Journal of the American Heart Association, Год журнала: 2024, Номер 13(16)
Опубликована: Авг. 13, 2024
Poor cardiovascular-kidney-metabolic (CKM) health is associated with premature mortality and excess morbidity in the United States. Adverse social conditions have a prominent impact on cardiometabolic diseases during life course. We aim to examine association between risk profile (SRP) CKM multimorbidity among US adults.
Язык: Английский
Circulation, Год журнала: 2023, Номер 148(20), С. 1606 - 1635
Опубликована: Окт. 9, 2023
Cardiovascular-kidney-metabolic health reflects the interplay among metabolic risk factors, chronic kidney disease, and cardiovascular system has profound impacts on morbidity mortality. There are multisystem consequences of poor cardiovascular-kidney-metabolic health, with most significant clinical impact being high associated incidence disease events is a prevalence in population, disproportionate burden seen those adverse social determinants health. However, there also growing number therapeutic options that favorably affect function, or both have cardioprotective effects. To improve related outcomes critical need for (1) more clarity definition syndrome; (2) an approach to staging promotes prevention across life course; (3) prediction algorithms include exposures relevant health; (4) strategies management relation reflect harmonization major subspecialty guidelines emerging scientific evidence. It incorporate considerations into care models syndrome reduce fragmentation by facilitating approaches patient-centered interdisciplinary care. This presidential advisory provides guidance definition, staging, paradigms, holistic patients details multicomponent vision effectively equitably enhancing population.
Язык: Английский
Процитировано
369
Circulation, Год журнала: 2023, Номер 149(6), С. 430 - 449
Опубликована: Ноя. 10, 2023
BACKGROUND: Multivariable equations are recommended by primary prevention guidelines to assess absolute risk of cardiovascular disease (CVD). However, current have several limitations. Therefore, we developed and validated the American Heart Association Predicting Risk CVD EVENTs (PREVENT) among US adults 30 79 years age without known CVD. METHODS: The derivation sample included individual-level participant data from 25 sets (N=3 281 919) between 1992 2017. outcome was (atherosclerotic heart failure). Predictors traditional factors (smoking status, systolic blood pressure, cholesterol, antihypertensive or statin use, diabetes) estimated glomerular filtration rate. Models were sex-specific, race-free, on scale, adjusted for competing non-CVD death. Analyses conducted in each set meta-analyzed. Discrimination assessed using Harrell C-statistic. Calibration calculated as slope observed versus predicted decile. Additional predict subtype failure) include optional predictors (urine albumin-to-creatinine ratio hemoglobin A1c), social deprivation index also developed. External validation performed 3 330 085 participants 21 additional sets. RESULTS: Among 6 612 004 included, mean±SD 53±12 years, 56% women. Over a follow-up 4.8±3.1 there 211 515 incident total events. median C-statistics external 0.794 (interquartile interval, 0.763–0.809) female 0.757 (0.727–0.778) male participants. calibration slopes 1.03 0.81–1.16) 0.94 (0.81–1.13) participants, respectively. Similar estimates discrimination atherosclerotic CVD– failure–specific models. improvement small but statistically significant when urine ratio, A1c, added together base model (ΔC-statistic [interquartile interval] 0.004 [0.004–0.005] 0.005 [0.004–0.007] respectively). improved significantly those with marked albuminuria (>300 mg/g; 1.05 [0.84–1.20] 1.39 [1.14–1.65]; P =0.01). CONCLUSIONS: PREVENT accurately precisely subtypes large, diverse, contemporary routinely available clinical variables.
Язык: Английский
Процитировано
214
Circulation, Год журнала: 2023, Номер 148(24), С. 1982 - 2004
Опубликована: Ноя. 10, 2023
Cardiovascular-kidney-metabolic (CKM) syndrome is a novel construct recently defined by the American Heart Association in response to high prevalence of metabolic and kidney disease. Epidemiological data demonstrate higher absolute risk both atherosclerotic cardiovascular disease (CVD) heart failure as an individual progresses from CKM stage 0 3, but optimal strategies for assessment need be refined. Absolute with goal match type intensity interventions predicted expected treatment benefit remains cornerstone primary prevention. Given growing number therapies our armamentarium that simultaneously address all 3 axes, prediction equations are needed incorporate predictors outcomes relevant context. This should also include social determinants health, which key upstream drivers CVD, more equitably estimate risk. scientific statement summarizes background, rationale, clinical implications newly developed sex-specific, race-free equations: PREVENT (AHA Predicting Risk CVD Events). The enable 10- 30-year estimates total (composite failure), estimated glomerular filtration rate predictor, adjust competing non-CVD death among adults 30 79 years age. Additional models accommodate enhanced predictive utility addition factors when clinically indicated measurement (urine albumin-to-creatinine ratio hemoglobin A1c) or health (social deprivation index) available. Approaches implement risk-based prevention using across various settings discussed.
