Daily Cardiology Research Analysis

BACKGROUND: Mortality due to ischemic heart disease (IHD) has declined in countries with high socioeconomic development. Whether these declines extend to other settings, and whether socioeconomic development influences IHD mortality among men and women differently, is unknown. METHODS: We obtained annual data on sex-specific IHD mortality rates for countries/territories in the GBD study (Global Burden of Disease) from 1980 to 2021. The sociodemographic index (SI), a measure of socioeconomic development, was retrieved for each country/territory. Age-adjusted IHD mortality rates were modeled as a smooth function of sex, year, and SI. RESULTS: From 1980 to 2021, IHD mortality rates did not decrease in low SI settings for men or women. In contrast, mortality rates relative to 1980 declined by >25% in average SI settings (age-adjusted mortality per 100 000, 153-107 for women and 218-161 for men) and >50% in high SI settings (age-adjusted mortality per 100 000, 162-69 for women and 258-114 for men). Comparing the 20th versus 80th percentile of SI in 2021 (corresponding to lower versus higher socioeconomic development), mortality rates were 81% higher for men and 111% higher for women living in socioeconomically deprived settings ( CONCLUSIONS: Across the past 4 decades, low socioeconomic development was associated with no improvement in IHD mortality rates for men or women, in contrast to the large reductions observed in settings with high socioeconomic development. In contemporary settings, socioeconomic deprivation is associated with larger relative excess mortality in women and larger absolute excess mortality in men.

BACKGROUND: Possible misdiagnosis of acute myocardial infarction (AMI) may occur due to inappropriate upper limit of normal (ULN) for cardiac troponin and has the potential to harm patients. In this observational international multicenter study, we aimed to assess to what extent the novel hs-cTn-assays are affected. METHODS: A total of 6646 patients presenting with suspected AMI to the emergency department were enrolled. All level pairs (n=18 732) of 4 widely used high-sensitivity cardiac troponin T/I (hs-cTnT/I) assays using (1) the regulatory-approved uniform and sex-specific clinical ULN and (2) mathematically derived close-to-bioequivalent ULNs were assessed. The primary outcome was the quantification of the incidence of inconsistencies in the diagnosis of AMI. Inconsistency was defined as hs-cTnT/I concentration above the recommended ULN in one but not the other assay: for example, hs-cTnT-Elecsys+/hs-cTnI-Architect- or hs-cTnT-Elecsys-/hs-cTnI-Architect+. RESULTS: AMI was the adjudicated diagnosis in 1422 patients (21.4%). When the regulatory-approved uniform ULN was used, the rate of inconsistent AMI diagnoses was 17.6% (Elecsys/Architect), 18.8% (Elecsys/Centaur), 14.2% (Elecsys/Access), 4.9% (Architect/Centaur), 8.3% (Architect/Access), and 7.4% (Access/Centaur), respectively. Overall, diagnostic mismatches were not decreased, but in fact increased using regulatory-approved sex-specific ULNs. In women as compared with men, they were 23.8% versus 17.6% (Elecsys/Architect), 30.1% versus 19.1% (Elecsys/Centaur), 23.2% versus 15% (Elecsys/Access), 7.2% versus 4.5% (Architect/Centaur), 8.3% versus 8.7% (Architect/Access) and 7.8% versus 8.2% (Access/Centaur), respectively. Using close-to-bioequivalent ULNs reduced inconsistencies by 15% to 20% ( CONCLUSIONS: Current regulatory-approved uniform and sex-specific ULNs for hs-cTnT/I result in discordances in binary assay results, possibly impacting the diagnosis of AMI. A regulatory process that defines bioequivalent ULNs could reduce inconsistencies significantly. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00470587.

AIMS: There are no effective medications to prevent the onset of degenerative valvular heart disease (VHD). Sweetened beverage consumption may contribute to the development of VHD by affecting metabolic disorders, systemic inflammation, and calcification processes. This study aimed to prospectively assess the association between sweetened beverage consumption and the risk of degenerative VHD. METHODS AND RESULTS: This prospective study included 167 801 participants from the UK Biobank who completed at least one dietary questionnaire. During a median follow-up of 14.53 years, 1464 cases of aortic valve stenosis (AS) events, 584 cases of aortic valve regurgitation (AR) events, and 1744 cases of mitral valve regurgitation (MR) events were recorded. Compared with non-consumers, participants consuming more than one drink per day of artificially sweetened beverages (ASBs) had a higher risk of AS [hazard ratio (HR): 1.36, 95% confidence interval (CI): 1.10-1.68], AR (HR: 1.42, 95% CI: 1.02-2.00), and MR (HR: 1.35, 95% CI: 1.10-1.64). Similarly, the consumption of more than one drink of sugar-sweetened beverages (SSBs) was associated with an increased incidence of MR (HR: 1.47, 95% CI: 1.22-1.77). In contrast, no significant association was observed between the consumption of natural juices (NJs) and VHD risk. Results for VHD-related interventions, deaths, or cardiovascular events were largely consistent. Substituting SSBs or ASBs per day with NJs was associated with a reduced risk of MR (HR: 0.83, 95% CI: 0.72-0.94) events or AS (HR: 0.81, 95% CI: 0.69-0.94) events, respectively. CONCLUSION: Lower consumption of SSBs or ASBs may reduce the risk of degenerative VHD and VHD-related events. This large prospective study using data from the UK Biobank investigated the dose–response relationship between sweetened beverage consumption and the risk of degenerative valvular heart disease (VHD). Key finding 1: Lower consumption of sugar-sweetened beverages or artificially sweetened beverages may reduce the risk of degenerative VHD and VHD-related events, while natural juices did not show a significant association with VHD risk. Key finding 2: These results highlight that healthy beverage consumption habits may play an important role in preventing degenerative VHD and may contribute to the development of public health strategies focused on reducing the burden of degenerative VHD through dietary modifications.