Cardio-metabolic outcomes in South Asians compared to White Europeans in the United Kingdom: a matched controlled population-based cohort study

Abstract Background There appears to be an inequality in the risk of cardio-metabolic disease between those from a South Asian (SA) background when compared to those of White Europeans (WE) descendance, however, this association has not been explored in a large European cohort. This population-based open retrospective cohort explores the incidence of cardio-metabolic disease in those without pre-existing cardiometabolic disease taken from a large UK primary care database from 1st January 2007 to 31st December 2017. Methods A retrospective open cohort matched population-based study using The Health Improvement Network (THIN) database. The outcomes of this study were the incidences of cardio-metabolic events (type 2 diabetes mellitus, hypertension, ischemic heart disease, stroke, heart failure, and atrial fibrillation). Results A total of 94,870 SA patients were matched with 189,740 WE patients. SA were at an increased risk of developing: T2DM (adjusted hazard ratio (aHR) 3.1; 95% CI 2.97–3.23); HTN (1.34; 95% CI: 1.29–1.39); ischaemic heart disease (IHD) (1.81; 95% CI: 1.68–1.93) and heart failure (HF) (1.11; 95% CI: 1.003–1.24). However, they were at a lower risk of atrial fibrillation (AF) (0.53; 95% CI: 0.48–0.59) when compared to WE. Of those of SA origin, the Bangladeshi community were at the greatest risk of T2DM, HTN, IHD and HF, but were at the lowest risk of AF in when compared to Indians and Pakistanis. Conclusion Considering the high risk of cardio-metabolic diseases in the SA cohort, differential public health measures should be considered in these patients to reduce their risk of disease, which may be furthered tailored depending on their country of origin.

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Incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes

Cardiovascular Diabetology ◽

10.1186/s12933-021-01313-7 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Amy Groenewegen ◽

Victor W. Zwartkruis ◽

Betül Cekic ◽

Rudolf. A. de Boer ◽

Michiel Rienstra ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Disease ◽

Ischaemic Heart Disease ◽

Incidence Rate ◽

Diabetes Status ◽

Increased Risk ◽

Patients With Diabetes ◽

Rate Ratios ◽

Age And Sex

Abstract Background Diabetes has strongly been linked to atrial fibrillation, ischaemic heart disease and heart failure. The epidemiology of these cardiovascular diseases is changing, however, due to changes in prevalence of obesity-related conditions and preventive measures. Recent population studies on incidence of atrial fibrillation, ischaemic heart disease and heart failure in patients with diabetes are needed. Methods A dynamic longitudinal cohort study was performed using primary care databases of the Julius General Practitioners’ Network. Diabetes status was determined at baseline (1 January 2014 or upon entering the cohort) and participants were followed-up for atrial fibrillation, ischaemic heart disease and heart failure until 1 February 2019. Age and sex-specific incidence and incidence rate ratios were calculated. Results Mean follow-up was 4.2 years, 12,168 patients were included in the diabetes group, and 130,143 individuals in the background group. Incidence rate ratios, adjusted for age and sex, were 1.17 (95% confidence interval 1.06–1.30) for atrial fibrillation, 1.66 (1.55–1.83) for ischaemic heart disease, and 2.36 (2.10–2.64) for heart failure. Overall, incidence rate ratios were highest in the younger age categories, converging thereafter. Conclusion There is a clear association between diabetes and incidence of the major chronic progressive heart diseases, notably with heart failure with a more than twice increased risk.

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Impact of stroke on heart function

ESC CardioMed ◽

10.1093/med/9780198784906.003.0226 ◽

2018 ◽

pp. 954-957

Author(s):

Christoph Kleinschnitz

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Atrial Fibrillation ◽

Congestive Heart Failure ◽

Heart Disease ◽

Neurological Disease ◽

Heart Function ◽

Population Based ◽

Cardiac Diseases ◽

Possible Cause

Much emphasis has been placed on the heart as a possible cause of neurological disease. Cardiac diseases, such as atrial fibrillation, valvular heart disease, or congestive heart failure are well-established, important risk factors for ischaemic stroke. Within population-based studies, about 30% of ischaemic strokes are caused by cardiac diseases.

