Category: Cardiovascular

A large proportion of patients who start taking ADHD medication, especially young adults, stop within the first year. However, people who use ADHD medicine for a long time and in higher-than-average doses seem to have a higher risk of some cardiovascular diseases. This is according to two new studies led by researchers from Karolinska Institutet and published in The Lancet Psychiatry and JAMA Psychiatry. More than half of all teenagers, young adults and adults who received ADHD medication had stopped taking it within the first year. The proportion of children, on whose behalf decisions are made by parents or guardians, was slightly lower, but nonetheless, 35 per cent stopped their medication within a year. So reports a multinational study led by researchers at Karolinska Institutet in Sweden and published in The Lancet Psychiatry. Risk falling between the cracks The researchers analysed prescription data from over 1.2 million patients who started ADHD medication in Australia, Denmark, Hong Kong, Iceland, the Netherlands, Norway, the UK, Sweden and the USA. The pattern was the same in all countries/regions. “It’s unlikely that so many people discontinue their treatment because their ADHD symptoms have remitted, meaning that the high rate of early discontinuation may be a major barrier to effective treatment,” says Zheng Chang, senior researcher at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet who led both studies. “We haven’t been able to analyse the direct causes in this study, but common reasons for discontinuing ADHD medication are adverse reactions and lack of effect.” The highest rate of medication discontinuation occurred among 18 to 19-year-olds. This is when they leave child and adolescent psychiatry and enter adult psychiatry, a transition where they risk falling between the cracks. This is a shortcoming that the healthcare services must remedy, researchers say. “We need to improve the transition to adult psychiatry and spread knowledge about the fact that problems associated with ADHD often persist over time,” says Isabell Brikell, research coordinator at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, and one of the first authors of the study in The Lancet Psychiatry. “In addition, new digital tools such as simple SMS-based inventions could be used to help people with ADHD manage their medication.” Denmark sticks out A country that sticks out in the statistics is Denmark, which had a much lower proportion of children who discontinue their treatment within a year – 18 per cent, as opposed to the mean of 35 per cent. Compared with other Nordic countries like Sweden and Norway, the prescription of ADHD drugs is lower, which could suggest that medication is only prescribed to those with severe ADHD and the greatest need, researchers say. Sweden has a relatively high prescription rate of ADHD medication compared with many other European countries, so it is possible that we over-prescribe here.” Zheng Chang, senior researcher at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet Related Stories In another study conducted with over 275,000 Swedish ADHD patients published in JAMA Psychiatry, Dr Chang and his research group examined ADHD medication use for up to 14 years. They were then able to show that ADHD medication when taken for a longer time and in higher doses than average is associated with a higher risk of some cardiovascular diseases, primarily hypertension and arterial disease. In general, the risk of cardiovascular disease increased by approximately four per cent annually. The risk increase was greatest in the first few years of treatment and then levelled off, and it was only statistically significant at doses higher than 1.5 times the average daily dose (so-called defined daily dose, DDD). This means that those treated with lower doses are not likely to develop cardiovascular disease, according to the researchers. Patients should be followed up “There is a long list of drugs that have been linked to a comparable increased risk of hypertension when used long-term such as the one found here, so patients should not be alarmed by these findings,” says Le Zhang, postdoc researcher in Dr Chang’s research group and first author of the JAMA Psychiatry study. “However, in clinical practice, the raised risk should be carefully weighed against the recognised benefits of treatment on a case-by-case basis. Doctors should also regularly follow up the ADHD patients to find signs and symptoms of cardiovascular disease while they’re on medication over the long-term.” Since this is an observational study, it is not possible to conclude that it is the ADHD medication that leads to an increased risk of cardiovascular disease. As the researchers point out, it could depend on other medications, symptom severity or lifestyle factors. The studies were financed by the EU’s Horizon 2020 Research and Innovation Programme and Forte (the Swedish Research Council for Health, Working Life and Welfare). Some of the coauthors have potential conflicts of interest to declare, see the scientific articles for more information. Karolinska Institutet Journal references: Brikell, I., et al. (2023). ADHD medication discontinuation and persistence across the lifespan: a retrospective observational study using population-based databases. The Lancet Psychiatry. doi.org/10.1016/s2215-0366(23)00332-2. Zhang, L., et al. (2023). Attention-Deficit/Hyperactivity Disorder Medications and Long-Term Risk of Cardiovascular Diseases. JAMA Psychiatry. doi.org/10.1001/jamapsychiatry.2023.4294.

