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1. Clinical features, socioeconomic status, management, short and long-term outcomes of patients with acute myocardial infarction: Phase I results of PEACE MENA registry

Author: Ayman Al Saleh, Amal Jamee, Kadhim Sulaiman, Mohamed Sobhy, Habib Gamra, Fahad Alkindi, Salim Benkhedda, Ahmed Al-Motarreb, Mohammad I. Amin, Wael Almahmeed, Ayman Hammoudeh, Hadi Skouri, Hasan A. Farhan, Mohammad Al Jarallah, Nadia Fellat, Prashanth Panduranga, Bayan K. Alnajm, Magdy Abdelhamid, Rafik Refaat, Hassen Amor, Salma Messaous, Hosameldin S. Ahmed, Ahcene Chibane, Azzouz AbdulMalek, Nora K. Alsagheer, Sobhi Dada, Zaki Mokhtar, Muhammad Ali, Anhar Ullah, Hanan AlBackr, and Khalid F. Alhabib
Subjects: Medicine, Science
Published: 2024

2. Morbidity and mortality of acute heart failure patients stratified by mitral regurgitation in the Arabian Gulf: Observations from the Gulf acute heart failure registry (Gulf CARE)

Author: Laura AlObaid, Rajesh Rajan, Mohammed Al Jarallah, Raja Dashti, Bassam Bulbanat, Mustafa Ridha, Kadhim Sulaiman, Ibrahim Al-Zakwani, Alawi A. Alsheikh-Ali, Prashanth Panduranga, Khalid F. AlHabib, Jassim Al Suwaidi, Wael Al-Mahmeed, Hussam AlFaleh, Abdelfatah Elasfar, Ahmed Al-Motarreb, Nooshin Bazargani, Nidal Asaad, Haitham Amin, Zhanna Kobalava, Peter A. Brady, Georgiana Luisa Baca, and Ahmad Al-Saber
Subjects: Mitral regurgitation, Acute heart failure, Mortality, HF rehospitalization, Science (General), Q1-390, Social sciences (General), H1-99
Abstract: This study aimed to evaluate the clinical outcomes of patients with acute heart failure (AHF) stratified by mitral regurgitation (MR) in the Arabian Gulf. Patients from the Gulf CARE registry were identified from 47 hospitals in seven Arabian Gulf countries (Yemen, Oman, Kuwait, Qatar, Bahrain, the United Arab Emirates, and Saudi Arabia) from February to November 2012. The cohort was stratified into two groups based on the presence of MR. Univariable and multivariable statistical analyses were performed. The population cohort included 5005 consecutive patients presenting with AHF, of whom 1491 (29.8 %) had concomitant MR. The mean age of patients with AHF and concomitant MR was 59.2 ± 14.9 years, and 63.1 % (n = 2886) were male. A total of 58.6 % (n = 2683) had heart failure (HF) with reduced ejection fraction (EF) (HFrEF), 21.0 % (n = 961) had HF with mildly reduced EF (HFmrEF), and 20.4 % (n = 932) had HF with preserved EF (HFpEF). Patients with MR had a lower haemoglobin (Hb) level (12.4 vs. 12.7 g/dL; p
Published: 2023
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3. Physicians' perceptions and beliefs on the current dyslipidemia management practices within Saudi Arabia

Author: Turky H. Almigbal, Dina S. Almunif, Eman Ali Deshisha, Hani Altaradi, Abdullah A. Alrasheed, Mohammed A. Batais, and Khalid F. Alhabib
Subjects: Dyslipidemia, Low-density lipoprotein cholesterol (LDL-C), Physician, Guideline, Survey, Therapeutics. Pharmacology, RM1-950
Abstract: Background: Limited reports addressing physicians’ understanding of the various low-density lipoprotein cholesterol (LDL-C) targets/statin intensity required for treating the various dyslipidemia patient populations in Saudi Arabia are available. Therefore, the current study assessed the perceptions and beliefs of practicing clinicians in Saudi Arabia regarding the current practice for management of dyslipidemia and potential perceived barriers to adherence to lipid guidelines encountered in their regular clinical practice. Knowledge of different clinical practices and beliefs could have a positive impact on improving the quality of future care provided by physicians. Methods: A survey questionnaire was designed to assess physicians’ familiarity, usage, and adherence to seven different international guidelines and used to evaluate the management of dyslipidemia, practice of patient treatment, and perceived obstacles to adhering to lipid guidelines related to specific patients, doctors, and practice issues. Results: A total of 467 physicians were recruited for the study: (1) 57.2% were primary care physicians (PCPs) and (2) 42.8% were specialists. About 90.8% of them followed lipid guidelines of which the most common set were based on those by the American College of Cardiology/American Heart Association. The most utilized risk assessment tool was the atherosclerotic cardiovascular disease (ASCVD) risk calculator. About 60% of the physicians set an LDL-C target for their patients based on a combination of patients’ risk factors and lipid profiles. In all, 42.1% of the physicians chose not to change existing therapy among patients with dyslipidemia to attain a non-high-density lipoprotein goal with controlled LDL-C level. Atorvastatin accounted for the greatest percentage of primary and secondary prevention choices (71.9% and 69.6%, respectively). Rosuvastatin was mostly preferred by physicians for patients with familial hypercholesterolemia. About two-thirds of the physicians (77.9%) prescribed statins to diabetic patients aged 40–75 years. Statin intolerance was encountered by 62.9% of the physicians in ≤ 10% of patients by 62.9%. Therapeutic strategies included switching to an alternative statin (40.1%) followed by reducing the statin dose (35.3%). Ezetimibe was prescribed by most physicians (77.9%) as an add-on to statin if the LDL-C target was not achieved. Fibrate was most preferred by physicians (62.7%) for hypertriglyceremia treatment followed by statins (28.7% of the physicians). Sixty-six percent reported not using proprotein convertase subtilisin/kexin type 9 serine protease inhibitors in their clinical practice due to unavailability at their institute (51.8%), high costs (26.3%), and/or lack of knowledge (20.6%). Perceived barriers to guideline adherence identified by physicians were lack of familiarity and knowledge of the guidelines, patient non-adherence, medication costs, and lack of timely follow-up appointments and educational tools. Multiple similarities and differences were observed after comparisons were made between specialists and PCPs in terms of guideline preference, clinical practice, and perceived barriers. Conclusion: Different perceptions and attitudes among physicians in Saudi Arabia were found due to variable recommendations by international lipid guidelines. Perceived barriers that included the patient, physician, and practice were identified by physicians at multiple levels. Multiple challenges and different action gaps were observed when comparing specialists to PCPs. It is recommended that standardized practices be followed by clinicians in Saudi Arabia, and actions to address the outlined barriers are essential for optimizing health outcomes and ASCVD prevention.
Published: 2023
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4. The burden of metabolic risk factors in North Africa and the Middle East, 1990–2019: findings from the Global Burden of Disease StudyResearch in context

Author: Mohammad-Reza Malekpour, Mohsen Abbasi-Kangevari, Seyyed-Hadi Ghamari, Javad Khanali, Mahsa Heidari-Foroozan, Sahar Saeedi Moghaddam, Mohammadreza Azangou-Khyavy, Sahba Rezazadeh-Khadem, Negar Rezaei, Parnian Shobeiri, Zahra Esfahani, Nazila Rezaei, Ali H. Mokdad, Mohsen Naghavi, Bagher Larijani, Farshad Farzadfar, Amirali Aali, Sherief Abd-Elsalam, Meriem Abdoun, Abdorrahim Absalan, Eman Abu-Gharbieh, Niveen ME. Abu-Rmeileh, Ahmed Abu-Zaid, Ali Ahmadi, Sepideh Ahmadi, Ayman Ahmed, Tarik Ahmed Rashid, Marjan Ajami, Mostafa Akbarzadeh-Khiavi, Hanadi Al Hamad, Tariq A. Alalwan, Khalid F. Alhabib, Yousef Alimohamadi, Vahid Alipour, Syed Mohamed Aljunid, Mahmoud A. Alomari, Saleh A. Alqahatni, Rajaa M. Al-Raddadi, Javad Javad Aminian Dehkordi, Mehrdad Amir-Behghadami, Sohrab Amiri, Davood Anvari, Jalal Arabloo, Judie Arulappan, Ashokan Arumugam, Zahra Aryan, Mohammad Athar, Seyyed Shamsadin Athari, Abolfazl Avan, Sina Azadnajafabad, Samad Azari, Hosein Azizi, Nayereh Baghcheghi, Nader Bagheri, Sara Bagherieh, Ovidiu Constantin Baltatu, Akshaya Srikanth Bhagavathula, Vijayalakshmi S. Bhojaraja, Souad Bouaoud, Muhammad Hammad Butt, Luciana Aparecida Campos, Abdulaal Chitheer, Reza Darvishi Cheshmeh Soltani, Aso Mohammad Darwesh, Shirin Djalalinia, Milad Dodangeh, Maysaa El Sayed Zaki, Iffat Elbarazi, Muhammed Elhadi, Waseem El-Huneidi, Rana Ezzeddini, Mohammad Fareed, Hossein Farrokhpour, Ali Fatehizadeh, Yaseen Galali, Amir Ghaderi, Mansour Ghafourifard, Mohammad Ghasemi Nour, Ahmad Ghashghaee, Maryam Gholamalizadeh, Pouya Goleij, Mohamad Golitaleb, Parham Habibzadeh, Nima Hafezi-Nejad, Rabih Halwani, Hamidreza Hasani, Maryam Hashemian, Amr Hassan, Soheil Hassanipour, Hadi Hassankhani, Kamal Hezam, Reza Homayounfar, Seyed Kianoosh Hosseini, Kaveh Hosseini, Mehdi Hosseinzadeh, Soodabeh Hoveidamanesh, Jalil Jaafari, Haitham Jahrami, Elham Jamshidi, Tahereh Javaheri, Sathish Kumar Jayapal, Ali Kabir, Amirali Karimi, Neda Kaydi, Mohammad Keykhaei, Yousef Saleh Khader, Morteza Abdullatif Khafaie, Moien A.B. Khan, Kashif Ullah Khan, Yusra H. Khan, Moawiah Mohammad Khatatbeh, Farzad Kompani, Hamid Reza Koohestani, Mohammed Kuddus, Savita Lasrado, Sang-woong Lee, Soleiman Mahjoub, Ata Mahmoodpoor, Elham Mahmoudi, Elaheh Malakan Rad, Narges Malih, Ahmad Azam Malik, Tauqeer Hussain Mallhi, Yosef Manla, Borhan Mansouri, Mohammad Ali Mansournia, Parham Mardi, Abdoljalal Marjani, Sahar Masoudi, Entezar Mehrabi Nasab, Ritesh G. Menezes, Vildan Mevsim, Yousef Mohammad, Mokhtar Mohammadi, Esmaeil Mohammadi, Noushin Mohammadifard, Arif Mohammed, Sara Momtazmanesh, Fateme Montazeri, Maryam Moradi, Maziar Moradi-Lakeh, Negar Morovatdar, Christopher J.L. Murray, Zuhair S. Natto, Seyed Aria Nejadghaderi, Ali Nowroozi, Morteza Oladnabi, Ahmed Omar Bali, Emad Omer, Hamidreza Pazoki Toroudi, Raffaele Pezzani, Ashkan Pourabhari Langroudi, Sima Rafiei, Mehran Rahimi, Vafa Rahimi-Movaghar, Shayan Rahmani, Amir Masoud Rahmani, Vahid Rahmanian, Chythra R. Rao, Sina Rashedi, Mohammad-Mahdi Rashidi, Reza Rawassizadeh, Elrashdy Moustafa Mohamed Redwan, Malihe Rezaee, Maryam Rezaei, Seyed Mohammad Riahi, Gholamreza Roshandel, Aly Saad, Maha Mohamed Saber-Ayad, Siamak Sabour, Leila Sabzmakan, Basema Saddik, Erfan Sadeghi, Saeid Sadeghian, Amirhossein Sahebkar, Morteza Saki, Saina Salahi, Sarvenaz Salahi, Amir Salek Farrokhi, Marwa Rashad Salem, Hamideh Salimzadeh, Abdallah M. Samy, Nizal Sarrafzadegan, Brijesh Sathian, Melika Shafeghat, Syed Mahboob Shah, Jaffer Shah, Ataollah Shahbandi, Fariba Shahraki-Sanavi, Mehran Shams-Beyranvand, Mohd Shanawaz, Kiomars Sharafi, Javad Sharifi-Rad, Jeevan K. Shetty, Zahra Shokri Varniab, Seyed Afshin Shorofi, Soraya Siabani, Mohammad Sadegh Soltani-Zangbar, Seidamir Pasha Tabaeian, Seyed-Amir Tabatabaeizadeh, Mohammad Tabish, Majid Taheri, Yasaman Taheri Abkenar, Moslem Taheri Soodejani, Amir Taherkhani, Arash Tehrani-Banihashemi, Mohamad-Hani Temsah, Bereket M. Tigabu, Alireza Vakilian, Siavash Vaziri, Bay Vo, Fereshteh Yazdanpanah, Arzu Yigit, Vahit Yiğit, Mazyar Zahir, Burhan Abdullah Zaman, Maryam Zamanian, Moein Zangiabadian, Iman Zare, and Zahra Zareshahrabadi
Subjects: Global burden of disease, Metabolic risk factors, High systolic blood pressure, High fasting plasma glucose, High body-mass index, High-LDL, Medicine (General), R5-920
Abstract: Summary: Background: The objective of this study is to investigate the trends of exposure and burden attributable to the four main metabolic risk factors, including high systolic blood pressure (SBP), high fasting plasma glucose (FPG), high body-mass index (BMI), and high low-density lipoproteins cholesterol (LDL) in North Africa and the Middle East from 1990 to 2019. Methods: The data were retrieved from Global Burden of Disease Study 2019. Summary exposure value (SEV) was used for risk factor exposure. Burden attributable to each risk factor was incorporated in the population attributable fraction to estimate the total attributable deaths and disability-adjusted life-years (DALYs). Findings: While age-standardized death rate (ASDR) attributable to high-LDL and high-SBP decreased by 26.5% (18.6–35.2) and 23.4% (15.9–31.5) over 1990–2019, respectively, high-BMI with 5.1% (−9.0–25.9) and high-FPG with 21.4% (7.0–37.4) change, grew in ASDR. Moreover, age-standardized DALY rate attributed to high-LDL and high-SBP declined by 30.2% (20.9–39.0) and 25.2% (16.8–33.9), respectively. The attributable age-standardized DALY rate of high-BMI with 8.3% (−6.5–28.8) and high-FPG with 27.0% (14.3–40.8) increase, had a growing trend. Age-standardized SEVs of high-FPG, high-BMI, high-SBP, and high-LDL increased by 92.4% (82.8–103.3), 76.0% (58.9–99.3), 10.4% (3.8–18.0), and 5.5% (4.3–7.1), respectively. Interpretation: The burden attributed to high-SBP and high-LDL decreased during the 1990–2019 period in the region, while the attributable burden of high-FPG and high-BMI increased. Alarmingly, exposure to all four risk factors increased in the past three decades. There has been significant heterogeneity among the countries in the region regarding the trends of exposure and attributable burden. Urgent action is required at the individual, community, and national levels in terms of introducing effective strategies for prevention and treatment that account for local and socioeconomic factors. Funding: Bill & Melinda Gates Foundation.
Published: 2023
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5. Characteristics and predictors of out-of-hospital cardiac arrest in young adults hospitalized with acute coronary syndrome: A retrospective cohort study of 30,000 patients in the Gulf region

Author: Abdulelah H. Alsaeed, Ahmed Hersi, Tarek Kashour, Mohammad Zubaid, Jassim Al Suwaidi, Haitham Amin, Wael AlMahmeed, Kadhim Sulaiman, Ahmed Al-Motarreb, Khalid F. Alhabib, and Wael Alqarawi
Subjects: Medicine, Science
Abstract: Introduction The characteristics of young adults with out-of-hospital cardiac arrest (OHCA) due to acute coronary syndrome (ACS) has not been well described. The mean age of gulf citizens in ACS registries is 10–15 years younger than their western counterparts, which provided us with a unique opportunity to investigate the characteristics and predictors of OHCA in young adults presenting with ACS. Methodology This was a retrospective cohort study using data from 7 prospective ACS registries in the Gulf region. In brief, all registries included consecutive adults who were admitted with ACS. OHCA was defined as cardiac arrest upon presentation (i.e., before admission to the hospital). We described the characteristics of young adults (< 50 years) who had OHCA and performed multivariate logistic regression analysis to assess independent predictors of OHCA. Results A total of 31,620 ACS patients were included in the study. There were 611 (1.93%) OHCA cases in the whole cohort [188/10,848 (1.73%) in young adults vs 423/20,772 (2.04%) in older adults, p = 0.06]. Young adults were predominantly males presenting with ST-elevation myocardial infarction (STEMI) [182/188 (96.8%) and 172/188 (91.49%), respectively]. OHCA was the sentinel event of coronary artery disease (CAD) in 70% of young adults. STEMI, male sex, and non-smoking status were found to be independent predictors of OHCA [OR = 5.862 (95% CI 2.623–13.096), OR: 4.515 (95% CI 1.085–18.786), and OR = 2.27 (95% CI 1.335–3.86), respectively]. Conclusion We observed a lower prevalence of OHCA in ACS patients in our region as compared to previous literature from other regions. Moreover, OHCA was the sentinel event of CAD in the majority of young adults, who were predominantly males with STEMIs. These findings should help risk-stratify patients with ACS and inform further research into the characteristics of OHCA in young adults.
Published: 2023

6. Clinical presentation and outcomes of peripartum cardiomyopathy in the Middle East: a cohort from seven Arab countries

Author: Amar M. Salam, Mohamed Badie Ahmed, Kadhim Sulaiman, Rajvir Singh, Mohammed Alhashemi, Alison S. Carr, Alawi A. Alsheikh‐Ali, Khalid F. AlHabib, Ibrahim Al‐Zakwani, Prashanth Panduranga, Nidal Asaad, Abdulla Shehab, Wael AlMahmeed, and Jassim Al Suwaidi
Subjects: Cardiomyopathy, Heart failure, Outcomes, Peripartum, Registry, Symptoms, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Abstract Aims Published data on the clinical presentation of peripartum cardiomyopathy (PPCM) are very limited particularly from the Middle East. The aim of this study was to examine the clinical presentation, management, and outcomes of patients with PPCM using data from a large multicentre heart failure (HF) registry from the Middle East. Methods and results From February to November 2012, a total of 5005 consecutive patients with HF were enrolled from 47 hospitals in 7 Middle East countries. From this cohort, patients with PPCM were identified and included in this study. Clinical features, in‐hospital, and 12 months outcomes were examined. During the study period, 64 patients with PPCM were enrolled with a mean age of 32.5 ± 5.8 years. Family history was identified in 11 patients (17.2%) and hypertension in 7 patients (10.9%). The predominant presenting symptom was dyspnoea New York Heart Association class IV in 51.6%, class III in 31.3%, and class II in 17.2%. Basal lung crepitations and peripheral oedema were the predominant signs on clinical examination (98.2% and 84.4%, respectively). Most patients received evidence‐based HF therapies. Inotropic support and mechanical ventilation were required in 16% and 5% of patients, respectively. There was one in‐hospital death (1.6%), and after 1 year of follow‐up, nine patients were rehospitalized with HF (15%), and one patient died (1.6%). Conclusions A high index of suspicion of PPCM is required to make the diagnosis especially in the presence of family history of HF or cardiomyopathy. Further studies are warranted on the genetic basis of PPCM.
Published: 2020
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7. Demographic, behavioral, and cardiovascular disease risk factors in the Saudi population: results from the Prospective Urban Rural Epidemiology study (PURE-Saudi)

Author: Khalid F. Alhabib, Mohammed A. Batais, Turky H. Almigbal, Mostafa Q. Alshamiri, Hani Altaradi, Sumathy Rangarajan, and Salim Yusuf
Subjects: Demographics, Prevalence, Risk factors, Cardiovascular disease, Urban, Rural, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Cardiovascular disease (CVD) is the major cause of death in Saudi Arabia. We aimed to assess associated demographic, behavioral, and CVD risk factors as part of the Prospective Urban Rural Epidemiology (PURE) study. Methods PURE is a global cohort study of adults ages 35–70 years in 20 countries. PURE-Saudi study participants were recruited from 19 urban and 6 rural communities randomly selected from the Central province (Riyadh and Alkharj) between February 2012 and January 2015. Data were stratified by age, sex, and urban vs rural and summarized as means and standard deviations for continuous variables and as numbers and percentages for categorical variables. Proportions and means were compared between men and women, among age groups, and between urban and rural areas, using Chi-square test and t-tests, respectively. Results The PURE-Saudi study enrolled 2047 participants (mean age, 46.5 ± 9.12 years; 43.1% women; 24.5% rural). Overall, 69.4% had low physical activity, 49.6% obesity, 34.4% unhealthy diet, 32.1% dyslipidemia, 30.3% hypertension, and 25.1% diabetes. In addition, 12.2% were current smokers, 15.4% self-reported feeling sad, 16.9% had a history of periods of stress, 6.8% had permanent stress, 1% had a history of stroke, 0.6% had heart failure, and 2.5% had coronary heart disease (CHD). Compared to women, men were more likely to be current smokers and have diabetes and a history of CHD. Women were more likely to be obese, have central obesity, self-report sadness, experience stress, feel permanent stress, and have low education. Compared to participants in urban areas, those in rural areas had higher rates of diabetes, obesity, and hypertension, and lower rates of unhealthy diet, self-reported sadness, stress (several periods), and permanent stress. Compared to middle-aged and older individuals, younger participants more commonly reported an unhealthy diet, permanent stress, and feeling sad. Conclusion These results of the PURE-Saudi study revealed a high prevalence of unhealthy lifestyle and CVD risk factors in the adult Saudi population, with higher rates in rural vs urban areas. National public awareness programs and multi-faceted healthcare policy changes are urgently needed to reduce the future burden of CVD risk and mortality.
Published: 2020
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8. Impact of diabetes on mortality and rehospitalization in acute heart failure patients stratified by ejection fraction

