The Cardiovascular Journal of Africa is pleased to announce an increase in its 2011 impact factor to 0.767, as provided by Thompson Reuters (ISI). Currently, we rank 161 out of 273 indexed journals in the field of cardiology and cardiovascular medicine throughout the world, according to the Scopus journalrating system. The Cardiovascular Journal of Africa is truly entrenched in Africa and worldwide In order to improve visibility for our authors, the Cardiovascular Journal of Africa has developed the capability of publishing your article to PubMed Central (PMC), which is the free electronic archive of the Biomedical and Life Sciences Journal literature at the US National Institutes of Health National Library of Medicine (NIH/NLM). Currently your article is available on PubMed as a PDF from Sabinet e-publications. PubMed Central is therefore an additional repository of your full-text article. This ensures a long existence for your research and availability for generations to come. The further value of PMC lies in its capacity to store and cross reference data from diverse sources using a common format within a single repository. With PMC, a user can quickly search the entire collection of full-text articles and locate all relevant material. PMC also allows for the integration of its literature with a variety of other information resources that can enhance the research and knowledge fields of scientists, clinicians and others. We are offering authors from our 2012 published articles first opportunity to use this service at an initial fee of 80 US dollars. Our authors will also be pleased to note that PubMed will now index our electronic journal. This allows us to publish more articles as we are not restricted by print dynamics. Since listing in Index Medicus, PubMed in 2007 as the Cardiovascular Journal of Africa, 590 peer-reviewed articles have been published and are freely available as linked full text. Authors and reviewers deserve our gratitude as their efforts help to record the development of cardiovascular research across our continent. The Cardiovascular Journal of Africa receives articles from across the world, but gives priority to articles from Africa. In order to assist Francophone Africa, we are enlisting French reviewers with competency in cardiovascular medicine. We need to expand this list, so if you are able to assist in reviewing, please contact our development editor, Glenda Hardy on Glenda@clinicscardive.com or go online to www.cvja.co.za and register as a reviewer. The Cardiovascular Journal of Africa will be present at the forthcoming PASCAR conference in Dakar, Senegal, 15–20 May 2013. We look forward to seeing you there, and of course, also at the 6th World Congress of Paediatric Cardiology and Cardiac Surgery, 17–22 February 2013 in Cape Town.
HomeCirculationVol. 83, No. 1An updated coronary risk profile. A statement for health professionals. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBAn updated coronary risk profile. A statement for health professionals. K M Anderson, P W Wilson, P M Odell and W B Kannel K M AndersonK M Anderson Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. , P W WilsonP W Wilson Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. , P M OdellP M Odell Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. and W B KannelW B Kannel Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. Originally published1 Jan 1991https://doi.org/10.1161/01.CIR.83.1.356Circulation. 1991;83:356–362 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hespe C, Giskes K, Harris M and Peiris D (2022) Findings and lessons learnt implementing a cardiovascular disease quality improvement program in Australian primary care: a mixed method evaluation, BMC Health Services Research, 10.1186/s12913-021-07310-6, 22:1, Online publication date: 1-Dec-2022. Lemke E, Vetter V, Berger N, Banszerus V, König M and Demuth I (2022) Cardiovascular health is associated with the epigenetic clock in the Berlin Aging Study II (BASE-II), Mechanisms of Ageing and Development, 10.1016/j.mad.2021.111616, 201, (111616), Online publication date: 1-Jan-2022. Wong N, Budoff M, Ferdinand K, Graham I, Michos E, Reddy T, Shapiro M and Toth P (2022) Atherosclerotic cardiovascular disease risk assessment: An American Society for Preventive Cardiology clinical practice statement, American Journal of Preventive Cardiology, 10.1016/j.ajpc.2022.100335, 10, (100335), Online publication date: 1-Jun-2022. Coller J, Gong F, McGrady M, Shiel L, Liew D, Stewart S, Owen A, Krum H, Reid C, Prior D and Campbell D (2021) Risk factors for asymptomatic echocardiographic abnormalities that predict symptomatic heart failure, ESC Heart Failure, 10.1002/ehf2.13695, 9:1, (196-212), Online publication date: 1-Feb-2022. Mittal M, McEniery C, Supramaniam P, Cardozo L, Savvas M, Panay N and Hamoda H (2022) Impact of micronised progesterone and medroxyprogesterone acetate in combination with transdermal oestradiol on cardiovascular markers in women diagnosed with premature ovarian insufficiency or an early menopause: a randomised pilot trial, Maturitas, 10.1016/j.maturitas.2022.01.012, 161, (18-26), Online publication date: 1-Jul-2022. Adikari D, Gharleghi R, Zhang S, Jorm L, Sowmya A, Moses D, Ooi S and Beier S (2022) A new and automated risk prediction of coronary artery disease using clinical endpoints and medical imaging-derived patient-specific insights: protocol for the retrospective GeoCAD cohort study, BMJ Open, 10.1136/bmjopen-2021-054881, 12:6, (e054881), Online publication date: 1-Jun-2022. Disouza J, Patil K, Kakade P and Patravale V (2022) Dietary Fibers and Nutraceuticals in Prevention of Hypertension Research Anthology on Recent Advancements in Ethnopharmacology and Nutraceuticals, 10.4018/978-1-6684-3546-5.ch040, (778-809) Barton T, Low D, Bakker E, Janssen T, de Groot S, van der Woude L and Thijssen D (2021) Traditional Cardiovascular Risk Factors Strongly Underestimate the 5-Year Occurrence of Cardiovascular Morbidity and Mortality in Spinal Cord Injured Individuals, Archives of Physical Medicine and Rehabilitation, 10.1016/j.apmr.2020.07.013, 102:1, (27-34), Online publication date: 1-Jan-2021. Sadat Halder M and Kumar De S (2021) A RETROSPECTIVE COHORT STUDY TO UNDERSTAND THE AGE, GENDER AND RISK FACTORS PATTERN IN PATIENTS ATTENDING FOR CARDIAC REHABILITATION (CR) AFTER CORONARY ARTERY BYPASS GRAFTING (CABG) SURGERY, INDIAN JOURNAL OF APPLIED RESEARCH, 10.36106/ijar/5702089, (57-60), Online publication date: 1-Jul-2021. Black J, Campbell J, Parker S, Sharman J, Nelson M, Otahal P, Hamilton G and Marwick T (2021) Absolute risk assessment for guiding cardiovascular risk management in a chest pain clinic, Medical Journal of Australia, 10.5694/mja2.50960, 214:6, (266-271), Online publication date: 1-Apr-2021. Wen J (2021) Stem Cell Therapies for Cardiac Disease: Which Cell Types Are the Best ICBBS 2021: 2021 10th International Conference on Bioinformatics and Biomedical Science, 10.1145/3498731.3498762, 9781450384308, (196-203), Online publication date: 29-Oct-2021. Mishra P, Mishra B, Lyytikäinen L, Hilvo M, Juonala M, Kähönen