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Association between Atrial Fibrillation, Myocardial Infarction, Heart Failure and Mortality in Patients with Nontuberculous Mycobacterial Infection: a nationwide population-based study

Scientific Reports ◽

10.1038/s41598-019-51801-w ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Chan Soon Park ◽

Eue-Keun Choi ◽

Bongseong Kim ◽

Kyung-Do Han ◽

So-Ryoung Lee ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Mycobacterial Infection ◽

Population Based ◽

Newly Diagnosed ◽

Increased Risk ◽

Significant Difference ◽

Risk Patients ◽

The Impact

Abstract NTM infection demonstrates an increasing incidence and prevalence. We studied the impact of NTM in cardiovascular events. Using the Korean nationwide database, we included newly diagnosed 1,730 NTM patients between 2005 and 2008 and followed up for new-onset atrial fibrillation (AF), myocardial infarction (MI), heart failure (HF), ischemic stroke (IS), and death. Covariates-matched non-NTM subjects (1:5, n = 8,650) were selected and analyzed. Also, NTM infection was classified into indolent or progressive NTM for risk stratification. During 4.16 ± 1.15 years of the follow-up period, AF, MI, HF, IS, and death were newly diagnosed in 87, 125, 121, 162, and 468 patients. In multivariate analysis, NTM group showed an increased risk of AF (hazard ratio [HR] 2.307, 95% confidence interval [CI] 1.560–3.412) and all-cause death (HR 1.751, 95% CI 1.412–2.172) compared to non-NTM subjects, whereas no significant difference in MI (HR 0.868, 95% CI 0.461–1.634), HF (HR 1.259, 95% CI 0.896–2.016), and IS (HR 1.429, 95% CI 0.981–2.080). After stratification, 1,730 NTM patients were stratified into 1,375 (79.5%) indolent NTM group and 355 (20.5%) progressive NTM group. Progressive NTM showed an increased risk of AF and mortality than indolent NTM group. Screening for AF and IS prevention would be appropriate in these high-risk patients.

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Darier disease is associated with heart failure: a cross-sectional case-control and population based study

Scientific Reports ◽

10.1038/s41598-020-63832-9 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Etty Bachar-Wikstrom ◽

Philip Curman ◽

Tara Ahanian ◽

Ivone U. S. Leong ◽

Henrik Larsson ◽

...

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Er Stress ◽

Population Based ◽

Case Control ◽

Gene Encoding ◽

Cross Sectional ◽

Darier Disease ◽

Increased Risk ◽

Matched Comparison

AbstractHuman data supporting a role for endoplasmic reticulum (ER) stress and calcium dyshomeostasis in heart disease is scarce. Darier disease (DD) is a hereditary skin disease caused by mutations in the ATP2A2 gene encoding the sarcoendoplasmic-reticulum Ca2+ ATPase isoform 2 (SERCA2), which causes calcium dyshomeostasis and ER stress. We hypothesized that DD patients would have an increased risk for common heart disease. We performed a cross-sectional case-control clinical study on 25 DD patients and 25 matched controls; and a population-based cohort study on 935 subjects with DD and matched comparison subjects. Main outcomes and measures were N-terminal pro-brain natriuretic peptide, ECG and heart diagnosis (myocardial infarction, heart failure and arrythmia). DD subjects showed normal clinical heart phenotype including heart failure markers and ECG. The risk for heart failure was 1.59 (1,16-2,19) times elevated in DD subjects, while no major differences were found in myocardial infarcation or arrhythmias. Risk for heart failure when corrected for cardivascular risk factors or alcohol misuse was 1.53 (1.11–2.11) and 1.58 (1,15–2,18) respectively. Notably, heart failure occurred several years earlier in DD patients as compared to controls. We conclude that DD patients show a disease specific increased risk of heart failure which should be taken into account in patient management. The observation also strenghtens the clinical evidence on the important role of SERCA2 in heart failure pathophysiology.