Author: Mohammed Al‐Jarallah, Rajesh Rajan, Ibrahim Al‐Zakwani, Raja Dashti, Bassam Bulbanat, Mustafa Ridha, Kadhim Sulaiman, Alawi A. Alsheikh‐Ali, Prashanth Panduranga, Khalid F. AlHabib, Jassim Al Suwaidi, Wael Al‐Mahmeed, Hussam AlFaleh, Abdelfatah Elasfar, Ahmed Al‐Motarreb, Nooshin Bazargani, Nidal Asaad, and Haitham Amin
Subjects: Heart failure, Diabetes mellitus, Mortality, Middle East, Readmission, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Abstract Aims The aim of this study is to determine the impact of diabetes mellitus on all‐cause mortality and rehospitalization rates at 3 months and at 1 year in patients admitted with acute heart failure (AHF) stratified by left ventricular ejection fraction (EF). Methods and results We analysed consecutive patients admitted to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) with AHF from February to November 2012 with AHF who were enrolled in Gulf CARE, a multinational registry of patients with heart failure (HF). AHF patients were stratified into three groups: HF patients with reduced (EF) (HFrEF) (
Published: 2020
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9. Age‐Related Sex Differences in Clinical Presentation, Management, and Outcomes in ST‐Segment–Elevation Myocardial Infarction: Pooled Analysis of 15 532 Patients From 7 Arabian Gulf Registries

Author: Abdulla Shehab, Akshaya Srikanth Bhagavathula, Khalid F. Alhabib, Anhar Ullah, Jassim Al Suwaidi, Wael Almahmeed, Hussam AlFaleh, and Mohammad Zubaid
Subjects: acute coronary syndrome, hospitalization, Middle East, mortality, myocardial infarction, sex, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background No studies from the Arabian Gulf region have taken age into account when examining sex differences in ST‐segment–elevation myocardial infarction (STEMI) presentation and outcomes. We examined the relationship between sex differences and presenting characteristics, revascularization procedures, and in‐hospital mortality after accounting for age in patients hospitalized with STEMI in the Arabian Gulf region from 2005 to 2017. Methods and Results This study was a pooled analysis of 31 620 patients with a diagnosis of acute coronary syndrome enrolled in 7 Arabian Gulf registries. Of these, 15 532 patients aged ≥18 years were hospitalized with a primary diagnosis of STEMI. A multiple variable regression model was used to assess sex differences in revascularization, in‐hospital mortality, and 1‐year mortality. Odds ratios and 95% CIs were calculated. Women were, on average, 8.5 years older than men (mean age: 61.7 versus 53.2 years; absolute standard mean difference: 68.9%). The age‐stratified analysis showed that younger women (aged
Published: 2020
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10. Mortality and Morbidity in HFrEF, HFmrEF, and HFpEF Patients with Diabetes in the Middle East

Author: Mohammed Al-Jarallah, Rajesh Rajan, Ibrahim Al-Zakwani, Raja Dashti, Bassam Bulbanat, Mustafa Ridha, Kadhim Sulaiman, Alawi A. Alsheikh-Ali, Prashanth Panduranga, Khalid F. AlHabib, Jassim Al Suwaidi, Wael Al-Mahmeed, Hussam AlFaleh, Abdelfatah Elasfar, Ahmed Al-Motarreb, Nooshin Bazargani, Nidal Asaad, and Haitham Amin
Subjects: heart failure, diabetes mellitus, mortality, middle east, patient readmission, Medicine
Abstract: Objectives: We sought to estimate the mortality and morbidity in diabetic acute heart failure (AHF) patients stratified by left ventricular ejection fraction. Methods: We analyzed the data of patients with AHF from seven Middle Eastern countries (Bahrain, Oman, Yemen, Kuwait, UAE, Qatar, and Saudi Arabia) from February to November 2012, who were enrolled in a multinational registry of patients with heart failure (HF). Results: A total of 2258 AHF patients had diabetes mellitus. The mean age was 63.0±11.0 years (ranging from 18 to 99 years), and 60.3% (n = 1362) of the patients were males. The mean ejection fraction (EF) was 37.0±13.0%. HF with reduced EF (< 40%) (HFrEF) was observed in 1268 patients (56.2%), whereas 515 patients (22.8%) had mid-range (40–49%) (HFmrEF) and 475 patients (21.0%) had preserved EF (≥ 50%) (HFpEF). The overall cumulative all-cause mortalities at three- and 12-months follow-up were 11.8% (n = 266) and 20.7% (n = 467), respectively. Those with HFpEF were associated with lower three-months cumulative all-cause mortality compared to those with HFrEF (7.6% vs. 5.9%; adjusted odds ratio (aOR) = 0.54, 95% confidence interval (CI): 0.31–0.95; p =0.031), but not significantly different when compared to those with HFmrEF (aOR = 0.86, 95% CI: 0.53–1.40; p =0.554). There were largely no significant differences among the groups with regards to the 12-months all-cause cumulative mortality (11% vs. 11% vs. 10%; p =0.984). There were also no significant differences in re-hospitalization rates between the three HF groups not only at three months (23% vs. 20% vs. 22%; p =0.520), but at one-year follow-up (28% vs. 30% vs. 32%; p =0.335). Conclusions: Three-month cumulative all-cause mortality was high in diabetic HFrEF patients when compared to those with HFpEF. However, there were no significant differences in mortality at one-year follow-up between the HF groups. There were also no significant differences in re-hospitalization rates between the HF groups not only at three months but also at one-year follow-up in the Middle East.
Published: 2020
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11. The prognostic impact of hyperglycemia on clinical outcomes of acute heart failure: Insights from the heart function assessment registry trial in Saudi Arabia

Author: Alwaleed Aljohar, Khalid F. Alhabib, Tarek Kashour, Ahmad Hersi, Waleed Al Habeeb, Anhar Ullah, Abdelfatah Elasfar, Ali Almasood, Abdullah Ghabashi, Layth Mimish, Saleh Alghamdi, Ahmed Abuosa, Asif Malik, Gamal Abdin Hussein, Mushabab Al-Murayeh, and Hussam AlFaleh
Subjects: Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background: The prognostic impact of hyperglycemia (HG) in acute heart failure (AHF) is controversial. Our aim is to examine the impact of HG on short- and long-term survival in AHF patients. Methods: Data from the Heart Function Assessment Registry Trial in Saudi Arabia (HEARTS) for patients who had available random blood sugar (RBS) were analyzed. The enrollment period was from October 2009 to December 2010. Comparisons were performed according to the RBS levels on admission as either
Published: 2018
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12. Demystifying Smoker's Paradox: A Propensity Score–Weighted Analysis in Patients Hospitalized With Acute Heart Failure

Author: Suhail A. Doi, Nazmul Islam, Kadhim Sulaiman, Alawi A. Alsheikh‐Ali, Rajvir Singh, Awad Al‐Qahtani, Nidal Asaad, Khalid F. AlHabib, Ibrahim Al‐Zakwani, Mohammed Al‐Jarallah, Wael AlMahmeed, Bassam Bulbanat, Nooshin Bazargani, Haitham Amin, Ahmed Al‐Motarreb, Husam AlFaleh, Prashanth Panduranga, Abdulla Shehab, Jassim Al Suwaidi, and Amar M. Salam
Subjects: covariate adjustment, covariate balance, heart failure, mortality, study design, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background Smoker's paradox has been observed with several vascular disorders, yet there are limited data in patients with acute heart failure (HF). We examined the effects of smoking in patients with acute HF using data from a large multicenter registry. The objective was to determine if the design and analytic approach could explain the smoker's paradox in acute HF mortality. Methods and Results The data were sourced from the acute HF registry (Gulf CARE [Gulf Acute Heart Failure Registry]), a multicenter registry that recruited patients over 10 months admitted with a diagnosis of acute HF from 47 hospitals in 7 Middle Eastern countries. The association between smoking and mortality (in hospital) was examined using covariate adjustment, making use of mortality risk factors. A parallel analysis was performed using covariate balancing through propensity scores. Of 5005 patients hospitalized with acute HF, 1103 (22%) were current smokers. The in‐hospital mortality rates were significantly lower in current smoker's before (odds ratio, 0.71; 95% CI, 0.52–0.96) and more so after (odds ratio, 0.47; 95% CI, 0.31–0.70) covariate adjustment. With the propensity score–derived covariate balance, the smoking effect became much less certain (odds ratio, 0.63; 95% CI, 0.36–1.11). Conclusions The current study illustrates the fact that the smoker's paradox is likely to be a result of residual confounding as covariate adjustment may not resolve this if there are many competing prognostic confounders. In this situation, propensity score methods for covariate balancing seem preferable. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01467973.
Published: 2019
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13. Baseline characteristics, management practices, and long-term outcomes among patients with first presentation acute myocardial infarction in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-II)

Author: Abdulaziz U. Joury, Ahmed S. Hersi, Hussam Alfaleh, Khalid F. Alhabib, and Tarek Seifaw Kashour
Subjects: Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background and objectives: Limited data are available highlighting the different clinical aspects of acute coronary syndrome (ACS) patients, especially in Gulf countries. In this study, we aimed to compare patients who presented with acute myocardial infarction (AMI) as the first presentation of patients who have a history of ACS in terms of initial presentation, medical history, laboratory findings, and overall mortality. Methods: We used the Second Gulf Registry of Acute Coronary Events (Gulf RACE-II), which is a multinational observational study of 7930 ACS patients. Results: Among all patients, 4723 (59.6%) patients presented with AMI. First presentation AMI patients were older (mean age, 55 years vs. 53 years; p
Published: 2018
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14. β‐Blocker Therapy Prior to Admission for Acute Coronary Syndrome in Patients Without Heart Failure or Left Ventricular Dysfunction Improves In‐Hospital and 12‐Month Outcome: Results From the GULF‐RACE 2 (Gulf Registry of Acute Coronary Events‐2)

Author: Charbel Abi Khalil, Khalid F. AlHabib, Rajvir Singh, Nidal Asaad, Hussam Alfaleh, Alawi A. Alsheikh‐Ali, Kadhim Sulaiman, Mostafa Alshamiri, Fayez Alshaer, Wael AlMahmeed, and Jassim Al Suwaidi
Subjects: acute coronary syndrome, β‐adrenergic receptor blocker, heart failure, ST‐segment elevation myocardial infarction, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: BackgroundThe prognostic impact of β‐blockers (BB) in acute coronary syndrome (ACS) patients without heart failure (HF) or left ventricular dysfunction is controversial, especially in the postreperfusion era. We sought to determine whether a BB therapy before admission for ACS has a favorable in‐hospital outcome in patients without HF, and whether they also reduce 12‐month mortality if still prescribed on discharge. Methods and ResultsThe GULF‐RACE 2 (Gulf Registry of Acute Coronary Events‐2) is a prospective multicenter study of ACS in 6 Middle Eastern countries. We studied in‐hospital cardiovascular events in patients hospitalized for ACS without HF in relation to BB on admission, and 1‐year mortality in relation to BB on discharge. Among the 7903 participants, 7407 did not have HF, of whom 5937 (80.15%) patients were on BB. Patients on BB tended to be older and have more comorbidities. However, they had a lower risk of in‐hospital mortality, mitral regurgitation, HF, cardiogenic shock, and ventricular tachycardia/ventricular fibrillation. Furthermore, 4208 patients were discharged alive and had an ejection fraction ≥40%. Among those, 84.1% had a BB prescription. At 12 months, they also had a reduced risk of mortality as compared with the non‐BB group. Even after correcting for confounding factors in 2 different models, in‐hospital and 12‐month mortality risk was still lower in the BB group. ConclusionsIn this cohort of ACS, BB therapy before admission for ACS is associated with decreased in‐hospital mortality and major cardiovascular events, and 1‐year mortality in patients without HF or left ventricular dysfunction if still prescribed on discharge.
Published: 2017
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15. Incidence of ventricular arrhythmia and associated patient outcomes in hospitalized acute coronary syndrome patients in Saudi Arabia: findings from the registry of the Saudi Project for Assessment of Acute Coronary Syndrome (SPACE)

Author: Ahmad S. Hersi, Khalid F. Alhabib, Hussam F. AlFaleh, Khalid AlNemer, Shukri AlSaif, Amir Taraben, Tarek Kashour, Ahmed M. Abuosa, and Mushabab A. Al-Murayeh
Subjects: Medicine
Abstract: BACKGROUND AND OBJECTIVES: Mortality in acute coronary syndrome (ACS) patients with ventricular arrhythmia (VA) has been shown to be higher than those without VA. However, there is a paucity of data on VA among ACS patients in the Middle Eastern countries. DESIGN AND SETTING: Prospective study of patients admitted in 17 government hospitals with ACS between December 2005 and December 2007. PATIENTS AND METHODS: Patients were categorized as having VA if they experienced either ventricular fibrillation (VF) or sustained ventricular tachycardia (VT) or both. RESULTS: Of 5055 patients with ACS enrolled in the SPACE registry, 168 (3.3%) were diagnosed with VA and 151 (98.8%) occurred in-hospital. The vast majority (74.4%) occurred in patients with ST-segment elevation myocardial infarction. In addition, males were twice as likely to develop VA than females (OR 1.7; 95% CI 1.1–3). Killip class >I (OR 2.0; 95% CI 1.3–3.1); and systolic blood pressure
Published: 2012
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16. Are acute coronary syndrome patients admitted during off-duty hours treated differently? An analysis of the Saudi Project for Assessment of Acute Coronary Syndrome (SPACE) study

Author: Hussam F. Al Faleh, Lukman Thalib, Khalid F. AlHabib, Anhar Ullah, Khalid AlNemer, Shukri M. AlSaif, Amir N. Taraben, Asif Malik, Ahmed M. Abuosa, Layth A. Mimish, and Ahmad Salah Hersia
Subjects: Medicine
Abstract: BACKGROUND AND OBJECTIVES: It is often suggested that acute coronary syndrome (ACS) patients admitted during off-duty hours (OH) have a worse clinical outcome than those admitted during regular working hours (RH). Our objective was to compare the management and hospital outcomes of ACS patients admitted during OH with those admitted during RH. DESIGN AND SETTING: Prospective observational study of ACS patients enrolled in the Saudi Project for Assessment of Acute Coronary Syndrome study from December 2005 to December 2007. PATIENTS AND METHODS: ACS patients with available date and admission times were included. RH were defined as weekdays, 8 AM-5 PM, and OH was defined as weekdays 5 PM-8 AM, weekends, during Eid (a period of several days marking the end of two major Islamic holidays), and national days. RESULTS: Of the 2825 patients qualifying for this analysis, 1016 (36%) were admitted during RH and 1809 (64%) during OH. OH patients were more likely to present with heart failure and ST elevation myocardial infarction (STEMI) and to receive fibrinolytic therapy, but were less likely to undergo primary percutaneous coronary interventions (PCI). The median door to balloon time was significantly longer (P
Published: 2012
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17. Baseline characteristics, management practices, and long-term outcomes of Middle Eastern patients in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-2)

Author: Khalid F. AlHabib, Kadhim Sulaiman, Ahmed Al-Motarreb, Wael Almahmeed, Nidal Asaad, Haitham Amin, Ahmad Hersi, Shukri Al-Saif, Khalid AlNemer, Jawad Al-Lawati, Norah Q. Al-Sagheer, Nizar AlBustani, and Jassim Al Suwaidi
Subjects: Medicine
Abstract: BACKGROUND AND OBJECTIVES: Limited data are available on patients with acute coronary syndromes (ACS) and their long-term outcomes in the Arabian Gulf countries. We evaluated the clinical features, management, in-hospital, and long-term outcomes in such a population. DESIGN AND SETTING: A 9-month prospective, multicenter study conducted in 65 hospitals from 6 countries that also included 30 day and 1-year mortality follow-up. PATIENTS AND METHODS: ACS patients included those with ST-elevation myocardial infarction (STEMI) and non–ST-elevation acute coronary syndrome (NSTEACS), including non-STEMI and unstable angina. The registry collected the data prospectively. RESULTS: Between October 2008 and June 2009, 7930 patients were enrolled. The mean age [standard deviation (SD)], 56 (17) years; 78.8% men; 71.2% Gulf citizens; 50.1% with central obesity; and 45.6% with STEMI. A history of diabetes mellitus was present in 39.5%, hypertension in 47.2%, and hyperlipidemia in 32.7%, and 35.7% were current smokers. The median time from symptom onset to hospital arrival for STEMI patients was 178 minutes (interquartile range, 210 minutes); 22.3% had primary percutaneous coronary intervention (PCI) and 65.7% thrombolytic therapy, with 34% receiving therapy within 30 minutes of arrival. Evidence-based medication rates upon hospital discharge were 68% to 95%. The in-hospital PCI was done in 21% and the coronary artery bypass graft surgery in 2.9%. The in-hospital mortality was 4.6%, at 30 days the mortality was 7.2%, and at 1 year after hospital discharge the mortality was 9.4%; 1-year mortality was higher in STEMI (11.5%) than in NSTEACS patients (7.7%; P
Published: 2012
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18. Clinical characteristics, management and outcomes of Indian subcontinent and Middle East acute heart failure patients: Results: From the Gulf acute heart failure registry

Author: Prashanth Panduranga, Ibrahim Al-Zakwani, Kadhim Sulaiman, Khalid F. AlHabib, Wael Almahmeed, Mohammed Al-Jarallah, Alawi Alsheikh-Ali, Jassim Al-Suwaidi, Hussam AlFaleh, Abdelfatah Elasfar, Ahmed Al-Motarreb, Mustafa Ridha, Bassam Bulbanat, Nooshin Bazargani, Nidal Asaad, and Haitham Amin
Subjects: Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Published: 2014
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19. Polyvascular Disease in Patients Presenting with Acute Coronary Syndrome: Its Predictors and Outcomes