M, Hutri-Kähönen N, Fotiadis D, Raitakari O, Laaksonen R and Lehtimäki T (2021) Assessment of plasma ceramides as predictor for subclinical atherosclerosis, Atherosclerosis Plus, 10.1016/j.athplu.2021.09.005, 45, (25-31), Online publication date: 1-Nov-2021. Okami Y, Ueshima H, Nakamura Y, Kondo K, Kadota A, Okuda N, Ohkubo T, Miyamatsu N, Okamura T, Miura K and Okayama A (2021) Risk Factors That Most Accurately Predict Coronary Artery Disease Based on the Duration of Follow-up ― NIPPON DATA80 ―, Circulation Journal, 10.1253/circj.CJ-20-0739, 85:6, (908-913), Online publication date: 25-May-2021. Wilson R, Aminian A and Tahrani A (2021) Metabolic surgery: A clinical update, Diabetes, Obesity and Metabolism, 10.1111/dom.14235, 23:S1, (63-83), Online publication date: 1-Feb-2021. Steger A, Dommasch M, Müller A, Sinnecker D, Huster K, Gotzler T, Gotzler O, Hapfelmeier A, Ulm K, Barthel P, Hnatkova K, Laugwitz K, Malik M and Schmidt G (2020) Polyscore of autonomic parameters for risk stratification of the elderly general population: the Polyscore study, EP Europace, 10.1093/europace/euaa359, 23:5, (789-796), Online publication date: 21-May-2021. Li Y, Sperrin M, Ashcroft D and van Staa T (2021) Consistency of ranking was evaluated as new measure for prediction model stability: longitudinal cohort study, Journal of Clinical Epidemiology, 10.1016/j.jclinepi.2021.06.026, 138, (168-177), Online publication date: 1-Oct-2021. Albaugh V, Kindel T, Nissen S and Aminian A (2021) Cardiovascular Risk Reduction Following Metabolic and Bariatric Surgery, Surgical Clinics of North America, 10.1016/j.suc.2020.12.012, 101:2, (269-294), Online publication date: 1-Apr-2021. Eftychidis I, Sakellari I, Anagnostopoulos A and Gavriilaki E (2021) Endothelial dysfunction and vascular complications after allogeneic hematopoietic cell transplantation: an expert analysis, Expert Review of Hematology, 10.1080/17474086.2021.1968823, 14:9, (831-840), Online publication date: 2-Sep-2021. Vaes B, Indestege P, Serneels T, Hegendörfer E, van Peet P, Poortvliet R, Wallemacq P, Gussekloo J and Degryse J (2020) Biomarkers versus traditional risk factors to predict cardiovascular events in very old adults: cross-validated prospective cohort study, BMJ Open, 10.1136/bmjopen-2019-035809, 10:6, (e035809), Online publication date: 1-Jun-2020. Wong N (2020) Cardiovascular risk assessment: The foundation of preventive cardiology, American Journal of Preventive Cardiology, 10.1016/j.ajpc.2020.100008, 1, (100008), Online publication date: 1-Mar-2020. Anžič Drofenik A, Vrtovec M, Božič Mijovski M, Sever M, Preložnik Zupan I, Kejžar N and Blinc A (2020) Progression of coronary calcium burden and carotid stiffness in patients with essential thrombocythemia associated with JAK2 V617F mutation, Atherosclerosis, 10.1016/j.atherosclerosis.2020.01.001, 296, (25-31), Online publication date: 1-Mar-2020. van Bussel E, Hoevenaar-Blom M, Poortvliet R, Gussekloo J, van Dalen J, van Gool W, Richard E and Moll van Charante E (2020) Predictive value of traditional risk factors for cardiovascular disease in older people: A systematic review, Preventive Medicine, 10.1016/j.ypmed.2020.105986, 132, (105986), Online publication date: 1-Mar-2020. Kim Y, Noh K, Byun S, Lee S, Kim T, Sunwoo L, Lee K, Kang S, Park K and Park S (2020) Effects of Hypertension, Diabetes, and Smoking on Age and Sex Prediction from Retinal Fundus Images, Scientific Reports, 10.1038/s41598-020-61519-9, 10:1, Online publication date: 1-Dec-2020. Palazón-Bru A, Ferri-Rufete D, Mares-García E, Durazo-Arvizu R, Divisón-Garrote J, Carbayo-Herencia J, Artigao-Rodenas L, Simarro-Rueda M, Molina-Escribano F, Ponce-García I, Gil-Guillén V and Pérez-Sempere Á (2020) Clusters of Cardiovascular Risk Factors and Their Impact on the 20-Year Cardiovascular Risk in a General Population, Journal of Cardiovascular Nursing, 10.1097/JCN.0000000000000637, 35:2, (210-216), Online publication date: 1-Mar-2020. Jamthikar A, Gupta D, Saba L, Khanna N, Viskovic K, Mavrogeni S, Laird J, Sattar N, Johri A, Pareek G, Miner M, Sfikakis P, Protogerou A, Viswanathan V, Sharma A, Kitas G, Nicolaides A, Kolluri R and Suri J (2020) Artificial intelligence framework for predictive cardiovascular and stroke risk assessment models: A narrative review of integrated approaches using carotid ultrasound, Computers in Biology and Medicine, 10.1016/j.compbiomed.2020.104043, 126, (104043), Online publication date: 1-Nov-2020. Torralbas-Ortega J, Paños-Martínez M, Patró-Moncunill E, Santiago-Barragán A, Cobo J, Escayola-Maranges A, Granero-Lázaro A and Marti-Mestre M (2020) Efficacy of a Short Psychoeducational Group Intervention for the Prevention of Cardiovascular Risk in Patients With Severe Mental Disorder, Journal of Nervous & Mental Disease, 10.1097/NMD.0000000000001081, 208:3, (222-229), Online publication date: 1-Mar-2020. Wang J, Smail-Crevier R, Nannarone M, Manuel D, MacQueen G, Patten S, Lashewicz B and Schmitz N (2020) The accuracy of depression risk perception in high risk Canadians, Journal of Affective Disorders, 10.1016/j.jad.2020.01.099, 265, (410-415), Online publication date: 1-Mar-2020. Vuksan V, Sievenpiper J, Jovanovski E, Jenkins A, Komishon A, Au-Yeung F, Zurbau A, Ho H, Li D and Smircic-Duvnjak L (2020) Effect of soluble-viscous dietary fibre on coronary heart disease risk score across 3 population health categories: data from randomized, double-blind, placebo-controlled trials, Applied Physiology, Nutrition, and Metabolism, 10.1139/apnm-2019-0728, 45:7, (801-804), Online publication date: 1-Jul-2020. Warner E, Nannarone M, Smail-Crevier R, Manuel D, Lashewicz B, Patten S, Schmitz N, MacQueen G and Wang J (2020) The relationship between depression risk perception and self-help behaviours in high risk Canadians: a cross-sectional study, BMC Public Health, 10.1186/s12889-020-08983-0, 20:1, Online publication date: 1-Dec-2020. Wallisch C, Heinze G, Rinner C, Mundigler G, Winkelmayer W and Dunkler D (2020) Re-estimation improved the performance of two Framingham cardiovascular risk equations and the Pooled Cohort equations: A nationwide registry analysis, Scientific Reports, 10.1038/s41598-020-64629-6, 10:1, Online publication date: 1-Dec-2020. Kim J, Yu M, Kim Y, Min S, Ha J, Lee J, Kim D, Oh K, Joo K, Ahn C, Kim Y and Lee H (2019) Ratio of triglyceride to high-density lipoprotein cholesterol and risk of major cardiovascular events in kidney transplant recipients, Clinical and Experimental Nephrology, 10.1007/s10157-019-01776-9, 23:12, (1407-1417), Online publication date: 1-Dec-2019. Gomez-Sanchez L, Gomez-Marcos M, Patino-Alonso M, Recio-Rodriguez J, Gomez-Sanchez M, González-Sánchez J, Alonso-Domínguez R, Sánchez-Aguadero N, Maderuelo-Fernandez J, Ramos R, Garcia-Ortiz L and Rodriguez-Sanchez E (2019) Reclassification by applying the Framingham equation 30 years to subjects with intermediate cardiovascular risk. MARK study, Medicina Clínica (English Edition), 10.1016/j.medcle.2019.01.035, 153:9, (351-356), Online publication date: 1-Nov-2019. Lee K, Yong H, Lee J, Kang E and Na J (2018) Is the epicardial adipose tissue area