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Global Heart

Publisher:
—
ISSN:
2211-8160
Category:
CARDIAC & CARDIOVASCULAR SYSTEMS
Impact factor:
3
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9 parsed articles

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Latest articles

Unraveling Emerging Data on Lipoprotein(a)-Driven Cardiovascular Disease via Multiomics: A Review

2026-03-23

Szilard Voros, Michael R. Barnes, David Watson, Wess Boatwright, Anthony Lozama, Denise Yates, Jagat Narula, Santica Marcovina

Evidence has shown that lipoprotein(a) (Lp[a]) is an independent, causal, genetic risk factor for cardiovascular disease (CVD) that promotes the progression of high-risk, vulnerable atherosclerotic plaque phenotypes. Systems biology integrates multiomics datasets to study linear and nonlinear relationships to enhance understanding of the molecular patterns of disease. One such example is the Genetic Loci and the Burden of Atherosclerotic Lesions (GLOBAL) study, which utilizes multiomics profiling to unravel the molecular signatures of Lp(a)-driven CVD. Using deep phenotyping of coronary atherosclerosis by coronary computed tomography angiography, whole-genome sequencing for genetic analysis, and evaluation of thousands of omics measurements and circulating biomarkers, it is possible to describe the atherogenic milieu associated with Lp(a)-driven CVD. By leveraging the multiomic evaluation of Lp(a)-driven coronary phenotypes, we can begin to translate these findings into real-world strategies for earlier recognition of distinct Lp(a)-driven CVD, which may contribute to improved risk mitigation strategies in clinical practice.

Prognostic Value of In-Hospital Nutritional Status Improvement in Heart Failure: Insights From JROADHF-NEXT Registry

2026-03-13

Toshitaka Okabe, Keisuke Kida, Nobuyuki Enzan, Masataka Ikeda, Takahiro Okumura, Takeshi Kitai, Takeshi Tohyama, Tatsunori Taniguchi, Shouji Matsushima, Yuya Matsue, Hiroyuki Tsutsui

Background: Malnutrition is common in heart failure (HF) and is associated with poor outcomes; however, longitudinal changes in the nutritional status of patients with HF are poorly investigated. Objectives: To assess the prognostic impact of changes in Controlling Nutritional Status (CONUT) score and identify predictors of malnutrition improvement in hospitalized patients with HF. Methods: We analyzed data on 4,016 patients from a nationwide acute HF registry in Japan (UMIN ID: UMIN000036592). We identified 812 patients with moderate or severe malnutrition at admission (CONUT score ≥5) and stratified them into an improvement (IMP, n = 168) or non-improvement (Non-IMP, n = 644) group based on in-hospital change in CONUT score. The primary outcome was all-cause mortality; the secondary outcome was a composite endpoint of all-cause mortality and HF rehospitalization. Results: Over a median follow-up of 712 days (IQR, 392–768 days), all-cause mortality was significantly lower in the IMP group than in the Non-IMP group (11.90% vs. 30.12%; log-rank P < 0.0001). The composite endpoint was also lower in the IMP group (29.76% vs. 47.98%; log-rank P < 0.0001). After propensity score matching, the IMP group had consistently lower all-cause mortality and composite endpoints than the Non-IMP group (log-rank P = 0.0002; log-rank P = 0.041). Multivariable Cox proportional hazards model for all-cause mortality with overlap weighting demonstrated that CONUT improvement was associated with lower all-cause mortality (HR, 0.357; 95% CI, 0.205–0.624; P = 0.0003). Conclusion: In hospitalized patients with acute HF and moderate to severe malnutrition, improvement in CONUT score during hospitalization was associated with lower post-discharge mortality and rehospitalization.