Author: Hassan Al Thani, Ayman El-Menyar, Khalid F. AlHabib, Ahmed Al-Motarreb, Ahmad Hersi, Hussam AlFaleh, Nidal Asaad, Shukri Al Saif, Wael Almahmeed, Kadhim Sulaiman, Haitham Amin, Alawi A. Alsheikh-Ali, Khalid AlNemer, and Jassim Al Suwaidi
Subjects: Technology, Medicine, Science
Abstract: We evaluated prevalence and clinical outcome of polyvascular disease (PolyVD) in patients presenting with acute coronary syndrome (ACS). Data for 7689 consecutive ACS patients were collected from the 2nd Gulf Registry of Acute Coronary Events between October 2008 and June 2009. Patients were divided into 2 groups (ACS with versus without PolyVD). All-cause mortality was assessed at 1 and 12 months. Patients with PolyVD were older and more likely to have cardiovascular risk factors. On presentation, those patients were more likely to have atypical angina, high resting heart rate, high Killip class, and GRACE risk scoring. They were less likely to receive evidence-based therapies. Diabetes mellitus, renal failure, and hypertension were independent predictors for presence of PolyVD. PolyVD was associated with worse in-hospital outcomes (except for major bleedings) and all-cause mortality even after adjusting for baseline covariates. Great efforts should be directed toward primary and secondary preventive measures.
Published: 2012
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20. Global fertility in 204 countries and territories, 1950-2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Author: V Bhattacharjee, N, E Schumacher, A, Aali, A, Habtegiorgis Abate, Y, Abbasgholizadeh, R, Abbasian, M, Abbasi-Kangevari, M, Abbastabar, H, Abd ElHafeez, S, Abd-Elsalam, S, Abdollahi, M, Abdollahifar, M, Abdoun, M, Abdullahi, A, Abebe, M, Shawel Abebe, S, Abiodun, O, Abolhassani, H, Abolmaali, M, Abouzid, M, Beressa Aboye, G, Guimarães Abreu, L, Aberhe Abrha, W, M Abrigo, M, Abtahi, D, Abualruz, H, Abubakar, B, Abu-Gharbieh, E, Me Abu-Rmeileh, N, Girum Girum Adal, T, Molla Adane, M, Atanda Adeagbo Adeagbo, O, Adesoji Adedoyin, R, Adekanmbi, V, Aden, B, Victor Adepoju, A, O Adetokunboh, O, Bunmi Adetunji, J, Adedayo Adeyinka, D, Israel Adeyomoye, O, Estiningtyas Sakilah Adnani, Q, Adra, S, Felix Afolabi, R, Afyouni, S, Sohail Afzal, M, Afzal, S, Aghamiri, S, Agodi, A, Agyemang-Duah, W, Opoku Ahinkorah, B, J Ahlstrom, A, Ahmad, A, Ahmad, D, Ahmad, F, M Ahmad, M, Ahmad, S, Ahmad, T, Ahmed, A, Ahmed, H, A Ahmed, L, Saleh Ahmed, M, Anees Ahmed, S, Ajami, M, Aji, B, Taddesse Akalu, G, Akbarialiabad, H, Olusola Akinyemi, R, Ahmed Akkaif, M, Akkala, S, Al Hamad, H, Mahfuz Al Hasan, S, Al Qadire, M, Mohammed Ali Al-Ahdal, T, O Alalalmeh, S, A Alalwan, T, Al-Aly, Z, Alam, K, Mustafa Al-Amer, R, Mashhour Alanezi, F, M Alanzi, T, Albakri, A, Albashtawy, M, T AlBataineh, M, Alemi, H, Alemi, S, Mulugeta Alemu, Y, Al-Eyadhy, A, Ali Saeed Al-Gheethi, A, F Alhabib, K, Alhajri, N, Alhalaiqa Naji Alhalaiqa, F, Kaba Alhassan, R, Ali, A, Abdulqadir Ali, B, Ali, L, Usman Ali, M, Ali, R, Shujait Shujait Ali, S, Mohammad Alif, S, Aligol, M, Alijanzadeh, M, M Aljasir, M, Mohamed Aljunid, S, Al-Marwani, S, Uy Almazan, J, M Al-Mekhlafi, H, Almidani, O, A Alomari, M, Al-Omari, B, S Alqahtani, J, Yaseen Alqutaibi, A, M Al-Raddadi, R, Khalifah Al-Sabah, S, Altaf, A, A Al-Tawfiq, J, A Altirkawi, K, Oyine Aluh, D, Jawad Alvi, F, Alvis-Guzman, N, Alwafi, H, Mohammed Al-Worafi, Y, Aly, H, Aly, S, H Alzoubi, K, Kwabena Ameyaw, E, Tawfik Amin, T, Amindarolzarbi, A, Amini-Rarani, M, Amiri, S, 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Jamshidi, Sabzali Javadov, Tahereh Javaheri, Sathish Kumar Jayapal, Shubha Jayaram, Sun Ha Jee, Jayakumar Jeganathan, Anil K Jha, Ravi Prakash Jha, Heng Jiang, Mohammad Jokar, Jost B Jonas, Tamas Joo, Nitin Joseph, Charity Ehimwenma Joshua, Farahnaz Joukar, Jacek Jerzy Jozwiak, Mikk Jürisson, Vaishali K, Billingsley Kaambwa, Abdulkareem Kabir, Ali Kabir, Hannaneh Kabir, Zubair Kabir, Rizwan Kalani, Leila R Kalankesh, Feroze Kaliyadan, Sanjay Kalra, Rajesh Kamath, Sagarika Kamath, Tanuj Kanchan, Edmund Wedam Kanmiki, Kehinde Kazeem Kanmodi, Suthanthira Kannan S, Sushil Kumar Kansal, Rami S Kantar, Neeti Kapoor, Mehrdad Karajizadeh, Manoochehr Karami, Ibraheem M Karaye, Faizan Zaffar Kashoo, Hengameh Kasraei, Nicholas J Kassebaum, Molly B Kassel, Joonas H Kauppila, Foad Kazemi, Sara Kazeminia, John H Kempen, Evie Shoshannah Kendal, Kamyab Keshtkar, Mohammad Keykhaei, Himanshu Khajuria, Amirmohammad Khalaji, Nauman Khalid, Anees Ahmed Khalil, Alireza Khalilian, Faham Khamesipour, Ajmal Khan, Asaduzzaman Khan, Ikramullah Khan, M Nuruzzaman Khan, Maseer Khan, Mohammad Jobair Khan, Moien Ab Khan, Young-Ho Khang, Shaghayegh Khanmohammadi, Khaled Khatab, Armin Khavandegar, Hamid Reza Khayat Kashani, Feriha Fatima Khidri, Moein Khormali, Mohammad Ali Khosravi, Mahmood Khosrowjerdi, Wondwosen Teklesilasie Kidane, Zemene Demelash Kifle, Julie Sojin Kim, Min Seo Kim, Ruth W Kimokoti, Kasey E Kinzel, Girmay Tsegay Kiross, Adnan Kisa, Sezer Kisa, Ali-Asghar Kolahi, Farzad Kompani, Gerbrand Koren, Oleksii Korzh, Soewarta Kosen, Sindhura Lakshmi Koulmane Laxminarayana, Kewal Krishan, Varun Krishna, Vijay Krishnamoorthy, Barthelemy Kuate Defo, Connor M Kubeisy, Burcu Kucuk Bicer, Md Abdul Kuddus, Mohammed Kuddus, Ilari Kuitunen, Mukhtar Kulimbet, Harish Kumar, Satyajit Kundu, Kunle Rotimi Kunle, Om P Kurmi, Asep Kusnali, Dian Kusuma, Evans F Kyei, Ilias Kyriopoulos, Carlo La Vecchia, Ben Lacey, Muhammad Awwal Ladan, Lucie Laflamme, Chandrakant Lahariya, Daphne Teck Ching Lai, Dharmesh Kumar Lal, Ratilal Lalloo, Judit Lám, Demetris Lamnisos, Iván Landires, Francesco Lanfranchi, Berthold Langguth, Ariane Laplante-Lévesque, Heidi Jane Larson, Anders O Larsson, Savita Lasrado, Kamaluddin Latief, Kaveh Latifinaibin, Long Khanh Dao Le, Nhi Huu Hanh Le, Trang Diep Thanh Le, Caterina Ledda, Munjae Lee, Paul H Lee, Seung Won Lee, Yo Han Lee, Gebretsadik Kiros Lema, Elvynna Leong, Temesgen L Lerango, An Li, Ming-Chieh Li, Shanshan Li, Wei Li, Xiaopan Li, Virendra S Ligade, Stephen S Lim, Ro-Ting Lin, Paulina A Lindstedt, Stefan Listl, Gang Liu, Jue Liu, Xiaofeng Liu, Xuefeng Liu, Yuewei Liu, Erand Llanaj, Rubén López-Bueno, Platon D Lopukhov, László Lorenzovici, Paulo A Lotufo, Jailos Lubinda, Giancarlo Lucchetti, Alessandra Lugo, Raimundas Lunevicius, Hengliang Lv, Zheng Feei Ma, Kelsey Lynn Maass, Monika Machoy, Áurea M Madureira-Carvalho, Mohammed Magdy Abd El Razek, Azzam A Maghazachi, Soleiman Mahjoub, Mansour Adam Mahmoud, Azeem Majeed, Jeadran N Malagón-Rojas, Elaheh Malakan Rad, Kashish Malhotra, Ahmad Azam Malik, Iram Malik, Deborah Carvalho Malta, Abdullah A Mamun, Yosef Manla, Yasaman Mansoori, Ali Mansour, Borhan Mansouri, Zeinab Mansouri, Mohammad Ali Mansournia, Joemer C Maravilla, Mirko Marino, Abdoljalal Marjani, Gabriel Martinez, Ramon Martinez-Piedra, Francisco Rogerlândio Martins-Melo, Miquel Martorell, Sharmeen Maryam, Roy Rillera Marzo, Alireza Masoudi, Jishanth Mattumpuram, Richard James Maude, Andrea Maugeri, Erin A May, Mahsa Mayeli, Maryam Mazaheri, John J McGrath, Martin McKee, Anna Laura Wensel McKowen, Susan A McLaughlin, Steven M McPhail, Rahul Mehra, Kamran Mehrabani-Zeinabad, Entezar Mehrabi Nasab, Tesfahun Mekene Meto, Max Alberto Mendez Mendez-Lopez, Walter Mendoza, Ritesh G Menezes, George A Mensah, Alexios-Fotios A Mentis, Sultan Ayoub Meo, Mohsen Merati, Atte Meretoja, Tuomo J Meretoja, Abera M Mersha, Tomislav Mestrovic, Pouya Metanat, Kukulege Chamila Dinushi Mettananda, Sachith Mettananda, Adquate Mhlanga, Laurette Mhlanga, Tianyue Mi, Tomasz Miazgowski, Georgia Micha, Irmina Maria Michalek, Ted R Miller, Le Huu Nhat Minh, Mojgan Mirghafourvand, Erkin M Mirrakhimov, Mizan Kiros Mirutse, Moonis Mirza, Roya Mirzaei, Ashim Mishra, Sanjeev Misra, Philip B Mitchell, Chaitanya Mittal, Babak Moazen, Abdalla Z Mohamed, Ahmed Ismail Mohamed, Jama Mohamed, Mouhand F H Mohamed, Nouh Saad Mohamed, Sakineh Mohammad-Alizadeh-Charandabi, Soheil Mohammadi, Abdollah Mohammadian-Hafshejani, Mustapha Mohammed, Salahuddin Mohammed, Shafiu Mohammed, Ali H Mokdad, Peyman Mokhtarzadehazar, Hossein Molavi Vardanjani, Sabrina Molinaro, Lorenzo Monasta, Mohammad Ali Moni, Maryam Moradi, Yousef Moradi, Paula Moraga, Rafael Silveira Moreira, Negar Morovatdar, Shane Douglas Morrison, Jakub Morze, Abbas Mosapour, Elias Mossialos, Rohith Motappa, Parsa Mousavi, Amin Mousavi Khaneghah, Christine Mpundu-Kaambwa, Sumaira Mubarik, Lorenzo Muccioli, Francesk Mulita, Kavita Munjal, Efrén Murillo-Zamora, Jonah Musa, Fungai Musaigwa, Ana-Maria Musina, Sathish Muthu, Saravanan Muthupandian, Muhammad Muzaffar, Woojae Myung, Ahamarshan Jayaraman Nagarajan, Gabriele Nagel, Pirouz Naghavi, Ganesh R Naik, Gurudatta Naik, Mukhammad David Naimzada, Firzan Nainu, Vinay Nangia, Sreenivas Narasimha Swamy, Bruno Ramos Nascimento, Gustavo G Nascimento, Abdallah Y Naser, Mohammad Javad Nasiri, Zuhair S Natto, Javaid Nauman, Muhammad Naveed, Biswa Prakash Nayak, Vinod C Nayak, Rawlance Ndejjo, Sabina Onyinye Nduaguba, Hadush Negash, Chernet Tafere Negesse, Ionut Negoi, Ruxandra Irina Negoi, Seyed Aria Nejadghaderi, Chakib Nejjari, Samata Nepal, Henok Biresaw Netsere, Georges Nguefack-Tsague, Josephine W Ngunjiri, Dang H Nguyen, Hau Thi Hien Nguyen, Phuong The Nguyen, QuynhAnh P Nguyen, Van Thanh Nguyen, Robina Khan Niazi, Yeshambel T Nigatu, Taxiarchis Konstantinos Nikolouzakis, Ali Nikoobar, Amin Reza Nikpoor, Chukwudi A Nnaji, Lawrence Achilles Nnyanzi, Efaq Ali Noman, Shuhei Nomura, Mamoona Noreen, Nafise Noroozi, Chisom Adaobi Nri-Ezedi, Mengistu H Nunemo, Virginia Nuñez-Samudio, Dieta Nurrika, Jerry John Nutor, Bogdan Oancea, Kehinde O Obamiro, Ismail A Odetokun, Nkechi Martina Odogwu, Martin James O'Donnell, Oluwakemi Ololade Odukoya, Ayodipupo Sikiru Oguntade, James Odhiambo Oguta, In-Hwan Oh, Sylvester Reuben Okeke, Akinkunmi Paul Okekunle, Osaretin Christabel Okonji, Patrick Godwin Okwute, Andrew T Olagunju, Omotola O Olasupo, Matthew Idowu Olatubi, Gláucia Maria Moraes Oliveira, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, Gideon Olamilekan Oluwatunase, Hany A Omar, Goran Latif Omer, Obinna E Onwujekwe, Michal Ordak, Orish Ebere Orisakwe, Verner N Orish, Doris V Ortega-Altamirano, Alberto Ortiz, Esteban Ortiz-Prado, Wael M S Osman, Uchechukwu Levi Osuagwu, Olayinka Osuolale, Adrian Otoiu, Stanislav S Otstavnov, Amel Ouyahia, Guoqing Ouyang, Mayowa O Owolabi, Yaz Ozten, Mahesh Padukudru P A, Mohammad Taha Pahlevan Fallahy, Feng Pan, Hai-Feng Pan, Adrian Pana, Paramjot Panda, Songhomitra Panda-Jonas, Helena Ullyartha Pangaribuan, Georgios D Panos, Leonidas D Panos, Ioannis Pantazopoulos, Anca Mihaela Pantea Stoian, Romil R Parikh, Seoyeon Park, Ashwaghosha Parthasarathi, Ava Pashaei, Roberto Passera, Hemal M Patel, Jay Patel, Shankargouda Patil, Dimitrios Patoulias, Venkata Suresh Patthipati, Uttam Paudel, Mihaela Paun, Hamidreza Pazoki Toroudi, Spencer A Pease, Amy E Peden, Paolo Pedersini, Minjin Peng, Umberto Pensato, Veincent Christian Filipino Pepito, Prince Peprah, Gavin Pereira, Mario F P Peres, Arokiasamy Perianayagam, Norberto Perico, Simone Perna, Richard G Pestell, Fanny Emily Petermann-Rocha, Hoang Tran Pham, Anil K Philip, Daniela Pierannunzio, Manon Pigeolet, David M Pigott, Evgenii Plotnikov, Dimitri Poddighe, Peter Pollner, Ramesh Poluru, Maarten J Postma, Ghazaleh Pourali, Akram Pourshams, Naeimeh Pourtaheri, Disha Prabhu, Sergio I Prada, Pranil Man Singh Pradhan, Manya Prasad, Akila Prashant, Bharathi M Purohit, Jagadeesh Puvvula, Nameer Hashim Qasim, Ibrahim Qattea, Deepthi R, Mehrdad Rabiee Rad, Amir Radfar, Venkatraman Radhakrishnan, Pourya Raee, Hadi Raeisi Shahraki, Alireza Rafiei, Seyedeh Niloufar Rafiei Alavi, Cat Raggi, Pankaja Raghav Raghav, Fakher Rahim, Md Jillur Rahim, Md Mosfequr Rahman, Mohammad Hifz Ur Rahman, Mosiur Rahman, Muhammad Aziz Rahman, Vahid Rahmanian, Masoud Rahmati, Niloufar Rahnavard, Pramila Rai, Diego Raimondo, Ali Rajabpour-Sanati, Prashant Rajput, Prasanna Ram, Shakthi Kumaran Ramasamy, Juwel Rana, Kritika Rana, Shailendra Singh Rana, Chhabi Lal Ranabhat, Nemanja Rancic, Amey Rane, Shubham Ranjan, Chythra R Rao, Indu Ramachandra Rao, Deepthi Rapaka, Davide Rasella, Sina Rashedi, Vahid Rashedi, Mohammad-Mahdi Rashidi, Azad Rasul, Zubair Ahmed Ratan, Giridhara Rathnaiah Babu, Santosh Kumar Rauniyar, Nakul Ravikumar, David Laith Rawaf, Salman Rawaf, Reza Rawassizadeh, Bharat Rawlley, Murali Mohan Rama Krishna Reddy, Elrashdy Moustafa Mohamed Redwan, Giuseppe Remuzzi, Bhageerathy Reshmi, Nazila Rezaei, Aida Rezaei Nejad, Mohsen Rezaeian, Abanoub Riad, Mavra A Riaz, Jennifer Rickard, Reza Rikhtegar, Hannah Elizabeth Robinson-Oden, Célia Fortuna Rodrigues, Jefferson Antonio Buendia Rodriguez, Ravi Rohilla, Debby Syahru Romadlon, Luca Ronfani, Himanshu Sekhar Rout, Bedanta Roy, Nitai Roy, Priyanka Roy, Enrico Rubagotti, Guilherme de Andrade Ruela, Susan Fred Rumisha, Tilleye Runghien, Manjula S, Chandan S N, Aly M A Saad, Zahra Saadatian, Maha Mohamed Saber-Ayad, Morteza SaberiKamarposhti, Siamak Sabour, Fatos Sada, Basema Saddik, Bashdar Abuzed Sadee, Ehsan Sadeghi, Erfan Sadeghi, Mohammad Reza Saeb, Umar Saeed, Sher Zaman Safi, Dominic Sagoe, Manika Saha, Amirhossein Sahebkar, Soumya Swaroop Sahoo, Monalisha Sahu, Zahra Saif, Joseph W Sakshaug, Payman Salamati, Afeez Abolarinwa Salami, Mohamed A Saleh, Marwa Rashad Salem, Mohammed Z Y Salem, Sohrab Salimi, Sara Samadzadeh, Yoseph Leonardo Samodra, Vijaya Paul Samuel, Abdallah M Samy, Juan Sanabria, Nima Sanadgol, Francesca Sanna, Milena M Santric-Milicevic, Haaris Saqib, Sivan Yegnanarayana Iyer Saraswathy, Aswini Saravanan, Babak Saravi, Yaser Sarikhani, Tanmay Sarkar, Rodrigo Sarmiento-Suárez, Gargi Sachin Sarode, Sachin C Sarode, Arash Sarveazad, Brijesh Sathian, Thirunavukkarasu Sathish, Anudeep Sathyanarayan, Abu Sayeed, Md Abu Sayeed, Nikolaos Scarmeas, Winfried Schlee, Art Schuermans, David C Schwebel, Falk Schwendicke, Siddharthan Selvaraj, Pallav Sengupta, Subramanian Senthilkumaran, Sadaf G Sepanlou, Dragos Serban, Edson Serván-Mori, Yashendra Sethi, SeyedAhmad SeyedAlinaghi, Seyed Arsalan Seyedi, Allen Seylani, Mahan Shafie, Jaffer Shah, Pritik A Shah, Ataollah Shahbandi, Samiah Shahid, Moyad Jamal Shahwan, Ahmed Shaikh, Masood Ali Shaikh, Muhammad Aaqib Shamim, Mehran Shams-Beyranvand, Mohammad Anas Shamsi, Mohd Shanawaz, Abhishek Shankar, Mohammed Shannawaz, Medha Sharath, Sadaf Sharfaei, Amin Sharifan, Javad Sharifi-Rad, Manoj Sharma, Rajesh Sharma, Ujjawal Sharma, Vishal Sharma, Rajesh P Shastry, Amin Shavandi, David H Shaw, Amir Mehdi Shayan, Maryam Shayan, Amr Mohamed Elsayed Shehabeldine, Aziz Sheikh, Rahim Ali Sheikhi, Manjunath Mala Shenoy, Pavanchand H Shetty, Peilin Shi, Desalegn Shiferaw, Mika Shigematsu, Rahman Shiri, Reza Shirkoohi, Aminu Shittu, Velizar Shivarov, Farhad Shokraneh, Sina Shool, Seyed Afshin Shorofi, Kanwar Hamza Shuja, Kerem Shuval, Emmanuel Edwar Siddig, João Pedro Silva, Luís Manuel Lopes Rodrigues Silva, Soraia Silva, Biagio Simonetti, Anjali Singal, Abhinav Singh, Balbir Bagicha Singh, Jasvinder A Singh, Md Shahjahan Siraj, Georgia Smith, Bogdan Socea, Anton Sokhan, Ranjan Solanki, Shipra Solanki, Hamidreza Soleimani, Sameh S M Soliman, Yonatan Solomon, Yimeng Song, Reed J D Sorensen, Michael Spartalis, Chandrashekhar T Sreeramareddy, Vijay Kumar Srivastava, Muhammad Haroon Stanikzai, Vladimir I Starodubov, Antonina V Starodubova, Simona Cătălina Stefan, Paschalis Steiropoulos, Mark A Stokes, Vetriselvan Subramaniyan, Muhammad Suleman, Rizwan Suliankatchi Abdulkader, Abida Sultana, Jing Sun, Chandan Kumar Swain, Bryan L Sykes, Lukasz Szarpak, Mindy D Szeto, Miklós Szócska, Payam Tabaee Damavandi, Rafael Tabarés-Seisdedos, Ozra Tabatabaei Malazy, Seyed-Amir Tabatabaeizadeh, Shima Tabatabai, Karen M Tabb, Mohammad Tabish, Moslem Taheri Soodejani, Jabeen Taiba, Ardeshir Tajbakhsh, Iman M Talaat, Ashis Talukder, Mircea Tampa, Jacques Lukenze Tamuzi, Ker-Kan Tan, Haosu Tang, Derbie Alemu DA Tareke, Mengistie Kassahun Tariku, Vivian Y Tat, Seyed Mohammad Tavangar, Mojtaba Teimoori, Mohamad-Hani Temsah, Reem Mohamad Hani Temsah, Masayuki Teramoto, Dufera Rikitu Terefa, Riki Tesler, Enoch Teye-Kwadjo, Ramna Thakur, Pugazhenthan Thangaraju, Kavumpurathu Raman Thankappan, Rekha Thapar, Samar Tharwat, Rasiah Thayakaran, Nihal Thomas, Ales Tichopad, Jansje Henny Vera Ticoalu, Tenaw Yimer Tiruye, Mariya Vladimirovna Titova, Marcello Tonelli, Marcos Roberto Tovani-Palone, Eugenio Traini, Jasmine T Tran, Nghia Minh Tran, Indang Trihandini, Samuel Joseph Tromans, Thien Tan Tri Tai Truyen, Aristidis Tsatsakis, Evangelia Eirini Tsermpini, Munkhtuya Tumurkhuu, Stefanos Tyrovolas, Sayed Mohammad Nazim Uddin, Aniefiok John Udoakang, Arit Udoh, Atta Ullah, Saeed Ullah, Sana Ullah, Srikanth Umakanthan, Chukwuma David Umeokonkwo, Brigid Unim, Bhaskaran Unnikrishnan, Era Upadhyay, Jibrin Sammani Usman, Marco Vacante, Seyed Mohammad Vahabi, Asokan Govindaraj Vaithinathan, Rohollah Valizadeh, Jef Van den Eynde, Elena Varavikova, Orsolya Varga, Priya Vart, Shoban Babu Varthya, Tommi Juhani Vasankari, Balachandar Vellingiri, Deneshkumar Venugopal, Nicholas Alexander Verghese, Madhur Verma, Massimiliano Veroux, Georgios-Ioannis Verras, Dominique Vervoort, Jorge Hugo Villafañe, Manish Vinayak, Francesco S Violante, Mukesh Vishwakarma, Sergey Konstantinovitch Vladimirov, Vasily Vlassov, Bay Vo, Simona Ruxandra Volovat, Theo Vos, Isidora S Vujcic, Hatem A Wafa, Yasir Waheed, Elias Bekele Wakwoya, Cong Wang, Denny Wang, Fang Wang, Shu Wang, Yanzhong Wang, Yuan-Pang Wang, Paul Ward, Emebet Gashaw Wassie, Stefanie Watson, Marcia R Weaver, Kosala Gayan Weerakoon, Daniel J Weiss, Katherine M Wells, Yi Feng Wen, Ronny Westerman, Taweewat Wiangkham, Dakshitha Praneeth Wickramasinghe, Nuwan Darshana Wickramasinghe, Peter Willeit, Yohannes Addisu Wondimagegene, Felicia Wu, Juan Xia, Hong Xiao, Gelin Xu, Suowen Xu, Xiaoyue Xu, Ali Yadollahpour, Shirin Yaghoobpoor, Tina Yaghoobpour, Sajad Yaghoubi, Zwanden Sule Yahaya, Danting Yang, Lin Yang, Yuichiro Yano, Habib Yaribeygi, Pengpeng Ye, Renjulal Yesodharan, Subah Abderehim Yesuf, Saber Yezli, Amanuel Yigezu, Paul Yip, Dong Keon Yon, Naohiro Yonemoto, Yuyi You, Mustafa Z Younis, Zabihollah Yousefi, Chuanhua Yu, Yong Yu, Chun-Wei Yuan, Nima Zafari, Fathiah Zakham, Nazar Zaki, Giulia Zamagni, Milad Zandi, Ghazal G Z Zandieh, Moein Zangiabadian, Mikhail Sergeevich Zastrozhin, Haijun Zhang, Meixin Zhang, Yunquan Zhang, Chenwen Zhong, Juexiao Zhou, Bin Zhu, Lei Zhu, Magdalena Zielińska, Zhiyong Zou, Samer H Zyoud, Christopher J L Murray, Amanda E Smith, and Stein Emil Vollset
Abstract: Background: Accurate assessments of current and future fertility-including overall trends and changing population age structures across countries and regions-are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios. Methods: To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10-54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in
Published: 2024

21. Association of the triglyceride glucose index as a measure of insulin resistance with mortality and cardiovascular disease in populations from five continents (PURE study): a prospective cohort study