on non-ECG gated low-dose chest CT useful for predicting coronary atherosclerosis in an asymptomatic population considered for lung cancer screening?, European Radiology, 10.1007/s00330-018-5562-4, 29:2, (932-940), Online publication date: 1-Feb-2019. Gibson C, Kerneis M, Yee M, Daaboul Y, Korjian S, Mehr A, Tricoci P, Alexander J, Kastelein J, Mehran R, Bode C, Lewis B, Mehta R, Duffy D, Feaster J, Halabi M, Angiolillo D, Duerschmied D, Ophuis T and Merkely B (2019) The CSL112-2001 trial: Safety and tolerability of multiple doses of CSL112 (apolipoprotein A-I [human]), an intravenous formulation of plasma-derived apolipoprotein A-I, among subjects with moderate renal impairment after acute myocardial infarction, American Heart Journal, 10.1016/j.ahj.2018.11.008, 208, (81-90), Online publication date: 1-Feb-2019. ter Wee M and Lissenberg-Witte B (2019) To Predict or not to Predict? A Quick Guide on How to Conduct Medical Research, 10.1007/978-90-368-2248-0_7, (189-227), . Wang J, MacQueen G, Patten S, Manuel D, Lashewicz B and Schmitz N (2019) A randomized controlled trial to examine the impacts of disclosing personalized depression risk information on the outcomes of individuals who are at high risk of developing major depression: a research protocol, BMC Psychiatry, 10.1186/s12888-019-2270-9, 19:1, Online publication date: 1-Dec-2019. Gavriilaki E, Gkaliagkousi E, Sakellari I, Anyfanti P, Douma S and Anagnostopoulos A (2019) Early Prediction of Cardiovascular Risk after Hematopoietic Cell Transplantation: Are We There Yet?, Biology of Blood and Marrow Transplantation, 10.1016/j.bbmt.2019.07.012, 25:10, (e310-e316), Online publication date: 1-Oct-2019. Sarfo F, Nichols M, Gebregziabher M, Tagge R, Asibey S, Jenkins C and Ovbiagele B (2019) Evaluation of Vascular Event Risk while on Long-term Anti-retroviral Suppressive Therapy [EVERLAST]: Protocol for a prospective observational study, eNeurologicalSci, 10.1016/j.ensci.2019.100189, 15, (100189), Online publication date: 1-Jun-2019. van Bronswijk S, Lemmens L, Keefe J, Huibers M, DeRubeis R and Peeters F (2018) A prognostic index for long-term outcome after successful acute phase cognitive therapy and interpersonal psychotherapy for major depressive disorder, Depression and Anxiety, 10.1002/da.22868, 36:3, (252-261), Online publication date: 1-Mar-2019. Dimberg L, Eriksson B and Hashem M (2019) Myocardial infarction and death findings from a 22-year follow-up of a cohort of 980 employed Swedish men, Public Health, 10.1016/j.puhe.2019.07.006, 175, (148-155), Online publication date: 1-Oct-2019. Cifkova R (2019) Arterial Hypertension and Cardiovascular Risk Management of Hypertension, 10.1007/978-3-319-92946-0_3, (57-74), . Rojas C, Ramírez H, Salazar L, Kalergis A, Gálvez A and Escobar‐Vera J (2019) Characterization of LDLR rs5925 and PCSK9 rs505151 genetic variants frequencies in healthy subjects from northern Chile: Influence on plasma lipid levels , Journal of Clinical Laboratory Analysis, 10.1002/jcla.23001, 33:9, Online publication date: 1-Nov-2019. Kotalik A, Eaton A, Lian Q, Serrano C, Connett J and Neaton J (2019) A win ratio approach to the re-analysis of Multiple Risk Factor Intervention Trial, Clinical Trials, 10.1177/1740774519868233, 16:6, (626-634), Online publication date: 1-Dec-2019. An Y, Yun S, Yang I, Kim D and Yang D (2019) Predictive Performance of Ultrasound-Determined Non-Alcoholic Fatty Pancreas Disease Severity for Intermediate and High Risk of Coronary Heart Disease, Journal of the Korean Society of Radiology, 10.3348/jksr.2019.80.6.1190, 80:6, (1190), . Sakaki J, Melough M, Lee S, Pounis G and Chun O (2019) Polyphenol-Rich Diets in Cardiovascular Disease Prevention Analysis in Nutrition Research, 10.1016/B978-0-12-814556-2.00010-5, (259-298), . Gomez-Sanchez L, Gomez-Marcos M, Patino-Alonso M, Recio-Rodriguez J, Gomez-Sanchez M, González-Sánchez J, Alonso-Domínguez R, Sánchez-Aguadero N, Maderuelo-Fernandez J, Ramos R, Garcia-Ortiz L and Rodriguez-Sanchez E (2019) Reclassification by applying the Framingham equation 30 years to subjects with intermediate cardiovascular risk. MARK study, Medicina Clínica, 10.1016/j.medcli.2019.01.033, 153:9, (351-356), Online publication date: 1-Nov-2019. Chen G, Gao L and Li X (2019) Effects of exercise training on cardiovascular risk factors in kidney transplant recipients: a systematic review and meta-analysis, Renal Failure, 10.1080/0886022X.2019.1611602, 41:1, (408-418), Online publication date: 1-Jan-2019. Rosenblit P (2019) Extreme Atherosclerotic Cardiovascular Disease (ASCVD) Risk Recognition, Current Diabetes Reports, 10.1007/s11892-019-1178-6, 19:8, Online publication date: 1-Aug-2019. Disouza J, Patil K, Kakade P and Patravale V (2019) Dietary Fibers and Nutraceuticals in Prevention of Hypertension Nutraceutical and Functional Foods in Disease Prevention, 10.4018/978-1-5225-3267-5.ch007, (192-232) Charles‐Schoeman C, DeMasi R, Valdez H, Soma K, Hwang L, Boy M, Biswas P and McInnes I (2019) Risk Factors for Major Adverse Cardiovascular Events in Phase III and Long‐Term Extension Studies of Tofacitinib in Patients With Rheumatoid Arthritis , Arthritis & Rheumatology, 10.1002/art.40911, 71:9, (1450-1459), Online publication date: 1-Sep-2019. Sánchez-Acevedo M, Acosta-Chí Z, Sabino-Moxo B, Márquez-Domínguez J and Canton-Croda R (2019) Big Data Analysis for Cardiovascular Diseases Coronary and Cardiothoracic Critical Care, 10.4018/978-1-5225-8185-7.ch004, (60-77) Plante T, Juraschek S, Zakai N, Tracy R and Cushman M (2019) Comparison of Frequency of Atherosclerotic Cardiovascular Disease Events Among Primary and Secondary Prevention Subgroups of the Systolic Blood Pressure Intervention Trial, The American Journal of Cardiology, 10.1016/j.amjcard.2019.08.028, 124:11, (1701-1706), Online publication date: 1-Dec-2019. Nakas G, Bechlioulis A, Marini A, Vakalis K, Bougiakli M, Giannitsi S, Nikolaou K, Antoniadou E, Kotsia A, Gartzonika K, Chasiotis G, Bairaktari E, Katsouras C, Triantis G, Sionis D, Michalis L and Naka K (2019) The importance of characteristics of angina symptoms for the prediction of coronary artery disease in a cohort of stable patients in the modern era, Hellenic Journal of Cardiology, 10.1016/j.hjc.2018.06.003, 60:4, (241-246), Online publication date: 1-Jul-2019. Buettner R and Schunter M (2019) Efficient machine learning based detection of heart disease 2019 IEEE International Conference on E-health Networking, Application & Services (HealthCom), 10.1109/HealthCom46333.2019.9009429, 978-1-7281-0402-7, (1-6) Albarqouni L, Doust J, Magliano D, Barr E, Shaw J and Glasziou P (2019) External validation and comparison of four cardiovascular risk prediction models with data from the Australian Diabetes, Obesity and Lifestyle study, Medical Journal of Australia, 10.5694/mja2.12061, 210:4, (161-167), Online publication date: 1-Mar-2019. Liu Y, Li Q, Chen S, Wang X, Zhou Y, Tan N and Chen J (2018) A Simple Modified Framingham Scoring System to Predict Obstructive Coronary Artery Disease, Journal of Cardiovascular Translational Research, 10.1007/s12265-018-9837-6, 11:6, (495-502), Online publication