KANSAS CITY, MO – A commonly used therapy for patients with type 2 diabetes, heart failure and kidney disease known as sodium-glucose cotransporter inhibitor (SGLTi), is showing promise for decreasing the risk of developing many common age-related conditions, including cardiovascular disease, cancer, dementia, fatty liver, and gout according to researchers at Saint Luke’s Mid America Heart Institute and University of Missouri-Kansas City. This is the first scientific paper to formally propose SGLTi as an agent that may slow aging at the cellular level and improve longevity. An evolving body of research shows that SGLTi, a once-daily well-tolerated pill, reduces risk for many of the most prevalent and lethal chronic diseases, and reduces hospitalizations. “Slowing aging tends to prevent disease and improve life expectancy much better than working on treatments for individual diseases,” said James O’Keefe, MD, the study’s lead author and director of preventive cardiology at Saint Luke’s Mid America Heart Institute. “This is the first therapy with a large amount of clinical data in humans to suggest that it that may indeed slow the pace of aging.” The innate aging process is the most important risk factor for the majority of serious chronic diseases and premature death. Aging results in the progressive loss of normal functions, beginning at the cellular level and progressing to affect organs, predisposing to disease, weakness, frailty and immobility. Aging increases the risk of developing a wide range of illnesses including cardiovascular, metabolic, neurodegenerative, infectious, and neoplastic diseases. SGLTi has been shown to reduce risk of many of these illnesses including heart failure, chronic kidney disease, atrial fibrillation, cancer, gout, emphysema, neurodegenerative disease/dementia, non-alcoholic fatty liver disease, atherosclerotic disease, and infections. SGLTi are a unique class of drugs that block reuptake of filtered glucose in the kidney. This simple action alters nutrient sensing in the body in a way that stimulates autophagy—cellular housekeeping that rejuvenates cells and organs, leading to reduced risk of disease and hospitalization. Not only do studies suggest SGLTi reduces the risk of developing common conditions, but also that they improve overall life expectancy and reduce the risks of death from cardiovascular disease and cancer. “Along with a healthy diet and an active lifestyle that involves plenty of exercise, this drug might help lower the risk for diseases across the board,” said Dr. O’Keefe. “Generic SGLT2 inhibitors are becoming available to make this previously expensive class of drugs affordable for almost everyone.” Read the full article SGLT inhibitors for improving healthspan and lifespan in Science Direct: Progress in Cardiovascular Diseases. Saint Luke’s Mid America Heart Institute, a part of Saint Luke’s Health System and a teaching affiliate of the University of Missouri-Kansas City School of Medicine, is one of the distinguished cardiovascular programs in the country. Its legacy of innovation began more than 40 years ago when it opened as the nation’s first freestanding heart hospital. Since then, the Heart Institute has earned a global reputation for excellence in the treatment of heart disease, including interventional cardiology, cardiovascular surgery, imaging, heart failure, transplant, heart disease prevention, cardiometabolic disease, women’s heart disease, electrophysiology, outcomes research, and health economics. Saint Luke’s Mid America Heart Institute cardiologists offer personalized cardio-oncology care, where our experts diagnose and treat heart conditions in patients who have been or are being treated for cancer. With more than 100 full-time, board-certified cardiovascular specialists on staff, Saint Luke’s Mid America Heart Institute offers one of the country’s largest heart failure and heart transplant programs, has the largest experience with transcatheter aortic valve replacement in the Midwest, and is a global teaching site for the newest approaches in coronary revascularization. The Heart Institute’s cardiovascular research program encompasses clinical areas as well as centers of excellence and core laboratories. It continues to serve as one of the four Analytic Centers, along with Duke, Harvard, and Yale, for the American College of Cardiology’s National Cardiovascular Data Registry. Saint Luke’s Mid America Heart Institute is ranked 47th in the nation for Cardiology, Heart & Vascular Surgery by U.S. News & World Report and is the third hospital in the U.S. to achieve Comprehensive Cardiac Center certification from The Joint Commission.

Share this article <!– –> BMS will make milestone payments totalling up to $2.2bn, apart from royalty payments based on net product sales, to Avidity. Credit: nitpicker / Shutterstock.com. Avidity Biosciences has entered an international licencing and research partnership with Bristol Myers Squibb (BMS) to discover, develop and market cardiovascular targets in a $2.3bn deal. Avidity will receive an upfront payment of $100m. This comprises $60m to be paid in cash and $40m for the purchase of the company’s common stock. BMS will make milestone payments of $2.2bn to Avidity, apart from royalty payments based on net product sales. Research and development-based milestone payments could be up to $1.35bn. $825m will be paid on meeting commercial milestones. All clinical development, as well as regulatory and commercialisation work linked to this partnership, will be financed by BMS. Access the most comprehensive Company Profiles on the market, powered by GlobalData. Save hours of research. Gain competitive edge. View profiles in store Company Profile – free sample Your download email will arrive shortly We are confident about the unique quality of our Company Profiles. However, we want you to make the most beneficial decision for your business, so we offer a free sample that you can download by submitting the below form By GlobalData The companies will work on up to five targets in the cardiovascular field utilising Avidity’s antibody oligonucleotide conjugate (AOC) platform technology. Created to act on the diseases’ root causes, which were previously untreatable with RNA therapies, AOCs merge the monoclonal antibodies’ specificity with the precision of oligonucleotide treatments. The new deal in the cardiovascular field is an expansion of an already existing deal between the companies. Avidity signed a research partnership with BMS subsidiary, MyoKardia, in 2021 to study the potential of AOCs in cardiac tissue. Avidity Biosciences president and CEO Sarah Boyce stated: “We are excited to expand our collaboration with Bristol Myers Squibb, who are world leaders in cardiovascular drug discovery and development. “This strategic collaboration solidifies our commitment to cardiology as we continue to advance our own research and development programmes in cardiac indications.” Avidity’s internal discovery pipeline comprises candidates for the treatment of rare skeletal muscle ailments and cardiac muscle diseases. Three of the company’s rare disease programmes are currently at the Phase I/II clinical trial stage. The latest development comes after BMS received priority review from the US Food and Drug Administration for its Breyanzi (lisocabtagene maraleucel) to treat patients with relapsed or refractory chronic lymphocytic leukaemia or small lymphocytic lymphoma. <!– –> Sign up for our daily news round-up! Give your business an edge with our leading industry insights.