Author: Patricio, Lopez-Jaramillo, Diego, Gomez-Arbelaez, Daniel, Martinez-Bello, Marc Evans M, Abat, Khalid F, Alhabib, Álvaro, Avezum, Olga, Barbarash, Jephat, Chifamba, Maria L, Diaz, Sadi, Gulec, Noorhassim, Ismail, Romaina, Iqbal, Roya, Kelishadi, Rasha, Khatib, Fernando, Lanas, Naomi S, Levitt, Yang, Li, Viswanathan, Mohan, Prem K, Mony, Paul, Poirier, Annika, Rosengren, Biju, Soman, Chuangshi, Wang, Yang, Wang, Karen, Yeates, Rita, Yusuf, Afzalhussein, Yusufali, Katarzyna, Zatonska, Sumathy, Rangarajan, and Salim, Yusuf
Subjects: Psychiatry and Mental health, Health (social science), Geriatrics and Gerontology, Family Practice
Abstract: The triglyceride glucose (TyG) index is an easily accessible surrogate marker of insulin resistance, an important pathway in the development of type 2 diabetes and cardiovascular diseases. However, the association of the TyG index with cardiovascular diseases and mortality has mainly been investigated in Asia, with few data available from other regions of the world. We assessed the association of insulin resistance (as determined by the TyG index) with mortality and cardiovascular diseases in individuals from five continents at different levels of economic development, living in urban or rural areas. We also examined whether the associations differed according to the country's economical development.We used the TyG index as a surrogate measure for insulin resistance. Fasting triglycerides and fasting plasma glucose were measured at the baseline visit in 141 243 individuals aged 35-70 years from 22 countries in the Prospective Urban Rural Epidemiology (PURE) study. The TyG index was calculated as Ln (fasting triglycerides [mg/dL] x fasting plasma glucose [mg/dL]/2). We calculated hazard ratios (HRs) using a multivariable Cox frailty model with random effects to test the associations between the TyG index and risk of cardiovascular diseases and mortality. The primary outcome of this analysis was the composite of mortality or major cardiovascular events (defined as death from cardiovascular causes, and non-fatal myocardial infarction, or stroke). Secondary outcomes were non-cardiovascular mortality, cardiovascular mortality, all myocardial infarctions, stroke, and incident diabetes. We also did subgroup analyses to examine the magnitude of associations between insulin resistance (ie, the TyG index) and outcome events according to the income level of the countries.During a median follow-up of 13·2 years (IQR 11·9-14·6), we recorded 6345 composite cardiovascular diseases events, 2030 cardiovascular deaths, 3038 cases of myocardial infarction, 3291 cases of stroke, and 5191 incident cases of type 2 diabetes. After adjusting for all other variables, the risk of developing cardiovascular diseases increased across tertiles of the baseline TyG index. Compared with the lowest tertile of the TyG index, the highest tertile (tertile 3) was associated with a greater incidence of the composite outcome (HR 1·21; 95% CI 1·13-1·30), myocardial infarction (1·24; 1·12-1·38), stroke (1·16; 1·05-1·28), and incident type 2 diabetes (1·99; 1·82-2·16). No significant association of the TyG index was seen with non-cardiovascular mortality. In low-income countries (LICs) and middle-income countries (MICs), the highest tertile of the TyG index was associated with increased hazards for the composite outcome (LICs: HR 1·31; 95% CI 1·12-1·54; MICs: 1·20; 1·11-1·31; pThe TyG index is significantly associated with future cardiovascular mortality, myocardial infarction, stroke, and type 2 diabetes, suggesting that insulin resistance plays a promoting role in the pathogenesis of cardiovascular and metabolic diseases. Potentially, the association between the TyG index and the higher risk of cardiovascular diseases and type 2 diabetes in LICs and MICs might be explained by an increased vulnerability of these populations to the presence of insulin resistance.Full funding sources are listed at the end of the paper (see Acknowledgments).
Published: 2023

22. Ultra-processed foods and mortality: analysis from the Prospective Urban and Rural Epidemiology study

Author: Mahshid Dehghan, Andrew Mente, Sumathy Rangarajan, Viswanathan Mohan, Sumathi Swaminathan, Alvaro Avezum, Scott A. Lear, Annika Rosengren, Paul Poirier, Fernando Lanas, Patricio Lopez-Jaramillo, Biju Soman, Chuangshi Wang, Andrés Orlandini, Noushin Mohammadifard, Khalid F. AlHabib, Jephat Chifamba, Afzal Hussein Yusufali, Romaina Iqbal, Rasha Khatib, Karen Yeates, Thandi Puoane, Yuksel Altuntas, Homer Uy Co, Sidong Li, Weida Liu, Katarzyna Zatońska, Rita Yusuf, Noorhassim Ismail, Victoria Miller, and Salim Yusuf
Subjects: Nutrition and Dietetics, Medicine (miscellaneous)
Published: 2023

23. Influenza vaccine to reduce adverse vascular events in patients with heart failure: a multinational randomised, double-blind, placebo-controlled trial

Author: Mark, Loeb, Ambuj, Roy, Hisham, Dokainish, Antonio, Dans, Lia M, Palileo-Villanueva, Kamilu, Karaye, Jun, Zhu, Yan, Liang, Fastone, Goma, Albertino, Damasceno, Khalid F, Alhabib, Gerald, Yonga, Charles, Mondo, Wael, Almahameed, Arif, Al Mulla, Vitheya, Thanabalan, Purnima, Rao-Melacini, Alex, Grinvalds, Tara, McCready, Shrikant I, Bangdiwala, and Salim, Yusuf
Subjects: Adult, Male, Heart Failure, Canada, Adolescent, Myocardial Infarction, Pneumonia, General Medicine, Kenya, Stroke, Influenza Vaccines, Influenza, Human, Humans, Female
Abstract: Influenza increases the risk of cardiovascular events and deaths. We aimed to see whether influenza vaccination reduces death and vascular events in patients with heart failure.We did a pragmatic, randomised, double-blind, placebo-controlled trial in 30 centres (mostly hospitals affliated with universities or a research institute) in ten countries in Asia, the Middle East, and Africa (7 in India, 4 in Philippines, 4 in Nigeria, 6 in China, 1 in Zambia, 2 in Mozambique, 3 in Saudi Arabia, 1 in Kenya, 1 in Uganda, and 1 in Zambia). Participants (aged ≥18 years; 52·1% female; not disaggregated by race or ethnicity) with heart failure (New York Heart Association class II, III, or IV) were randomly assigned (1:1) by a centralised web-based system with block randomisation stratified by site, to receive 0·5 ml intramuscularly once a year for up to 3 years of either inactivated standard dose influenza vaccine or placebo (saline). We excluded people who had received influenza vaccine in 2 of the previous 3 years, and those likely to require valve repair or replacement. Those who administered assigned treatments were not masked and had no further role in the study. Investigators, study coordinators, outcome adjudicators, and participants were masked to group assignment. The first of two co-primary outcomes was a first-event composite for cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke, and the second was a recurrent-events composite for cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and hospitalisation for heart failure. Outcomes were assessed every 6 months in the intention-to-treat population. Secondary outcomes were all-cause death, cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, all-cause hospitalisation, hospitalisation for heart failure, and pneumonia, both overall and during periods of peak influenza exposure. This study is registered with ClinicalTrials.gov, NCT02762851.Between June 2, 2015, and Nov 21, 2021, we enrolled 5129 participants and randomly assigned (1:1) 2560 (50·0%) to influenza vaccine and 2569 (50·0%) to placebo. The first co-primary outcome occurred in 380 (14·8%) of 2560 participants in the vaccine group and 410 (16·0%) of 2569 participants in the placebo group (hazard ratio [HR] 0·93 [95% CI 0·81-1·07]; p=0·30). The second co-primary outcome occurred in 754 (29·5%) of 2560 participants in the vaccine group and 819 (31·9%) of 2569 participants in the placebo group; HR 0·92 [95% CI 0·84-1·02]; p=0·12). The secondary outcomes of all-cause hospitalisations (HR 0·84 [95% CI 0·74-0·97]; p=0·013) and pneumonia (HR 0·58 [0·42-0·80]; p=0·0006) were significantly reduced in the vaccine group compared with in the placebo group but there was no significant difference between groups for all-cause death, cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and hospitalisation for heart failure. In a prespecified analysis, in which events were limited to periods of peak influenza circulation, the first co-primary outcome, and the secondary outcomes of all-cause death, cardiovasular death, and pneumonia were significantly lower in the vaccinated group than in the placebo group, whereas the second co-primary outcome and the secondary outcomes of non-fatal myocardial infarction, non-fatal stroke, all-cause hospitalisation, and hospitalisation for heart failure were not significantly lower.Although the prespecified co-primary outcomes during the entire period of observation were not statistically significant, the reduction during the peak influenza circulating period suggests that there is likely to be a clinical benefit of giving influenza vaccine, given the clear reduction in pneumonia, a moderate reduction in hospitalisations, and a reduction in cardiovascular events and deaths during periods of peak circulation of influenza. Taken in conjunction with previous trials and the observational studies, the collective data suggest benefit.UK Joint Global Health Trials Scheme and Canadian Institutes for Health Research Foundation.
Published: 2022

24. Variations in risks from smoking between high-income, middle-income, and low-income countries: an analysis of data from 179 000 participants from 63 countries

Author: Thirunavukkarasu Sathish, Koon K Teo, Philip Britz-McKibbin, Biban Gill, Shofiqul Islam, Guillaume Paré, Sumathy Rangarajan, MyLinh Duong, Fernando Lanas, Patricio Lopez-Jaramillo, Prem K Mony, Lakshmi Pinnaka, Vellappillil Raman Kutty, Andres Orlandini, Alvaro Avezum, Andreas Wielgosz, Paul Poirier, Khalid F Alhabib, Ahmet Temizhan, Jephat Chifamba, Karen Yeates, Iolanthé M Kruger, Rasha Khatib, Rita Yusuf, Annika Rosengren, Katarzyna Zatonska, Romaina Iqbal, Weida Lui, Xinyue Lang, Sidong Li, Bo Hu, Antonio L Dans, Afzal Hussein Yusufali, Ahmad Bahonar, Martin J O’Donnell, Martin McKee, Salim Yusuf, Masira, and 12079642 - Kruger, Iolanthe Marike
Subjects: Adult, Male, Carbon Monoxide, Nicotine, Developed Countries, Respiratory Tract Diseases, Myocardial Infarction, General Medicine, Middle Aged, Stroke, Cardiovascular Diseases, Neoplasms, Tobacco Smoking, Humans, Female, Prospective Studies, Developing Countries, Aged
Abstract: Digital, Background Separate studies suggest that the risks from smoking might vary between high-income (HICs), middle-income (MICs), and low-income (LICs) countries, but this has not yet been systematically examined within a single study using standardised approaches. We examined the variations in risks from smoking across different country income groups and some of their potential reasons. Methods We analysed data from 134 909 participants from 21 countries followed up for a median of 11·3 years in the Prospective Urban Rural Epidemiology (PURE) cohort study; 9711 participants with myocardial infarction and 11 362 controls from 52 countries in the INTERHEART case-control study; and 11 580 participants with stroke and 11 331 controls from 32 countries in the INTERSTROKE case-control study. In PURE, all-cause mortality, major cardiovascular disease, cancers, respiratory diseases, and their composite were the primary outcomes for this analysis. Biochemical verification of urinary total nicotine equivalent was done in a substudy of 1000 participants in PURE. Findings In PURE, the adjusted hazard ratio (HR) for the composite outcome in current smokers (vs never smokers) was higher in HICs (HR 1·87, 95% CI 1·65–2·12) than in MICs (1·41, 1·34–1·49) and LICs (1·35, 1·25–1·46; interaction p, Funding Full funding sources are listed at the end of the paper (see Acknowledgments)., Ciencias Médicas y de la Salud
Published: 2022

25. Urbanization and physical activity in the global Prospective Urban and Rural Epidemiology study

Author: Kwadwo Boakye, Marit Bovbjerg, John Schuna, Branscum Adam, D Ravi Varma, Rosnah Ismail, Olga Barbarash, Juan Dominguez, Yuksel Altuntas, Ranjit Anjana, Rita Yusuf, Roya Kelishadi, Patricio Jaramillo, Romaina Iqbal, Pamela Seron, Annika Rosengren, Paul Poirier, PVM Lakshmi, Rasha Khatib, Katarzyna Zatońska, Bo Hu, Lu Yin, Chuangshi Wang, Karen Yeates, Jephat Chifamba, Khalid F Alhabib, Álvaro Avezum, Antonio Das, Scott Lear, Salim Yusuf, and Perry Hystad
Subjects: Multidisciplinary
Abstract: Urbanization may influence physical activity (PA) levels, although little evidence is available for low- and middle- income countries where urbanization is occurring fastest. We evaluated associations between urbanization and total PA, as well as work-, leisure-, home-, and transport-specific PA, for 138,206 adults living in 698 communities across 22 countries within the Prospective Urban and Rural Epidemiology (PURE) study. The 1-week long-form International PA Questionnaire was administered at baseline (2003–2015). We used satellite-derived population density and impervious surface area estimates to quantify baseline urbanization levels for study communities, as well as change measures for 5- and 10-years prior to PA surveys. We used generalized linear mixed effects models to examine associations between urbanization measures and PA levels, controlling for individual, household and community factors. Higher community baseline levels of population density (− 12.4% per IQR, 95% CI − 16.0, − 8.7) and impervious surface area (− 29.2% per IQR, 95% CI − 37.5, − 19.7), as well as the rate of change in 5-year population density (− 17.2% per IQR, 95% CI − 25.7, − 7.7), were associated with lower total PA levels. Important differences in the associations between urbanization and PA were observed between PA domains, country-income levels, urban/rural status, and sex. These findings provide new information on the complex associations between urbanization and PA.
Published: 2023

26. Associations of Antibiotics, Hormonal Therapies, Oral Contraceptives, and Long-Term NSAIDs with Inflammatory Bowel Disease: Results from the Prospective Urban Rural Epidemiology (PURE) Study

Author: Neeraj Narula, Emily C.L. Wong, Cara Pray, John K. Marshall, Sumathy Rangarajan, Shofiqul Islam, Ahmad Bahonar, Khalid F. Alhabib, Anna Kontsevaya, Farnaza Ariffin, Homer U. Co, Wadeia Al Sharief, Andrzej Szuba, Andreas Wielgosz, Maria Luz Diaz, Rita Yusuf, Lanthé Kruger, Biju Soman, Yang Li, Chuangshi Wang, Lu Yin, Mirrakhimov Erkin, Fernando Lanas, Kairat Davletov, Annika Rosengren, Patricio Lopez-Jaramillo, Rasha Khatib, Aytekin Oguz, Romaina Iqbal, Karen Yeates, Álvaro Avezum, Walter Reinisch, Paul Moayyedi, and Salim Yusuf
Subjects: Hepatology, Gastroenterology
Abstract: Several medications have been suspected to contribute to the etiology of inflammatory bowel disease (IBD). This study assessed the association between medication use and risk of developing IBD using the Prospective Urban Rural Epidemiology (PURE) cohort.This was a prospective cohort study of 133,137 individuals between the ages of 20-80 from 24 countries. Country-specific validated questionnaires documented baseline and follow-up medication use. Participants were followed prospectively at least every 3 years. The main outcome was development of IBD, including Crohn's disease (CD) and ulcerative colitis (UC). Short-term (baseline but not follow-up use) and long-term use (baseline and subsequent follow-up use) were evaluated. Results are presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI).During a median follow-up of 11.0 years [interquartile range (IQR) 9.2-12.2], there were 571 incident IBD cases (143 CD and 428 UC). Incident IBD was significantly associated with baseline antibiotic [aOR: 2.81 (95% CI: 1.67-4.73), p=0.0001] and hormonal medication use [aOR: 4.43 (95% CI: 1.78-11.01), p=0.001]. Among females, previous or current oral contraceptive use was also associated with IBD development [aOR: 2.17 (95% CI: 1.70-2.77), p0.001]. NSAID users were also observed to have increased odds of IBD [aOR: 1.80 (95% CI: 1.23-2.64), p=0.002], which was driven by long-term use [aOR: 5.58 (95% CI: 2.26-13.80), p0.001]. All significant results were consistent in direction for CD and UC with low heterogeneity.Antibiotics, hormonal medications, oral contraceptives, and long-term NSAID use were associated with increased odds of incident IBD after adjustment for covariates.
Published: 2022

27. White Rice Intake and Incident Diabetes: A Study of 132,373 Participants in 21 Countries

Author: Jephat Chifamba, Chuangshi Wang, Afzalhussein Yusufali, Rajeev Gupta, Viswanathan Mohan, Balaji Bhavadharini, Andrew Mente, Katarzyna Zatońska, Noushin Mohammadifard, Edelweiss Wentzel-Viljoen, Patricio Lopez-Jaramillo, Paul Poirier, Mirac Vural Keskinler, Noor Hassim Ismail, Xiaoyun Liu, Sumathi Swaminathan, Rasha Khatib, Fernando Lanas, Rita Yusuf, Ng Kien Keat, P V M Lakshmi, Andreas Wielgosz, Annika Rosengren, Patrick Sheridan, Romaina Iqbal, Li Wei, Sumathy Rangarajan, Khalid F. AlHabib, Rafael Diaz, Alvaro Avezum, Mahshid Dehghan, Salim Yusuf, Lia M. Palileo-Villanueva, Antonio L. Dans, Karen Yeates, Masira, and 10998497 - Wentzel-Viljoen, Edelweiss
Subjects: Adult, Male, Rural Population, Research design, Canada, medicine.medical_specialty, Asia, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, Eating, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Diabetes mellitus, Epidemiology, Prevalence, Internal Medicine, Humans, Medicine, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Aged, Proportional Hazards Models, Advanced and Specialized Nursing, business.industry, Proportional hazards model, Incidence, Incidence (epidemiology), Oryza, Middle Aged, South America, medicine.disease, Diet, Europe, Diabetes Mellitus, Type 2, Africa, Cohort, White rice, Female, business, Follow-Up Studies, Demography
Abstract: Digital, OBJECTIVE Previous prospective studies on the association of white rice intake with incident diabetes have shown contradictory results but were conducted in single countries and predominantly in Asia. We report on the association of white rice with risk of diabetes in the multinational Prospective Urban Rural Epidemiology (PURE) study. RESEARCH DESIGN AND METHODS Data on 132,373 individuals aged 35–70 years from 21 countries were analyzed. White rice consumption (cooked) was categorized as, Ciencias Médicas y de la Salud
Published: 2020

28. Association of nut intake with risk factors, cardiovascular disease, and mortality in 16 countries from 5 continents: analysis from the Prospective Urban and Rural Epidemiology (PURE) study

Author: Russell J. de Souza, Rosnah Ismail, Pure study investigators, Paul Poirier, G Dagenais, Mahshid Dehghan, Roya Kelishadi, Rafael Diaz, Alicja Basiak-Rasała, Leela Itty Amma, Sonia S. Anand, Karen Yeates, Yuksel Altuntas, Rasha Khatib, Khalid F. AlHabib, Koon K. Teo, Shrikant I. Bangdiwala, Annika Rosengren, Edelweiss Wentzel-Viljoen, Rita Yusuf, Sumathy Rangarajan, Andrew Mente, Salim Yusuf, Patricio Lopez-Jaramillo, Sumathi Swaminathan, Viswanathan Mohan, Scott A. Lear, SH Ahmed, and 10998497 - Wentzel-Viljoen, Edelweiss
Subjects: Adult, Male, Rural Population, Nut, medicine.medical_specialty, Urban Population, Global health, Medicine (miscellaneous), Disease, 030204 cardiovascular system & hematology, Lower risk, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Epidemiology, medicine, Humans, Nuts, Prospective Studies, 030212 general & internal medicine, Myocardial infarction, Mortality, Prospective cohort study, Stroke, Nutrition and Dietetics, Asia, Eastern, business.industry, Middle Aged, Prospective cohort, Cardiovascular disease, medicine.disease, United States, Europe, Cardiovascular Diseases, Heart failure, Female, business, Demography
Abstract: Background The association of nuts with cardiovascular disease and deaths has been investigated mostly in Europe, the USA, and East Asia, with few data available from other regions of the world or from low- and middle-income countries. Objective To assess the association of nuts with mortality and cardiovascular disease (CVD). Methods The Prospective Urban Rural Epidemiology study is a large multinational prospective cohort study of adults aged 35–70 y from 16 low-, middle-, and high-income countries on 5 continents. Nut intake (tree nuts and ground nuts) was measured at the baseline visit, using country-specific validated FFQs. The primary outcome was a composite of mortality or major cardiovascular event [nonfatal myocardial infarction (MI), stroke, or heart failure]. Results We followed 124,329 participants (age = 50.7 y, SD = 10.2; 41.5% male) for a median of 9.5 y. We recorded 10,928 composite events [deaths (n = 8,662) or major cardiovascular events (n = 5,979)]. Higher nut intake (>120 g per wk compared with
Published: 2020

29. The burden of disease in Saudi Arabia 1990–2017: results from the Global Burden of Disease Study 2017

Author: Badr Hasan Sobaih, Rajaa Al-Raddadi, Varsha Krish, Ziad A. Memish, Suliman Alghnam, Neeraj Bedi, Nasir Salam, Ali H. Mokdad, Yousef Mohammad, Charbel El Bcheraoui, Demosthenes B. Panagiotakos, Majid A Almadi, Khalid F. AlHabib, Stefanos Tyrovolas, Alex Molassiotis, and Maha El Tantawi
Subjects: Burden of disease, Health (social science), Index (economics), Occupational risk, Health Status, Population, education, Saudi Arabia, Medicine (miscellaneous), Population health, 010501 environmental sciences, 01 natural sciences, Health Services Accessibility, Global Burden of Disease, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Environmental health, Health care, parasitic diseases, Medicine, 030212 general & internal medicine, Mortality, lcsh:Environmental sciences, 0105 earth and related environmental sciences, lcsh:GE1-350, education.field_of_study, Middle East, business.industry, Health Policy, Public Health, Environmental and Occupational Health, Articles, humanities, Substance use, business, geographic locations
Abstract: Summary Background Availability of data to assess the population health and provision and quality of health care in Saudi Arabia has been lacking. In 2010, Saudi Arabia began a major investment and transformation programme in the health-care sector. Here we assess the impact of this investment era on mortality, health loss, risk factors, and health-care services in the country. Methods We used results of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to describe the levels and temporal patterns in deaths, health loss, risk factors, and health-care access and quality in the Saudi Arabian population during 1990–2010 (before the health-care investments and reform) and 2010–17 (during health-care investments and reform). We also compared patterns in health outcomes between these periods with those in the north Africa and the Middle East GBD region and the Gulf Cooperation Council countries. Findings Age-standardised mortality in Saudi Arabia decreased from 1990 to 2010 (annualised rate of change of −0·58%), and this decrease was further accelerated from 2010 to 2017 (–2·20%). The north Africa and the Middle East GBD region also had decreases in mortality during these periods, but for 2010–17 the decrease was not as low as in Saudi Arabia (–1·29%). Transport injuries decreased from third ranked cause of disability-adjusted life-years in 2010 to fifth ranked cause in 2017 in Saudi Arabia, below cardiovascular diseases (ranked first) and musculoskeletal disorders (ranked second). Years lived with disability (YLDs) due to mental disorders, substance use disorders, neoplasms, and neurological disorders consistently increased over the periods 1990–2010 and 2010–17. Between 1990 and 2017, attributable YLDs due to metabolic, behavioural, and environmental or occupational risk factors remained almost unchanged in Saudi Arabia, with high body-mass index, high fasting plasma glucose concentration, and drug use increasing across all age groups. Health-care Access and Quality (HAQ) Index levels increased in Saudi Arabia during this period with similar patterns to the rest of the Gulf Cooperation Council countries and the north Africa and the Middle East GBD region. Interpretation Decreases in mortality continued at greater rates in Saudi Arabia during the period of 2010–17 than in 1990–2010. HAQ Index levels have also improved. Public health policy makers in Saudi Arabia need to increase efforts to address preventable risk factors that are major contributors to the burden of ill health and disability. Funding Bill & Melinda Gates Foundation.
Published: 2020

