Rural-urban Health Disparities for Cardiovascular Disease in the Republic of Kazakhstan

BACKGROUND: An important global public health problem in many economically developed countries, in particular Kazakhstan, is the leading cause of incidence of and mortality from cardiovascular disease (CVD). AIM: The purpose of our study was to compare incidence and mortality from CVD in urban and rural areas of the Republic of Kazakhstan in 2019 based on statistics. METHODS: We conducted a descriptive study, which based on secondary data from the statistical reports on the Republic of Kazakhstan «Health of the Republic of Kazakhstan and the activities of health care organizations». Information from this database were generated by 14 provinces, three cities of republican significance and whole Kazakhstan. In addition, these indicators were divided for rural and urban settlements. RESULTS: Data from our epidemiological study of the incidence of and mortality from cardiovascular disease (CVD) in all provinces indicate a relatively high incidence of and mortality from CVD among urban population of the Republic of Kazakhstan. Among urban residents (per 100,000 population), the highest incidence rates of CVD was in Akmola province (3771.7), the ischemic heart disease (IHD) was in Almaty city (850.8), arterial hypertension (AH) was in Akmola province (2623.8), acute myocardial infarction was in the North Kazakhstan province (212.9), the highest mortality from CVD was in Karaganda province (365), the IHD was in East Kazakhstan province (135.4). Among rural residents (per 100,000 population), there are high incidence rates of CVD in the East Kazakhstan province (3452.8), the IHD in Zhambyl province (713.1), AH in the East Kazakhstan province (1871.4), acute myocardial infarction in Atyrau province (148.3), the highest mortality from CVD was in East Kazakhstan province (201.9), and the IHD also in East Kazakhstan province (77.3). CONCLUSIONS: There is rural-urban health inequality in many countries and CVD is not the exclusion. In the Republic of Kazakhstan, the rural population has got lower rates of incidence and mortality. This may be due to the bad access to medical facilities that are typical for rural areas of Kazakhstan and the shortage of modern diagnostic equipment which may interfere with timely diagnosis.

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High Incidence of Coronary Artery Calcification Among Patients With a First Acute Myocardial Infarction: Results of a Multicenter Trial Using Electron Beam Tomography

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(97)84615-3 ◽

1998 ◽

Vol 31 (2) ◽

pp. 209A-210A

Author(s):

J Mahmarian

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Electron Beam ◽

Coronary Artery ◽

Coronary Artery Calcification ◽

Multicenter Trial ◽

Electron Beam Tomography ◽

High Incidence

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Thrombolytic Therapy in the Current ERA: Myocardial Infarction and Beyond

Current Pharmaceutical Design ◽

10.2174/1381612824666171227211623 ◽

2018 ◽

Vol 24 (4) ◽

pp. 414-426 ◽

Cited By ~ 3

Author(s):

Patrick Proctor ◽

Massoud A. Leesar ◽

Arka Chatterjee

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Disease ◽

Acute Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Coronary Intervention ◽

Evidence Base ◽

Primary Pci ◽

Percutaneous Coronary

Thrombolytic therapy kick-started the era of modern cardiology but in the last few decades it has been largely supplanted by primary percutaneous coronary intervention (PCI) as the go-to treatment for acute myocardial infarction. However, these agents remain important for vast populations without access to primary PCI and acute ischemic stroke. More innovative uses have recently come up for the treatment of a variety of conditions. This article summarizes the history, evidence base and current use of thrombolytics in cardiovascular disease.

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OP0234 RISK OF ACUTE MYOCARDIAL INFARCTION AMONG NEW USERS OF CHONDROITIN SULPHATE: A NESTED CASE-CONTROL STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.123 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 144.1-144

Author(s):