Financial Burden, Out-of-Pocket Health Spending, and Household Economic Well-Being in Heart Failure Patients in India: A Multicentre Cross-Sectional Survey

2026-03-12

Panniyammakal Jeemon, Reethu Salim, K. Safvan, Greeva Philip, Aditya Kapoor, Amir Rashid, Ajay Bahl, Animesh Mishra, Bhavesh Roy, Bishav Mohan, Dinesh Choudhary, Jabir Abdullakutty, Justin Paul Gnanaraj, Jayesh Prajapati, Neelam Dahiya, Prakash C. Negi, Rishi Sethi, Satyanarayan Routray, Rajendiran Gopalan, P. Shyam Sunder Reddy, Veena Nanjappa, Meenakshi Sharma, Roopa Shivashankar, Sanjay Ganapathi, Sivadasanpillai Harikrishnan

Background: Heart failure (HF) is a complex clinical condition requiring resource-intensive management and substantial health expenditure. The adverse economic impact of medical care on patients or financial burden is increasingly recognised as a significant non-clinical entity affecting HF management in low- and middle-income countries (LMIC). We explored the factors associated with Financial Burden (FB) in HF patients in India. Methods: We recruited HF patients from 21 hospitals across India, selected to reflect regional diversity and varying stages of epidemiological transition. Trained personnel collected clinical and economic data using a validated and structured questionnaire. Expenditures were recorded in Indian rupees (INR) and converted to international dollars (INT$). Results: We recruited 1,859 participants. Nearly one-third of participants (30.2%) were women. The mean age was 55.9 (11.3) years, and the mean duration of formal education was 11.3 (3.8) years. Health insurance coverage was reported in one-third (32.2%) of the study population. The average annual out-of-pocket (OOP) expenditure was INR 1,06,566 (INT$ 4,709.10), constituting 92.6% (95% CI: 92.5–92.7) of the total health expenditure. Compared to the previous year, a decline in monthly income was reported by 32.3% of individuals and 36.2% of households. Catastrophic health spending (CHS) and distress financing (DF) were observed in 37.7% (35.5–39.9) and 17.7% (15.9–19.4) of the households, respectively. However, CHS and DF were lower [30.8% (26.2–35.4) and 13.6% (10.2–17.0), respectively] among those with health insurance compared to the uninsured [40.3% (37.6–43.0) and 18.9% (16.7–21.1), respectively]. Conclusion: Seven out of 10 HF patients in India lack financial health protection. OOP expenditures, accounting for over 90% of total health spending, contribute significantly to economic distress in HF patients. Financial burden, affecting more than one-third of HF patients, carries profound implications for individual well-being. Addressing this financial burden, including CHS and DF, is essential for improving clinical outcomes and ensuring health equity.

Assessment of Ten Insulin Resistance Surrogate Indexes Predicts New-Onset Cardiovascular Disease Incidence in Patients with Prediabetes or Diabetes: Insights from CHARLS Data with Machine Learning Analysis

2026-03-12

Hang Xie, Chaoying Yan, Yi Zheng, Haoyu Wu

Objective: Insulin resistance (IR) is a key driver of prediabetes, type 2 diabetes, and cardiovascular disease (CVD) risk. This study evaluated the predictive performance of ten IR surrogate indexes (TyG, TyG-BMI, TyG-WC, TyG-WHtR, METS-IR, AIP, TyHGB, CTI, eGDR, CVAI) for new-onset CVD in Chinese patients with prediabetes or diabetes, aiming to identify the most effective index for cardiovascular risk stratification. Methods: This longitudinal cohort study analyzed 3,532 middle-aged and elderly participants from the China Health and Retirement Longitudinal Study (CHARLS) baseline (Wave 1), with incident CVD events assessed at follow-up (Wave 4). Ten IR surrogate indexes were calculated at baseline. Multivariate logistic regression, adjusted for confounders, assessed associations between these indexes and CVD. Non-linear relationships were explored using restricted cubic spline analyses. Nine machine learning algorithms were employed to develop predictive models, with performance evaluated via receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis. Results: During follow-up, 874 participants (24.7%) developed CVD. Each standard deviation increase in eGDR was associated with reduced CVD risk (OR = 0.822, 95% CI: 0.696–0.969), while CVAI was linked to increased risk (OR = 1.124, 95% CI: 1.028–1.229). Compared to the lowest quartile, the highest eGDR quartile had a 47.3% lower CVD risk (OR = 0.527, 95% CI: 0.353–0.789, P = 0.0018), and the highest CVAI quartile had a 33.1% higher risk (OR = 1.331, 95% CI: 1.038–1.709, P = 0.0243). Incorporating eGDR and CVAI into machine learning models, particularly K-Nearest Neighbors (KNN), enhanced discrimination (AUC = 0.936, 95% CI: 0.928–0.943). Conclusion: eGDR and CVAI outperformed other IR indexes in predicting CVD in Chinese patients with prediabetes or diabetes. Their integration into KNN models significantly improved risk stratification, suggesting their utility as accessible clinical tools for early identification and intervention to reduce CVD burden.