30. Variations in the financial impact of the COVID-19 pandemic across 5 continents: A cross-sectional, individual level analysis

Author: Aditya K Khetan, Salim Yusuf, Patricio Lopez-Jaramillo, Andrzej Szuba, Andres Orlandini, Nafiza Mat-Nasir, Aytekin Oguz, Rajeev Gupta, Álvaro Avezum, Ismail Rosnah, Paul Poirier, Koon K Teo, Andreas Wielgosz, Scott A. Lear, Lia M. Palileo-Villanueva, Pamela Serón, Jephat Chifamba, Sumathy Rangarajan, Maha Mushtaha, Deepa Mohan, Karen Yeates, Martin McKee, Prem K Mony, Marjan Walli-Attaei, Hamda Khansaheb, Annika Rosengren, Khalid F Alhabib, Iolanthé M Kruger, María-José Paucar, Erkin Mirrakhimov, Batyrbek Assembekov, Darryl P Leong, and Masira
Subjects: Medicine (General), R5-920, Articles, General Medicine
Abstract: Digital, Background COVID-19 has caused profound socio-economic changes worldwide. However, internationally comparative data regarding the financial impact on individuals is sparse. Therefore, we conducted a survey of the financial impact of the pandemic on individuals, using an international cohort that has been well-characterized prior to the pandemic. Methods Between August 2020 and September 2021, we surveyed 24,506 community-dwelling participants from the Prospective Urban-Rural Epidemiology (PURE) study across high (HIC), upper middle (UMIC)-and lower middle (LMIC)-income countries. We collected information regarding the impact of the pandemic on their self-reported personal finances and sources of income. Findings Overall, 32.4% of participants had suffered an adverse financial impact, defined as job loss, inability to meet financial obligations or essential needs, or using savings to meet financial obligations. 8.4% of participants had lost a job (temporarily or permanently); 14.6% of participants were unable to meet financial obligations or essential needs at the time of the survey and 16.3% were using their savings to meet financial obligations. Participants with a post-secondary education were least likely to be adversely impacted (19.6%), compared with 33.4% of those with secondary education and 33.5% of those with pre-secondary education. Similarly, those in the highest wealth tertile were least likely to be financially impacted (26.7%), compared with 32.5% in the middle tertile and 30.4% in the bottom tertile participants. Compared with HICs, financial impact was greater in UMIC [odds ratio of 2.09 (1.88–2.33)] and greatest in LMIC [odds ratio of 16.88 (14.69–19.39)]. HIC participants with the lowest educational attainment suffered less financial impact (15.1% of participants affected) than those with the highest education in UMIC (22.0% of participants affected). Similarly, participants with the lowest education in UMIC experienced less financial impact (28.3%) than those with the highest education in LMIC (45.9%). A similar gradient was seen across country income categories when compared by pre-pandemic wealth status. Interpretation The financial impact of the pandemic differs more between HIC, UMIC, and LMIC than between socio-economic categories within a country income level. The most disadvantaged socio-economic subgroups in HIC had a lower financial impact from the pandemic than the most advantaged subgroup in UMIC, with a similar disparity seen between UMIC and LMIC. Continued high levels of infection will exacerbate financial inequity between countries and hinder progress towards the sustainable development goals, emphasising the importance of effective measures to control COVID-19 and, especially, ensuring high vaccine coverage in all countries., Funding Funding for this study was provided by the Canadian Institutes of Health Research and the International Development Research Centre., Ciencias Médica y de la Salud
Published: 2022

31. The Gulf Familial Hypercholesterolemia Registry (Gulf FH): Design, Rationale and Preliminary Results

Author: Mohammed A. Batais, Ibrahim Al-Zakwani, Hani Sabbour, Khalid Al-Rasadi, Khalid Al-Waili, Abdulhalim Jamal Kinsara, Ahmad Al-Sarraf, Nasreen Al-Sayed, Turky H. Almigbal, Hani Altaradi, Mohammad Alghamdi, Wael Almahmeed, Zuhier Awan, Omer A. Elamin, Khalid F. AlHabib, Fahad Alnouri, Ashraf Hammouda, Mohammed Al-Jarallah, Haitham Amin, Faisal A. Al-Allaf, Heba Kary, Abdullah Shehab, and Fahad Zadjali
Subjects: Adult, Male, Pediatrics, medicine.medical_specialty, Time Factors, Adolescent, Adult population, Consanguinity, Familial hypercholesterolemia, 030204 cardiovascular system & hematology, Hyperlipoproteinemia Type II, Middle East, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Prevalence, Humans, Medicine, Genetic Predisposition to Disease, Longitudinal Studies, Registries, 030212 general & internal medicine, Lipid clinic, Aged, Retrospective Studies, Genetic testing, Pharmacology, medicine.diagnostic_test, business.industry, Middle Aged, Prognosis, medicine.disease, Lipids, Cross-Sectional Studies, Phenotype, Research Design, Clinical diagnosis, Cohort, Female, Cardiology and Cardiovascular Medicine, business, Lipid profile, Biomarkers, Preliminary Data
Abstract: Aim: To determine the prevalence, genetic characteristics, current management and outcomes of familial hypercholesterolaemia (FH) in the Gulf region. Methods: Adult (18-70 years) FH patients were recruited from 9 hospitals and centres across 5 Arabian Gulf countries. The study was divided into 4 phases and included patients from 3 different categories. In phase 1, suspected FH patients (category 1) were collected according to the lipid profile and clinical data obtained through hospital record systems. In phase 2, patients from category 2 (patients with a previous clinical diagnosis of FH) and category 1 were stratified into definitive, probable and possible FH according to the Dutch Lipid Clinic Network criteria. In phase 3, 500 patients with definitive and probable FH from categories 1 and 2 will undergo genetic testing for 4 common FH genes. In phase 4, these 500 patients with another 100 patients from category 3 (patients with previous genetic diagnosis of FH) will be followed for 1 year to evaluate clinical management and cardiovascular outcomes. The Gulf FH cohort was screened from a total of 34,366 patients attending out-patient clinics. Results: The final Gulf FH cohort consisted of 3,317 patients (mean age: 47±12 years, 54% females). The number of patients with definitive FH is 203. In this initial phase of the study, the prevalence of (probable and definite) FH is 1/232. Conclusion: The prevalence of FH in the adult population of the Arabian Gulf region is high. The Gulf FH registry, a first-of-a-kind multi-national study in the Middle East region, will help in improving underdiagnosis and undertreatment of FH in the region.
Published: 2019

32. Impact of diabetes on mortality and rehospitalization in acute heart failure patients stratified by ejection fraction

Author: Ahmed Al-Motarreb, Haitham Amin, Abdelfatah Elasfar, Nooshin Bazargani, Ibrahim Al-Zakwani, Alawi A. Alsheikh-Ali, Rajesh Rajan, Kadhim Sulaiman, Jassim Al Suwaidi, Khalid F. AlHabib, Mustafa Ridha, Prashanth Panduranga, Hussam AlFaleh, Mohammed Al-Jarallah, Raja Dashti, Nidal Asaad, Bassam Bulbanat, and Wael Almahmeed
Subjects: Adult, Male, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Adolescent, Heart failure, 030204 cardiovascular system & hematology, Ventricular Function, Left, 03 medical and health sciences, Middle East, Young Adult, 0302 clinical medicine, Diabetes mellitus, Risk Factors, Internal medicine, Original Research Articles, Cause of Death, medicine, Humans, In patient, 030212 general & internal medicine, Original Research Article, Prospective Studies, Registries, Mortality, Aged, Aged, 80 and over, Ejection fraction, business.industry, Mean age, Stroke Volume, Odds ratio, Middle Aged, medicine.disease, Prognosis, Confidence interval, Hospitalization, lcsh:RC666-701, Cohort, Acute Disease, Female, Cardiology and Cardiovascular Medicine, business, Readmission, Follow-Up Studies
Abstract: Aims The aim of this study is to determine the impact of diabetes mellitus on all‐cause mortality and rehospitalization rates at 3 months and at 1 year in patients admitted with acute heart failure (AHF) stratified by left ventricular ejection fraction (EF). Methods and results We analysed consecutive patients admitted to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) with AHF from February to November 2012 with AHF who were enrolled in Gulf CARE, a multinational registry of patients with heart failure (HF). AHF patients were stratified into three groups: HF patients with reduced (EF) (HFrEF) (
Published: 2019

33. Timing of Staged Nonculprit Artery Revascularization in Patients With ST-Segment Elevation Myocardial Infarction

Author: Complete Investigators, Brandi Meeks, David A. Wood, Jaydeep Sarma, Robert F. Storey, Stefan James, Madhu K. Natarajan, Vladimir Dzavik, Jia Wang, Michel Nguyen, John A. Cairns, Matyas Keltai, Roxana Mehran, Helen Nguyen, Payam Dehghani, Sanjit S. Jolly, Shamir R. Mehta, Asim N. Cheema, Ota Hlinomaz, Jean-François Tanguay, Hahn-Ho Kim, Khalid F. AlHabib, Kari Niemelä, Anthony Della Siega, Basil S. Lewis, Vijay Kunadian, and John Amerena
Subjects: medicine.medical_specialty, Randomization, business.industry, medicine.medical_treatment, Hazard ratio, Percutaneous coronary intervention, 030204 cardiovascular system & hematology, medicine.disease, Revascularization, Coronary artery disease, 03 medical and health sciences, surgical procedures, operative, 0302 clinical medicine, Internal medicine, Conventional PCI, medicine, Cardiology, ST segment, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Cardiology and Cardiovascular Medicine, business
Abstract: Background The COMPLETE (Complete vs Culprit-only Revascularization to Treat Multi-vessel Disease After Early PCI for STEMI) trial demonstrated that staged nonculprit lesion percutaneous coronary intervention (PCI) reduced major cardiovascular (CV) events in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD). Objectives The purpose of this study was to determine the effect of nonculprit-lesion PCI timing on major CV outcomes and also the time course of the benefit of complete revascularization. Methods Following culprit-lesion PCI, 4,041 patients with STEMI and multivessel CAD were randomized to staged nonculprit-lesion PCI or culprit-lesion only PCI. Randomization was stratified according to investigator-planned timing of nonculprit-lesion PCI: during or after the index hospitalization. The first coprimary outcome was the composite of CV death or myocardial infarction (MI). In pre-specified analyses, hazard ratios (HRs) were calculated for each time stratum. Landmark analyses of the entire population were performed within 45 days and after 45 days. Results For nonculprit-lesion PCI planned during the index hospitalization (actual time: median 1 day), CV death or MI was reduced with complete revascularization compared with culprit-lesion only PCI (HR: 0.77; 95% confidence interval [CI]: 0.59 to 1.00). For nonculprit lesion PCI planned to occur after hospital discharge (actual time: median 23 days), CV death or MI was also reduced with complete revascularization (HR: 0.69; 95% CI: 0.49 to 0.97; interaction p = 0.62). Landmark analyses demonstrated an HR of 0.86 (95% CI: 0.59 to 1.24) during the first 45 days and 0.69 (95% CI: 0.54 to 0.89) from 45 days to the end of follow-up for intended nonculprit lesion PCI versus culprit lesion only PCI. Conclusions Among STEMI patients with multivessel disease, the benefit of complete revascularization over culprit-lesion only PCI was consistent irrespective of the investigator-determined timing of nonculprit-lesion intervention. The benefit of complete revascularization on hard clinical outcomes emerged mainly over the long term.
Published: 2019

34. Psychosocial Risk Factors and Cardiovascular Disease and Death in a Population-Based Cohort From 21 Low-, Middle-, and High-Income Countries

Author: Ailiana Santosa, Annika Rosengren, Chinthanie Ramasundarahettige, Sumathy Rangarajan, Sadi Gulec, Jephat Chifamba, Scott A. Lear, Paul Poirier, Karen E. Yeates, Rita Yusuf, Andreas Orlandini, Liu Weida, Li Sidong, Zhu Yibing, Viswanathan Mohan, Manmeet Kaur, Katarzyna Zatonska, Noorhassim Ismail, Patricio Lopez-Jaramillo, Romaina Iqbal, Lia M. Palileo-Villanueva, Afzalhusein H. Yusufali, Khalid F. AlHabib, Salim Yusuf, and Masira
Subjects: Adult, Male, Social Determinants of Health, Financial Stress, Disclosure, Global Health, Life Change Events, Humans, cardiovascular diseases, Prospective Studies, Developing Countries, Original Investigation, Aged, Proportional Hazards Models, Conflict of Interest, Research, Developed Countries, General Medicine, Middle Aged, Online Only, Socioeconomic Factors, Cardiovascular Diseases, Heart Disease Risk Factors, Female, Public Health, Stress, Psychological, Follow-Up Studies
Abstract: Digital, IMPORTANCE Stress may increase the risk of cardiovascular disease (CVD). Most studies on stress and CVD have been conducted in high-income Western countries, but whether stress is associated with CVD in other settings has been less well studied. OBJECTIVE To investigate the association of a composite measure of psychosocial stress and the development of CVD events and mortality in a large prospective study involving populations from 21 high-, middle-, and low-income countries across 5 continents. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used data from the Prospective Urban Rural Epidemiology study, collected between January 2003 and March 2021. Participants included individuals aged 35 to 70 years living in 21 low-, middle-, and high-income countries. Data were analyzed from April 8 to June 15, 2021. EXPOSURES All participants were assessed on a composite measure of psychosocial stress assessed at study entry using brief questionnaires concerning stress at work and home, major life events, and financial stress. MAIN OUTCOMES AND MEASURES The outcomes of interest were stroke, major coronary heart disease (CHD), CVD, and all-cause mortality. RESULTS A total of 118 706 participants (mean [SD] age 50.4 [9.6] years; 69 842 [58.8%] women and 48 864 [41.2%] men) without prior CVD and with complete baseline and follow-up data were included. Of these, 8699 participants (7.3%) reported high stress, 21 797 participants (18.4%) reported moderate stress, 34 958 participants (29.4%) reported low stress, and 53 252 participants (44.8%) reported no stress. High stress, compared with no stress, was more likely with younger age (mean [SD] age, 48.9 [8.9] years vs 51.1 [9.8] years), abdominal obesity (2981 participants [34.3%] vs 10 599 participants [19.9%]), current smoking (2319 participants [26.7%] vs 10 477 participants [19.7%]) and former smoking (1571 participants [18.1%] vs 3978 participants [7.5%]), alcohol use (4222 participants [48.5%] vs 13 222 participants [24.8%]), and family history of CVD (5435 participants [62.5%] vs 20 255 participants [38.0%]). During a median (IQR) follow-up of 10.2 (8.6-11.9) years, a total of 7248 deaths occurred. During the course of follow-up, there were 5934 CVD events, 4107 CHD events, and 2880 stroke events. Compared with no stress and after adjustment for age, sex, education, marital status, location, abdominal obesity, hypertension, smoking, diabetes, and family history of CVD, as the level of stress increased, there were increases in risk of death (low stress: hazard ratio [HR], 1.09 [95% CI, 1.03-1.16]; high stress: 1.17 [95% CI, 1.06-1.29]) and CHD (low stress: HR, 1.09 [95% CI, 1.01-1.18]; high stress: HR, 1.24 [95% CI, 1.08-1.42]). High stress, but not low or moderate stress, was associated with CVD (HR, 1.22 [95% CI, 1.08-1.37]) and stroke (HR, 1.30 [95% CI, 1.09-1.56]) after adjustment. CONCLUSIONS AND RELEVANCE This cohort study found that higher psychosocial stress, measured as a composite score of self-perceived stress, life events, and financial stress, was significantly associated with mortality as well as with CVD, CHD, and stroke events., Ciencias Médicas y de la Salud
Published: 2021

35. Global variations in the prevalence, treatment, and impact of atrial fibrillation in a multi-national cohort of 153 152 middle-aged individuals

Author: Salim Yusuf, Philip Joseph, Fernando Lanas, Khawar Kazmi, Katarzyna Zatońska, Thomas Iype, Rajesh Kumar, Shofiqul Islam, Quazi Ibrahim, Karen Yeates, Hugo W. Huisman, Reuben Douma, Gilles R. Dagenais, Sumathy Rangarajan, Parminder Raina, Andres Orlandini, Stuart J. Connolly, Jephat Chifamba, Alvaro Avezum, Andre Pascal Kengne, Li Wei, Antonio L. Dans, Patricio Lopez-Jaramillo, Mirac Vural Keskinler, Afzalhussein Yusufali, Koon K. Teo, Ahmad Bahonar, Rajeev Gupta, Viswanathan Mohan, Scott A. Lear, Annika Rosengren, Khalid F. AlHabib, Jeff S. Healey, Prem Mony, Omar Rahman, Rosnah Ismail, and Masira
Subjects: Adult, Male, medicine.medical_specialty, Time Factors, Physiology, 030204 cardiovascular system & hematology, Global Health, Risk Assessment, 03 medical and health sciences, Electrocardiography, 0302 clinical medicine, Fibrinolytic Agents, Risk Factors, Physiology (medical), Antithrombotic, Epidemiology, Atrial Fibrillation, Prevalence, Medicine, Humans, 030212 general & internal medicine, Prospective Studies, Healthcare Disparities, Practice Patterns, Physicians', Stroke, Aged, business.industry, Hazard ratio, Atrial fibrillation, Middle Aged, medicine.disease, Confidence interval, Drug Utilization, 3. Good health, Cross-Sectional Studies, Treatment Outcome, Atrial Flutter, Cohort, Female, Cardiology and Cardiovascular Medicine, business, Fibrinolytic agent, Demography
Abstract: Digital, Aims To compare the prevalence of electrocardiogram (ECG)-documented atrial fibrillation (or flutter) (AF) across eight regions of the world, and to examine antithrombotic use and clinical outcomes. Methods and results Baseline ECGs were collected in 153 152 middle-aged participants (ages 35–70 years) to document AF in two community-based studies, spanning 20 countries. Medication use and clinical outcome data (mean follow-up of 7.4 years) were available in one cohort. Cross-sectional analyses were performed to document the prevalence of AF and medication use, and associations between AF and clinical events were examined prospectively. Mean age of participants was 52.1 years, and 57.7% were female. Age and sex-standardized prevalence of AF varied 12-fold between regions; with the highest in North America, Europe, China, and Southeast Asia (270–360 cases per 100 000 persons); and lowest in the Middle East, Africa, and South Asia (30–60 cases per 100 000 persons) (P, Ciencias Médicas y de la Salud
Published: 2021

36. In‐hospital ventricular arrhythmia in heart failure patients: 7 year follow‐up of the multi‐centric HEARTS registry

Author: Tarek Kashour, Ahmad Hersi, Khalid F. AlHabib, Basel Alenazy, Hussam AlFaleh, and Shabana Tharkar
Subjects: Male, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Population, Saudi Arabia, Cardiomyopathy, Heart failure, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Original Research Articles, Internal medicine, medicine, Humans, Original Research Article, Prospective Studies, Registries, In‐hospital ventricular arrhythmia, 030212 general & internal medicine, Myocardial infarction, education, Stroke, Aged, education.field_of_study, business.industry, Cardiogenic shock, Incidence (epidemiology), Arrhythmias, Cardiac, Middle Aged, Prognosis, medicine.disease, Hospitalization, Treatment Outcome, lcsh:RC666-701, Ventricular fibrillation, Cardiology, Female, HEARTS registry, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: Aims The aim of this study was to determine the incidence, predictors, and short‐term and long‐term outcomes associated with in‐hospital sustained ventricular tachycardia (VT) and ventricular fibrillation (VF) collectively termed ventricular arrhythmia (VA) in the heart failure (HF) patients. Methods and results The HEart function Assessment Registry Trial in Saudi Arabia (HEARTS registry) is a prospective national registry of patients with chronic HF from18 tertiary care hospitals across Saudi Arabia. Diagnosis of HF was in accordance with American Heart Association/European Society of Cardiology definition criteria. The registry had enrolled 2610 HF patients during the 14 month recruitment period between October 2009 and December 2010. Occurrence of in‐hospital cardiac events, prognosis, and outcome were monitored during the 7 year follow‐up period. The incidence of in‐hospital VA in HF was 4.2%. VA was more common among men, and mean age was lesser than non‐VA patients (58.5 ± 16: 61.5 ± 15 years; P = 0.042). Smoking and family history of cardiomyopathy were significant risk factors of VA. Previous history of arrhythmia, ST elevated myocardial infarction, infections, and hypotension remained significant predictors of in‐hospital VA associated with three to seven times more risk. Patients with VA had higher rates of in‐hospital events like recurrent HF, haemodialysis, shock, sepsis, major bleeding, intra‐aortic balloon pump, and stroke compared with those without VA, all being highly significant (P
Published: 2019

37. Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study

Author: Marjan W. Attaei, Jephat Chifamba, Noor Hassim Ismail, Chuangshi Wang, Manmeet Kaur, Rasha Khatib, Karen Yeates, Iolanthé M. Kruger, Fernando Lanas, Noushin Mohammadifard, Prem Mony, Shrikant I. Bangdiwala, Deren Quiang, Kristina Bengtsson Boström, Afzalhusein H. Yusufali, Andreas Wielgosz, Rajeev Gupta, Annika Rosengren, Philip Joseph, Sarojiniamma Srilatha, Yang Wang, Khalid F. AlHabib, Koon K. Teo, Andrzej Szuba, Romaina Iqbal, Patricio Lopez-Jaramillo, Khalid Yusoff, Sadi Gulec, Salim Yusuf, Paul Poirier, Viswanathan Mohan, Scott A. Lear, Martin McKee, Chinthanie Ramasundarahettige, Ehi Igumbor, Wei Li, Pablo Lamelas, Rita Yusuf, Sumathy Rangarajan, Alvaro Avezum, Andrew Smyth, and 12079642 - Kruger, Iolanthé Marike
Subjects: Male, Rural Population, Urban Population, Higher education, 030231 tropical medicine, Disease, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Health care, Humans, Medicine, 030212 general & internal medicine, Risk factor, Prospective cohort study, Developing Countries, Socioeconomic status, business.industry, Developed Countries, lcsh:Public aspects of medicine, Incidence (epidemiology), lcsh:RA1-1270, General Medicine, Middle Aged, Social Class, Cardiovascular Diseases, Female, business, Inclusion (education), Demography
Abstract: Background Socioeconomic status is associated with differences in risk factors for cardiovascular disease incidence and outcomes, including mortality. However, it is unclear whether the associations between cardiovascular disease and common measures of socioeconomic status—wealth and education—differ among high-income, middle-income, and low-income countries, and, if so, why these differences exist. We explored the association between education and household wealth and cardiovascular disease and mortality to assess which marker is the stronger predictor of outcomes, and examined whether any differences in cardiovascular disease by socioeconomic status parallel differences in risk factor levels or differences in management. Methods In this large-scale prospective cohort study, we recruited adults aged between 35 years and 70 years from 367 urban and 302 rural communities in 20 countries. We collected data on families and households in two questionnaires, and data on cardiovascular risk factors in a third questionnaire, which was supplemented with physical examination. We assessed socioeconomic status using education and a household wealth index. Education was categorised as no or primary school education only, secondary school education, or higher education, defined as completion of trade school, college, or university. Household wealth, calculated at the household level and with household data, was defined by an index on the basis of ownership of assets and housing characteristics. Primary outcomes were major cardiovascular disease (a composite of cardiovascular deaths, strokes, myocardial infarction, and heart failure), cardiovascular mortality, and all-cause mortality. Information on specific events was obtained from participants or their family. Findings Recruitment to the study began on Jan 12, 2001, with most participants enrolled between Jan 6, 2005, and Dec 4, 2014. 160 299 (87·9%) of 182 375 participants with baseline data had available follow-up event data and were eligible for inclusion. After exclusion of 6130 (3·8%) participants without complete baseline or follow-up data, 154 169 individuals remained for analysis, from five low-income, 11 middle-income, and four high-income countries. Participants were followed-up for a mean of 7·5 years. Major cardiovascular events were more common among those with low levels of education in all types of country studied, but much more so in low-income countries. After adjustment for wealth and other factors, the HR (low level of education vs high level of education) was 1·23 (95% CI 0·96–1·58) for high-income countries, 1·59 (1·42–1·78) in middle-income countries, and 2·23 (1·79–2·77) in low-income countries (pinteractionInterpretation Although people with a lower level of education in low-income and middle-income countries have higher incidence of and mortality from cardiovascular disease, they have better overall risk factor profiles. However, these individuals have markedly poorer health care. Policies to reduce health inequities globally must include strategies to overcome barriers to care, especially for those with lower levels of education. Funding Full funding sources are listed at the end of the paper (see Acknowledgments).
Published: 2019

38. Randomized controlled trial of influenza vaccine in patients with heart failure to reduce adverse vascular events (IVVE): Rationale and design

Author: Wael Almahmeed, Albertino Damasceno, Gerald Yonga, Jun Zhu, Ambuj Roy, Khalid F. AlHabib, Mark Loeb, Antonio L. Dans, Salim Yusuf, Yan Liang, Kamilu M. Karaye, Lia M. Palileo-Villanueva, Arif Al Mulla, Hisham Dokainish, Charles Mondo, and Fastone Goma
Subjects: Research design, medicine.medical_specialty, Intention-to-treat analysis, Influenza vaccine, business.industry, 030204 cardiovascular system & hematology, medicine.disease, Article, 3. Good health, law.invention, Vaccination, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, Heart failure, medicine, Observational study, 030212 general & internal medicine, Myocardial infarction, Cardiology and Cardiovascular Medicine, business
Abstract: Background Influenza is associated with an increase in the risk of cardiac and other vascular events. Observational data and small randomized trials suggest that influenza vaccination may reduce such adverse vascular events. Research Design and Methods In a randomized controlled trial patients with heart failure are randomized to receive either inactivated influenza vaccine or placebo annually for 3 years. Patients aged ≥18 years with a clinical diagnosis of heart failure and NYHA functional class II, III and IV are eligible. Five thousand patients from 10 countries where influenza vaccination is not common (Asia, the Middle East, and Africa) have been enrolled. The primary outcome is a composite of the following: cardiovascular death, non-fatal myocardial infarction, non-fatal stroke and hospitalizations for heart failure using standardized criteria. Analyses will be based on comparing event rates between influenza vaccine and control groups and will include time to event, rate comparisons using Poisson methods, and logistic regression. The analysis will be conducted by intention to treat i.e. patients will be analyzed in the group in which they were assigned. Multivariable secondary analyses to assess whether variables such as age, sex, seasonality modify the benefits of vaccination are also planned for the primary outcome. Conclusion This is the largest randomized trial to test if influenza vaccine compared to control reduces adverse vascular events in high risk individuals. Trial registration number Clinicaltrials.gov NCT02762851
Published: 2019

39. Association of Sitting Time With Mortality and Cardiovascular Events in High-Income, Middle-Income, and Low-Income Countries

Author: Sidong Li, Scott A. Lear, Sumathy Rangarajan, Bo Hu, Lu Yin, Shrikant I. Bangdiwala, Khalid F. Alhabib, Annika Rosengren, Rajeev Gupta, Prem K. Mony, Andreas Wielgosz, Omar Rahman, M. Y. Mazapuspavina, Alvaro Avezum, Aytekin Oguz, Karen Yeates, Fernando Lanas, Antonio Dans, Marc Evans M. Abat, Afzalhussein Yusufali, Rafael Diaz, Patricio Lopez-Jaramillo, Lloyd Leach, P. V. M. Lakshmi, Alicja Basiak-Rasała, Romaina Iqbal, Roya Kelishadi, Jephat Chifamba, Rasha Khatib, Wei Li, Salim Yusuf, and Masira
Subjects: Cohort Studies, Heart Failure, Male, Stroke, Myocardial Infarction, Humans, Female, Prospective Studies, Sedentary Behavior, Cardiology and Cardiovascular Medicine, Original Investigation
Abstract: Digital, Importance High amounts of sitting time are associated with increased risks of cardiovascular disease (CVD) and mortality in high-income countries, but it is unknown whether risks also increase in low- and middle-income countries. Objective To investigate the association of sitting time with mortality and major CVD in countries at different economic levels using data from the Prospective Urban Rural Epidemiology study. Design, Setting, and Participants This population-based cohort study included participants aged 35 to 70 years recruited from January 1, 2003, and followed up until August 31, 2021, in 21 high-income, middle-income, and low-income countries with a median follow-up of 11.1 years. Exposures Daily sitting time measured using the International Physical Activity Questionnaire. Main Outcomes and Measures The composite of all-cause mortality and major CVD (defined as cardiovascular death, myocardial infarction, stroke, or heart failure). Results Of 105 677 participants, 61 925 (58.6%) were women, and the mean (SD) age was 50.4 (9.6) years. During a median follow-up of 11.1 (IQR, 8.6-12.2) years, 6233 deaths and 5696 major cardiovascular events (2349 myocardial infarctions, 2966 strokes, 671 heart failure, and 1792 cardiovascular deaths) were documented. Compared with the reference group (, Ciencias Médicas y de la Salud
Published: 2022

40. Pure Autonomic Failure with Asymptomatic Hypertensive Urgency: A Case Report and Literature Review

Author: Abdulrahman Aldeeri, Ahmad Hersi, Khalid F. AlHabib, Anwar Jammah, Alwaleed Aljohar, and Taim Muayqil
Subjects: medicine.medical_specialty, Ambulatory blood pressure, Supine hypertension, Fludrocortisone, Midodrine, Saudi Arabia, Case Report, 030204 cardiovascular system & hematology, Asymptomatic, lcsh:RC346-429, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Pure autonomic failure, lcsh:Neurology. Diseases of the nervous system, Orthostatic hypotension, business.industry, Hypertensive urgency, medicine.disease, Blood pressure, Cardiology, Ambulatory blood pressure monitoring, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery, medicine.drug
Abstract: We report the case study of a 70-year-old gentleman who presented with isolated, slowly progressive dizziness after prolonged standing and was eventually diagnosed with pure autonomic failure. Initially, his symptoms improved with the use of midodrine and fludrocortisone, but gradually became refractory and disabling. Despite multiple therapeutic interventions, his symptoms persisted along with worsening supine hypertension. We discuss the challenges faced in the treatment of an uncommon condition and discuss the clinical utility of performing serial 24-h ambulatory monitoring to detect subclinical blood pressure fluctuations.
Published: 2018

41. Association of estimated sleep duration and naps with mortality and cardiovascular events: a study of 116 632 people from 21 countries

Author: Rita Yusuf, Maria Wolyniec, Lloyd Leach, Karen Yeates, Paul Poirier, Khalid F. AlHabib, Indu Mohan, Wei Li, Shrikant I. Bangdiwala, Annika Rosengren, Zhiguang Liu, Noor Hassim Ismail, Lanthe Kruger, Sumathy Rangarajan, Rasha Khatib, Pamela Seron, Antonio L. Dans, Nahed Monsef, Rajesh Kumar, Lap Ah Tse, Viswanathan Mohan, Vijayakumar Krishnapillai, Scott A. Lear, Patricio Lopez-Jaramillo, Chuangshi Wang, Koon K. Teo, Andres Orlandini, Salim Yusuf, Khalid Yusoff, Ahmet Temizhan, and Ahmad Bahonar
Subjects: Adult, Male, Time Factors, Health Status, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Humans, Medicine, Prospective Studies, Life Style, Aged, business.industry, Hazard ratio, Composite outcomes, 030229 sport sciences, Middle Aged, Sleep in non-human animals, Confidence interval, Nap, Increased risk, Time in bed, Cardiovascular Diseases, Female, Self Report, Sleep, Cardiology and Cardiovascular Medicine, business, Demography, Sleep duration
Abstract: Aims To investigate the association of estimated total daily sleep duration and daytime nap duration with deaths and major cardiovascular events. Methods and results We estimated the durations of total daily sleep and daytime naps based on the amount of time in bed and self-reported napping time and examined the associations between them and the composite outcome of deaths and major cardiovascular events in 116 632 participants from seven regions. After a median follow-up of 7.8 years, we recorded 4381 deaths and 4365 major cardiovascular events. It showed both shorter (≤6 h/day) and longer (>8 h/day) estimated total sleep durations were associated with an increased risk of the composite outcome when adjusted for age and sex. After adjustment for demographic characteristics, lifestyle behaviours and health status, a J-shaped association was observed. Compared with sleeping 6–8 h/day, those who slept ≤6 h/day had a non-significant trend for increased risk of the composite outcome [hazard ratio (HR), 1.09; 95% confidence interval, 0.99–1.20]. As estimated sleep duration increased, we also noticed a significant trend for a greater risk of the composite outcome [HR of 1.05 (0.99–1.12), 1.17 (1.09–1.25), and 1.41 (1.30–1.53) for 8–9 h/day, 9–10 h/day, and >10 h/day, P trend < 0.0001, respectively]. The results were similar for each of all-cause mortality and major cardiovascular events. Daytime nap duration was associated with an increased risk of the composite events in those with over 6 h of nocturnal sleep duration, but not in shorter nocturnal sleepers (≤6 h). Conclusion Estimated total sleep duration of 6–8 h per day is associated with the lowest risk of deaths and major cardiovascular events. Daytime napping is associated with increased risks of major cardiovascular events and deaths in those with >6 h of nighttime sleep but not in those sleeping ≤6 h/night.
Published: 2018

42. Health-related quality of life and mortality in heart failure. The global congestive heart failure study of 23000 patients from 40 countries

Author: Andrzej Budaj, Abel Makubi, Philip Joseph, T. Wittlinger, Anastase Dzudie, Khalid F. AlHabib, Jefferey L. Probstfield, Patricio Lopez-Jaramillo, A. Temizhan, Isabelle Johansson, Aldo P. Maggioni, Koon K. Teo, Bianca Fukakusa, Tara McCready, Keith A.A. Fox, Alex Grinvalds, Kumar Balasubramanian, Antonio L. Dans, Salim Yusuf, John J.V. McMurray, Deepak Y. Kamath, Justin A. Ezekowitz, Antoni Bayes-Genis, Lars H. Lund, José Silva-Cardoso, Fernando Lanas, Karen Sliwa, Kamilu M. Karaye, Hisham Dokainish, and Masira
Subjects: Heart Failure, Male, Health related quality of life, medicine.medical_specialty, business.industry, heart failure, health status, medicine.disease, Survival Analysis, Quality of life (healthcare), quality of life, Physiology (medical), Heart failure, Quality of Life, medicine, Geographic regions, Humans, ventricular function, left, Female, prognosis, Cardiology and Cardiovascular Medicine, Intensive care medicine, business, Aged
Abstract: Digital, Background: Poor health-related quality of life (HRQL) is common in heart failure (HF), but there are few data on HRQL in HF and the association between HRQL and mortality outside Western countries. Methods: We used the Kansas City Cardiomyopathy Questionnaire–12 (KCCQ-12) to record HRQL in 23 291 patients with HF from 40 countries in 8 different world regions in the G-CHF study (Global Congestive Heart Failure). We compared standardized KCCQ-12 summary scores (adjusted for age, sex, and markers of HF severity) among regions (scores range from 0 to 100, with higher score indicating better HRQL). We used multivariable Cox regression with adjustment for 15 variables to assess the association between KCCQ-12 summary scores and the composite of all-cause death, HF hospitalization, and each component over a median follow-up of 1.6 years. Results: The mean age of participants was 65 years; 61% were men; 40% had New York Heart Association class III or IV symptoms; and 46% had left ventricular ejection fraction ≥40%. Average HRQL differed between regions (lowest in Africa [mean± SE, 39.5±0.3], highest in Western Europe [62.5±0.4]). There were 4460 (19%) deaths, 3885 (17%) HF hospitalizations, and 6949 (30%) instances of either event. Lower KCCQ-12 summary score was associated with higher risk of all outcomes; the adjusted hazard ratio (HR) for each 10-unit KCCQ-12 summary score decrement was 1.18 (95% CI, 1.17–1.20) for death. Although this association was observed in all regions, it was less marked in South Asia, South America, and Africa (weakest association in South Asia: HR, 1.08 [95% CI, 1.03–1.14]; strongest association in Eastern Europe: HR, 1.31 [95% CI, 1.21–1.42]; interaction P, Ciencias Medicas y de la Salud
Published: 2021

43. Impact of social isolation on mortality and morbidity in 20 high-income, middle-income and low-income countries in five continents

Author: Rasha Khatib, Shofiqul Islam, Jephat Chifamba, Manmeet Kaur, S. V. Subramanian, Pamela Seron, Khalid F. AlHabib, Roya Kelishadi, Karen Yeates, Yundong Sheng, Leela Itty Amma K R, Andrzej Szuba, Alvaro Avezum, Thandi Puoane, Ryo Naito, Shrikant I. Bangdiwala, Rafael Diaz, Kubilay Karsidag, Annika Rosengren, Martin McKee, Darryl P. Leong, Salim Yusuf, Yibing Zhu, Koon K. Teo, Antonio L. Dans, Weida Liu, Scott A. Lear, Afzalhussein Yusufali, Rajeev Gupta, Omar Rahman, Patricio Lopez-Jaramillo, I Rosnah, Syed Iqbal Azam, Sumathy Rangarajan, and Masira
Subjects: Adult, Male, Mediation (statistics), medicine.medical_specialty, Population, Developing country, Disease, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, 0302 clinical medicine, medicine, Risk of mortality, Humans, lcsh:RC109-216, 030212 general & internal medicine, Social isolation, education, Developing Countries, Poverty, Original Research, Aged, education.field_of_study, lcsh:R5-920, 030505 public health, business.industry, Health Policy, Public health, public health, Public Health, Environmental and Occupational Health, Middle Aged, Social Isolation, Income, Female, medicine.symptom, Rural area, Morbidity, 0305 other medical science, business, lcsh:Medicine (General), Demography
Abstract: Digital, Objective To examine the association between social isolation and mortality and incident diseases in middle-aged adults in urban and rural communities from high-income, middle-income and low-income countries. Design Population-based prospective observational study. Setting Urban and rural communities in 20 high income, middle income and low income. Participants 119894 community-dwelling middle-aged adults. Main outcome measures Associations of social isolation with mortality, cardiovascular death, non-cardiovascular death and incident diseases. Results Social isolation was more common in middleincome and high-income countries compared with lowincome countries, in urban areas than rural areas, in older individuals and among women, those with less education and the unemployed. It was more frequent among smokers and those with a poorer diet. Social isolation was associated with greater risk of mortality (HR of 1.26, 95% CI: 1.17 to 1.36), incident stroke (HR: 1.23, 95%CI: 1.07 to 1.40), cardiovascular disease (HR: 1.15, 95%CI: 1.05 to 1.25) and pneumonia (HR:1.22, 95%CI: 1.09 to 1.37), but not cancer. The associations between social isolation and mortality were observed in populations in high-income, middle-income and low-income countries (HR (95%CI): 1.69 (1.32 to 2.17), 1.27 (1.15 to 1.40) and 1.47 (1.25 to 1.73), respectively, interaction p=0.02). The HR associated with social isolation was greater in men than women and in younger than older individuals. Mediation analyses for the association between social isolation and mortality showed that unhealthy behaviours and comorbidities may account for about one-fifth of the association. Conclusion Social isolation is associated with increased risk of mortality in countries at different economic levels. The increasing share of older people in populations in many countries argues for targeted strategies to mitigate its adverse effects, Ciencias Médicas y de la Salud
Published: 2021

44. Associations of Fish Consumption with Risk of Cardiovascular Disease and Mortality among Individuals with or without Vascular Disease from 58 Countries

Author: K Vijayakumar, Salim Yusuf, Martin O'Donnell, Andrew Mente, Khalid F. AlHabib, Fernando Lanas, Jephat Chifamba, Manmeet Kaur, Gilles R. Dagenais, Viswanathan Mohan, Sumathy Rangarajan, Origin Trial Investigators, Mahshid Dehghan, Scott A. Lear, Sadi Gulec, Alvaro Avezum, Rasha Khatib, Deepa Mohan, Hertzel C. Gerstein, Annika Rosengren, Noushin Mohammadifard, Rajeev Gupta, Romaina Iqbal, Li Wei, Patricio Lopez-Jaramillo, Rafael Diaz, Sumathi Swaminathan, Pure, Ontarget, Transcend, Edelweiss Wentzel-Viljoen, Andreas Wielgosz, Rita Yusuf, Andrzej Szuba, Koon K. Teo, Weihong Hu, Khalid Yusoff, Afzalhussein Yusufali, Karen Yeates, Antonio L. Dans, and Masira
Subjects: Male, medicine.medical_specialty, Lower risk, 01 natural sciences, Sudden death, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Fatty Acids, Omega-3, Epidemiology, Internal Medicine, medicine, Animals, Humans, Oily fish, Prospective Studies, Vascular Diseases, 030212 general & internal medicine, 0101 mathematics, Prospective cohort study, Proportional Hazards Models, Original Investigation, business.industry, Vascular disease, 010102 general mathematics, Fishes, Feeding Behavior, Middle Aged, medicine.disease, Cardiovascular Diseases, Cohort, Female, business, Cohort study
Abstract: Digital, Importance Cohort studies report inconsistent associations between fish consumption, a major source of long-chain ω-3 fatty acids, and risk of cardiovascular disease (CVD) and mortality. Whether the associations vary between those with and those without vascular disease is unknown. Objective To examine whether the associations of fish consumption with risk of CVD or of mortality differ between individuals with and individuals without vascular disease. Design, Setting, and Participants This pooled analysis of individual participant data involved 191 558 individuals from 4 cohort studies—147 645 individuals (139 827 without CVD and 7818 with CVD) from 21 countries in the Prospective Urban Rural Epidemiology (PURE) study and 43 413 patients with vascular disease in 3 prospective studies from 40 countries. Adjusted hazard ratios (HRs) were calculated by multilevel Cox regression separately within each study and then pooled using random-effects meta-analysis. This analysis was conducted from January to June 2020. Exposures Fish consumption was recorded using validated food frequency questionnaires. In 1 of the cohorts with vascular disease, a separate qualitative food frequency questionnaire was used to assess intake of individual types of fish. Main Outcomes and Measures Mortality and major CVD events (including myocardial infarction, stroke, congestive heart failure, or sudden death). Results Overall, 191 558 participants with a mean (SD) age of 54.1 (8.0) years (91 666 [47.9%] male) were included in the present analysis. During 9.1 years of follow-up in PURE, compared with little or no fish intake (≤50 g/mo), an intake of 350 g/wk or more was not associated with risk of major CVD (HR, 0.95; 95% CI, 0.86-1.04) or total mortality (HR, 0.96; 0.88-1.05). By contrast, in the 3 cohorts of patients with vascular disease, the HR for risk of major CVD (HR, 0.84; 95% CI, 0.73-0.96) and total mortality (HR, 0.82; 95% CI, 0.74-0.91) was lowest with intakes of at least 175 g/wk (or approximately 2 servings/wk) compared with 50 g/mo or lower, with no further apparent decrease in HR with consumption of 350 g/wk or higher. Fish with higher amounts of ω-3 fatty acids were strongly associated with a lower risk of CVD (HR, 0.94; 95% CI, 0.92-0.97 per 5-g increment of intake), whereas other fish were neutral (collected in 1 cohort of patients with vascular disease). The association between fish intake and each outcome varied by CVD status, with a lower risk found among patients with vascular disease but not in general populations (for major CVD, I2 = 82.6 [P = .02]; for death, I2 = 90.8 [P = .001]). Conclusions and Relevance Findings of this pooled analysis of 4 cohort studies indicated that a minimal fish intake of 175 g (approximately 2 servings) weekly is associated with lower risk of major CVD and mortality among patients with prior CVD but not in general populations. The consumption of fish (especially oily fish) should be evaluated in randomized trials of clinical outcomes among people with vascular disease., Ciencias Médicas y de la Salud
Published: 2021