brand stories Published on Nov 29, 2023 01:04 PM IST 60-year-old Arif Ali turned towards Chirayu Hospital’s Cardiovascular and Thoracic Surgery (CTVS) department after being referred to Jaipur. Chirayu Hospital’s CTVS department treats the cardiovascular condition of a 60-year-old Follow Us Share Via Copy Link ByHT Brand Studio In the heart of Jaipur, on Kalwar Road lies the Chirayu Hospital, a multispeciality hospital that has been profoundly working and offering top notch medical services for Rajasthan. Chirayu Hospital has always been the true testament to quality, reliable, and affordable medical services. It is a center where patients are cared for and offered finest medical treatments. This hospital has continued to be the most trusted among everyone and with the recent happenings, the hospital has only deepened this trust. Recently, the hospital hit a milestone and established itself as the best center of cardiovascular treatments by successfully taking over and treating a very complicated medical case. A resident of Churu, Arif Ali who was under serious cardiovascular condition and required immediate care was treated successfully by the CTVS team at Chirayu Hospital. The exceptional care provided by the cardiologists and the cardiovascular surgeons team saved Arif Ali and gave him a new life. We’re now on WhatsApp. Click to join. Talking more about this unique case, the 60-year-old Arif Ali turned towards Chirayu Hospital’s Cardiovascular and Thoracic Surgery (CTVS) department after being referred to Jaipur for advanced angioplasty. A few weeks back, Arif Ali experienced a feeling of restlessness and pain in his chest which led him to seek medical care. Earlier he had experienced a severe chest pain with a history of coronary disease and an unsuccessful angioplasty at a local private hospital in Sikar. The doctors there witnessed his serious condition and referred him to a cardiac specialist after which he underwent angiography. The results revealed a blockage that required immediate medical attention. This led him to be referred to Jaipur for a bypass surgery. He was brought to Chirayu Hospital in no time for his advanced medical treatments to relieve his heart blockage. Upon arriving, Arif Ali was examined and consulted by renowned CTVS surgeon, Dr. Gaurav Goyal. All the preliminary tests were done that uncovered his rare case of dextrocardia while he required a bypass surgery. During the tests, it was found that his heart was on the right side along with all the left structures of the heart on the right side and vice versa. This was a unique case in which the patient’s heart was totally lying in the opposite direction as compared to a normal heart, found in only 1 out of 10,000 patients. At Chirayu Hospital, Dr. Gaurav Goyal faced technical challenges. As he was a right handed surgeon, in this case, due to reversed heart anatomy which required a left handed surgeon and Dr. Gaurav Goyal had difficulties regarding the exposure of arteries. But the team navigated these complexities and aptly performed a successful bypass surgery using vein grafting. This case showcased the innovative as well as human centric approach of Chirayu Hospital. The team successfully handled the complex case with great precision and compassion. As this case came into light, the most critical part of it has been the very rare condition of dextrocardia as diagnosed in Arif Ali. This is a very rare condition in which the heart points towards the right instead of the usual left. This is a kind of congenital abnormality that affects less than 1 percent of the population. The main cause of this abnormality still remains to be a mystery and is believed to occur during the fetal development which leads to variations in the heart anatomy. Dextrocardia’s condition poses its unique challenges especially in cases just like Arif’s. Being such a rare condition, it brought in a lot of challenges for the surgeons in successfully treating the condition. In this case, the dextrocardia presented as an isolated form, with the heart on the right side but all the other organs intact. The skilled team led by Dr. Gaurav, addressed this unique condition with precision. If discovered incidentally without any complications, isolated dextrocardia often shows no symptoms. However, Arif Ali’s case displays the importance of thorough medical examination, as dextrocardia can impact respiratory health and, in some cases, might require corrective surgery. To ensure optimal heart function in the case of Arif Ali, the team at the cardiology department of Chirayu Hospital utilized interventions like pacemakers and surgery. Beyond the intricacies of Arif Ali’s case, the rarity of dextrocardia requires a specialized approach, and Arif Ali’s successful treatment highlights the hospital’s expertise and dedication to personalized healthcare solutions. This case marked a milestone for the hospital, as it became the first among 1046 cardiovascular surgery cases to be successfully treated. The achievement reflects the hospital’s commitment to tackling complex medical issues and emerging victorious. This case also highlights the exceptional cardiology and CTVS department of the Chirayu Hospital that does not only have the best team of doctors and surgeons but also is equipped with the top notch technology and advanced features that withstands any kind of cardiovascular complexes with great expertise and ease. The department under the guidance of Dr. Gaurav Goyal worked tirelessly with great consideration and expertise to restore the condition of Arif Ali. This case reflects on the exceptional prowess of the cardiovascular department. Behind this exceptional medical success lies the visionary surgeon and his team, Dr. Gaurav Goyal who also emphasized the importance of teamwork and dedication in achieving medical milestones by treating such complex cases. Chirayu Hospital’s CTVS team not only demonstrated technical proficiency but also their compassionate approach to ensure that Arif Ali and his family felt supported and cared for throughout the process. Arif Ali and his family expressed their gratitude to the Chirayu Hospital management, including Executive Director Mohit Choudhary, Director Dr. Manoj Kumar Choudhary, Banwari Lal from the Cardiothoracic ICU, and Dr. Gaurav Goyal’s exceptional team. They acknowledge how the hospital and the proficient

