, often occurring at a younger age compared to other minority groups and Non-Hispanic White adults. In view of these trends, in 2010 the American Heart Association designated Filipino Americans as a high cardiovascular risk group. Despite this, in 2023, Filipino Americans remain underrepresented in landmark cardiovascular cohort studies and are often over looked as a group at increased cardiovascular risk. In this updated narrative review, we summarize the current state of knowledge about the burden of cardiovascular risk factors and diseases experienced by the Filipino American population. Our aim is to inform enhanced clinical, population, and policy-level prevention interventions and boost research in this space.
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Doenças Cardiovasculares , Adulto , Feminino , Humanos , Masculino , Asiático , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Fatores de Risco de Doenças Cardíacas , Estados Unidos/epidemiologiaRESUMO
Background: Aortic stenosis (AS) is the world's most prevalent heart valve disease. Transcatheter aortic valve replacement (TAVR) or Implantation (TAVI) is widely available yet adopting this procedure in Asia has been slow due to high device cost, the need for specific training programs, and the lack of specialized heart teams and dedicated infrastructures. The limited number of randomized controlled trials describing TAVI outcomes among the Asian population hampered the approval for medical reimbursements as well as acceptance among surgeons and operators in some Asian countries. Methods: A comprehensive medical literature search on TAVI and/or TAVR performed in Asian countries published between January 2015 and June 2022 was done through MEDLINE and manual searches of bibliographies. The full text of eligible articles was obtained and evaluated for final analysis. The event rates for key efficacy and safety outcomes were calculated using the data from the registries and randomized controlled trials. Results: A total of 15,297 patients were included from 20 eligible studies. The mean patient age was 82.88 ± 9.94 years, with over half being females (62.01%). All but one study reported Society of Thoracic Surgeons (STS) scores averaging an intermediate risk score of 6.28 ± 1.06%. The mean logistic European Systems for Cardiac Operations Risk Evaluation (EuroSCORE) was 14.85. The mean baseline transaortic gradient and mean aortic valve area were 50.93 ± 3.70 mmHg and 0.64 ± 0.07 cm 2 , respectively. The mean procedural success rate was 95.28 ± 1.51%. The weighted mean 30-day and 1-year all-cause mortality rate was 1.66 ± 1.21% and 8.79 ± 2.3%, respectively. The mean average for stroke was 1.98 ± 1.49%. The acute kidney injury (AKI) rate was 6.88 ± 5.71%. The overall major vascular complication rate was 2.58 ± 2.54%; the overall major bleeding rate was 3.88 ± 3.74%. Paravalvular aortic regurgitation rate was 15.07 ± 9.58%. The overall rate of pacemaker insertion was 7.76 ± 4.6%. Conclusions: Compared to Americans and Europeans, Asian patients who underwent TAVI had lower all-cause mortality, bleeding, and vascular complications, however, had a higher rate of postprocedural aortic regurgitation. More studies with greater sample sizes are needed among Asian patients for a more robust comparison.
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Stroke is becoming increasingly prevalent among the non-elderly adults (<65 years of age) in the United States. Using the National Health Interview Survey database from 2012 to 2018, we examined the association of traditional risk factors, sociodemographic, cardiovascular risk factor (CRF) profile, family income, and educational attainment in young (18-44 years) and middle-aged (45-64 years) adults. CRF profiles were defined by the number of traditional risk factors with "Poor" (≥4 risk factors), "Average," or "Optimal" (0-1). The study included 168,862 non-elderly adults (55% in young adults). Overall prevalence of stroke was 1.83% among the non-elderly (0.64% and 3.31% in young- and middle-aged adults, respectively). Adults with low family income, lesser education, and who were Non-Hispanic Blacks were more likely to have stroke. Those with poor CRF profiles exhibited a 3-4 times higher odds of stroke compared to those with optimal CRF profiles. Lower income status coupled with a poor CRF profile augmented the prevalence of stroke in non-elderly adults. This national survey of non-elderly US adults showed a correlation between lower income and education, both factors of SES, and stroke. When viewed together, there was an increasing stroke burden in the non-elderly with worsening CRF profile, income status, and educational attainment.
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Acidente Vascular Cerebral , Pessoa de Meia-Idade , Adulto Jovem , Humanos , Estados Unidos/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Fatores de Risco , Fatores Socioeconômicos , Escolaridade , RendaRESUMO
Among the greatest general challenges in bioengineering is to mimic human physiology. Advanced efforts in tissue engineering have led to sophisticated 'brain-on-chip' (BoC) microfluidic devices that can mimic structural and functional aspects of brain tissue. BoC may be used to understand the biochemical pathways of neurolgical pathologies and assess promising therapeutic agents for facilitating regenerative medicine. We evaluated the potential of microfluidic BoC devices in various neurological pathologies, such as Alzheimer's, glioblastoma, traumatic brain injury, stroke and epilepsy. We also discuss the principles, limitations and future considerations of BoC technology. Results suggest that BoC models can help understand complex neurological pathologies and augment drug testing efforts for regenerative applications. However, implementing organ-on-chip technology to clinical practice has some practical limitations that warrant greater attention to improve large-scale applicability. Nevertheless, they remain to be versatile and powerful tools that can broaden our understanding of pathophysiological and therapeutic uncertainties to neurological diseases.