Язык: Английский
Процитировано
179
Current Problems in Cardiology, Год журнала: 2023, Номер 49(2), С. 102344 - 102344
Опубликована: Дек. 14, 2023
Язык: Английский
Процитировано
58
Circulation, Год журнала: 2024, Номер 150(4)
Опубликована: Июнь 4, 2024
BACKGROUND: Cardiovascular disease and stroke are common costly, their prevalence is rising. Forecasts on the of risk factors clinical events crucial. METHODS: Using 2015 to March 2020 National Health Nutrition Examination Survey 2019 Medical Expenditure Panel Survey, we estimated trends in for cardiovascular based adverse levels Life’s Essential 8 stroke. We projected through 2050, overall by age race ethnicity, accounting changes demographics. RESULTS: estimate that among adults, hypertension will increase from 51.2% 61.0% 2050. Diabetes (16.3% 26.8%) obesity (43.1% 60.6%) increase, whereas hypercholesterolemia decline (45.8% 24.0%). The prevalences poor diet, inadequate physical activity, smoking improve over time, sleep worsen. Prevalences coronary (7.8% 9.2%), heart failure (2.7% 3.8%), (3.9% 6.4%), atrial fibrillation (1.7% 2.4%), total (11.3% 15.0%) rise. Clinical CVD affect 45 million including more than 184 adults 2050 (>61%). Similar children. Most be worse people identifying as American Indian/Alaska Native or multiracial, Black, Hispanic. CONCLUSIONS: many most established diseases next 30 years. public health interventions needed effectively manage, stem, even reverse these trends.
Язык: Английский
Процитировано
54
Nature Reviews Disease Primers, Год журнала: 2024, Номер 10(1)
Опубликована: Окт. 17, 2024
Язык: Английский
Процитировано
43
The Lancet Global Health, Год журнала: 2024, Номер 12(3), С. e342 - e343
Опубликована: Фев. 15, 2024
Chronic kidney disease is a global public health problem, involving about 10% of the population.1Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work GroupKDIGO 2024 Clinical Practice Guideline for Evaluation and Management Kidney Disease.Kidney Int. 2024; 105: S1-S197Summary Full Text PDF Scopus (1) Google Scholar The awareness this major burden relatively recent still incomplete. Unfortunately, multifaceted chronic (prevalence, morbidity, mortality, costs) relentlessly growing, particularly in low-income countries (LIC).1Kidney In Lancet Health, Aminu K Bello colleagues update International Society Nephrology Health Atlas, which assesses disparities care across around 200 countries.2Bello AK Okpechi IG Levin A et al.An on world regions.Lancet Glob Health. 12: e382-e395Google report relies detailed review literature, available databases registries to estimate disease, incidence prevalence treated failure. Findings were triangulated with data from multinational survey opinion leaders based WHO's building blocks systems (ie, financing, service delivery, access essential medicines technology, information systems, workforce, governance). authors deserve be congratulated colossal effort. median 9·5% (IQR 5·9–11·7). Haemodialysis (defined as provided >50% people failure, minimalist definition) 162 (98%) 165 surveyed countries, whereas peritoneal dialysis transplantation are three-quarters countries. replacement therapy (KRT, either or transplantation) varies by factor high-income regions (highest Taiwan) LIC such sub-Saharan Africa Within LICs, wide KRT availability depend political agendas individual workforce increased somewhat recently, but number nephrologists remains very low LIC. almost 50% funding expenses solely private out-of-pocket payments.2Bello picture captured important. Unsurprisingly, massive effort, some results raise questions point limitations. Africa, 4·2% much lower than other reports (12·2–15·8%).3Kaze AD Ilori T Jaar BG Echouffo-Tcheugui JB Burden African continent: systematic meta-analysis.BMC Nephrol. 