National Trends and Factors Associated with Ischemic Heart Disease Among Individuals with Hypertension in Thailand from 2011 to 2018

2026-02-25

Boonsub Sakboonyarat, Kamakshi Lakshminarayan, Ram Rangsin

Background: Epidemiological data on ischemic heart disease (IHD) in individuals with hypertension in Thailand are limited. We examined national trends and factors associated with IHD among individuals with hypertension in Thailand from 2011 to 2018, following a decade of universal health coverage (UHC) implementation. Methods: We conducted a repeated cross-sectional study using data from the Thailand DM/HT study. This study included 226,420 Thai people aged ≥20 years with hypertension who received outpatient care nationwide. The annual prevalence and incidence of IHD were estimated. Modified Poisson regression analysis identified associated factors. Results: Across the 2011–2018 cycles, the age- and sex-adjusted IHD prevalence decreased from 56.6 to 34.5 per 1,000 people ( p -trend < 0.001), and the incidence decreased from 9.8 to 4.0 per 1,000 people ( p -trend < 0.001). This pattern was observed in both sexes. Men had a higher IHD incidence than women (adjusted risk ratio [aRR]: 1.32; 95% confidence interval [CI]: 1.12–1.56). IHD risk increased with age. Sex modified the effect of age on IHD incidence. Priests were at a higher risk of IHD than agriculturists (aRR: 2.45; 95% CI: 1.46–4.10). IHD incidence was higher in the Central (aRR: 1.49; 95% CI: 1.13–1.96) and Southern (aRR: 1.48; 95% CI: 1.04–2.10) regions than in the Northeast. IHD risk varied based on healthcare coverage scheme and treatment location. Individuals with comorbidities such as diabetes (aRR: 1.20; 95% CI: 1.01–1.43) and chronic kidney disease (aRR: 1.52; 95% CI: 1.30–1.79) had an increased IHD risk. Conclusion: After a decade of UHC implementation, Thailand witnessed a reduction in IHD prevalence and incidence among individuals with hypertension from 2011 to 2018. Nevertheless, further opportunities exist to mitigate the IHD risk within this population. Policymakers can use this evidence to prioritize efforts toward reducing the risk of IHD in individuals with hypertension.