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ATRIAL FIBRILLATION IN HEART FAILURE IS ASSOCIATED WITH AN INCREASED RISK OF DEATH ONLY IN PATIENTS WITH ISCHEMIC HEART DISEASE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(10)60270-7 ◽

2010 ◽

Vol 55 (10) ◽

pp. A28.E269

Author(s):

Jakob Raunso ◽

Ole D. Pedersen ◽

Helena Dominguez ◽

Morten L. Hansen ◽

Jacob E. Moller ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Ischemic Heart ◽

Risk Of Death ◽

Increased Risk

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Risk of sick sinus syndrome in patients diagnosed with atrial fibrillation: a population-based cohort

10.22541/au.161555510.06165605/v1 ◽

2021 ◽

Author(s):

Pil-Sung Yang ◽

Daehoon Kim ◽

Eunsun Jang ◽

Hee Tae Yu ◽

Tae-Hoon Kim ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Elderly Population ◽

Sick Sinus Syndrome ◽

Sinus Node ◽

Pacemaker Implantation ◽

Population Based ◽

Av Block ◽

Increased Risk ◽

Observation Period

Background: Sinoatrial node dysfunction and atrial fibrillation (AF) frequently coexist and interact with each other, often to initiate and perpetuate each other. Objective: To determine the effect of AF on the incidence and risk of sick sinus syndrome (SSS). Methods: The association of incident AF with the development of incident SSS was assessed from 2004 to 2013 in 302,229 SSS- and pacemaker-free participants aged ≥60 years in the Korea National Health Insurance Service-Senior cohort. Results: During an observation period of 1,854,800 person-years, incident AF was observed in a total of 12,797 participants (0.69%/year). The incidence of SSS was 0.2 and 3.4 per 1000 person-years in the incident AF and the propensity score matched no-AF groups, respectively. After adjustment, the risk of SSS caused by incident AF was significantly increased, with a hazard ratio (HR) of 13.4 (95% confidence interval [CI]: 8.4–21.4). This finding was consistently observed after censoring for heart failure (HR, 16.0; 95% CI: 9.2–28.0) or heart failure/myocardial infarction (HR, 16.6; 95% CI: 9.3-29.7). Incident AF also was associated with an increased risk of pacemaker implantation related with both SSS (HR, 21.8; 95% CI: 8.7–18.4) and atrioventricular (AV) block (HR, 9.5; 95% CI: 4.9–18.4). These results were consistent regardless of sex and comorbidities. Conclusion: Incident AF was associated with more than ten times increased risk of SSS in an elderly population regardless of comorbidities. Risk of pacemaker implantations related with both sinus node dysfunction and AV block were increased in elderly population with incident AF.

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P3787Incidence, risk predictors, and mortality risk of new heart failure in an incident hospitalised atrial fibrillation cohort: a Western Australia population-based study, 2000–2010

European Heart Journal ◽

10.1093/eurheartj/ehz745.0634 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Weber ◽

J Hung ◽

S Hickling ◽

L Nedkoff ◽

K Murray ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Mortality Risk ◽

Proportional Hazards ◽

Population Based ◽

Competing Risk ◽

Chronic Obstructive ◽

Increased Risk ◽

Risk Predictors ◽

Hospitalisation Event

Abstract Background Atrial fibrillation (AF) is a risk factor for heart failure (HF) and new HF onset is associated with increased mortality. Purpose To determine the incidence, risk predictors and mortality risk of a new HF hospitalisation event in patients after incident AF hospital admission. Methods This was a contemporary, population-based retrospective cohort study which included all Western Australian residents, aged 25 to 94 years, who survived an incident hospitalisation for AF, between 2000 and 2010. Patients hospitalised with AF that had no previous AF or HF hospitalisations up to 15 years beforehand were identified. Time to first-ever HF hospitalisation in the three years following incident AF was assessed using Kaplan-Meier methods, accounting for all-cause death as a competing risk. Cox proportional hazards models were used to determine independent predictors of HF. The association of first HF with subsequent survival was estimated using a time-dependent HF variable with other risk covariates in a proportional hazards model. Results The cohort comprised of 34 999 patients, 56.8% male, with a mean age of 71.0 (SD 13.1) years. Females were on average 6 years older than males (P<0.001). Among the cohort, 20.4% had died from any cause at 3-year follow-up. The cumulative incidence of a first HF hospitalisation event at 3 years (n=4298), after accounting for death as a competing risk, was 12.3% (95% CI 11.9%-12.6%). Most HF hospitalisations (56.2%) occurred within the first year after incident AF admission (median of 279 days; IQR 64–649 days). Of the incident HF hospitalisations, 88.9% were an emergency admission. Independent predictors of an increased risk of HF hospitalisation included older age and a history of hypertension, diabetes, excessive alcohol consumption, myocardial infarction, chronic obstructive pulmonary disease, valvular heart disease, and chronic kidney disease (all P<0.0001). Incident AF patients who were hospitalised for first HF had an adjusted hazard ratio of 2.89 (95% CI; 2.71–3.08) for all-cause mortality (P<0.0001). Conclusion Hospitalisation for HF is a frequent and troublesome problem in patients after incident AF admission, and is independently associated with increased risk of mortality. The clinical predictors of new HF occurrence highlight the importance of assessment and comprehensive management of associated risk factors and comorbid diseases in order to prevent HF morbidity and mortality in AF patients. Acknowledgement/Funding NHMRC CRECOI Scholarship