45. Glycemic Index, Glycemic Load, and Cardiovascular Disease and Mortality

Author: David J A, Jenkins, Mahshid, Dehghan, Andrew, Mente, Shrikant I, Bangdiwala, Sumathy, Rangarajan, Kristie, Srichaikul, Viswanathan, Mohan, Alvaro, Avezum, Rafael, Díaz, Annika, Rosengren, Fernando, Lanas, Patricio, Lopez-Jaramillo, Wei, Li, Aytekin, Oguz, Rasha, Khatib, Paul, Poirier, Noushin, Mohammadifard, Andrea, Pepe, Khalid F, Alhabib, Jephat, Chifamba, Afzal Hussein, Yusufali, Romaina, Iqbal, Karen, Yeates, Khalid, Yusoff, Noorhassim, Ismail, Koon, Teo, Sumathi, Swaminathan, Xiaoyun, Liu, Katarzyna, Zatońska, Rita, Yusuf, Salim, Yusuf, A, Chinhara, and Masira
Subjects: Adult, Male, medicine.medical_specialty, Dietary Sugars, MEDLINE, Disease, 030204 cardiovascular system & hematology, Diet Surveys, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Glycemic load, medicine, Dietary Carbohydrates, Humans, 030212 general & internal medicine, Aged, business.industry, Follow up studies, Glycemic Load, General Medicine, Middle Aged, Diet, Glycemic index, Multicenter study, Cardiovascular Diseases, Glycemic Index, Heart Disease Risk Factors, Female, business, Follow-Up Studies
Abstract: Digital, BACKGROUND Most data regarding the association between the glycemic index and cardiovascular disease come from high-income Western populations, with little information from non-Western countries with low or middle incomes. To fill this gap, data are needed from a large, geographically diverse population. METHODS This analysis includes 137,851 participants between the ages of 35 and 70 years living on five continents, with a median follow-up of 9.5 years. We used countryspecific food-frequency questionnaires to determine dietary intake and estimated the glycemic index and glycemic load on the basis of the consumption of seven categories of carbohydrate foods. We calculated hazard ratios using multivariable Cox frailty models. The primary outcome was a composite of a major cardiovascular event (cardiovascular death, nonfatal myocardial infarction, stroke, and heart failure) or death from any cause. RESULTS In the study population, 8780 deaths and 8252 major cardiovascular events occurred during the follow-up period. After performing extensive adjustments comparing the lowest and highest glycemic-index quintiles, we found that a diet with a high glycemic index was associated with an increased risk of a major cardiovascular event or death, both among participants with preexisting cardiovascular disease (hazard ratio, 1.51; 95% confidence interval [CI], 1.25 to 1.82) and among those without such disease (hazard ratio, 1.21; 95% CI, 1.11 to 1.34). Among the components of the primary outcome, a high glycemic index was also associated with an increased risk of death from cardiovascular causes. The results with respect to glycemic load were similar to the findings regarding the glycemic index among the participants with cardiovascular disease at baseline, but the association was not significant among those without preexisting cardiovascular disease. CONCLUSIONS In this study, a diet with a high glycemic index was associated with an increased risk of cardiovascular disease and death. (Funded by the Population Health Research Institute and others.), Ciencias Médicas y de la Salud
Published: 2021

46. The impact of mineralocorticoid receptor antagonist use on all-cause mortality in acute heart failure patients

Author: Nidal Asaad, Abdelfatah Elasfar, Bassam Bulbanat, Raja Dashti, Alawi A. Alsheikh-Ali, Ahmed Al-Motarreb, Nooshin Bazargani, Haitham Amin, Hussam AlFaleh, Prashanth Panduranga, Wael Almahmeed, Mohammed Al-Jarallah, Kadhim Sulaiman, Mustafa Ridha, Amar M Salam, Khalid F. AlHabib, Rajesh Rajan, Jassim Al Suwaidi, and Ibrahim Al-Zakwani
Subjects: medicine.medical_specialty, Ejection fraction, business.industry, Mean age, General Medicine, Odds ratio, medicine.disease, Confidence interval, Mineralocorticoid receptor, Heart failure, Internal medicine, medicine, Cardiology, business, All cause mortality
Abstract: Background: The impact of mineralocorticoid receptor antagonist (MRA) use in acute heart failure (AHF) patients in the Middle East is not well studied. The objective of this study was to examine the impact of MRA therapy on all-cause mortality in AHF patients in the Middle East stratified by left ventricular ejection fraction. Methods: Data were analyzed from 3792 consecutive patients admitted to 47 hospitals in 7 Middle Eastern countries. Results: The overall mean age was 59 ± 15 years and 62% (n = 2353) were male. At discharge, MRA therapy was prescribed in 34% (n = 1301) of the patients. A total of 54% (n = 2048) of the patients had AHF with reduced ejection fraction (EF) (HFrEF) (
Published: 2021

47. Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019: A systematic analysis from the Global Burden of Disease Study 2019

Author: Mohsen Naghavi, Saman Esmaeilnejad, Irena Ilic, Chhabi Lal Ranabhat, Hubert Amu, Jalil Jaafari, Walter Mendoza, Yanzhong Wang, Atta Abbas Naqvi, Mahesh P A, Afshin Maleki, Songhomitra Panda-Jonas, Akila Prashant, Jessica Y Islam, Ali H. Mokdad, Rahmatollah Moradzadeh, Roman Shrestha, Muhammad Naveed, Andre M. N. Renzaho, Santi Martini, Reza Rawassizadeh, Chisom Joyqueenet Akunna, Tudorel Andrei, Jason A. Anderson, Martin McKee, Iffat Elbarazi, Golnaz Heidari, Abdollah Mohammadian-Hafshejani, Soewarta Kosen, Davood Anvari, Randah R. Hamadeh, G. K. Mini, Emerito Jose A. Faraon, Farhad Islami, Yasir Waheed, Fahad Alanezi, Maciej Banach, Sheikh Mohammed Shariful Islam, Ismaeel Yunusa, Suresh Mehata, Tarun Gupta, Mavra A Riaz, Derrick A Bennett, Nithin Kumar, Ali Soroush, Kurt Straif, Muhammad Aziz Rahman, Hasan Yusefzadeh, Avirup Guha, Catalina Liliana Andrei, Muhammed Shahriar Zaman, Arief Hargono, Sandhya Neupane Kandel, Adam E. Berman, Giulia Carreras, Ali Bijani, Christoph Nowak, Rafael Alves Guimarães, Aziz Sheikh, Kamal Hezam, Carlo Eduardo Medina-Solís, Simon I. Hay, Deborah Carvalho Malta, Rahman Shiri, Ashok Pandey, Ramesh Holla, Gyu Ri Kim, Aidin Abedi, Sharath Burugina Nagaraja, Andem Effiong, Samad Azari, Bhaskar Thakur, Mohsen Mazidi, Vahid Yazdi-Feyzabadi, Prashant Mathur, Bay Vo, Robert Ancuceanu, Eun-Kee Park, Mehdi Fazlzadeh, Thomas Hsiao, Richard G Pestell, Sindhura Lakshmi Koulmane Laxminarayana, Doo Woong Lee, Bayew Kelkay, Erkin M. Mirrakhimov, Hualiang Lin, Mohsen Bayati, Florian Fischer, Wei Liu, Stefan Stortecky, Javad Nazari, Fatemeh Pashazadeh Kan, Virginia Núñez-Samudio, Nitish Naik, Sreenivas Narasimha Swamy, Rajat Gupta, Rakhi Dandona, Hermann Brenner, Chandrashekhar T Sreeramareddy, Mohammad Ali Mansournia, Yuichiro Yano, Pankaj Bhardwaj, Samath D Dharmaratne, Constantine I. Vardavas, Gabriela Fernanda Gil, Azeem Majeed, Akram Pourshams, Nachimuthu Senthil Kumar, Florentino Luciano Caetano dos Santos, Juan Sanabria, Iván Landires, Parkes J Kendrick, Dinh-Toi Chu, Asma Tahir Awan, Khem Narayan Pokhrel, Siddharudha Shivalli, Omid Shafaat, Shankar Prasad Nagaraju, Manu Raj Mathur, Rachel L Updike, Mohammad Ebrahimi Kalan, Ryan David Kennedy, Alessandra Lugo, Olalekan A. Uthman, Tarek Tawfik Amin, Jiregna Darega Gela, Zhi-Jiang Zhang, Yeshambel T. Nigatu, Bedanta Roy, Arielle Wilder Eagan, Jalal Arabloo, Milena Ilic, Mehdi Hosseinzadeh, Jost B. Jonas, Dian Kusuma, Shahrzad Bazargan-Hejazi, Yo Han Lee, Mohammed Shannawaz, Mohammad Ali Moni, Valery L. Feigin, Himal Kandel, Lalit Dandona, Milena Santric-Milicevic, Jasvinder A. Singh, Till Bärnighausen, Neeraj Bhala, Sara Sheikhbahaei, Alireza Ansari-Moghaddam, Borhan Mansouri, Narayana Manjunatha, Giuseppe Gorini, Saif Ullah, Sheikh M. Alif, Giang Thu Vu, Ai Koyanagi, Mahaveer Golechha, Ingan Ukur Tarigan, Sumaira Mubarik, Naohiro Yonemoto, Ahmad Ghashghaee, Yves Miel H Zuniga, Bach Xuan Tran, Sorin Hostiuc, Catherine P. Benziger, Ritesh G. Menezes, Leonardo Roever, Xiaochen Dai, Meghnath Dhimal, Medhat Farwati, Chenwen Zhong, Seyed Sina Naghibi Irvani, G Anil Kumar, Jaya Prasad Tripathy, Amirhossein Sahebkar, Simiao Chen, Zubair Kabir, Meseret Derbew Molla, Tilahun Ali, Animut Tagele Tamiru, Negussie Boti Sidemo, Monika Sawhney, Bright Opoku Ahinkorah, Ruxandra Irina Negoi, Segun Emmanuel Ibitoye, Vin Gupta, Mona Pathak, Lorenzo Monasta, Andrew T Olagunju, Nermin Ghith, Nuwan Darshana Wickramasinghe, Kazumasa Yamagishi, Virendra Singh, Takahiro Tabuchi, Gholamreza Roshandel, Andre R. Brunoni, Hayley D. Tymeson, Madhur Verma, Eyayou Girma Tadesse, Adrian Pana, Isabela M. Benseñor, Abdullah Al Mamun, Jianrong Zhang, Hai Quang Pham, Mihaela Hostiuc, Sung-In Jang, Vinay Nangia, Luca Ronfani, Rizwan Suliankatchi Abdulkader, Dhirendra N Sinha, Josip Car, Sohail Ahmad, Rekha Thapar, Salman Rawaf, Joanna L Whisnant, Sanjay Basu, Abdallah M. Samy, Michal Grivna, Zahid A Butt, Abera Getachew Obsa, Mahdi Nalini, Ted R. Miller, Sanjeev Misra, Utsav Parekh, Budi Aji, Saeed Amini, João Pedro Silva, Felix Akpojene Ogbo, Mihajlo Jakovljevic, Demosthenes B. Panagiotakos, Baye Dagnew, Yousef Khader, Atif Amin Baig, Habib Benzian, Keivan Ahmadi, Marco Vacante, Brijesh Sathian, Akshaya Srikanth Bhagavathula, Savita Lasrado, Maryam Khayamzadeh, Darshan B B, Mohammad Rifat Haider, Yonas Akalu, Irmina Maria Michalek, Simone Vidale, Getie Lake Aynalem, Rosa A. S. Couto, Yigizie Yeshaw, Syed Mohamed Aljunid, Pradhum Ram, Shrikant Pawar, Kevin Welding, Suzanne Barker-Collo, Hamideh Salimzadeh, Luisa Sorio Flor, Priya Rathi, Hiba Jawdat Barqawi, Marcos Roberto Tovani-Palone, K M Shivakumar, Gebiyaw Wudie Tsegaye, Fares Alahdab, Vafa Rahimi-Movaghar, Om P Kurmi, Nataliya Foigt, André Karch, Marina Pinheiro, Basema Saddik, Paschalis Steiropoulos, Chuanhua Yu, Graeme J. Hankey, Panniyammakal Jeemon, Abdul-Aziz Seidu, Ramaiah Itumalla, Befikadu Legesse Wubishet, Vera Marisa Costa, Shanshan Li, Ambrish Singh, Yuming Guo, Reza Malekzadeh, Nikha Bhardwaj, Mikhail Sergeevich Zastrozhin, Maryam Zamanian, Onyema greg Chido-Amajuoyi, Ibtihal Fadhil, Sabina O Nduaguba, Turki Alanzi, Eun-Cheol Park, Nicholas Arian, Salah Eddin Karimi, Parnaz Daneshpajouhnejad, Minale Tareke, Paramjit Gill, Chukwudi A Nnaji, Haroon Ahmed, Irina Filip, Juwel Rana, Aziz Rezapour, Huong Lan Thi Nguyen, Ashish Badiye, Kewal Krishan, Nima Hafezi-Nejad, Masood Ali Shaikh, Tanuj Kanchan, Shilpashree Madhava Kunjathur, Reza Ghanei Gheshlagh, Thomas R. Hird, Yousef Mohammad, Soraya Siabani, Falk Schwendicke, Ziyad Al-Aly, Desta Debalkie Atnafu, Krittika Bhattacharyya, Mika Kivimäki, Ayodipupo Sikiru Oguntade, Zabihollah Yousefi, Neeti Kapoor, Syed Mahboob Shah, Kavumpurathu Raman Thankappan, Mika Shigematsu, Ben Lacey, Ireneous N. Soyiri, Amir Radfar, Lemma Getacher, Sameer Vali Gopalani, David Laith Rawaf, Amir Masoud Rahmani, Birhan Gebresillassie Gebregiorgis, Morenike Oluwatoyin Folayan, Salime Goharinezhad, Ambuj Roy, Ruth W Kimokoti, Nuworza Kugbey, Getinet Ayano, Mohammad Hifz Ur Rahman, Benny Antony, Katrin Burkart, Christopher J L Murray, Khalid F. AlHabib, Mariam Molokhia, Mansour Ghafourifard, Abebaw Alemayehu Desta, Tariku Tesfaye Bekuma, Shailesh Advani, Kiomars Sharafi, Kurnia Dwi Artanti, E S Abhilash, Ejaz Ahmad Khan, Sana Salehi, Dan J. Stein, Pankaj Chaturvedi, Mahmoud A. Alomari, Kawkab Shishani, Dejana Braithwaite, Jung-Chen Chang, Rajeev Gupta, Giovanni Damiani, Maha El Tantawi, Maria Sofia Sofia Cattaruzza, Amir Abdoli, Narayanaswamy Venketasubramanian, Rakibul M Islam, Ibrahim Abdelmageed Ginawi, Victor Aboyans, Ganesh Kumar Saya, Silvano Gallus, João Mauricio Castaldelli-Maia, Vardhmaan Jain, Masoud Foroutan, Janni Leung, Mohammad Abdollahi, Mohammed Zewdu Yimmer, Vahid Alipour, Wondwossen Niguse Asmare, Ravi Prakash Jha, Gerhard Sulo, Brigid Unim, Sheng-Chia Chung, Sadaf G. Sepanlou, Hamed Mirzaei, Anna Aleksandrovna Skryabina, In-Hwan Oh, Rannveig Sigurvinsdottir, Oladimeji Adebayo, Farshad Farzadfar, Anasthasia Zastrozhina, Shafiu Mohammed, Johan Sundström, Ali Kabir, Paolo Lauriola, Tilahun Belete Mossie, Sadia Bibi, Bartosz Miazgowski, Erin C Mullany, Keyvan Pakshir, Srikanta Banerjee, Mowafa Househ, Mohamed M. Gad, Leila R Kalankesh, Mikk Jürisson, Ismail Tareque, Albertino Damasceno, Musliu Adetola Tolani, Andrea Werdecker, Shane D. Morrison, Inga Dora Sigfusdottir, Marcel Ausloos, Monika Arora, Marissa B Reitsma, Filippos Filippidis, Biniyam Sahiledengle Geberemariyam, Bruno Piassi Sao Jose, Leeberk Raja Inbaraj, Antonio Biondi, Mohsen Abbasi-Kangevari, Junjie Huang, Mohammad Mahdi Zamani, Jean Jacques Noubiap, Emmanuela Gakidou, Valentin Yurievich Skryabin, Mayowa O. Owolabi, Shubha Jayaram, Hiroyasu Iso, Charles Ugochukwu Ibeneme, Molly R Nixon, Rachel Feldman, Liliana G Ciobanu, Kristina Edvardsson, Claudiu Herteliu, Andreea Mirica, Kindie Mitiku Kebede, Department of Public Health, Collaborators, GBD 2019 Chewing Tobacco, and Lacey, B
Subjects: Male, Health Status, Smoking Prevention, DETERMINANTS, Global Health, 01 natural sciences, Global Burden of Disease, SMOKELESS TOBACCO, 0302 clinical medicine, Risk Factors, Global health, Prevalence, 030212 general & internal medicine, 610 Medicine & health, RISK, High prevalence, WOMEN, Public Health, Global Health, Social Medicine and Epidemiology, Articles, Middle Aged, 3142 Public health care science, environmental and occupational health, Chewing tobacco, Smokeless tobacco, Population Surveillance, A990 Medicine and Dentistry not elsewhere classified, Female, Quality-Adjusted Life Years, Burden of disease, Adult, medicine.medical_specialty, Tobacco, Smokeless, Adolescent, WHO Framework Convention on Tobacco Control, VALIDATION, 03 medical and health sciences, Young Adult, Age Distribution, SDG 3 - Good Health and Well-being, Environmental health, medicine, Humans, 0101 mathematics, Sex Distribution, Chewing tobacco, Prevalence, Global Burden, Smokeless tobacco, business.industry, Public health, Smoking Tobacco, 010102 general mathematics, Public Health, Environmental and Occupational Health, Global Burden, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, STATES, Socioeconomic Factors, Smoking Cessation, business
Abstract: Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Findings In 2019, 273 center dot 9 million (95% uncertainty interval 258 center dot 5 to 290 center dot 9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 center dot 72% (4 center dot 46 to 5 center dot 01). 228 center dot 2 million (213 center dot 6 to 244 center dot 7; 83 center dot 29% [82 center dot 15 to 84 center dot 42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global agestandardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 center dot 21% [-1 center dot 26 to -1 center dot 16]), similar progress was not observed for chewing tobacco (0 center dot 46% [0 center dot 13 to 0 center dot 79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 center dot 94% [-1 center dot 72 to -0 center dot 14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Summary Background Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. Findings In 2019, 273 & middot;9 million (95% uncertainty interval 258 & middot;5 to 290 & middot;9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 & middot;72% (4 & middot;46 to 5 & middot;01). 228 & middot;2 million (213 & middot;6 to 244 & middot;7; 83 & middot;29% [82 & middot;15 to 84 & middot;42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 & middot;21% [-1 & middot;26 to -1 & middot;16]), similar progress was not observed for chewing tobacco (0 & middot;46% [0 & middot;13 to 0 & middot;79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 & middot;94% [-1 & middot;72 to -0 & middot;14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. For complete list of authors see http://dx.doi.org/10.1016/S2468-2667(21)00065-7
Published: 2021

48. Global perspective of familial hypercholesterolaemia: a cross-sectional study from the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC)