Introduction Chronic medical conditions, including type 2 diabetes and cardiovascular diseases (CVDs), are common among elderly patients worldwide. According to previous estimates, studies found that–50–99% of patients aged ≥ 60 years presented with at least two chronic medical conditions in which cardiovascular diseases topped the chronic morbidities in this population.1 A large–scale survey conducted in the USA on elderly patients found that CVD commonly coincided with diabetes mellitus disease (37.1–47.1%).2 Elderly individuals with CVD and Diabetes usually have other aging-associated conditions, including geriatric syndromes (GSs), defined as impaired organ physiological functions due to the augmented cumulative effects of multiple diseases on organ functions.3 Elderly patients could experience more than GSs during their lifetime leading to higher risk of frailty, falls, and cognitive functions impairments.4–6 Reports have linked such manifestations to a decline in physiological organ functions and frequent use of medications for various types of GSs in the elderly patients.7,8 The treatment of CVD and diabetes in elderly patients usually involves various medications to control blood glucose levels as well as different symptoms related to CVD. Such intensive drug therapy in the elderly undoubtedly leads to polypharmacy. Polypharmacy refers to the simultaneous administration of multiple medications (≥ 5 medications concurrently).9,10 While prescribing multiple medications is generally necessary for obtaining clinical benefits in these patients, polypharmacy can lead to a significant drug burden and rising concern for developing drug-related problems. Polypharmacy is a highly prevalent issue in elderly subjects and is generally linked to health-related negative consequences in older adults, including non-or poor medication adherence, drug interactions and adverse drug events, increased number of hospitalizations, and increased level of mortality.11–13 Medication-dependent approaches are considered the mainstay of treatment for CVD and diabetes. CVD and antidiabetic medications are frequently prescribed to individuals worldwide, especially geriatric populations. Adherence to medication regimens to control chronic disease-related negative manifestations is becoming increasingly complicated for elderly individuals with multiple morbidities. Many factors have been identified to be associated with lack of proper medications adherence in patients. These factors are classified into healthcare system-related factors (eg, lack of accessibility to healthcare facilities), patient-specific personal factors (intentional and non-intentional), socioeconomic-related factors, psychosocial factors and medication-related factors (eg, cost and adverse drug reactions).14–16 Identifying and addressing these barriers are crucial for improving adherence and patient outcomes. Ensuring consistent medication adherence among older patients with chronic diseases remains a major challenge. Non-adherence can lead to negative outcomes such as therapeutic failure and futile disease control, higher rates of hospital readmissions due to medication-related issues, need for additional medical or surgical procedures, and increased healthcare expenses.17–19 This study aimed to examine and identify the prevalence of medications non-adherence, evaluate the degree of non-adherence, and identify the factors that influence medication non-adherence in elderly patients with coexisted type 2 diabetes mellitus and other CVDs, including hypertension, ischemic heart disease, heart failure, and cardiac arrhythmia. It is noteworthy that limited studies in Jordan have investigated non-adherence issues in the geriatric population in general and have not evaluated the prevalence and associated factors leading to poor adherence among elderly patients with CVD and diabetes. Methods Study Design and Population A cross-sectional study was conducted on 506 patients who attended King Abdullah University Hospital (KAUH) outpatient diabetes and cardiology clinics from March 6, 2023, to July 6, 2023. Patients’ data collection was accomplished by using a structured questionnaire and electronic medical records. During the data collection phase, the study included patients aged 60 years and older who had a confirmed diagnosis of type 2 diabetes mellitus (DM) and diagnosed with at least one cardiovascular disease (CVD). CVDs included in this study were hypertension, acute coronary syndrome (ACS), atrial fibrillation, venous thromboembolism, heart failure and cardiomyopathy, and rheumatic valvular heart disease. Participation in the study was voluntary, and the patients provided their consent by signing a consent form. However, patients without any diagnosed cardiovascular disease or those not taking any medication specifically intended for their type 2 diabetes and cardiovascular conditions were excluded from the study. Measurements Sociodemographic data, including marital status, and living conditions, were collected through a survey. Medical records were used to collect age, gender, biomedical data, including measurements of serum creatinine, creatinine clearance, fasting blood sugar (FBS), random blood sugar (RBS), glycosylated hemoglobin (HbA1C), low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol, triglycerides, hemoglobin, systolic blood pressure (SBP), and diastolic blood pressure (DBP). Additionally, patients’ medications details and medical characteristics were obtained from their hospital electronic medical records. Adherence Instrument The Arabic version of the 4-item Morisky, Green, and Levine Medication Adherence Scale-Medication Assessment Questionnaire (MGL-MAG) was used to previously validated,20,21 was used. It consists of four questions that help determine the level of medication adherence. Patients were categorized into three levels based on their responses to these questions. If the patient answered “NO” to all four questions, they were considered to have high adherence, indicating that the patient reported not forgetting their medication, did not alter the dose, and did not stop the medication without consulting a health care provider. Conversely, if the patient answered “YES” to one or two questions, they were categorized as having moderate adherence. This suggests that patients may occasionally forget their medication or make slight alterations to the dosing regimen but not to a significant extent. If the patients answered “YES” to three or more questions, they were classified as having low adherence. This implies that patients frequently forget to take their medication, intentionally skip doses, or make significant changes to their dosing regimens without medical advice. Sample Size Calculation To ensure the reliability and accuracy of our study outcomes, we calculated the sample size using the Krejcie and Morgan formula. This calculation aimed to achieve statistically meaningful results with a consistent level of confidence and a small margin of error. The formula considers target confidence level of 95% and margin of error of 5%. Based on this calculation, we determined that a minimum of 385 subjects was required for our study.22 Statistical Analysis Data analysis was performed using the SPSS Software version 23. Descriptive