ST-Elevation Myocardial Infarction Systems of Care in Africa: A Scoping Review

2026-02-17

Albertus Johannes Pool, Pierre Christo Smit, Helen Slabber, Willem Stassen

Background: ST-elevation myocardial infarction (STEMI) is a life-threatening, time-sensitive emergency. Cardiovascular diseases, including STEMI, are increasing on the African continent. Improving optimal outcomes for these patients requires a system-wide approach as the existing literature is unclear. Objectives: To describe and summarise the African literature on STEMI Systems of Care (STEMI SOC). Methods: This scoping review was designed following the PRISMA-ScR guidelines. An a priori search strategy was applied to EbscoHost, PubMed, and Google Scholar databases. Results: A total of 671 articles were identified. Following the exclusion of 619 articles, 52 articles were eligible for inclusion. STEMI patients in Africa are generally younger than their Western counterparts, present late to healthcare facilities, have insufficient healthcare insurance, and are non-adherent to discharge medication. Emergency medical services are lacking, there is a shortage of percutaneous coronary intervention (PCI) facilities, and emergency departments are disorganised. STEMI reperfusion times are delayed, data collection and quality assurance initiatives are inadequate, and STEMI referral networks and registries are underdeveloped. In addition, there is a deficiency of ECG and telemetry, a shortage of healthcare workers, a lack of adherence to guideline-recommended therapy, and a perceived hesitancy of medical personnel to administer fibrinolytics. These findings suggest a need for more clinical education. Conclusion: A myriad of barriers, as well as potential facilitators in the implementation of these networks, have been reported in this scoping review. The coordination and introduction of a STEMI SOC in African settings potentially holds great advantages, as has been witnessed in other low- and middle-income countries (LMICs) and high-income countries (HICs).

Cardiac and Obstetric Complications of Pregnant Women with Rheumatic Heart Disease in Sub-Saharan Africa: A Systematic Review

2026-01-30

Evangelia Alexopoulos, Doreen Nakagaayi, Elizabeth R. Blackwood, Felix Barasa, Joan Kiyeng, Wycliffe Kosgei, G. Titus Ng’eno, Shanti Nulu, Rebecca Lumsden, Andrea Beaton, Gerald S. Bloomfield

Background: Rheumatic heart disease (RHD) is a key contributor to maternal cardiovascular morbidity and mortality in sub-Saharan Africa (SSA). Though low- and middle-income countries (LMICs), particularly those in SSA, face a greater burden of RHD, existing systematic reviews have not specifically focused on cardiac and obstetric complications among affected women. We aimed to study cardiac and obstetric complications in pregnant and postpartum women with RHD in SSA and to evaluate the rate of valvular interventions in pregnant or postpartum women with severe disease. Methods: We performed a systematic search in MEDLINE and online sources for studies of women of childbearing age (15–49 years) with RHD published after 2000 in SSA. Included study types were randomized controlled trials, retrospective and prospective cohort studies, case-control studies, case reports, and case series. Two authors independently extracted data and critically appraised articles. PROSPERO registration number: CRD42024628121. Results: We identified 1,478 unique citations, and nine full-text studies met inclusion criteria. Included studies were case series (7), one cohort study, and one case-control study, including a total of 787 pregnant women with cardiac disease, of whom the majority had RHD. Mitral stenosis and regurgitation were the most common valve lesions. Heart failure and arrhythmia occurred in at least 12.9% and up to 36% of study participants, respectively. Eight studies reported deaths due to cardiac causes (median: six deaths due to cardiac disease; total number of deaths: 56). Preterm labor/delivery was the most reported obstetric event, with incidence ranging from 5.2–35.2%. Few pregnant patients received any valve intervention. Conclusions: Pregnant women with RHD in SSA are at risk for both adverse cardiac and obstetric outcomes in pregnancy, particularly heart failure and preterm labor. Future efforts may include registries focused on pregnant women with RHD and scaling cardiac interventional capacity to benefit pregnant women with RHD in SSA. Unstructured Abstract We performed a systematic search in MEDLINE and online sources to study cardiac and obstetric complications and rates of valvular interventions in pregnant and postpartum women with rheumatic heart disease (RHD) in sub-Saharan Africa (SSA). Two authors independently extracted data and critically appraised articles. Nine full-text studies met inclusion criteria, capturing 787 pregnant women with cardiac disease, mostly RHD. Heart failure and arrhythmia occurred in at least 12.9% and up to 36% of study participants, respectively. Fifty-six deaths were reported from cardiac causes. Preterm labor/delivery was the most reported obstetric event, and few pregnant patients received any valve intervention. We found that women with RHD in SSA are at risk for adverse cardiac and obstetric outcomes in pregnancy, particularly heart failure and preterm labor. Future efforts may include registries focused on pregnant women with RHD and scaling cardiac interventional capacity to benefit pregnant women with RHD in SSA.