In this paper, the authors describe the role of microfluidic 'brain-on-chip' systems as a tool to model and study the human brain. While animal studies have provided significant insights, they lack the complexity of human brain tissue in order to verify the effects of drugs on patients, study complex physiological pathways or personalize regenerative therapies. This makes studying diseases of complex human organs challenging. Microfluidics is a field of study that can address these challenges by developing sophisticated and miniaturized devices that can chamber human tissue. These devices could allow scientists to better study diseases on a model that is accurate and controllable, allowing researchers to better understand complex diseases, assess drug efficacy to specific areas of the brain and potentially accelerate the development of new therapies. Herein, we characterize the principles, development and challenges of microfluidics and the role they have served in different neurological diseases.
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Microfluídica , Engenharia Tecidual , Humanos , Microfluídica/métodos , Engenharia Tecidual/métodos , Dispositivos Lab-On-A-Chip , Medicina Regenerativa , EncéfaloRESUMO
In 2022, the Vietnamese population in the United States (US) comprises 2.2 million individuals, and Vietnam ranks as the sixth most frequent country of origin among immigrants in the US. The American Heart Association and the National Institutes of Health have called for research to define the burden of cardiovascular risk factors, cardiovascular disease, and their determinants across Asian American subgroups, including Vietnamese Americans. Despite these calls, Vietnamese Americans remain remarkably overlooked in cardiovascular research in the US. Studies in Vietnam, small cross-sectional surveys in the US, and research using US mortality data point to a high prevalence of hypertension and tobacco use among men and a high incidence of gestational diabetes among women. Moreover, Vietnamese Americans have one of the highest rates of cerebrovascular mortality in the country. Adverse social determinants of health-including frequent language barriers, limited health literacy, and low average income-have been suggested as important factors that contribute to cardiovascular risk in this group. In this narrative review, we summarize the existing knowledge in this space, highlight the distinct characteristics of cardiac risk in both Vietnamese and Vietnamese American individuals, discuss upstream determinants, and identify key knowledge gaps. We then outline several proposed interventions and emphasize the need for further studies in this underrepresented population. Our aim is to increase awareness of the significant burden of risk factors and cardiovascular disease shouldered by this large-but thus far overlooked-population in the US, boost research in this space, and help inform tailored, effective preventive interventions.
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Aterosclerose , Doenças Cardiovasculares , Masculino , Humanos , Estados Unidos/epidemiologia , Feminino , Doenças Cardiovasculares/epidemiologia , Fatores de Risco , Determinantes Sociais da Saúde , Estudos Transversais , Fatores de Risco de Doenças Cardíacas , Aterosclerose/epidemiologiaRESUMO
Ventricular septal ruptures (VSR) are a rare but fatal complication of acute myocardial infarctions. We present a patient complaining of new onset heart failure symptoms that were found to be secondary to a new ventricular septal rupture from a recently undiagnosed anterior myocardial infarction. The patient underwent successful VSR patch repair with eventual recovery. This case highlights the importance of early diagnosis of VSR and reviews management options and appropriate timing for intervention.
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Infarto Miocárdico de Parede Anterior , Insuficiência Cardíaca , Infarto do Miocárdio , Ruptura do Septo Ventricular , Humanos , Ruptura do Septo Ventricular/diagnóstico por imagem , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Infarto Miocárdico de Parede Anterior/complicações , Infarto Miocárdico de Parede Anterior/diagnóstico por imagemRESUMO
Background: The combined influence of traditional cardiovascular risk factors and socioeconomic status (SES) on premature CHD (<65 years) remains understudied. Methods: We used the National Health Interview Survey (NHIS) database (2012-2018) to examine the association of sociodemographic (income, education, insurance status) and cardiovascular risk profile (CRF: ranging from optimal (0-1 risk CV factor) to poor (≥4 risk CV factors)) with CHD in young (18- 44 years) and middle-aged (45-64 years) adults. Results: Among the 168,969 included adults (young: 46.6%), the prevalence of CHD was 3%, translating to 6.4 million young and middle-aged adults. Adults with low family income, lesser education and no insurance were more likely to have CHD. While majority of young adults (65%) had optimal CRF profile and only 4% had poor CRF profile, 26% of middle-aged adults carried poor CRF profile. When examined by income status, education, and insurance status, odds of CHD were increased with worsening CRF profile. In multivariate regressions, low income participants who had a poor CRF (reference: optimal CRF) had higher odds of CHD in both young (aOR: 9.12 [95% CI, 6.16-13.50]) and middle-aged adults (aOR: 8.22 [95% CI, 6.12-11.05]). Within participants with a high school education or lower, those with a poor CRF profile (reference: optimal CRF) had increased odds of CHD in young (aOR: 10.35 [95% CI, 6.66-16.11]) and middle-aged adults (aOR: 10.40 [95% CI, 7.91-13.66]). In the uninsured, those with a poor CRF profile (reference: optimal CRF) had an 8-9 fold increased odds of CHD in young (aOR: 7.65 [95% CI, 4.26-13.73]) and middle-aged adults (aOR: 9.34 [95% CI, 5.90-14.79]). Conclusions: In this national survey, individuals with poor CRF profile had higher odds of premature CHD than those with optimal profile, and burden of CHD increased with worsening of CRF profile.