date: 1-Dec-2018. Hermansson J and Kahan T (2017) Systematic Review of Validity Assessments of Framingham Risk Score Results in Health of Therapies in Online publication date: M, V, J, E, C, G, L and A (2018) levels in and as markers of and adipose tissue BMC Online publication date: 1-Dec-2018. H, T, D and E (2018) Risk Factors for Heart Disease International on Medical and (1-6) J, B, Wang J, S, S, C, S, C and MacQueen G (2018) for of the study, BMC Psychiatry, Online publication date: 1-Dec-2018. A, M, and M (2017) of in research the review of the of the Framingham Journal of Medical Online publication date: C, J, J, C, J, E, J, D and F (2018) Online publication date: T, G and E (2018) The of in for Primary Prevention of Cardiovascular Diseases in Current Cardiovascular Risk Reports, Online publication date: M, D, M, M and M (2018) a review of and Biomedical Online publication date: R and L (2018) The of Cardiovascular Disease Risk is the Best Risk for the Journal of and in Medical and Online publication date: H (2018) Risk Prediction in Biomedical . L, S, T, C, A, S, D, H, J, Jenkins D, C and Sievenpiper J (2018) Dietary and Cardiovascular Disease: A Systematic Review and of Trials, in Cardiovascular Online publication date: H (2018) Risk Prediction of Cardiovascular Research and Medicine, . Most J, L, S, H, E and L (2018) improvement in health in healthy individuals and American Journal of and Metabolism, Online publication date: J, B, F, I, M, M, M, E, N, A, M, L, T, D, J and Neaton J (2018) Which with high from of A of the trial, The Online publication date: J, C, E, N, E and N (2018) Risk Factors in Cardiovascular Disease Risk Online publication date: R, K, R, W and L (2018) The of the model for prognostic in health a review, and Research, Online publication date: 1-Dec-2018. S and I (2018) Clínica Online publication date: M, I and D (2017) The cardiovascular of of and International Journal of and Nutrition, Online publication date: T and S (2018) assessment of to health in patients with cardiovascular disease in BMC Health Services Research, Online publication date: 1-Dec-2018. C, L, A, A, M, M, V, A, M, N, A and A (2018) Is With a Risk of Atherosclerosis in Patients on Journal of Online publication date: Sánchez-Acevedo M, Acosta-Chí Z, Sabino-Moxo B, Márquez-Domínguez J and Canton-Croda R (2018) Big Data Analysis for Cardiovascular Diseases Big Data Management and the of for Health V, J, S, J, J, S and R (2018) Cardiovascular Risk Prediction Underestimate Risk in Online publication date: X, Wang X, Y, Chen S, Zhang R, Li L, Yu B and J (2017) Impact of Smoking and Smoking on as by The American Journal of Cardiology, Online publication date: S, J and R (2017) Cardiovascular Disease and Blood Pressure & Online publication date: J, I, M, D, B, R and de A (2017) of in a general population Clínica Online publication date: Marini A, Naka K, Vakalis K, Bechlioulis A, Bougiakli M, Giannitsi S, Nikolaou K, Antoniadou E, Gartzonika C, Chasiotis G, Bairaktari E, Katsouras C, Triantis G, Sionis D and Michalis L (2017) of coronary artery disease in patients for stable or acute coronary Hellenic Journal of Cardiology, Online publication date: V, A, P, R and S (2017) of a in Fibers and at Low in in and Nutrition . M, K, D and M (2017) E de Medicina Online publication date: E, R, C, T, S, W and N and of that and the risk of cardiovascular Diabetes, Obesity and Metabolism, 19:1, Online publication date: Jenkins D, B, F, M, P, A, A, W, M, de R, C, N, Jenkins A, S and N (2017) Effect of Current Dietary on and Cardiovascular Risk Journal of the American of Cardiology, Online publication date: S, L, Y, F, Zhang S, Li D, W, Zhang X, D and X (2017) of and traditional risk factors the performance of coronary heart disease Online publication date: O, D and G Efficacy of on for Cardiovascular Disease Risk Reduction among a Review of the Journal of and Health Online publication date: Most J, V, L and L (2017) in An update, Ageing Research Online publication date: J, K, E, C, T, B, N, T, Li Q, A and Peiris D (2017) of for with cardiovascular Australian Journal of Primary Health, 23:5, . Lee S, Yun S, Kim D, H and Park Y (2017) Severity of disease on and risk of coronary heart Journal of Clinical 45:7, Online publication date: H and L (2017) An early risk of coronary heart using model International Conference on of Data and Online publication date: J The and Medical Online publication date: E, N and A (2017) for of Research
Sub-Saharan Africa (SSA) has been witnessing a persistent increase in the burden of cardiovascular diseases (CVD), such as stroke and heart disease, over several decades. A key driver of this burden has been the poor adoption of healthy lifestyles such as physical activity. The goal of this systematic review was to critically appraise and synthesize evidence on the barriers and facilitators to adopting healthy lifestyles for CVD prevention in SSA. We searched PubMed, African Journals Online, Google Scholar, Medline, and Web of Science from January to March 2024 for both quantitative and qualitative studies that assessed barriers and/or facilitators to the adoption of at least one preventative measure for CVD prevention. The socioecological model was used to categorize barriers and facilitators into four levels: intrapersonal, interpersonal, institutional, and community. The Critical Appraisal Skills Program (CASP) checklist was used to determine the quality of qualitative studies, while the AXIS checklist was used to assess the quality of cross-sectional studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to estimate the certainty of the evidence. There were a total of 25 studies included in this review. At the intrapersonal level, barriers included perceived self-efficacy, limited knowledge and awareness, personal attitudes and behaviours, and poverty, while health literacy and awareness served as facilitators. At the interpersonal level, social norms and limited social support were the main barriers, while social support and having positive role models were facilitators. At the institutional level, accessibility and affordability of preventive healthcare services, as well as healthcare provider characteristics, were barriers, while trust in healthcare providers, affordability of care, reputation, and approachability of healthcare providers, quality of patient-provider relationships, and quantity and quality of patient education were facilitators. Lastly, at the community level, the physical, social, and economic characteristics of the community acted as either facilitators or barriers. A complex interplay of multiple barriers and facilitators influences the adoption of healthy lifestyles in SSA. While individual factors, such as knowledge and motivation, are crucial, they are often overshadowed by deeply rooted socioeconomic disparities, limited access to healthcare and resources, and cultural norms. A multi-sectoral approach that empowers individuals, strengthens community support systems, improves access to affordable, healthy options, and implements supportive policies could address these barriers.