Author: Jie Lin, Snejana Tisheva, Ishwar C. Verma, Francesco Cipollone, Liam R. Brunham, Florentina Predica, Perla A.C. Gonzalez, Jocelyne Inamo, André R. Miserez, Belma Pojskic, Michel Farnier, Avishay Ellis, Katia Bonomo, Ibrahim Al-Zakwani, Maria Grazia Zenti, Humberto A. Lopez, Khairul Shafiq Ibrahim, Erkin M. Mirrakhimov, Alexey Meshkov, Jose P. de Moura, Muthukkaruppan Annamalai, Raul D. Santos, F. Paillard, Maria Del Ben, Jan Lacko, Miguel T. Rico, Ximena Reyes, Laura E.G. de Leon, Noor Shafina Mohd Nor, Ulrich Julius, Mohammed A. Batais, Dieter Böhm, Ta-Chen Su, Takuya Kobayashi, Magdalena Chmara, Marco Gebauer, Marcos M. Lima-Martínez, Ravshanbek D. Kurbanov, Daisaku Masuda, Amro El-Hadidy, Melanie Schüler, Francisco Fuentes, Florian J. Mayer, Helena Vaverkova, F. Ulrich Beil, Juraj Bujdak, Mario Stoll, Isabelle Ruel, Elena Dorn, Thomas M. Stulnig, Abubaker Elfatih, Rano B. Alieva, Jiri Vesely, Valérie Carreau, Cristina M. Sibaja, Sophie Béliard, Olivier Ziegler, Adriana Branchi, Daniel Schurr, G.B. John Mancini, Tai E. Shyong, Eric L.T. Siang, Mafalda Bourbon, Zerrin Yigit, Meral Kayıkçıoğlu, Jacques Genest, Wei Yu, Michal Vrablík, Shavkat U. Hoshimov, Dan Gaita, Antonio Pipolo, Ashraf H.A. AlQudaimi, Walter Speidl, Gianfranco Parati, Zaliha Ismail, Victoria M. Zubieta, René Valéro, Tomas Salek, Hana Halamkova, Gustavs Latkovskis, Nicole Allendorf-Ostwald, Agnes Perrin, Vladimir Soska, Anastasia Garoufi, Francisco Araujo, Nacu C. Portilla, Thomas Segiet, Charalambos Koumaras, Hila Knobler, Fatih Sivri, Hani Altaradi, Ivan Pećin, Long Jiang, Alexander Dressel, Marlena Woś, Jana Franekova, D. Agapakis, Quitéria Rato, Dirk J. Blom, Marcin A. Bartlomiejczyk, Krzysztof Dyrbuś, Maurizio Averna, Phivos Symeonides, Yung A. Chua, Asim Rana, András Nagy, Juan C.G. Cuellar, Alexander Jäkel, Maya Safarova, Neama Luqman, Amalia-Despoina Koutsogianni, Patrick Tounian, Jose A. Alvarez, Ada Cuevas, Corinna Richter, Sybil Charrieres, Vitaliy Zafiraki, Michalis Doumas, Angela Lux, Thanh Huong Truong, Elaine Chow, José Luis Díaz-Díaz, Jesus R.H. Almada, Sabine Füllgraf-Horst, Gustavo G. Retana, Claudio Borghi, Gianni Biolo, Ivajlo Tzvetkov, Patrícia Pais, Mehmet Akbulut, Kumiko Nagahama, Oner Ozdogan, Frank Leistikow, Jianxun He, Alexander R.M. Lyons, Poranee Ganokroj, Luis E.S. Mendia, Ann-Cathrin Koschker, Gabriela A.G. Ramirez, Dainus Gilis, Karin Balinth, José Ramiro Cruz, Paolo Calabrò, Alberico L. Catapano, Emmanouil Skalidis, Hamida Al-Barwani, Genovefa Kolovou, Carolyn S.P. Lam, Yoto Yotov, Yaacov Henkin, Gabriella Iannuzzo, Aimi Z. Razman, Alma B.M. Rodriguez, Hans Dieplinger, Darlington E. Obaseki, Ursulo J. Herrera, Arcangelo Iannuzzi, Christoph Säly, Elena Olmastroni, Francisco G. Padilla, S.A. Nazli, Ioanna Gouni-Berthold, Miriam Kozárová, Urh Groselj, Igor Shaposhnik, Lorenzo Iughetti, Nawal Rwaili, Cinthia E. 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Rasulic I., Lalic N.M., Lam C., Le T.J., Siang E.L.T., Dissanayake S., I-Shing J.T., Shyong T.E., Jin T.C.S., Balinth K., Buganova I., Fabryova L., Kadurova M., Klabnik A., Kozarova M., Sirotiakova J., Battelino T., Kovac J., Mlinaric M., Sustar U., Podkrajsek K.T., Fras Z., Jug B., Cevc M., Pilcher G.J., Blom D.J., Wolmarans K.H., Brice B.C., Muniz-Grijalvo O., Diaz-Diaz J.L., de Isla L.P., Fuentes F., Badimon L., Martin F., Lux A., Chang N.-T., Ganokroj P., Akbulut M., Alici G., Bayram F., Can L.H., Celik A., Ceyhan C., Coskun F.Y., Demir M., Demircan S., Dogan V., Durakoglugil E., Dural I.E., Gedikli O., Hacioglu A., Ildizli M., Kilic S., Kirilmaz B., Kutlu M., Oguz A., Ozdogan O., Onrat E., Ozer S., Sabuncu T., Sahin T., Sivri F., Sonmez A., Temizhan A., Topcu S., Tuncez A., Vural M., Yenercag M., Yesilbursa D., Yigit Z., Yildirim A.B., Yildirir A., Yilmaz M.B., Atallah B., Traina M., Sabbour H., Hay D.A., Luqman N., Elfatih A., Abdulrasheed A., Kwok S., Oca N.D., Reyes X., Alieva R.B., Kurbanov R.D., Hoshimov S.U., Nizamov U.I., Ziyaeva A.V., Abdullaeva G.J., Do D.L., Nguyen M.N.T., Kim N.T., Le T.T., Le H.A., Tokgozoglu L., Catapano A.L., Ray K.K., Vallejo-Vaz, A. J., Stevens, C. A. T., Lyons, A. R. M., Dharmayat, K. I., Freiberger, T., Hovingh, G. K., Mata, P., Raal, F. J., Santos, R. D., Soran, H., Watts, G. F., Abifadel, M., Aguilar-Salinas, C. A., Alhabib, K. F., Alkhnifsawi, M., Almahmeed, W., Alnouri, F., Alonso, R., Al-Rasadi, K., Al-Sarraf, A., Al-Sayed, N., Araujo, F., Ashavaid, T. F., Banach, M., Beliard, S., Benn, M., Binder, C. J., Bogsrud, M. P., Bourbon, M., Chlebus, K., Corral, P., Davletov, K., Descamps, O. S., Durst, R., Ezhov, M., Gaita, D., Genest, J., Groselj, U., Harada-Shiba, M., Holven, K. B., Kayikcioglu, M., Khovidhunkit, W., Lalic, K., Latkovskis, G., Laufs, U., Liberopoulos, E., Lima-Martinez, M. M., Lin, J., Maher, V., Marais, A. D., Marz, W., Mirrakhimov, E., Miserez, A. R., Mitchenko, O., Nawawi, H., Nordestgaard, B. G., Panayiotou, A. G., Paragh, G., Petrulioniene, Z., Pojskic, B., Postadzhiyan, A., Raslova, K., Reda, A., Sadiq, F., Sadoh, W. E., Schunkert, H., Shek, A. B., Stoll, M., Stroes, E., Su, T. -C., Subramaniam, T., Susekov, A. V., Tilney, M., Tomlinson, B., Truong, T. H., Tselepis, A. D., Tybjaerg-Hansen, A., Vazquez Cardenas, A., Viigimaa, M., Wang, L., Yamashita, S., Kastelein, J. J. P., Bruckert, E., Vohnout, B., Schreier, L., Pang, J., Ebenbichler, C., Dieplinger, H., Innerhofer, R., Winhofer-Stockl, Y., Greber-Platzer, S., Krychtiuk, K., Speidl, W., Toplak, H., Widhalm, K., Stulnig, T., Huber, K., Hollerl, F., Rega-Kaun, G., Kleemann, L., Maser, M., Scholl-Burgi, S., Saly, C., Mayer, F. J., Sablon, G., Tarantino, E., Nzeyimana, C., Pojskic, L., Sisic, I., Nalbantic, A. D., Jannes, C. E., Pereira, A. C., Krieger, J. E., Petrov, I., Goudev, A., Nikolov, F., Tisheva, S., Yotov, Y., Tzvetkov, I., Baass, A., Bergeron, J., Bernard, S., Brisson, D., Brunham, L. R., Cermakova, L., Couture, P., Francis, G. A., Gaudet, D., Hegele, R. A., Khoury, E., Mancini, G. B. J., Mccrindle, B. W., Paquette, M., Ruel, I., Cuevas, A., Asenjo, S., Wang, X., Meng, K., Song, X., Yong, Q., Jiang, T., Liu, Z., Duan, Y., Hong, J., Ye, P., Chen, Y., Qi, J., Li, Y., Zhang, C., Peng, J., Yang, Y., Yu, W., Wang, Q., Yuan, H., Cheng, S., Jiang, L., Chong, M., Jiao, J., Wu, Y., Wen, W., Xu, L., Zhang, R., Qu, Y., He, J., Fan, X., Wang, Z., Chow, E., Pecin, I., Perica, D., Symeonides, P., Vrablik, M., Ceska, R., Soska, V., Tichy, L., Adamkova, V., Franekova, J., Cifkova, R., Kraml, P., Vonaskova, K., Cepova, J., Dusejovska, M., Pavlickova, L., Blaha, V., Rosolova, H., Nussbaumerova, B., Cibulka, R., Vaverkova, H., Cibickova, L., Krejsova, Z., Rehouskova, K., Malina, P., Budikova, M., Palanova, V., Solcova, L., Lubasova, A., Podzimkova, H., Bujdak, J., Vesely, J., Jordanova, M., Salek, T., Urbanek, R., Zemek, S., Lacko, J., Halamkova, H., Machacova, S., Mala, S., Cubova, E., Valoskova, K., Burda, L., Bendary, A., Daoud, I., Emil, S., Elbahry, A., Rafla, S., Sanad, O., Kazamel, G., Ashraf, M., Sobhy, M., El-Hadidy, A., Shafy, M. A., Kamal, S., Bendary, M., Talviste, G., Angoulvant, D., Boccara, F., Cariou, B., Carreau, V., Carrie, A., Charrieres, S., Cottin, Y., Di-Fillipo, M., Ducluzeau, P. H., Dulong, S., Durlach, V., Farnier, M., Ferrari, E., Ferrieres, D., Ferrieres, J., Gallo, A., Hankard, R., Inamo, J., Lemale, J., Moulin, P., Paillard, F., Peretti, N., Perrin, A., Pradignac, A., Rabes, J. P., Rigalleau, V., Sultan, A., Schiele, F., Tounian, P., Valero, R., Verges, B., Yelnik, C., Ziegler, O., Haack, I. A., Schmidt, N., Dressel, A., Klein, I., Christmann, J., Sonntag, A., Stumpp, C., Boger, D., Biedermann, D., Usme, M. M. N., Beil, F. U., Klose, G., Konig, C., Gouni-Berthold, I., Otte, B., Boll, G., Kirschbaum, A., Merke, J., Scholl, J., Segiet, T., Gebauer, M., Predica, F., Mayer, M., Leistikow, F., Fullgraf-Horst, S., Muller, C., Schuler, M., Wiener, J., Hein, K., Baumgartner, P., Kopf, S., Busch, R., Schomig, M., Matthias, S., Allendorf-Ostwald, N., Fink, B., Bohm, D., Jakel, A., Koschker, A. -C., Schweizer, R., Vogt, A., Parhofer, K., Konig, W., Reinhard, W., Bassler, A., Stadelmann, A., Schrader, V., Katzmann, J., Tarr, A., Steinhagen-Thiessen, E., Kassner, U., Paulsen, G., Homberger, J., Zemmrich, C., Seeger, W., Biolik, K., Deiss, D., Richter, C., Pantchechnikova, E., Dorn, E., Schatz, U., Julius, U., Spens, A., Wiesner, T., Scholl, M., Rizos, C. V., Sakkas, N., Elisaf, M., Skoumas, I., Tziomalos, K., Rallidis, L., Kotsis, V., Doumas, M., Athyros, V., Skalidis, E., Kolovou, G., Garoufi, A., Bilianou, E., Koutagiar, I., Agapakis, D., Kiouri, E., Antza, C., Katsiki, N., Zacharis, E., Attilakos, A., Sfikas, G., Koumaras, C., Anagnostis, P., Anastasiou, G., Liamis, G., Koutsogianni, A. -D., Karanyi, Z., Harangi, M., Bajnok, L., Audikovszky, M., Mark, L., Benczur, B., Reiber, I., Nagy, G., Nagy, A., Reddy, L. L., Shah, S. A. V., Ponde, C. K., Dalal, J. J., Sawhney, J. P. S., Verma, I. C., Altaey, M., Al-Jumaily, K., Rasul, D., Abdalsahib, A. F., Jabbar, A. A., Al-ageedi, M., Agar, R., Cohen, H., Ellis, A., Gavishv, D., Harats, D., Henkin, Y., Knobler, H., Leavit, L., Leitersdorf, E., Rubinstein, A., Schurr, D., Shpitzen, S., Szalat, A., Casula, M., Zampoleri, V., Gazzotti, M., Olmastroni, E., Sarzani, R., Ferri, C., Repetti, E., Sabba, C., Bossi, A. C., Borghi, C., Muntoni, S., Cipollone, F., Purrello, F., Pujia, A., Passaro, A., Marcucci, R., Pecchioli, V., Pisciotta, L., Mandraffino, G., Pellegatta, F., Mombelli, G., Branchi, A., Fiorenza, A. M., Pederiva, C., Werba, J. P., Parati, G., Carubbi, F., Iughetti, L., Iannuzzi, A., Iannuzzo, G., Calabro, P., Averna, M., Biasucci, G., Zambon, S., Roscini, A. R., Trenti, C., Arca, M., Federici, M., Del Ben, M., Bartuli, A., Giaccari, A., Pipolo, A., Citroni, N., Guardamagna, O., Bonomo, K., Benso, A., Biolo, G., Maroni, L., Lupi, A., Bonanni, L., Zenti, M. G., Matsuki, K., Hori, M., Ogura, M., Masuda, D., Kobayashi, T., Nagahama, K., Al-Jarallah, M., Radovic, M., Lunegova, O., Bektasheva, E., Khodzhiboboev, E., Erglis, A., Gilis, D., Nesterovics, G., Saripo, V., Meiere, R., Upena-RozeMicena, A., Terauda, E., Jambart, S., Khoury, P. E., Elbitar, S., Ayoub, C., Ghaleb, Y., Aliosaitiene, U., Kutkiene, S., Kasim, N. A. M., Nor, N. S. M., Ramli, A. S., Razak, S. A., Al-Khateeb, A., Kadir, S. H. S. A., Muid, S. A., Rahman, T. A., Kasim, S. S., Radzi, A. B. M., Ibrahim, K. S., Razali, S., Ismail, Z., Ghani, R. A., Hafidz, M. I. A., Chua, A. L., Rosli, M. M., Annamalai, M., Teh, L. K., Razali, R., Chua, Y. A., Rosman, A., Sanusi, A. R., Murad, N. A. A., Jamal, A. R. A., Nazli, S. A., Razman, A. Z., Rosman, N., Rahmat, R., Hamzan, N. S., Azzopardi, C., Mehta, R., Martagon, A. J., Ramirez, G. A. G., Villa, N. E. A., Vazquez, A. V., Elias-Lopez, D., Retana, G. G., Rodriguez, B., Macias, J. J. C., Zazueta, A. R., Alvarado, R. M., Portano, J. D. M., Lopez, H. A., Sauque-Reyna, L., Herrera, L. G. G., Mendia, L. E. S., Aguilar, H. G., Cooremans, E. R., Aparicio, B. P., Zubieta, V. M., Gonzalez, P. A. C., Ferreira-Hermosillo, A., Portilla, N. C., Dominguez, G. J., Garcia, A. Y. R., Cazares, H. E. A., Gonzalez, J. R., Valencia, C. V. M., Padilla, F. G., Prado, R. M., De los Rios Ibarra, M. O., Villicana, R. D. A., Rivera, K. J. A., Carrera, R. A., Alvarez, J. A., Martinez, J. C. A., de los Reyes Barrera Bustillo, M., Vargas, G. C., Chacon, R. C., Andrade, M. H. F., Ortega, A. F., Alcala, H. G., de Leon, L. E. G., Guzman, B. G., Garcia, J. J. G., Cuellar, J. C. G., Cruz, J. R. G., Garcia, A. H., Almada, J. R. H., Herrera, U. J., Sobrevilla, F. L., Rodriguez, E. M., Sibaja, C. M., Rodriguez, A. B. M., Oyervides, J. C. M., Vazquez, D. I. P., Rodriguez, E. A. R., Osorio, M. L. R., Saucedo, J. R., Tamayo, M. T., Talavera, L. A. V., Arroyo, L. E. V., Carrillo, E. A. Z., Isara, A., Obaseki, D. E., Al-Waili, K., Al-Zadjali, F., Al-Zakwani, I., Al-Kindi, M., Al-Mukhaini, S., Al-Barwani, H., Rana, A., Shah, L. S. U., Starostecka, E., Konopka, A., Lewek, J., Bartlomiejczyk, M., Gasior, M., Dyrbus, K., Jozwiak, J., Gruchala, M., Pajkowski, M., Romanowska-Kocejko, M., Zarczynska-Buchowiecka, M., Chmara, M., Wasag, B., Parczewska, A., Gilis-Malinowska, N., Borowiec-Wolna, J., Strozyk, A., Wos, M., Michalska-Grzonkowska, A., Medeiros, A. M., Alves, A. C., Silva, F., Lobarinhas, G., Palma, I., de Moura, J. P., Rico, M. T., Rato, Q., Pais, P., Correia, S., Moldovan, O., Virtuoso, M. J., Salgado, J. M., Colaco, I., Dumitrescu, A., Lengher, C., Mosteoru, S., Meshkov, A., Ershova, A., Rozkova, T., Korneva, V., Yu, K. T., Zafiraki, V., Voevoda, M., Gurevich, V., Duplyakov, D., Ragino, Y., Safarova, M., Shaposhnik, I., Alkaf, F., Khudari, A., Rwaili, N., Al-Allaf, F., Alghamdi, M., Batais, M. A., Almigbal, T. H., Kinsara, A., Alqudaimi, A. H. A., Awan, Z., Elamin, O. A., Altaradi, H., Rajkovic, N., Popovic, L., Singh, S., Stosic, L., Rasulic, I., Lalic, N. M., Lam, C., Le, T. J., Siang, E. L. T., Dissanayake, S., I-Shing, J. T., Shyong, T. E., Jin, T. C. S., Balinth, K., Buganova, I., Fabryova, L., Kadurova, M., Klabnik, A., Kozarova, M., Sirotiakova, J., Battelino, T., Kovac, J., Mlinaric, M., Sustar, U., Podkrajsek, K. T., Fras, Z., Jug, B., Cevc, M., Pilcher, G. J., Blom, D. J., Wolmarans, K. H., Brice, B. C., Muniz-Grijalvo, O., Diaz-Diaz, J. L., de Isla, L. P., Fuentes, F., Badimon, L., Martin, F., Lux, A., Chang, N. -T., Ganokroj, P., Akbulut, M., Alici, G., Bayram, F., Can, L. H., Celik, A., Ceyhan, C., Coskun, F. Y., Demir, M., Demircan, S., Dogan, V., Durakoglugil, E., Dural, I. E., Gedikli, O., Hacioglu, A., Ildizli, M., Kilic, S., Kirilmaz, B., Kutlu, M., Oguz, A., Ozdogan, O., Onrat, E., Ozer, S., Sabuncu, T., Sahin, T., Sivri, F., Sonmez, A., Temizhan, A., Topcu, S., Tuncez, A., Vural, M., Yenercag, M., Yesilbursa, D., Yigit, Z., Yildirim, A. B., Yildirir, A., Yilmaz, M. B., Atallah, B., Traina, M., Sabbour, H., Hay, D. A., Luqman, N., Elfatih, A., Abdulrasheed, A., Kwok, S., Oca, N. D., Reyes, X., Alieva, R. B., Kurbanov, R. D., Hoshimov, S. U., Nizamov, U. I., Ziyaeva, A. V., Abdullaeva, G. J., Do, D. L., Nguyen, M. N. T., Kim, N. T., Le, T. T., Le, H. A., Tokgozoglu, L., Catapano, A. L., Ray, K. K., and EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC), Borghi C
Subjects: Male, Settore MED/09 - Medicina Interna, Arterial disease, Cross-sectional study, Adult population, Coronary Disease, Disease, Global Health, Medical and Health Sciences, Doenças Cardio e Cérebro-vasculares, Anticholesteremic Agent, Monoclonal, Prevalence, Registries, Familial Hypercholesterolemia, Humanized, Stroke, 11 Medical and Health Sciences, LS2_9, Studies Collaboration, Anticholesteremic Agents, General Medicine, Heart Disease Risk Factor, Middle Aged, FHSC global registry data, Europe, Treatment Outcome, Lower prevalence, Guidance, lipids (amino acids, peptides, and proteins), Female, Proprotein Convertase 9, Familial hypercholesterolaemia, Life Sciences & Biomedicine, Human, Adult, medicine.medical_specialty, Combination therapy, FHSC global registry, heterozygous familial hypercholesterolaemia, Cardiovascular risk factors, Antibodies, Monoclonal, Humanized, Insights, Antibodies, NO, Hyperlipoproteinemia Type II, Clinician, Medicine, General & Internal, Internal medicine, General & Internal Medicine, Health Sciences, medicine, Humans, EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC), Cross-Sectional Studie, Science & Technology, Global Perspective, business.industry, Cholesterol, LDL, medicine.disease, Cross-Sectional Studies, Heart Disease Risk Factors, Hydroxymethylglutaryl-CoA Reductase Inhibitor, Hydroxymethylglutaryl-CoA Reductase Inhibitors, business
Abstract: Background The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry provides a platform for the global surveillance of familial hypercholesterolaemia through harmonisation and pooling of multinational data. In this study, we aimed to characterise the adult population with heterozygous familial hypercholesterolaemia and described how it is detected and managed globally. Methods Using FHSC global registry data, we did a cross-sectional assessment of adults (aged 18 years or older) with a clinical or genetic diagnosis of probable or definite heterozygous familial hypercholesterolaemia at the time they were entered into the registries. Data were assessed overall and by WHO regions, sex, and index versus non-index cases. Findings Of the 61 612 individuals in the registry, 42 167 adults (21 999 [53.6%] women) from 56 countries were included in the study. Of these, 31 798 (75.4%) were diagnosed with the Dutch Lipid Clinic Network criteria, and 35 490 (84.2%) were from the WHO region of Europe. Median age of participants at entry in the registry was 46.2 years (IQR 34.3-58.0); median age at diagnosis of familial hypercholesterolaemia was 44.4 years (32.5-56.5), with 40.2% of participants younger than 40 years when diagnosed. Prevalence of cardiovascular risk factors increased progressively with age and varied by WHO region. Prevalence of coronary disease was 17.4% (2.1% for stroke and 5.2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men. Among patients receiving lipid-lowering medications, 16 803 (81.1%) were receiving statins and 3691 (21.2%) were on combination therapy, with greater use of more potent lipid-lowering medication in men than in women. Median LDL cholesterol was 5.43 mmol/L (IQR 4.32-6.72) among patients not taking lipid-lowering medications and 4.23 mmol/L (3.20-5.66) among those taking them. Among patients taking lipid-lowering medications, 2.7% had LDL cholesterol lower than 1.8 mmol/L; the use of combination therapy, particularly with three drugs and with proprotein convertase subtilisin-kexin type 9 inhibitors, was associated with a higher proportion and greater odds of having LDL cholesterol lower than 1.8 mmol/L. Compared with index cases, patients who were non-index cases were younger, with lower LDL cholesterol and lower prevalence of cardiovascular risk factors and cardiovascular diseases (all p, Pfizer Independent Grant for Learning Change [16157823]; Amgen; Merck Sharp Dohme; Sanofi-Aventis; Daiichi Sankyo; Regeneron; National Institute for Health Research (NIHR) Imperial Biomedical Research Centre, UK; NIHR; Czech Ministry of Health [NU20-02-00261]; Canadian Institutes of Health Research; Austrian Heart Foundation; Tyrolean Regional Government; Gulf Heart Association, The EAS FHSC is an academic initiative that has received funding from a Pfizer Independent Grant for Learning & Change 2014 (16157823) and from investigator-initiated research grants to the European Atherosclerosis Society-Imperial College London from Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Daiichi Sankyo, and Regeneron. KKR acknowledges support from the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre, UK. KID acknowledges support from a PhD Studentship from NIHR under the Applied Health Research programme for Northwest London, UK (the views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health). TF was supported by a grant from the Czech Ministry of Health (NU20-02-00261). JG receives support from the Canadian Institutes of Health Research. The Austrian Familial Hypercholesterolaemia registry has been supported by funds from the Austrian Heart Foundation and the Tyrolean Regional Government. The Gulf Familial Hypercholesterolaemia registry was done under the auspices of the Gulf Heart Association.
Published: 2021

49. ‘Corrigendum to 'Association of bedtime with mortality and major cardiovascular events: an analysis of 112,198 individuals from 21 countries in the PURE study' [Sleep Medicine 80 (2021) 265–272]’

Author: Chuangshi Wang, Bo Hu, Sumathy Rangarajan, Shrikant I. Bangdiwala, Sadi Gulec, Scott A. Lear, Viswanathan Mohan, Rajeev Gupta, Khalid F. Alhabib, Biju Soman, Marc Evans M. Abat, Annika Rosengren, Fernando Lanas, Alvaro Avezum, Patricio Lopez-Jaramillo, Rafael Diaz, Khalid Yusoff, Romaina Iqbal, Jephat Chifamba, Karen Yeates, Katarzyna Zatońska, Iolanthé M. Kruger, Ahmad Bahonar, Afzalhussein Yusufali, Wei Li, and Salim Yusuf
Subjects: General Medicine
Published: 2022

50. THE EFFECT OF BETA-BLOCKER MEDICATIONS POST MYOCARDIAL INFARCTION WITH EJECTION FRACTION >40%: POOLED ANALYSIS DATA FROM SEVEN ARABIAN GULF ACS REGISTRY

Author: Rasha Al-Bawardy, Wael Alqarawi, Jassim AlSuwaidi, Wael Almahmeed, Mohammad Zubaid, Haitham Amin, Kadhim Sulaiman, and Khalid F. AlHabib
Subjects: Cardiology and Cardiovascular Medicine
Published: 2022

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