Introduction Chronic kidney disease (CKD) is highly prevalent worldwide, it affects 8–16% of the population,1 and CKD is the third fastest growing cause of death globally.2 In high-income countries, CKD is mainly caused by diabetes or hypertension,3 which also represent central risk factors for development of cardiovascular diseases, both individually and synergistically.4,5 Cardiovascular disease and CKD frequently coexist in patients.1 Consequently, the current European Society of Cardiology (ESC) guidelines for chronic coronary syndrome (CCS) recommend that patients with CKD are treated to target values for cardiovascular risk factors such as hyperlipidemia, hypertension, and hyperglycemia.6 Moreover, CKD has previously been established as an important predictor of clinical cardiovascular outcomes, although data are sparse in patients with CCS.7,8 However, strong associations between impaired kidney function and long-term cardiovascular outcomes (risk of death, heart failure and myocardial infarction (MI)) in patients with CCS were recently reported in a Swedish cohort.9 We have previously shown that the absence of CAD eliminates the excess MI risk in patients with diabetes,10–13 reduces the excess risk of stroke and limb amputations in patients with diabetes,14,15 and reduces the risk of stroke in patients with atrial fibrillation.16 In the current study we aimed to investigate if CAD is also a strong negative predictor across different stages of CKD. To answer this question, we used a cohort of CCS patients undergoing coronary angiography (CAG) in Western Denmark and a matched general population comparison cohort. Methods Data Collection Patients were identified from the Western Denmark Heart Registry (WDHR), where patient and procedure data from all cardiac procedures in Western Denmark are prospectively recorded, including CAGs since 1999.17 The WDHR was linked with other registries using the unique, individual Civil Person Register number, assigned to all Danish citizens, and recorded in the Danish Civil Registration System.18 This system allows us to collect long-term follow-up on patients by providing information on emigration and vital status.18 Several registries were used in this study; the Danish National Patient Registry (DNPR),19 the Danish National Prescription Registry,20 and the Danish Register of Causes of Death.21 The DNPR collects primary and secondary discharge diagnoses after patient admissions. These diagnoses are registered in accordance with the International Classification of Diseases, 10th revision. Patient Selection We identified all patients undergoing CAG in Western Denmark from January 1, 2003 – December 31, 2016 (Figure 1). Patients below 18 years were excluded. Patients with CAG performed due to acute coronary syndromes or other indications than stable angina pectoris were excluded. We excluded all patients with missing CAD status and estimated glomerular filtration rate (eGFR) data and follow-up <30 days. Patients undergoing dialysis were excluded. Thereby, patients undergoing CAG due to suspicion of CCS were included and stratified on presence of CAD and kidney function. Figure 1 Patient selection. Flowchart displaying selection of patients with chronic coronary syndrome. Abbreviations: CAG, coronary angiography; CAD, coronary artery disease; eGFR, estimated glomerular filtration rate. Exposure Kidney function was assessed by eGFR, which was estimated according to the most recent plasma creatinine measured before CAG. eGFR was calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and adjusted to body surface area (BSA) as calculated by the Du Bois formula.22 The CKD-EPI equation is validated in a US population.23 Kidney function was classified in CKD stages based on eGFR: eGFR ≥90 mL/min/1.73 m2 as normal or high function; 60–89 mL/min/1.73 m2 as mildly decreased; 30–59 mL/min/1.73 m2 as moderately decreased; and <30 mL/min/1.73 m2 as severely decreased/kidney failure.24 CAD status was evaluated by CAG and recorded in the WDHR. CAD was defined as ≥1 coronary vessel(s) with obstructive stenosis (≥50% lumen narrowing and/or a fractional flow reserve ≤0.80, the latter officially included in the definition in 2014) or diffuse non-significant vessel disease. Baseline Characteristics Information on age and sex were collected from the Civil Registration System. The WDHR and the DNPR were used to obtain patient data and information on comorbidities. Diabetes was defined as (1) being in dietary treatment, insulin treatment with or without oral glucose lowering treatment, or oral glucose lowering treatment according to the WDHR, (2) a diabetes diagnosis registered in the DNPR before CAG or within 30 days after CAG, (3) redemption of diabetes medication (being either insulin or non-insulin glucose lowering treatment) within 6 months before CAG to 30 days after as recorded in the Danish National Prescription Registry. Hypertension was defined as a combination of treatment for hypertension in the WDHR and a previous hypertension diagnosis registered in the DNPR. Heart failure with reduced ejection fraction (HFrEF) was characterized as an ejection fraction ≤40% registered in the WDHR or a diagnosis of heart failure in the DNPR, before CAG or within 30 days after CAG. Prescription records on medications (within 6 months before CAG until 30 days after CAG) were obtained from the Danish National Prescription Registry. Charlson Comorbidity Index (CCI) was modified to exclude moderate-to-severe kidney disease.25 Outcomes Major adverse cardiac events (MACE) were defined as a composite of MI, ischemic stroke, and cardiac death. Data on MI and ischemic stroke were obtained by the primary and secondary discharge diagnoses from hospital admissions in the DNPR (Supplementary Table 1). Information on cardiac death is registered in the Danish Register of Causes of Death. All-cause mortality was determined from the Danish Civil Registration System. Follow-up and registration of events were initiated 30 days after CAG to avoid double recording of procedure-related events. Statistical Analyses Follow-up began 30 days after the CAG procedure and end of follow-up was defined as outcome, death, emigration, maximum 10-year follow-up, or at the date of last available data (December 31, 2018). Event rates were estimated per 100 person-years at risk. Information on smoking status was missing in 4% of patients and BMI in 0.1% of patients. These missing data were handled by imputation of 5 datasets using chained equations.26 A modified Poisson regression with a robust variance-covariance estimator was used to compute unadjusted and adjusted incidence rate ratio (IRR), with the eGFR ≥90 mL/min/1.73 m2 stratum as reference.27 Analyses of event rates and

DALLAS, November 28, 2023 — Cardiovascular disease (CVD) claims more lives than all forms of cancer, yet many women, particularly younger women, remain unaware.[1] Through its Go Red for Women® movement, the American Heart Association, which is devoted to a world of healthier lives for all, is being supported by Miss America’s Scholarship Foundation to empower the next generation of women to take charge of their health and make a lasting impact on the health and well-being of communities nationwide. The new support of Go Red for Women by Miss America’s Scholarship Foundation will activate around three pillars: promoting awareness of CVD as the No. 1 killer of women; educating and empowering Miss America’s participants at the local, state and national levels; and raising critical funds to support the Go Red for Women movement which champions equitable research and treatment for women. Nearly 45% of women over age 20 are living with some form of CVD, and as women grow and change so does their risk for cardiovascular disease. Yet, younger generations of women, Gen Z and Millennials, are less likely to be aware of their greatest health threat, including knowing the warning signs of heart attack and stroke.