Cardiovascular disease (CVD) remains one of the preventable causes of death. Increasing patient knowledge of CVD may lead to success in the prevention and control of CVD, and an improved quality of life. The study aimed to assess the knowledge, attitudes and perception of patients with CVD, and the need for regular monitoring and medication compliance at a state tertiary hospital in Johannesburg, South Africa. A cross-sectional study was conducted among 191 adults with high cardiovascular (CV) risk in the vascular and diabetic outpatient clinics. A researcher-administered questionnaire was used to gather responses and a point-of-care-test (POCT) assessing glycated haemoglobin (HbA1c) and lipogram was done. The mean age of the cohort was 54 years, with a female predominance (64.4%), of which 56.5% were familiar with the term 'CVD' and 97.4% acknowledging the importance of attending follow-up visits. Despite having heard of CVD conditions, many participants did not have a sufficient understanding. There was an association of knowledge with medication adherence, socio-economic status, monthly income, and level of education. Patients' perceptions of disease control did not align with values measured in POCTs. Approximately 30% of participants achieved target blood pressure levels and 25% achieved target HbA1c levels. Healthcare professionals were well recognised in the role of CVD prevention and monitoring. Although more than half of the study participants had knowledge of CVD, target blood pressure and HbA1c were only achieved in approximately one-third and a quarter of the patients, respectively. A significant gap exists between self-perception and knowledge among participants.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
Digital health interventions (DHIs) offer major potential for improving cardiovascular disease (CVD) primary and secondary prevention, but their adoption by healthcare providers (HCPs) remains inconsistent. To identify barriers and facilitators to DHI uptake in CVD primary and secondary prevention from HCPs' perspectives. We conducted a systematic review of studies published between 2020 and 2024 that investigated HCPs' perceptions of DHI implementation for CVD primary and secondary prevention. We appraised individual study quality using a validated tool. We performed a qualitative synthesis of reported barriers and facilitators, categorized according to country income level and according to the World Heart Federation Roadmap domains: HCPs, patients, technology, and health systems. We included 125 primary studies (101 qualitative, 15 quantitative, 9 mixed methods). The most frequently cited barrier was excessive workload, both from existing responsibilities and additional tasks introduced by DHIs. The leading facilitator was the perceived positive clinical impact of DHIs-such as improved adherence, reduced hospital readmissions, and better outcomes. HCP motivation, adequate training, and system integration also facilitated adoption. Many factors-like effects on HCP-patient relationships and workflow-functioned as either barriers or facilitators, depending on the setting. Patient-related barriers included limited digital access and literacy; facilitators included perceived gains in patient-centered care. Health system factors such as organizational structure, financing, and policy support were commonly mentioned, with mixed views. Technology-related facilitators included usability, adaptability, and integration with electronic records; instability was a key barrier. This is the first systematic review to synthesize post-COVID-19 literature on HCPs' perceptions of DHIs in CVD primary and secondary prevention. While offering a rich, global overview, limitations include a predominance of qualitative studies and lack of data from low-income countries. Effective implementation must address workload, align with workflows, and build trust through training and leadership. This research analyzed 125 studies from 33 countries to understand the factors that influence healthcare professionals' uptake of digital health tools, such as apps and wearable devices, for preventing cardiovascular disease.The leading facilitator for adoption is the perceived positive clinical impact; doctors and nurses are highly motivated to use digital tools when they help patients follow treatments better, reduce hospital readmission rates, and improve overall heart health.The most significant barrier is the perceived excessive workload. While some digital health tools can be time-saving, many providers feel that they add burdensome technical tasks to their already busy schedules, which undermines their acceptance.Uptake is also influenced by patient-related factors, such as digital literacy and internet access, as well as technological factors like how easily a tool integrates into existing hospital computer systems.To improve the future of cardiovascular care, digital tools should be co-designed with clinicians to ensure they fit seamlessly into daily work routines and are supported by proper training and strong institutional leadership.
Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease, is one of the most prevalent liver diseases globally, contributing to both economic and health-related challenges. We aimed to evaluate the global, regional, and national burden of MASLD from 1990 to 2023, quantify the contribution of identified modifiable risk factors, and project future prevalence up to the year 2050. Estimates of MASLD prevalence and disability-adjusted life-years (DALYs) were produced by age, sex, region, Socio-demographic Index (SDI), and Healthcare Access and Quality (HAQ) index across 204 countries and territories from 1990 to 2023 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023. The MASLD burden attributable to three risk factors (smoking, high BMI, and high fasting plasma glucose) was assessed as part of the GBD comparative risk assessment. As a secondary analysis, we used these estimates to forecast MASLD prevalence up to 2050 using fasting plasma glucose and mean BMI as predictors. Furthermore, to examine the relative contributions of population ageing, population growth, and changes in MASLD prevalence rate to the forecasted changes in case counts from 2023 to 2050, we conducted a decomposition analysis. In 2023, approximately 1·3 billion (95% uncertainty interval [UI] 1·2 to 1·4) individuals were estimated to be living with MASLD (ie, 16·1% of the global population), with an age-standardised prevalence rate of 14 429·3 (95% UI 13 268·3 to 15 990·6) per 100 000 population, representing a percentage increase of 142·7% (95% UI 139·2 to 146·7) in crude numbers from 1990 (0·5 billion [0·5 to 0·6]) and of 28·6% (27·8 to 29·5) in the rate (11 217·2 [10 276·8 to 12 467·0] per 100 000 in 1990). An estimated 3·6 million (2·8 to 4·5) total DALYs were attributable to MASLD worldwide in 2023, corresponding to an age-standardised DALY rate of 39·6 (31·2 to 49·9) per 100 000 population. Despite a 116·3% (93·3 to 139·4) increase in crude DALYs (from 1·7 million [1·3 to 2·1] in 1990), its age-standardised estimate remained consistent (1·8% [-8·6 to 12·8]) from 1990 (38·9 [30·1 to 49·8] per 100 000) to 2023. There was substantial variation in age-standardised estimates across regions. North Africa and the Middle East had the highest prevalence rate (29 246·1 [26 848·3 to 32 048·7] per 100 000) and Andean Latin America showed the highest DALY rate (152·3 [114·1 to 194·7] per 100 000). By contrast, the high-income Asia Pacific region had the lowest prevalence rate (8653·5 [7923·7 to 9592·8] per 100 000) and east Asia had the lowest DALY rate (16·3 [13·5 to 19·9] per 100 000) among all GBD regions. North Africa and the Middle East showed disproportionately higher prevalence rates relative to other regions with similar SDIs. Lower SDIs and HAQs were associated with higher age-standardised DALY rates. The age-standardised prevalence rate was consistently higher in males (15 616·4 [14 349·2 to 17 263·3] per 100 000 people in 2023) than in females (13 245·2 [12 132·0 to 14 692·6] per 100 000 people), and peaked at age 80-84 years in both sexes. The number of MASLD prevalent cases was the highest in younger adults, peaking at age 35-39 years for males and age 55-59 years for females. Among the risk factors for MASLD, high fasting plasma glucose presented the largest contribution to the age-standardised DALY rate of total MASLD in 2023 (2·2 [95% UI 1·6 to 3·1] per 100 000 people), followed by high BMI (1·4 [0·6 to 2·4] per 100 000 people) and smoking (1·0 [0·3 to 1·8] per 100 000 people). Our forecasting model estimates that 1·8 billion (95% UI 1·6 to 2·0) individuals are likely to have MASLD by 2050, representing a 42·0% increase from 2023. The age-standardised prevalence rate is expected to increase to 15 774·9 (95% UI 14 613·9 to 17 336·2) per 100 000 people in 2050, representing an average annual percentage change of 0·3% (95% UI 0·3-0·3). According to our decomposition analysis, this change will be primarily due to population growth, particularly in sub-Saharan Africa and North Africa and Middle East, and less by population ageing or epidemiological change. With a global prevalence of 16·1% and approximately 1·3 billion people already living with MASLD in 2023, the condition has and will continue to have substantial health and economic impacts worldwide. An inverse association between the HAQ Index and age-standardised DALY rates suggests that countries with lower health-care access and quality might be less well positioned to manage the growing MASLD burden, underscoring the need for strengthened health-system capacity in these settings. Gates Foundation.