R. Mazzucchelli ◽

S. Rodriguez-Martin ◽

A. García-Vadillo ◽

M. Gil ◽

A. Rodríguez-Miguel ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Disease ◽

Acute Myocardial Infarction ◽

Cardiovascular Risk ◽

Case Control Study ◽

Chondroitin Sulphate ◽

Case Control ◽

Nested Case Control ◽

Incident Cases ◽

Control Study

Background:There is some evidence from epidemiological studies suggesting that CS and glucosamine could play a role in cardiovascular disease (CVD) prevention (1-4).Studies to date have included prevalent users, therefore a bias that overestimates protection cannot be excluded.Objectives:To test the hypothesis that chondroitin sulphate (CS) or glucosamine reduce the risk of acute myocardial infarction (AMI).Methods:Case-control study nested in a primary cohort composed of patients aged 40 to 99 years, with at least one year of follow-up in the BIFAP database during the 2002-2015 study period. From this cohort of patients, we identified incident cases of AMI and randomly selected five controls per case, matched by exact age, gender, and index date. Adjusted odds ratios (AOR) and their corresponding 95% confidence interval (CI)) were calculated through a conditional logistic regression. Only new users of CS or glucosamine were considered.Results:A total of 23,585 incident cases of AMI and 117,405 controls were included. The mean age was 67.0 (SD 13.4) years and 71.75% were male, in both groups. 558 (2.37%) cases and 3,082 (2.62%) controls used or had used CS. The current use of CS was associated with a lower risk of AMI (AOR 0.57; 95%CI: 0.46–0.72) and disappeared after discontinuation (recent and past users). The reduced risk among current users was observed in both short-term (<365 days AOR 0.58; 95%CI: 0.45-0.75) and long-term users (>364 days AOR 0.56; 95%CI 0.36-0.87), in both sexes (men, AOR=0.52; 95%CI:0.38-0.70; women, AOR=0.65; 95%CI: 0.46-0.91), in individuals over or under 70 years of age (AOR=0.54; 95%CI:0.38-0.77, and AOR=0.61; 95%CI:0.45-0.82, respectively) and in individuals at intermediate (AOR=0.65; 95%CI:0.48-0.91) and high cardiovascular risk (AOR=0.48;95%CI:0.27-0.83), but not in those at low risk (AOR=1.11; 95%CI:0.48-2.56). In contrast, the current use of glucosamine was not associated with either increased or decreased risk of AMI (AOR= 0.86; CI95% 0.66-1.08)Conclusion:Our results support a cardioprotective effect of CS, while no effect was observed with glucosamine. The highest protection was found among subgroups at higher cardiovascular risk.References:[1]Ma H, Li X, Sun D, Zhou T, Ley SH, Gustat J, et al. Association of habitual glucosamine use with risk of cardiovascular disease: prospective study in UK Biobank. BMJ. 2019;365(Journal Article):l1628.[2]de Abajo FJ, Gil MJ, Garcia Poza P, Bryant V, Oliva B, Timoner J, et al. Risk of nonfatal acute myocardial infarction associated with non-steroidal antiinflammatory drugs, non-narcotic analgesics and other drugs used in osteoarthritis: a nested case-control study. PharmacoepidemiolDrug Saf. 2014;23(11):1128–38.[3]Li Z-H, Gao X, Chung VC, Zhong W-F, Fu Q, Lv Y-B, et al. Associations of regular glucosamine use with all-cause and cause-specific mortality: a large prospective cohort study. Ann Rheum Dis. 2020 Apr 6;annrheumdis-2020-217176.[4]King DE, Xiang J. Glucosamine/Chondroitin and Mortality in a US NHANES Cohort. J Am Board Fam Med. 2020 Dec;33(6):842–7.Disclosure of Interests:Ramón Mazzucchelli Speakers bureau: UCB, Lilly, Grant/research support from: Pfizer, Roche, Amgen, Sara Rodriguez-Martin: None declared, Alberto García-Vadillo: None declared, Miguel Gil: None declared, Antonio Rodríguez-Miguel: None declared, Diana Barreira-Hernández: None declared, Alberto García-Lledó: None declared, Francisco de Abajo: None declared

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The gut hormone GLP-2 predicts cardiovascular risk in patients with acute myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.1592 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