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Pergolide Associated Cardiac Valvulopathy Based on Ontario Administrative Data

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100008593 ◽

2008 ◽

Vol 35 (2) ◽

pp. 173-178 ◽

Cited By ~ 8

Author(s):

Cindy Zadikoff ◽

Minh Duong-Hua ◽

Kathy Sykora ◽

Connie Marras ◽

Anthony Lang ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Heart Disease ◽

Valvular Heart Disease ◽

Hospital Admissions ◽

Population Based ◽

Hazard Ratio ◽

Exposure Effect ◽

Increased Risk ◽

Secondary Objective

Introduction:Pergolide is an ergot derived dopamine agonist that is widely used for the treatment of Parkinson’s disease. Studies have found an association between pergolide and valvular heart abnormalities although there is still much to be learned about the clinical significance of the valvular changes, who is at risk, and whether there is duration of exposure effect.Objective:To assess the long term risk of hospital admissions for valvular heart disease (VHD) or congestive heart failure (CHF, a clinically overt outcome of VHD) in new users of pergolide compared to new users of levodopa. The secondary objective was to assess whether there are any characteristics that can predict who is at higher risk of developing this outcome.Design:Retrospective, population-based cohort study.Setting:Ontario, Canada.Subjects:Ontario residents aged 66 and older, newly started on treatment with either pergolide or levodopa.Outcomes:Admission to hospital with the most responsible diagnosis of congestive heart failure or valvular heart disease.Results:The risk for admission for valvular heart disease or congestive heart failure were higher in those with 1-4 years exposure to pergolide compared with no exposure to pergolide (VHD: hazard ratio 2.4, p = 0.04; CHF: hazard ratio 1.6, p =0.02). No such pattern was found with exposure to levodopa.Conclusion:Our study demonstrates that treatment with pergolide is associated with a higher risk of hospital admission for valvular heart disease or congestive heart failure and that this risk is greater in those with 1-4 years exposure than in those with less exposure. We did not find an increased risk beyond four years.

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The Upcoming Epidemic of Heart Failure in South Asia

Circulation Heart Failure ◽

10.1161/circheartfailure.120.007218 ◽

2020 ◽

Vol 13 (10) ◽

Author(s):

Pablo Martinez-Amezcua ◽

Waqas Haque ◽

Rohan Khera ◽

Alka M. Kanaya ◽

Naveed Sattar ◽

...

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Type 2 Diabetes ◽

Heart Disease ◽

South Asia ◽

South Asian ◽

South Asians ◽

Asian Countries ◽

Increased Risk

Currently, South Asia accounts for a quarter of the world population, yet it already claims ≈60% of the global burden of heart disease. Besides the epidemics of type 2 diabetes mellitus and coronary heart disease already faced by South Asian countries, recent studies suggest that South Asians may also be at an increased risk of heart failure (HF), and that it presents at earlier ages than in most other racial/ethnic groups. Although a frequently underrecognized threat, an eventual HF epidemic in the densely populated South Asian nations could have dramatic health, social and economic consequences, and urgent interventions are needed to flatten the curve of HF in South Asia. In this review, we discuss recent studies portraying these trends, and describe the mechanisms that may explain an increased risk of premature HF in South Asians compared with other groups, with a special focus on highly relevant features in South Asian populations including premature coronary heart disease, early type 2 diabetes mellitus, ubiquitous abdominal obesity, exposure to the world’s highest levels of air pollution, highly prevalent pretransition forms of HF such as rheumatic heart disease, and underdevelopment of healthcare systems. Other rising lifestyle-related risk factors such as use of tobacco products, hypertension, and general obesity are also discussed. We evaluate the prognosis of HF in South Asian countries and the implications of an anticipated HF epidemic. Finally, we discuss proposed interventions aimed at curbing these adverse trends, management approaches that can improve the prognosis of prevalent HF in South Asian countries, and research gaps in this important field.

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