Cardiovascular disease is now a leading cause of premature mortality across Africa and is accelerating faster than the capacity to prevent, detect, and manage chronic illness. Most patients still engage with the health system only when heart failure, stroke, or ischemic disease is advanced, reflecting a legacy architecture designed primarily to confront acute infections. At the same time, multiple African countries have demonstrated that high-impact cardiovascular care can be delivered at scale when services are organized around primary and district facilities, supported by clear protocols, continuous supply of essential medicines, workforce development, and access to remote specialist expertise. Global experience, including major reforms in Brazil and Thailand, shows that population-level gains arise from deliberate health system design. Africa now stands at a turning point. By embedding cardiovascular disease prevention and treatment within national strategies for universal health coverage and by aligning financing and service delivery with the realities of chronic care, the region can prevent millions of avoidable deaths. The opportunity to define a different future for cardiovascular health is within reach and must be acted upon with urgency and coherence.
Few studies have assessed the prevalence and independent prognostic relevance of right ventricular dysfunction (RVD) and pulmonary hypertension (PH) in Africans with heart failure (HF) despite the different trajectories of HF in Africans compared to other ethnicities. We investigated the frequency and independent associations of RVD and PH with incident death in Nigerian-Africans with hypertensive HF. Present analyses include 118 participants (mean age 57.6 years, 55% men) with ambulatory hypertensive HF. RVD was assessed with pulsed wave Doppler of tricuspid inflow velocities, tissue Doppler imaging of the tricuspid annulus and tricuspid annular plane systolic excursion (TAPSE) while PH was assessed with systolic pulmonary artery pressure during transthoracic echocardiography. Independent predictors of each of RVD and PH were determined using multivariable logistic regression models. Associations between each of RVD, PH and incident death were determined using Kaplan Meier plots and Cox proportional hazards regression models. The frequency of right ventricular systolic dysfunction (RVSD) was 56.8%, right ventricular diastolic dysfunction (RVDD) was 65.3% while PH was 56.8%. Over a mean follow-up of 2.4 years, each of RVSD, RVDD and PH was associated with higher risk of incident death (adjusted Hazards Ratio (aHR) 2.32 [95% CI: 1.39-3.90]; aHR 2.32 [95% CI:1.31-4.12]; aHR 1.69 [95% CI: 1.02-2.81] respectively). Associations of RVDD and PH with incident death were fully explained by left ventricular function indices, arrhythmia and systolic blood pressure while RVSD remained significantly associated with incident death after accounting for potential mediators. Only RVSD was independently associated with incident death when RVSD, RVDD and PH were mutually adjusted for each other (aHR 1.92 [95% CI: 1.10-3.32]; aHR 1.67 [95% CI: 0.82-3.41]; aHR 1.13 [95% CI: 0.62-2.07] respectively). RVSD, RVDD and PH are common in hypertensive HF but only RVSD significantly increases the risk of incident death independent of RVDD, PH or left ventricular function. aHR: adjusted Hazards Ratio, EDV: end diastolic volume, ESV: end systolic volume, FS: fractional shortening, HF: heart failure, HFpEF: heart failure with preserved ejection fraction, HFrEF: heart failure with reduced ejection fraction, LV: left ventricle, LVEF: left ventricular ejection fraction, LVIDd: LV internal diameter in diastole, LVIDs: LV internal diameter in systole, RV: right ventricle, RVDD: right ventricular diastolic dysfunction, RVSD: right ventricular systolic dysfunction, SBP: systolic blood pressure, SPAP: systolic pulmonary artery pressure, PH: pulmonary hypertension.
In many low-income and middle-income countries, access to specialised surgical care is limited by infrastructure gaps, workforce shortages and weak financing, leading to unmet needs and cross-border inequities. The African Network of Medical Excellence (ANME) was created as a public-non-government organisation partnership to strengthen national health systems through specialised centres of excellence providing free, high-quality care. This paper outlines the design, implementation and outcomes of the ANME Regional Programme (RP), a coordinated cross-border referral system.The RP operates through formal agreements with Ministries of Health, structured referral pathways, specialist outreach missions, and full coverage of patient travel, accommodation, surgery, follow-up and essential medicines. Two ANME hospitals-the Salam Centre for Cardiac Surgery in Sudan and the Children's Surgical Hospital in Uganda-serve as regional hubs. By December 2024, 190 screening and follow-up missions had reached over 16 000 patients across 28 countries, with 2024 receiving specialised surgical care.Outcomes confirm the feasibility and safety of this model. At the Salam Centre, early postoperative mortality among RP-referred patients was lower than that of host-country patients (1.8% vs 2.9%), reflecting effective case selection and continuity of care. At the Children's Surgical Hospital in Uganda, early implementation of the paediatric RP addressed major unmet needs for complex congenital conditions, with no postoperative deaths reported.The ANME regional programme demonstrates how a not-for-profit, government-supported referral system can expand equitable access to specialised care, strengthen local capacity and support sustainable, rights-based health system development. Its approach offers transferable lessons for regional collaboration in other resource-limited settings.
Ischemic heart disease and metabolic dysfunction-associated steatotic liver disease represent significant global health challenges, characterized by overlapping pathophysiological mechanisms. A comprehensive understanding of their spatial co-occurrence, common risk factors, and disparities in health care quality is essential for the development of integrated prevention and treatment strategies. Using data from the 2021 GBD (Global Burden of Disease) study, encompassing 204 countries and territories, we conducted an analysis of the spatial co-occurrence patterns of ischemic heart disease and metabolic dysfunction-associated steatotic liver disease. To identify principal risk factors, we used machine learning techniques, specifically Shapley Additive Explanations, alongside negative binomial regression models. Furthermore, the Quality-of-Care Index was computed to assess the alignment of health care services with the disease burden. A notable spatial co-occurrence of ischemic heart disease and metabolic dysfunction-associated steatotic liver disease was identified, especially prevalent in regions such as the Middle East, North Africa, and emerging economies. The primary shared risk factors encompassed kidney dysfunction, high body mass index, and ambient particulate matter pollution. Disparities in the Quality-of-Care Index were apparent, with regions including Eastern Europe, South Asia, and certain areas of Africa exhibiting insufficient health care resources in comparison with the burden of disease. The comorbidity of ischemic heart disease and metabolic dysfunction-associated steatotic liver disease constitutes a significant global health concern. Implementing comprehensive interventions aimed at addressing risk factors has the potential to mitigate the worldwide burden of cardiometabolic diseases.