F Kahles ◽

R.W Mertens ◽

M.V Rueckbeil ◽

M.C Arrivas ◽

J Moellmann ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Disease ◽

Acute Myocardial Infarction ◽

Receiver Operating Characteristic Curve ◽

Operating Characteristic ◽

Characteristic Curve ◽

Funding Source ◽

Cardiovascular Prognosis ◽

Operating Characteristic Curve ◽

Hs Crp

Abstract Background GLP-1 and GLP-2 (glucagon-like peptide-1/2) are gut derived hormones that are co-secreted from intestinal L-cells in response to food intake. While GLP-1 is known to induce postprandial insulin secretion, GLP-2 enhances intestinal nutrient absorption and is clinically used for the treatment of patients with short bowel syndrome. The relevance of the GLP-2 system for cardiovascular disease is unknown. Purpose The aim of this study was to assess the predictive capacity of GLP-2 for cardiovascular prognosis in patients with myocardial infarction. Methods Total GLP-2 levels, NT-proBNP concentrations and the Global Registry of Acute Coronary Events (GRACE) score were assessed at time of admission in 918 patients with myocardial infarction, among them 597 patients with NSTEMI and 321 with STEMI. The primary composite outcome of the study was the first occurrence of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke (3-P-MACE) with a median follow-up of 311 days. Results Kaplan-Meier survival plots (separated by the median of GLP-2 with a cut-off value of 4.4 ng/mL) and univariable cox regression analyses found GLP-2 values to be associated with adverse outcome (logarithmized GLP-2 values HR: 2.87; 95% CI: 1.75–4.68; p<0.0001). Further adjustment for age, sex, smoking, hypertension, hypercholesterolemia, diabetes mellitus, family history of cardiovascular disease, hs-Troponin T, NT-proBNP and hs-CRP levels did not affect the association of GLP-2 with poor prognosis (logarithmized GLP-2 values HR: 2.96; 95% CI: 1.38–6.34; p=0.0053). Receiver operating characteristic curve (ROC) analyses illustrated that GLP-2 is a strong indicator for cardiovascular events and proved to be comparable to other established risk markers (area under the curve of the combined endpoint at 6 months; GLP-2: 0.72; hs-Troponin: 0.56; NT-proBNP: 0.70; hs-CRP: 0.62). Adjustment of the GRACE risk estimate by GLP-2 increased the area under the receiver-operating characteristic curve for the combined triple endpoint after 6 months from 0.70 (GRACE) to 0.75 (GRACE + GLP-2) in NSTEMI patients. Addition of GLP-2 to a model containing GRACE and NT-proBNP led to a further improvement in model performance (increase in AUC from 0.72 for GRACE + NT-proBNP to 0.77 for GRACE + NT-proBNP + GLP-2). Conclusions In patients admitted with acute myocardial infarction, GLP-2 levels are associated with adverse cardiovascular prognosis. This demonstrates a strong yet not appreciated crosstalk between the heart and the gut with relevance for cardiovascular outcome. Future studies are needed to further explore this crosstalk with the possibility of new treatment avenues for cardiovascular disease. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): German Society of Cardiology (DGK), German Research Foundation (DFG)

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Japan Expects Decrements in Both the Incidence and Mortality of Acute Myocardial Infarction in the Modern Era:

Circulation Journal ◽

10.1253/circj.cj-09-0885 ◽

2010 ◽

Vol 74 (1) ◽

pp. 43-44 ◽

Cited By ~ 1

Author(s):

Masanori Asakura ◽

Tetsuo Minamino ◽

Masafumi Kitakaze

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Incidence And Mortality ◽

Modern Era

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Management of Cardiovascular Disease in Dialysis Patients

10.2310/im.12060 ◽

2017 ◽

Author(s):

John K. Roberts ◽

John P. Middleton

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Cardiovascular Disease ◽

Acute Myocardial Infarction ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Volume Overload ◽

Current Evidence ◽

Dialysis Patients ◽

Esrd Patients

Cardiovascular disease is a common cause of death and disease in patients with end-stage renal disease (ESRD). Registry data show that 41% of deaths in ESRD patients are due to a variety of cardiovascular causes, such as acute myocardial infarction, congestive heart failure, arrhythmia/sudden cardiac death, and stroke. In the general population, each of these disease entities in isolation can be effectively managed according to evidence from large clinical trials and evidence-based guidelines. However, many of these trials did not include patients with ESRD, limiting the transferability of this evidence to the care of patients on dialysis. To complicate matters, cardiovascular events in ESRD patients are likely augmented from a unique interplay of cardiac risk due to both reduced kidney function and the necessity for artificial renal replacement therapies. In this light, the patient on dialysis is subjected to a series of unique factors: the continued presence of the metabolic perturbations of uremia and the peculiar environment of the dialysis treatment itself. Since the ESRD heart is under a considerable amount of strain due to chronic volume overload, rapid electrolyte and fluid shifts, and accelerated vascular calcification, management can be complex and outcomes multifactorial. In this review, we summarize the current evidence regarding management of acute myocardial infarction, heart failure, sudden cardiac death, and atrial fibrillation. We also address modifiable risk factors related to the dialysis procedure itself and highlight recent randomized controlled trials that included dialysis patients and measured important cardiovascular outcomes.

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Risk of Ischemic Stroke After Acute Myocardial Infarction in Patients Undergoing Coronary Artery Bypass Graft Surgery

Scientific Reports ◽

10.1038/s41598-020-60854-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

André Åström ◽

Lars Söderström ◽

Thomas Mooe

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Ischemic Stroke ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

Incidence Rates ◽

P2y12 Inhibitors ◽

Over Time

AbstractOnly sparse epidemiological data are available regarding the risk of ischemic stroke (IS) after coronary artery bypass surgery (CABG). Here we aimed to describe the incidence and predictors of IS associated with CABG performed after acute myocardial infarction (AMI), as well as trends over time. We analyzed data for 248,925 unselected AMI patients. We separately analyzed groups of patients who underwent CABG early or late after the index infarction. IS incidence rates per year at risk were 15.8% (95% confidence interval, 14.5–17.1) and 10.9% (10.6–11.2), respectively, among patients with and without CABG in the early cohort, and 4.0% (3.5–4.5) and 2.3% (2.2–2.3), respectively, among patients with and without CABG in the late cohort. Predictors of post-AMI IS included prior IS, CABG, prior atrial fibrillation, prior hemorrhagic stroke, heart failure during hospitalization, older age, diabetes mellitus, and hypertension. Reduced IS risk was associated with use of statins and P2Y12 inhibitors. IS incidence markedly decreased among patients who did not undergo CABG, while no such reduction over time occurred among those who underwent CABG. This emphasizes the need to optimize modifiable risk factors and to consistently use treatments that may reduce IS risk among CABG patients.