2018; 19: 125Crossref PubMed (97) Scholar, 4Masimango MI Jadoul M Binns-Roemer EA al.APOL1 renal risk variants sickle cell trait associations reduced function large Congolese population-based study.Kidney Int Rep. 2021; 7: 474-482Summary (5) This unexpected because high apolipoprotein L1 mutations, populations ancestry.4Masimango do not discuss quality (frequency duration haemodialysis sessions, modern immunosuppressive drugs, etc). addition, they just mention that half before KRT. Finally, paper had only small component devoted patients' voices regarding impact their life. addition reducing above-mentioned limitations, next iteration(s) should expand Indeed, failure costly tip iceberg. Morbidity mortality mostly occur largely driven cardiovascular disease. Whereas until tools delay progression limited antihypertensive renin angiotensin system blockers, now moves into direction multidrug therapy. Multiple trials have demonstrated SGLT2 inhibitors reduce hard outcomes events patients albuminuric both without diabetes.1Kidney 5Mark PB Sarafidis P Ekart R al.SGLT2i evidence-based cardiorenal protection diabetic non-diabetic disease: comprehensive EURECA-m ERBP working groups ERA.Nephrol Dial Transplant. 2023; 38: 2444-2455Crossref (3) Finerenone, non-steroidal mineralocorticoid receptor antagonist, has been approved management type 2 diabetes.6Agarwal Filippatos G Pitt B al.Cardiovascular finerenone diabetes FIDELITY pooled analysis.Eur Heart J. 2022; 43: 474-484Crossref (297) Thus, guidelines recommend use appropriate patients. wave new drugs likely continue: indeed, phase 3 study ongoing An endothelin-receptor antagonist an aldosterone synthase inhibitor will soon tested trials, after positive studies.7Heerspink HJL Kiyosue Wheeler DC al.Zibotentan combination dapagliflozin compared (ZENITH-CKD): multicentre, randomised, active-controlled, 2b, clinical trial.Lancet. 402: 2004-2017Summary (2) 8Tuttle KR Hauske SJ Canziani ME al.Efficacy safety inhibition empagliflozin controlled, (published online Dec 15.)https://doi.org/10.1016/S0140–6736(23)02408-XSummary yet unpublished trial semaglutide, GLP1 agonist, was terminated interim analysis independent Data Monitoring Committee concluded prespecified criteria met stopping early efficacy primary outcome.9Novo NordiskNovo Nordisk stop once-weekly injectable semaglutide trial, FLOW, analysis.https://www.novonordisk.com/news-and-media/news-and-ir-materials/news-details.html?id=166327Date: Oct 10, 2023Date accessed: January 17, 2024Google But drugs' registration end beginning battle. role many health-care physicians, nephrologists, also cardiologists, endocrinologists, others caring undiagnosed key. position statement American Association10Ndumele CE Neeland IJ Tuttle al.A synopsis evidence science Cardiovascular-Kidney-Metabolic (CKM) syndrome: scientific Association.Circulation. 148: 1636-1664Crossref (8) cardio-kidney metabolic syndrome (whose earlier diagnosis possible urinalysis, when eGFR normal) noteworthy. Collaboration between medical specialties, patients, organisations important increase prescription effectively delaying Admittedly, having enough. Access medications required poor middle-income Hence, additional efforts WHO policy makers needed make globally available. conclusion, highlights advocacy urgently inclusion agenda. insufficient policies missing most Future action plans improve promote detection high-risk groups, training practitioners, provision MJ cochair (KDIGO), publishes nephrology; he consultant speaker AstraZeneca, Bayer, Boehringer-Ingelheim. declare no competing interests. regionsThis provides its treatment. Countries low-resource settings substantially diminished capacity delivery. These findings implications achieving equitable care. Full-Text Open
Язык: Английский
Процитировано
36
Nature Reviews Nephrology, Год журнала: 2024, Номер 20(9), С. 569 - 585
Опубликована: Июль 18, 2024
Язык: Английский
Процитировано
34
Cell, Год журнала: 2024, Номер 187(15), С. 3789 - 3820
Опубликована: Июль 1, 2024
Язык: Английский
Процитировано
30
Cardiovascular Diabetology, Год журнала: 2024, Номер 23(1)
Опубликована: Авг. 7, 2024
The American Heart Association (AHA) has recently introduced the concept of Cardiovascular-Kidney-Metabolic (CKM) syndrome, which is result an increasing emphasis on interplay metabolic, renal and cardiovascular diseases (CVD). Furthermore, there substantial evidence a correlation between triglyceride glucose-body mass index (TyG-BMI ) CVD as assessment insulin resistance (IR). However, it remains unknown whether this exists in population with CKM syndrome.
Язык: Английский
Процитировано
24