 Cardiovascular diseases (CVDs) are a leading contributor to morbidity, mortality, and healthcare spending in low- and middle-income countries (LMICs). Despite this burden, economic evidence on system-level interventions to strengthen hypertension and CVD care in sub-Saharan Africa remains limited. This study estimates the costs and budget impact of the Ghana Heart Initiative (GHI), a multi-component health systems strengthening intervention.  We conducted a retrospective cost analysis from the health system perspective using an activity-based costing approach. We estimated the financial and economic costs incurred during the design (2018-2019) and initial implementation phase (2020-2022) of the GHI across 42 public health facilities in the Greater Accra Region. Costs were disaggregated by activity cluster and input category. We then projected the budget impact of hypothetical national scale-up under three implementation scenarios that varied in scope and cost-sharing assumptions. All costs were inflation-adjusted and reported in 2024 US dollars (US $).  The total economic cost of designing and implementing the GHI over 4 years was US$1.96 million, of which 91.5% was attributable to implementation activities. Human resources were the primary cost driver. Average annual economic costs were US$11,960 per health facility, US$997 per targeted health provider trained, and US$39.9 per outpatient attendee. Projected annual costs for nationwide scale-up ranged from US$12.1 million to US$30.1 million, depending on implementation scenario, with a streamlined service-delivery-only model representing a lower-bound estimate.  This study provides granular, activity-level cost estimates for a complex health system strengthening intervention targeting hypertension and CVD care. The findings offer policy-relevant inputs for budget planning and highlight how implementation choices influence the fiscal implications of scaling up system-level CVD interventions in LMICs.
Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023. Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population. In 2023, there were an estimated 2·30 million (95% uncertainty interval [UI] 2·01 to 2·61) breast cancer incident cases, 764 000 deaths (672 000 to 854 000), and 24·1 million (21·3 to 27·5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44·2 per 100 000 person-years [31·2 to 58·4]), the age-standardised mortality rate (ASMR) was the highest (24·1 per 100 000 [16·8 to 31·9]). The highest ASIR was in the high-income group (75·7 per 100 000 [67·1 to 84·0]), and the lowest ASMR was in the upper-middle-income group (11·2 per 100 000 [10·2 to 12·3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147·2% (38·1 to 271·7), compared with a 1·2% (-11·5 to 17·2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29·9% (-33·6 to -25·9), but increased by 99·3% (12·5 to 202·9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28·3% (16·6 to 38·9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3·56 million (2·29 to 4·83), with 1·37 million (0·841 to 2·02) deaths. The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2·5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action. Gates Foundation, St Jude Children's Research Hospital.
Cardiometabolic diseases (CMD) which include cardiovascular disease (CVD), diabetes, hypertension, and other metabolic syndromes represent a significant global health burden. Three quarters of global CVD deaths occur in low-and-middle-income countries (LMICs) and CMD account for approximately 35 percent of deaths in the Sub-Saharan Africa (SSA) region. The COVID-19 Pandemic significantly accelerated the transformation of the landscape in the management of patients with multiple long-term conditions, prompting innovation in healthcare delivery and highlighting the importance of more integrated and adaptable healthcare approaches. Addressing CMD requires a multifaceted approach involving both individual-level interventions, health system approaches, community-based approaches, and broader population-wide strategies for prevention. This study aimed to develop and pilot a person-centred model of health care for CMD management, integrating key principles from the Chronic Care Model (CCM) and Collaborative Care Model (CoCM) to assess feasibility and potential scalability in LMICs. The development of the CREATE intervention took a mixed method approach utilizing both qualitative and quantitative methodologies, including a systematic review, qualitative synthesis, and needs assessment including the delivery of workshops with local stakeholders and people living with CMD in Ghana, Kenya and Mozambique. A CoCCM with the following components was developed as the CREATE intervention: 1) Self-Management support, 2) Decision support (which included health care provider training), 3) Community linkages, 4) Organisation of health care, 5) Clinical information system, and 6) Delivery system design (streamlining the referral pathway). The CREATE intervention was informed by a systematic review, needs assessment, and six stakeholder workshops across three LMICs, identifying barriers such as limited primary care infrastructure, lack of referral systems, and gaps in self-management education. This is the first CoCCM model for Multiple Long-term Conditions (MLTC) to be developed for SSA. The intervention is currently being tested as part of a feasibility study in Kenya, Ghana and Mozambique. The CREATE intervention has the potential for adaptability to local context, however there is need for more rigorous research to evaluate the model effectiveness in relation to improving patient outcomes.
Information on childhood cancer burden is crucial for effective cancer policy planning. Unfortunately, observed paediatric cancer data are not available in every country, and previous global burden estimates have not discretely reported several common cancers of childhood. We aimed to inform efforts to address childhood cancer burden globally by analysing results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, which now include nine additional cancer causes compared with previous GBD analyses. GBD 2023 data sources for cancer estimation included population-based cancer registries, vital registration systems, and verbal autopsies. For childhood cancers (defined as those occurring at ages 0-19 years), mortality was estimated using cancer-specific ensemble models and incidence was estimated using mortality estimates and modelled mortality-to-incidence ratios (MIRs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the standard life expectancy at the age of death. Prevalence was estimated using survival estimates modelled from MIRs and multiplied by sequelae-specific disability weights to estimate years lived with disability (YLDs). Disability-adjusted life-years (DALYs) were estimated as the sum of YLLs and YLDs. Estimates are presented globally and by geographical and resource groupings, and all estimates are presented with 95% uncertainty intervals (UIs). Globally, in 2023, there were an estimated 377 000 incident childhood cancer cases (95% UI 288 000-489 000), 144 000 deaths (131 000-162 000), and 11·7 million (10·7-13·2) DALYs due to childhood cancer. Deaths due to childhood cancer decreased by 27·0% (15·5-36·1) globally, from 197 000 (173 000-218 000) in 1990, but increased in the WHO African region by 55·6% (25·5-92·4), from 31 500 (24 900-38 500) to 49 000 (42 600-58 200) between 1990 and 2023. In 2023, age-standardised YLLs due to childhood cancer were inversely correlated with country-level Socio-demographic Index. Childhood cancer was the eighth-leading cause of childhood deaths and the ninth-leading cause of DALYs among all cancers in 2023. The percentage of DALYs due to uncategorised childhood cancers was reduced from 26·5% (26·5-26·5) in GBD 2017 to 10·5% (8·1-13·1) with the addition of the nine new cancer causes. Target cancers for the WHO Global Initiative for Childhood Cancer (GICC) comprised 47·3% (42·2-52·0) of global childhood cancer deaths in 2023. Global childhood cancer burden remains a substantial contributor to global childhood disease and cancer burden and is disproportionately weighted towards resource-limited settings. The estimation of additional cancer types relevant in childhood provides a step towards alignment with WHO GICC targets. Efforts to decrease global childhood cancer burden should focus on addressing the inequities in burden worldwide and support comprehensive improvements along the childhood cancer diagnosis and care continuum. St Jude Children's Research Hospital, Gates Foundation, and St Baldrick's Foundation.