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Pattern of serum cardiac troponin-I in symptomatic acute myocardial infarction patients in national institute of cardiovascular disease in Bangladesh

Bangladesh Medical Journal ◽

10.3329/bmj.v42i1.18969 ◽

2014 ◽

Vol 42 (1) ◽

pp. 3-6

Author(s):

SS Shahina ◽

JU Ahmed ◽

S Ahmed ◽

E Shahriar ◽

MN Uddin ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Disease ◽

Acute Myocardial Infarction ◽

Myocardial Injury ◽

Troponin I ◽

Clinical Symptoms ◽

Cardiac Injury ◽

Circadian Variation ◽

Assay Method ◽

Ctni Level

Troponin I (cTnI) isoform is cardiac muscle specific protein and shown to have several features as a preferred marker of myocardial injury. It rises early in acute myocardial infarction (AMI) and attains levels that are clearly separated from baseline values. It remains elevated for several days providing a long window for detection of cardiac injury. The objective of the study was to evaluate for the profile of cTnI level among symptomatic AMI patients. The study was conducted at National Institute of Cardiovascular Disease, Dhaka, Bangladesh from July 2007 to June 2008 and total 9552 patients with type 1 or type 2 MI were included. Blood Sample was taken within 3 days of symptoms and cTnI was measured by chemiluminescent immunometric assay method. cTnI was considered positive when the value was >1ng/ml and study population was divided as per age, sex and cTnI level. The mean (+ SD) age of all patients was 55(+ 12.8) years and majority was males (82.20%). Seasonal variation showed highest positive cases in winter. In case of circadian variation positive cTnI results were suggestive of morning peak of AMI. Positive results were obtained in 32.3% of Cases. cTnI is now considered as a better indicator of myocardial injury. Further study in depth is necessary to correlate with clinical symptoms and other diagnostic tests to make a complete profile of AMI according to the latest subtypes. DOI: http://dx.doi.org/10.3329/bmj.v42i1.18969 Bangladesh Med J. 2013 Jan; 42 (1): 3-6

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Epidemiology of ovarian cancer in Kazakhstan (2013-2018)

Oncologia i radiologia Kazakhstana ◽

10.52532/2521-6414-2020-2-56-9-11 ◽

2020 ◽

Vol 56 (2) ◽

pp. 9-11

Author(s):

E. K. Kukubasov ◽

A. R. Satanova ◽

R. O. Bolatbekova ◽

D. B. Kaldibekov ◽

А. А. Kurmanova ◽

...

Keyword(s):

Ovarian Cancer ◽

Western Europe ◽

Malignant Tumors ◽

Age Groups ◽

Incidence Rates ◽

Preventative Measures ◽

Age Related ◽

Working Age ◽

East Kazakhstan ◽

The Republic

Relevance: According to Globocan 2018, ovarian cancer (OC) ranks 18th among all other cancers affecting women around the world. More than 295,414 new cases of OC were reported only in 2018. The incidence is low in Western Europe and is high in Latvia, Poland, Lithuania, Estonia, Russia, and Kazakhstan. In 2018, ovarian malignancies ranked 8th (3.1%) in Kazakhstan among all malignant tumors. At that, there are no clearly recognized preventative measures to ensure the early detection of OC. 70% of ovarian malignancies are detected at stage III-IV. The purpose of this study was to conduct a comparative analysis and assessment of the dynamics of the prevalence of OC in the Republic of Kazakhstan in 2013-2018. Results: The analysis of age-related OC incidence in Kazakhstan showed the presence of ovarian malignancies in all age groups, with a marked increase by the age of 65-69 years. The majority of patients were women of the working age. Differences were found in the incidence rates by regions of the country. In the study period, the incidence was high in Qostanai, Pavlodar, and North Kazakhstan regions (northern part of the country) and Almaty. The incidence was below the national average in Atyrau, Jambyl, and South Kazakhstan regions (southern and western parts of the country). Recent years have witnessed a sharp increase in OC incidence in East Kazakhstan and Karaganda regions. Conclusion: The analysis of OC prevalence in the Republic of Kazakhstan and by regions showed an increase in OC incidence. There is a marked increase in OC detection in the northern areas of the country and a decrease in the number of cases in the south.

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