Clinical burden, risk factor impact and outcomes following myocardial infarction and stroke: A 25-year individual patient level linkage study

Shah, Anoop; Lee, Kuan Ken; Perez, Jesus A. Rodriguez; Campbell, Desmond; Astengo, F; Logue, Jennifer; Gallacher, Peter J.; Katikireddi, Srinivasa Vittal; Bing, Rong; Alam, Shirjel; Anand, Atul; Sudlow, Catherine; Fischbacher, Colin; Lewsey, Jim; Perel, Pablo; Newby, David E.; Mills, Nicholas L; McAllister, David

doi:10.1016/j.lanepe.2021.100141

Cited by 19 publications

(27 citation statements)

References 64 publications

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“…This can be due to two reasons: first, the age of the population increased over the period of study,12 and second, because the risk factors for stroke were better managed 22. A decline in stroke incidence has also been observed in high-income countries,2 which is consistent with the findings of this study: age-standardised incidence rate of ischaemic stroke decreased from 1990 to 2014 in Scotland,23 decreased from 2003 to 2013 in Iran,4 decreased from 2005 to 2018 in Denmark,24 and showed a declining trend from 2003 to 2011, then increased until 2017 in Canada 25…”

Section: Discussionsupporting

confidence: 91%

Temporal trend of first-ever ischaemic stroke incidence from 2010 to 2019 in South Korea: a nationwide retrospective cohort study

et al. 2022

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ObjectiveIschaemic stroke incidence is on the decline globally, but the trend in South Korea is unknown. In this study, the 10-year incidence trends of first-ever ischaemic stroke in South Korea were evaluated.Design, setting and participantsThe National Health Insurance Services medical claim data were used to construct 10 annual cohorts of adults aged 20 years and older, who had not been diagnosed with stroke, to find out the incidence trends of first-ever ischaemic stroke from 2010 to 2019.Outcome measuresThe primary outcomes were crude and age-adjusted incidence rates for 10 years. Crude incidence rates of the age groups and incidence age statistics were calculated. For comparison among the income groups, age-adjusted incidence rates were used. Incidence rates in all the groups were analysed separately by sex.ResultsAge-standardised incidence rates of ischaemic stroke per 100 000 were 101.0 in men, and 67.6 in women in 2010; and 92.2 in men, and 55.0 in women in 2019. By age group, there was a decrease in women over 40 years of age, and men over 60 years of age. The relative difference in stroke incidence rates between medical aid beneficiaries and the highest income group increased from 1.5 to 1.87 over 10 years.ConclusionsAge-standardised incidence rate of ischaemic stroke has decreased from 2010 to 2019 for both man and women. The incidence rate was stable in the younger age groups and decreased in the older age groups, and the disparities between income groups have widened over the past decade. Stroke prevention strategies are needed for the younger age group and the low-income group. Further research is needed to study the risk factors contributing to the incidence of ischaemic stroke in different groups.

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Section: Discussionsupporting

confidence: 91%

Temporal trend of first-ever ischaemic stroke incidence from 2010 to 2019 in South Korea: a nationwide retrospective cohort study

et al. 2022

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“…27 Our analysis highlights the importance of incorporating a measure of socioeconomic deprivation status in risk estimation systems to reduce inequalities in health care provision for cardiovascular disease. Low socioeconomic status is associated with worse cardiovascular outcomes, [1][2][3][4][5] and our study showed that the magnitude of this association was strengthened after adjusting for sex and age. This is in line with published data showing that the differences in mortality rates between socioeconomic classes increased when age decreased, and observed mortality rates were highest in the youngest age groups.…”

Section: Discussionmentioning

confidence: 49%

“…The ASSIGN risk score was derived from a population in the 1980s in which the baseline risk was high. 10 This baseline risk has fallen dramatically during the last 25 years, 5 and the overestimation is most likely the result of an inaccurate baseline risk used in the risk equation. 5 Our study shows that cardiovascular risk estimates could be optimized when risk scores are recalibrated using contemporary local data, which is in line with previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…ocioeconomic deprivation is closely associated with cardiovascular morbidity and mortality. [1][2][3][4][5] Although the burden from cardiovascular disease has decreased over time, health care inequity by deprivation status has persisted. 6 Individuals from poorer backgrounds are less likely to receive evidence-based therapy and more likely to experience higher cardiovascular mortality and morbidity.…”

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confidence: 99%

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Socioeconomic deprivation: an important largely unrecognized risk factor in primary prevention of cardiovascular disease