The burden of non-communicable diseases (NCDs) in adolescent and young adult females in sub-Saharan Africa (SSA) has not been comprehensively studied. To address this gap, we analysed data from the Global Burden of Diseases (GBD) 2021, focusing on death due to NCDs in females aged 10-24 years in SSA. We extracted data from GBD 2021 on NCD deaths in females aged 10-24 years in SSA from 2000 to 2021. We presented the numbers and death rates of NCDs, and the proportion of NCDs in all-cause deaths was calculated. Pearson's correlation was applied to explore the NCD burden on the socioeconomic development and health system. Additionally, we projected the NCD burden until 2050 by applying mixed-effects models. In 2021, 52 083.13 (42 018.18∼61 630.88) NCD deaths, at a mortality rate of 27.59 (22.26∼32.64) per 100 000 population, emerged, accounting for 21.13% (17.57%∼24.22%) of the total deaths. Neoplasms, cardiovascular diseases, digestive diseases, neurological disorders, and diabetes and kidney diseases were the top five leading causes of deaths. Inverse associations were observed between the NCD death rates and indicators of the socioeconomic and health system (P < .001). An increasing trend was observed of the NCD death numbers and the contributing proportions since 2000, and it was predicted to continue increasing through to 2050, with the highest increasing trend in neoplasms. The rising disease burden of NCDs for adolescent and young adult females in SSA has attracted attention. Targeted interventions and strengthened health systems should be prioritized to address the concerning NCD burden in adolescent girls in SSA.
Liver transplantation is the only known potentially curative treatment for homozygous familial hypercholesterolaemia (HoFH). While this procedure often normalises low-density lipoprotein cholesterol (LDL-C) levels and can reverse coronary atherosclerosis and regress xanthomata, its long-term risks and benefits remain elusive. The purpose of this review was to examine the extant literature on the safety and efficacy of liver transplantation in patients with HoFH. A scoping review was conducted for relevant literature primarily focused on safety (e.g. surgical complications, rejection, immunosuppressive therapy, mortality) and effectiveness outcomes (e.g. serum LDL-C levels, xanthoma changes, atherosclerotic cardiovascular disease or events) of liver transplantation in severe HoFH. The PRISMA-ScR guideline was followed. We searched five databases (Medline, Embase, Global Health, Web of Science and CINAHL) from inception to September 2025. A total of 76 studies and 212 cases were included. The majority (53%) of studies were case reports. Liver transplantation was done mostly in children, genetically or phenotypically diagnosed with HoFH. The median follow-up time for individuals was 3.5 years. While the effectiveness of liver transplantation with reference to LDL-C reduction and xanthomata regression were well documented, long-term outcomes such as cardiovascular events and mortality were not consistently reported. While liver transplantation holds great potential for normalising circulatory LDL-C levels in patients with HoFH, due to the rare nature of HoFH, the current literature remains incomplete concerning its safety and efficacy. To fill this gap, future efforts should utilise liver transplantation registries, to increase sample size and standardise longer-term follow-up.
Cardiovascular diseases, including ischemic heart disease (IHD), are leading causes of mortality and morbidity worldwide. High body mass index (BMI) is a major contributing factor. This study aimed to comprehensively analyze the geographic distribution, socioeconomic trends, and age-period-cohort effects of the IHD burden attributable to high BMI to inform targeted interventions. Researchers utilized data from the Global Burden of Disease Study 2021 (GBD 2021) to examine the mortality, incidence, and disability-adjusted life years (DALYs) of IHD related to high BMI among 20-49 year-olds across 204 countries and territories. Joinpoint regression, age-period-cohort modeling, and decomposition analyses were employed to assess the heterogeneous epidemiological patterns across sociodemographic contexts. The findings revealed stark geographical disparities, with Central America, the Caribbean, North Africa, and parts of the Middle East and Southeast Asia experiencing the most pronounced IHD burden. Across socioeconomic levels, low sociodemographic index (SDI) countries exhibited persistent increases, while high-middle and high SDI nations showed signs of stabilization or decline. The age-period-cohort analysis uncovered heterogeneous patterns, with the epidemiological transition progressing more rapidly in lower-SDI settings. Decomposition analysis indicated that epidemiological changes and population growth were the dominant drivers of the rising burden in less developed regions. This comprehensive analysis elucidates the geographic distribution and socioeconomic differences in the IHD burden attributable to high BMI, providing crucial evidence to guide the development of tailored public health interventions. Context-specific strategies are needed to address the persistent upward trends in resource-limited settings while consolidating the gains made in more developed countries to achieve equitable and sustainable cardiovascular health improvements.
Structural remodelling of the heart and blood vessels is an important basis for the development of cardiovascular disease. Krüppel-like factor 5 (KLF5), an important regulator of cardiovascular remodelling, promotes vascular smooth muscle cell (VSMC) proliferation and inflammatory responses. Neuregulin 1 (NRG1) is a positive regulator of angiogenesis, and its receptors are human epidermal growth factor receptors ErbB2, ErbB3, and ErbB4, which constitute the NRG1/ErbB signalling system. However, the relationship between the mechanism by which KLF5 promotes smooth muscle cell proliferation and the role of NRG1 has not been elucidated. Human coronary artery smooth muscle cells (HCASMCs) were cultured, and DNA fragments specifically enriched for binding to KLF5 proteins in HCASMCs. These were sequenced and analysed by chromatin immunoprecipitation sequencing (ChIP-seq), and downstream proteins NRG1 that could be regulated by KLF5 were identified. Dual luciferase assay was performed to verify whether KLF5 regulated the expression of NRG1, and HCASMC was transfected using KLF5 lentivirus, which was further verified by reverse transcription-polymerase chain reaction (RT-PCR) and western blot. To examine the function of the KLF5/NRG1/ErbB pathway in VSMC proliferation, we performed VSMC proliferation assays utilising ErbB2/3/4 receptor blockers. NRG1 is a direct transcriptional target gene of KLF5. KLF5 was able to promote the mRNA and protein expression of NRG1 in HCASMC, blocking ErbB2/3/4 receptors, and the role of KLF5 in promoting smooth muscle cell proliferation was attenuated. KLF5 may be one of the mechanisms by which VSMC proliferation may be promoted by upregulating the NRG1/ErbB pathway.
Recently under the European Society of Cardiology (ESC) EURObservational Research Programme (EORP) PPCM registry the first predictive score was derived. This study sought to test the validity of this predictive score in a cohort of women with PPCM in Uganda. 80 PPCM cases enrolled had a 12-lead electrocardiography, echocardiography at baseline and at 6-months follow-up. Core clinical data included LVEF, LVEDD, duration of symptoms, QRS duration and pre-eclampsia were captured. Recovered participants' scores included one case who scored ≤ 1 and one of 2, six cases had a score of 3, fifteen cases had a score of 4, six cases had a score of 5, two cases had a score of 6 and only five cases had the highest score of 7. The discrimination analysis achieved a c-statistic of 0.67. The ESC EORP PPCM LV predictive recovery score under performed in predicting LV recovery in our Ugandan PPCM cohort.