[2] That’s why it’s important for all women to take charge of their heart health and encourage others to do the same. “By aligning our shared goals to empower and invest in the lives of women, we can expand our reach to improve the health of our communities and inspire women to become the best versions of themselves,” said Robin Fleming, Miss America’s CEO. Go Red for Women, established in 2004, works with organizations and individuals toward a shared vision of saving and improving women’s lives by advancing equitable research and care, advocating for inclusive health policies and raising awareness. Today, the Go Red for Women movement is here for women at every age, every stage, and every season of their lives as their trusted, relevant source for credible, equitable health solutions. ​ “In the 20 years Go Red for Women has worked to save and improve women’s lives, one thing we’ve learned is that women—particularly young women—need to know that heart disease doesn’t discriminate,” said Nancy Brown, CEO of the American Heart Association. “Anyone can be a lifesaver,” she continued. “You just need to know the signs and symptoms and have confidence to speak up. The life you save could be your own.” ### About the American Heart Association The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for a century. During 2024 – our Centennial year – we celebrate our rich 100-year history and accomplishments. As we forge ahead into our second century of bold discovery and impact, our vision is to advance health and hope for everyone, everywhere. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1. About Go Red for Women® The American Heart Association’s signature initiative, Go Red for Women®, is a comprehensive platform designed to increase women’s heart health awareness and serve as a catalyst for change to improve the lives of women globally. While the majority of cardiac events can be prevented, cardiovascular disease is the leading cause of death in women, claiming the lives of 1 in 3 women. For more than two decades, Go Red for Women has encouraged awareness. The movement harnesses the energy, passion and power of women to band together and collectively wipe out heart disease. It challenges them to know their risk for heart disease and take action to reduce their personal risk. It also gives them tools they need to lead a heart healthy life. The Go Red for Women movement is nationally sponsored by CVS Health, with additional support from national cause supporters. For more information, please visit GoRedforWomen.org or call 1-800-AHA-USA1 (242-8721). [1] https://www.ahajournals.org/doi/10.1161/CIR.0000000000000907 [2] https://newsroom.heart.org/news/heart-disease-awareness-decline-spotlights-urgency-to-reach-younger-women-and-women-of-color Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

<!– –> Rise of the Indian Challengers in the Global Cardiovascular Devices Market, ET HealthWorld <!– –> <!– –> <!– We have updated our terms and conditions and privacy policy Click “Continue” to accept and continue with ET HealthWorld –> <!– X We use cookies to ensure best experience for you We use cookies and other tracking technologies to improve your browsing experience on our site, show personalize content and targeted ads, analyze site traffic, and understand where our audience is coming from. You can also read our privacy policy, We use cookies to ensure the best experience for you on our website. By choosing I accept, or by continuing being on the website, you consent to our use of Cookies and Terms & Conditions. Analytics and Performance Cookies Targeted and Advertising Cookies –> <!– skip to main content –> <section class="container article-section status_prime_article single-post currentlyInViewport inViewPort" id="news_dtl_105572044" data-article="0" page-title="Rise of the Indian Challengers in the Global Cardiovascular Devices Market" data-href="https://health.economictimes.indiatimes.com/news/medical-devices/rise-of-the-indian-challengers-in-the-global-cardiovascular-devices-market/105572044" data-msid="105572044" data-news="{"link":"/news/medical-devices/rise-of-the-indian-challengers-in-the-global-cardiovascular-devices-market/105572044","seolocation":"/news/medical-devices/rise-of-the-indian-challengers-in-the-global-cardiovascular-devices-market/105572044","seolocationalt":"/news/medical-devices/rise-of-the-indian-challengers-in-the-global-cardiovascular-devices-market/105572044","seometatitle":false,"seo_meta_description":"The Indian domestic market is now poised for much faster growth compared to its global peers due to its considerably small base versus the size of its population. Deepening insurance penetration, rising affordability and the widening of patient pool driven by government sponsored schemes are some of the key factors driving this growth. ","canonical_url":false,"url_seo":"/news/medical-devices/rise-of-the-indian-challengers-in-the-global-cardiovascular-devices-market/105572044","category_name":"Medical Devices","category_link":"/news/medical-devices","category_name_seo":"medical-devices","updated_at":"2023-11-29 05:58:33","artexpdate":false,"agency_name":"ETHealthWorld","agency_link":"/agency/88675629/ETHealthWorld","read_duration":"4 min","no_index_no_follow":false,"keywords":[{"id":1832783,"name":"ujjwal singh","type":"General","weightage":80,"keywordseo":"ujjwal-singh","botkeyword":false,"source":"Orion","link":"/tag/ujjwal+singh"},{"id":3727552,"name":"meril life sciences","type":"General","weightage":80,"keywordseo":"meril-life-sciences","botkeyword":false,"source":"Orion","link":"/tag/meril+life+sciences"},{"id":1715229,"name":"smt","type":"General","weightage":50,"keywordseo":"smt","botkeyword":false,"source":"Orion","link":"/tag/smt"},{"id":53564,"name":"southeast asia","type":"General","weightage":50,"keywordseo":"southeast-asia","botkeyword":false,"source":"Orion","link":"/tag/southeast+asia"},{"id":15378315,"name":"Cardiovascular devices","type":"General","weightage":20,"keywordseo":"Cardiovascular-devices","botkeyword":false,"source":"Orion","link":"/tag/cardiovascular+devices"},{"id":1069791,"name":"translumina","type":"General","weightage":20,"keywordseo":"translumina","botkeyword":false,"source":"Orion","link":"/tag/translumina"},{"id":5949510,"name":"percutaneous coronary interventions","type":"General","weightage":20,"keywordseo":"percutaneous-coronary-interventions","botkeyword":false,"source":"Orion","link":"/tag/percutaneous+coronary+interventions"},{"id":1544318,"name":"stent implants","type":"General","weightage":20,"keywordseo":"stent-implants","botkeyword":false,"source":"Orion","link":"/tag/stent+implants"}],"read_industry_leader_count":false,"read_industry_leaders":false,"embeds":[{"title":"Over the last six years, most Indian stent manufacturers have seen exponential growth in international markets and have established a strong foothold in multiple countries.","type":"image","caption":false,"elements":[]}],"thumb_big":"https://etimg.etb2bimg.com/thumb/msid-105572044,imgsize-132670,width-1200,height=765,overlay-ethealth/medical-devices/rise-of-the-indian-challengers-in-the-global-cardiovascular-devices-market.jpg","thumb_small":"https://etimg.etb2bimg.com/thumb/img-size-132670/105572044.cms?width=150&height=112","time":"2023-11-29 05:58:12","is_live":false,"prime_id":0,"highlights":[],"highlights_html":"","also_read_available":false,"body":" by Ujjwal Singh The Indian Cardiovascular devices landscape witnessed a turning point in November 2018, when the Government of India notified price control on stents, bringing down the prices by more than 80%. With a current market size of ~USD 200 million, this market is slated to be one of the fastest growing in the world, growing at a staggering 14-15% CAGR over next decade. Let’s find out what’s driving this growth. A stent in timeHistorically