Kimenai

Pirondini

Gregson

et al. 2022

European Heart Journal

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Background Socioeconomic deprivation is associated with higher cardiovascular morbidity and mortality. Whether deprivation status should be incorporated in more cardiovascular risk estimation scores remains unclear. Purpose This study evaluates how socioeconomic deprivation status affects the performance of three primary prevention cardiovascular risk scores. Methods The Generation Scotland Scottish Family Health Study was used to evaluate the performance of three cardiovascular risk scores with (ASSIGN) and without (SCORE2, PCE) socioeconomic deprivation as a covariate in the risk prediction model. Deprivation was defined by Scottish Index of Multiple Deprivation score. The predicted 10-year risk was evaluated against the observed event rate for the cardiovascular outcome of each risk score. The comparison was made across three groups defined by the deprivation index score consisting of group 1 defined as most deprived, group 3 defined as least deprived and group 2 which consisted of individuals in the middle deprivation categories. Results The study population consisted of 15,506 individuals (60.0% female, median age of 51). Across the population 1,808 (12%) individuals were assigned to group 1 (most deprived), 8,119 (55%) to group 2, and 4,708 (32%) to group 3 (least deprived). Risk scores based on models that did not include deprivation status significantly under predicted risk in the most deprived (6.4% observed versus 4.6% predicted for SCORE2 and 6.7% observed versus 4.7% predicted for PCE, p<0.001 for both). Both risk scores also significantly overpredicted the risk in the least deprived group (4.0% observed versus 4.7% predicted for SCORE2, p=0.007 and 4.2% observed versus 4.9% predicted for PCE, p=0.028). In contrast, no significant difference was demonstrated in the observed versus predicted risk when using the ASSIGN risk score, which included socioeconomic deprivation status in the risk model. Conclusions Socioeconomic status is a largely unrecognized risk factor in primary prevention of cardiovascular disease. Risk scores that exclude socioeconomic deprivation as a covariate under- and overestimate the risk in the most and least deprived individuals, respectively. This study highlights the importance of incorporating socioeconomic deprivation status in risk estimation systems to ultimately reduce inequalities in health care provision for cardiovascular disease. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The British Heart Foundation.Health Data Research UK which receives its funding from HDR UK Ltd (HDR-5012) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation and the Wellcome Trust.

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“…ACE converts the inactive protein angiotensin I into an effective vasoconstrictor angiotensin II, which leads to an increase in blood pressure ( 12 ). Myocardial infarction and stroke that are significantly relative with higher blood pressure are top mortality in the world ( 32 ). Hence, the inhibitors of ACE and pancreatic lipase are very important to protect human health and has been widely concerned by researchers.…”

Section: Discussionmentioning

confidence: 99%

Novel angiotensin-converting enzyme and pancreatic lipase oligopeptide inhibitors from fermented rice bran

Hu¹,

Wang²,

Weng³

et al. 2022

Front. Nutr.

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This study determined the inhibitory activity of oligopeptides against angiotensin-converting enzyme (ACE) and pancreatic lipase through in vitro tests, molecular docking, and enzyme inhibition. The results showed that the IC50 of GLLGY, HWP, and VYGF for ACE inhibition was 1 mg/mL, and the IC50 of HWP for pancreatic lipase was 3.95 mg/mL. Molecular docking revealed that the binding energies between GLLGY, HWP, and VYGF and ACE were –9.0, –8.4, and –9.2 kcal/mol, respectively. The binding free energy between HWP and pancreatic lipase was –7.3 kcal/mol. GLLGY, HWP, and VYGF inhibited ACE compentitively. HWP inhibited pancreatic lipase through non-competition. in vitro simulated gastrointestinal digestion, the three oligopeptides still had inhibitory activity and low toxicity. The results revealed that the peptides GLLGY, HWP, and VYGF may be suitable candidates for further research on ACE inhibition, and HWP may be a suitable candidate for studying pancreatic lipase inhibition.

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Clinical burden, risk factor impact and outcomes following myocardial infarction and stroke: A 25-year individual patient level linkage study

Cited by 19 publications

References 64 publications

Temporal trend of first-ever ischaemic stroke incidence from 2010 to 2019 in South Korea: a nationwide retrospective cohort study

Temporal trend of first-ever ischaemic stroke incidence from 2010 to 2019 in South Korea: a nationwide retrospective cohort study

Socioeconomic deprivation: an important largely unrecognized risk factor in primary prevention of cardiovascular disease

Novel angiotensin-converting enzyme and pancreatic lipase oligopeptide inhibitors from fermented rice bran

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