speaking, it’s interesting to note that India’s medical devices market was dominated by global majors. This heavy reliance on expensive imported devices hindered accessibility to life-saving interventions, with only a fraction of the population receiving essential procedures, such as percutaneous coronary interventions (PCI). However, post implementation of the price cap, there was an over 30% surge in the number of stent implants in just 12 months. The price control combined with inclusion of stent implants in government schemes led to both a multi-fold increase in stent implants and a remarkable shift in the Indian landscape, with Indian players increasing their market share from 35% to an impressive 60%. Global majors such as Abbott Vascular, Boston Scientific, and Medtronic, had to adapt to the revised pricing, allowing local players, such as, SMT, Translumina, and Meril room to grow their share by providing high-quality products but at a much lower cost. India’s advantage in manufacturing, with low labour costs and a pool of skilled talent, further fuelled the growth of domestic production. The Indian domestic market is now poised for much faster growth compared to its global peers due to its considerably small base versus the size of its population. Deepening insurance penetration, rising affordability and the widening of patient pool driven by government sponsored schemes are some of the key factors driving this growth. Global exports are also likely to play a critical role for domestic medical devices manufacturers, particularly those with high quality standards and in-house capabilities. Expanding into global marketsThe pricing reforms coincided with two big milestones in the Indian stent space – the successful completion of first clinical trial in India by SMT Pvt. Ltd and the launch of the first bioabsorbable stent by Meril Life Sciences. These two episodes provided a perfect launch pad to succeed in the international markets via increased acceptability and reliability of Indian manufactured cardiology devices. This led to a successful expansion by select Indian manufacturers across global markets, including Europe, Southeast Asia, Africa and the Middle East. Strong growth, global expansion and, rising profitability led to increased interest from financial sponsors, including Private Equity investors. This enabled Indian players to build world-class R&D and manufacturing infrastructure, while maintaining the local cost advantage. With additional capital and capabilities, select Indian manufacturers have been able to conduct expensive global trials and establish techno-commercial teams to navigate the complex regulatory and marketing processes in developed markets. Over the last six years, most Indian stent manufacturers have seen exponential growth in international markets and have established a strong foothold in multiple countries. Next Opportunity: Foray into the Structural Heart Devices marketWhile Indian players enjoyed success in stents in both domestic as well as international markets, structural heart devices market is still a nascent play for most. In recent years, many of the global CVD leaders have been shifting their focus towards structural heart devices due to significantly higher sophistication and realization. While the global structural heart devices market stood at USD 5.6 billion in 2020 and is expected to grow at 13% over the next 5 years, India’s structural heart market stands at a mere USD 12.4 million and is projected to grow at a 31% CAGR due to a very low base. In India, the limited penetration can be attributed to factors like affordability, accessibility, and a shortage of specialists capable of conducting these complex procedures. Per our interaction with few leading clinicians, we understand that minimally invasive procedures for structural heart disease can cost up to INR 30 lakhs using MNC products and nearly half using products from Indian players. On top of this high treatment cost, this procedure is currently not reimbursed by any government schemes, thus making it out of reach for most Indians. The success of Indian players in the stent market provides an ideal thesis for their foray into the structural heart devices market. With established distribution networks in both domestic and global markets, Indian companies can leverage their strengths to introduce new products through organic development and/or strategic acquisitions. With

Abstract Current risk scores using clinical risk factors for predicting ischemic heart disease (IHD) events—the leading cause of global mortality—have known limitations and may be improved by imaging biomarkers. While body composition (BC) imaging biomarkers derived from abdominopelvic computed tomography (CT) correlate with IHD risk, they are impractical to measure manually. Here, in a retrospective cohort of 8139 contrast-enhanced abdominopelvic CT examinations undergoing up to 5 years of follow-up, we developed multimodal opportunistic risk assessment models for IHD by automatically extracting BC features from abdominal CT images and integrating these with features from each patient’s electronic medical record (EMR). Our predictive methods match and, in some cases, outperform clinical risk scores currently used in IHD risk assessment. We provide clinical interpretability of our model using a new method of determining tissue-level contributions from CT along with weightings of EMR features contributing to IHD risk. We conclude that such a multimodal approach, which automatically integrates BC biomarkers and EMR data, can enhance IHD risk assessment and aid primary prevention efforts for IHD. To further promote research, we release the Opportunistic L3 Ischemic heart disease (OL3I) dataset, the first public multimodal dataset for opportunistic CT prediction of IHD. Introduction Ischemic heart disease (IHD) is the leading cause of global mortality and among the top causes of morbidity. In 2019, it was responsible for over 9 million deaths worldwide and the loss of more than 180 million disability-adjusted life years (http://ghdx.healthdata.org/gbd-results-tool). Preventive treatments including lifestyle modifications and pharmacologic interventions (e.g., cholesterol-lowering medications) can be guided by risk assessment. The Framingham coronary heart disease risk score (FRS) and the Pooled Cohort Equations (PCE) are commonly utilized risk estimation methods for IHD and atherosclerotic cardiovascular disease, respectively1,2. The FRS uses demographic risk factors and cholesterol values to predict 10-year IHD risk in individuals aged 30–74 years old without known IHD at baseline examination. The PCE were developed to model the 10-year risk of major atherosclerotic cardiovascular disease events, including fatal and nonfatal IHD as well as fatal and nonfatal stroke. These risk scores have been used as a standard for IHD risk assessment in current clinical practice guidelines and policy recommendations, including the most recent American College of Cardiology/American Heart Association guideline on primary prevention of cardiovascular disease3. Validation of both risk scores has shown varying performance depending on the subpopulation analyzed. Performance is typically reported as a c-statistic value, which corresponds to the proportion of case–control pairs in which a higher risk is assigned to the case (a measure of discrimination). Previously reported c-statistic values for the FRS and PCE are modest with typical ranges of 0.66–0.76 and 0.68–0.76, respectively4, leaving potential room for improvement. Thus, the discovery of additional biomarkers that improve or independently inform the predictive power of these existing models has been the objective of multiple recent research endeavors5,6. Imaging biomarkers derived from computed tomography (CT) have shown promise in the assessment of cardiovascular risk. For example, the coronary artery calcium (CAC) score measures the extent of plaque in the coronary arteries from coronary CTs, and is an important tool for IHD risk stratification7,8. Although CAC scoring is a strong independent predictor of cardiovascular events9, the integration of both clinical factors (e.g., FRS) and imaging factors (e.g., CAC score) has been shown to significantly improve prediction of major cardiac events and all-cause mortality (compared with clinical or imaging metrics alone)10,11. Other studies have combined metrics from coronary CT angiography with blood biomarkers such as high-sensitivity cardiac troponin to successfully improve upon current measures of cardiovascular risk12,13. These specialized methods apply to a subset of patients already being assessed for cardiovascular risk. Alternatively, abdominopelvic CTs contain body composition (BC) imaging biomarkers for atherosclerotic cardiovascular disease, such as hepatic steatosis14, low muscle mass15, an increased ratio of visceral to subcutaneous adipose tissue (VAT/SAT)16, and abdominal aortic calcification17. Notably, 20 million abdominopelvic CTs are acquired annually almost twice as often as CT scans that image the heart or coronary vessels, such as non-contrasted chest CT and coronary CT18,19. According to the National Hospital Ambulatory Care Survey (https://bit.ly/2SL6957), in 2016 over 10 million abdominopelvic CTs were acquired in the US during emergency department visits alone, often in relation to abdominal pain—the most common principal reason for visiting an emergency department20. By comparison, roughly 3 million chest CTs were performed during emergency department visits in 2016. Within abdominopelvic CTs, these biomarkers could be measured during such routine imaging procedures without resulting in additional costs or radiation exposure, referred to as opportunistic imaging21. However, the current clinical workflow and volume of imaging is not well-suited to allow practical utilization of the additional resources required to manually extract measurements of imaging biomarkers22. Consequently, despite the potential value, cardiovascular risk is not routinely assessed upon abdominopelvic CT acquisition, thereby missing opportunities for early disease detection and prevention. In this work, we developed IHD risk assessment models that use automatically measured imaging features from abdominopelvic CT examinations in combination with the patient’s EMR. We evaluate the benefit of extracting BC imaging biomarkers from an axial slice at the level of the third lumbar vertebra (L3) in addition to traditional PCE metrics. We also develop an IHD risk assessment tool using the raw L3 slice image in an end-to-end manner using deep learning. We further develop a method to quantitatively assess the contribution of imaging features to the model prediction, aggregated at the tissue level. We introduce this method, Tissue Saliency, in this work. Finally, we combine features derived from the EMR in addition to the L3 slice, yielding the greatest risk prediction performance, and interpret the individual contribution of clinical features. To spur further research, we publicly release the Opportunistic L3 for IHD prediction (OL3I) dataset. Overall, we depict how opportunistic utilization of already-acquired CT imaging and EMR data can facilitate primary prevention of IHD without requiring additional testing, radiation, cost, or radiological assessment. Methods Study population Following Stanford University Institutional Review Board approval and in accordance with relevant guidelines and regulations, we identified an initial cohort of 36,354

We show how a build-up of propionyl-CoA in a mouse model of propionic acidaemia produces histone modifications in the heart. The transcriptional responses included genes implicated in contractile dysfunction. Notably, female mice are more severely affected, owing to a protective effect of β-alanine in males, a therapeutically important finding. 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#069;border-radius:0;cursor:pointer;display:block;padding:9px;outline:0;text-align:center;text-decoration:none;min-width:80px;max-width:320px;margin-top:10px}.Button-1078489254 .readcube-label,.Button-2496381730 .readcube-label{color:#069} /* style specs end */ Subscribe to this journal Receive 12 digital issues and online access to articles $119.00 per year only $9.92 per issue Learn more Rent or buy this article Prices vary by article type from$1.95 to$39.95 Learn more Prices may be subject to local taxes which are calculated during checkout Additional access options: Log in Learn about institutional subscriptions Read our FAQs Contact customer support Fig. 1: Sex-dependent changes in histone modifications in the hypomorphic mouse model of PA. References Richard, E., Pérez, B., Pérez-Cerdá, C. & Desviat, L. R. Understanding molecular mechanisms in propionic acidemia and investigated therapeutic strategies. Expert Opin. Orphan Drugs 3, 1427–1438 (2015). This review presents an overview of propionic acidemia. Article CAS Google Scholar Kebede, A. F. et al. Histone propionylation is a mark of active chromatin. Nat. Struct. Mol. Biol. 24, 1048–1056 (2017). This paper reports histone propionylation in vivo. Article CAS PubMed Google Scholar He, W., Wang, Y., Xie, E. J., Barry, M. A. & Zhang, G.-F. Metabolic perturbations mediated by propionyl-CoA accumulation in organs of mouse model of propionic acidemia. Mol. Gen. Metab. 134, 257–266 (2021). This review discusses the metabolic changes in propionic acidemia. Article CAS Google Scholar Guenzel, A. J. et al. Generation of a hypomorphic model of propionic acidemia amenable to gene therapy testing. Mol. Ther. 21, 1316–1323 (2013). This paper introduces the hypomorphic mouse model of PA. Article CAS PubMed PubMed Central Google Scholar Gillette, T. G. & Hill, J. A. Readers, writers, and erasers: chromatin as the whiteboard of heart disease. Circ. Res. 116, 1245–1253 (2015). The review discusses the role of changes in chromatin structure in cardiac disease. Article CAS PubMed PubMed Central Google Scholar Download references Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This is a summary of: Park, K. C. et al. Disrupted propionate metabolism evokes transcriptional changes in the heart by increasing histone acetylation and propionylation. Nat. Cardiovas. Res. https://doi.org/10.1038/s44161-023-00365-0 (2023). Rights and permissions Reprints and Permissions About this article Cite this article Studying a propionic acidaemia mouse model reveals epigenetic mechanisms in the heart. Nat Cardiovasc Res (2023). https://doi.org/10.1038/s44161-023-00371-2 Download citation Published: 29 November 2023 DOI: https://doi.org/10.1038/s44161-023-00371-2 Share this article Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative