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AbstractObjectiveTo investigate the incidence of cardiovascular disease (CVD) overall and by age, sex, and socioeconomic status, and its variation over time, in the UK during 2000-19.DesignPopulation based study.SettingUK.Participants1 650 052 individuals registered with a general practice contributing to Clinical Practice Research Datalink and newly diagnosed with at least one CVD from 1 January 2000 to 30 June 2019.Main outcome measuresThe primary outcome was incident diagnosis of CVD, comprising acute coronary syndrome, aortic aneurysm, aortic stenosis, atrial fibrillation or flutter, chronic ischaemic heart disease, heart failure, peripheral artery disease, second or third degree heart block, stroke (ischaemic, haemorrhagic, and unspecified), and venous thromboembolism (deep vein thrombosis or pulmonary embolism). Disease incidence rates were calculated individually and as a composite outcome of all 10 CVDs combined and were standardised for age and sex using the 2013 European standard population. Negative binomial regression models investigated temporal trends and variation by age, sex, and socioeconomic status.ResultsThe mean age of the population was 70.5 years and 47.6% (n=784 904) were women. The age and sex standardised incidence of all 10 prespecified CVDs declined by 19% during 2000-19 (incidence rate ratio 2017-19 v 2000-02: 0.80, 95% confidence interval 0.73 to 0.88). The incidence of coronary heart disease and stroke decreased by about 30% (incidence rate ratios for acute coronary syndrome, chronic ischaemic heart disease, and stroke were 0.70 (0.69 to 0.70), 0.67 (0.66 to 0.67), and 0.75 (0.67 to 0.83), respectively). In parallel, an increasing number of diagnoses of cardiac arrhythmias, valve disease, and thromboembolic diseases were observed. As a result, the overall incidence of CVDs across the 10 conditions remained relatively stable from the mid-2000s. Age stratified analyses further showed that the observed decline in coronary heart disease incidence was largely restricted to age groups older than 60 years, with little or no improvement in younger age groups. Trends were generally similar between men and women. A socioeconomic gradient was observed for almost every CVD investigated. The gradient did not decrease over time and was most noticeable for peripheral artery disease (incidence rate ratio most deprived v least deprived: 1.98 (1.87 to 2.09)), acute coronary syndrome (1.55 (1.54 to 1.57)), and heart failure (1.50 (1.41 to 1.59)).ConclusionsDespite substantial improvements in the prevention of atherosclerotic diseases in the UK, the overall burden of CVDs remained high during 2000-19. For CVDs to decrease further, future prevention strategies might need to consider a broader spectrum of conditions, including arrhythmias, valve diseases, and thromboembolism, and examine the specific needs of younger age groups and socioeconomically deprived populations.

BackgroundThe prevalence of anaemia and iron deficiency and their prognostic association with cardiovascular disease have rarely been explored at population level.MethodsNational Health Service records of the Greater Glasgow region for patients aged ≥50 years with a broad range of cardiovascular diagnoses were obtained. During 2013/14, prevalent disease was identified and results of investigations collated. Anaemia was defined as haemoglobin <13 g/dL for men or <12 g/dL for women. Incident heart failure, cancer and death between 2015 and 2018 were identified.ResultsThe 2013/14 dataset comprised 197 152 patients, including 14 335 (7%) with heart failure. Most (78%) patients had haemoglobin measured, especially those with heart failure (90%). Of those tested, anaemia was common both in patients without (29%) and with heart failure (prevalent cases in 2013/14: 46%; incident cases during 2013/14: 57%). Ferritin was usually measured only when haemoglobin was markedly depressed; transferrin saturation (TSAT) even less often. Incidence rates for heart failure and cancer during 2015–18 were inversely related to nadir haemoglobin in 2013/14. A haemoglobin of 13–15 g/dL for women and 14–16 g/dL for men was associated with the lowest mortality. Low ferritin was associated with a better prognosis and low TSAT with a worse prognosis.ConclusionIn patients with a broad range of cardiovascular disorders, haemoglobin is often measured but, unless anaemia is severe, markers of iron deficiency are usually not. Low haemoglobin and TSAT, but not low ferritin, are associated with a worse prognosis. The nadir of risk occurs at haemoglobin 1–3 g/dL above the WHO definition of anaemia.

Background Clinical guidelines recommend use of (1) antiplatelet, (2) lipid-lowering, and (3) beta blocker medication, and (4) angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEi/ARB) for secondary prevention following myocardial infarction (MI). This study examines whether sociodemographic factors and comorbidity were associated with receipt of guideline-recommended medication, and whether receipt was associated with all-cause mortality. Methods A cohort study was conducted on West of Scotland patients aged 53 years or above who were discharged from hospital alive after an incident MI between 2014 and 2022. Receipt of guideline-directed therapy was defined as relevant medications dispensed within 3 months of discharge. Age, sex, area-deprivation, care/nursing home residence, year of incident MI, and pre-existing conditions were included as predictors of non-receipt and covariates in the analysis of the association between non-receipt and death. Results Among 12,204 MI survivors, 7898 (64.72%) received all four classes of recommended medications. Non-receipt increased over the study period and was more likely in women, older people, more deprived people, care/nursing home residents, or those with preexisting atrial fibrillation, chronic kidney disease, liver diseases, chronic obstructive pulmonary disease, or psychosis; and was less likely in those who had prior revascularisation. Non-receipt was associated with higher mortality (HR 1.15, 95% CI 1.05–1.26) after adjusting for sociodemographic factors and preexisting conditions. Excess mortality due to area deprivation and care/nursing home residence could be partly explained by non-receipt of ACEi/ARB (9.4% for deprivation; 40.7% for care/nursing home residence) and lipid lowering medication (39.7% for care/nursing home residence). Conclusions Recommended secondary prevention medications were less likely to be received by women, those deprived, living in care/nursing homes, and with comorbid conditions. Equivalising appropriate ACEi/ARB use for secondary prevention could slightly reduce socioeconomic inequality of cardiovascular mortality.

Purpose of Review Heart failure is a highly prevalent condition caused by many different aetiologies and characterised by cardiac dysfunction and congestion. Once developed, congestion leads to signs (peripheral oedema) and symptoms (breathlessness on exertion), adverse cardiac remodelling, and an increased risk of hospitalisation and premature death. This review summarises strategies that could enable early identification and a more objective management of congestion in patients with heart failure. Recent Findings For patients with suspected or diagnosed heart failure, combining an echocardiogram with assessment of great veins, lungs, and kidneys by ultrasound might facilitate recognition and quantification of congestion, the management of which is still difficult and highly subjective. Summary Congestion is a one of the key drivers of morbidity and mortality in patients with heart failure and is often under-recognised. The use of ultrasound allows for a timely, simultaneous identification of cardiac dysfunction and multiorgan congestion; ongoing and future studies will clarify how to tailor diuretic treatments in those with or at risk of heart failure.

Background NICE guidelines recommend GPs use the kidney failure risk equation (KFRE) to identify people with chronic kidney disease (CKD) at higher risk of kidney failure. Albuminuria results are required to calculate KFRE. Aim Analyse the implementation of KFRE into clinical practice and investigate if albuminuria testing varied amongst patients with CKD, particularly for underserved groups. Design and setting Retrospective cohort study of 23,063 adults in Glasgow from 2013 to 2022. Method We evaluated albuminuria testing rates and the predictive performance of KFRE in estimating 5-year kidney failure risk amongst people with CKD. Logistic regression models quantified associations between demographic/clinical variables and albuminuria testing. Amongst people who developed kidney failure, we retrospectively assessed the impact of KFRE on the timing of meeting criteria for referral to renal services. Results Albuminuria testing was performed in 44.5% of 10,874 adults with CKD. Females (adjusted odds ratio (aOR) 0.86: 95% CI 0.79–0.93) and those with hypertension (aOR 0.69: 95% CI 0.63–0.77) were less likely to have albuminuria testing. Those aged 40–50 years (aOR 1.83: 95% CI 1.15–2.91), with diabetes (aOR 2.35: 95% CI 2.14–2.58) and living in the least socioeconomically deprived areas (aOR 1.11: 95% CI 1.00-1.23) were more likely to have albuminuria testing. Of 1,352 individuals with incident kidney failure, incorporating KFRE into referral guidelines helped identify high-risk patients early. Conclusion KFRE could be calculated for less than half of people due to lack of albuminuria testing. Focus should be given to improving albuminuria testing and inequities identified to allow wider implementation of KFRE.

ObjectivesTo estimate condition-specific patient travel distances and associated carbon emissions across common chronic diseases in routine National Health Service (NHS) care, and to assess the potential carbon savings of modal shifts in transportation.DesignRetrospective population-based cohort study.SettingNHS Greater Glasgow and Clyde, Scotland.Participants6599 patients aged 50–55 years at diagnosis, including cardiovascular disease (n=1711), epilepsy (n=1044), cancer (n=716), rheumatoid arthritis (RA; n=172) and a matched control group based on age, sex and area-level deprivation (n=2956).Main outcome measuresAnnual home-to-clinic distances and associated carbon emissions modelled under four transport modes (petrol car, electric car, bus, train) across five time points: 2-year prediagnosis, diagnosis year and 2-year postdiagnosis.ResultsMean annual travel distances to hospital varied by condition and peaked at diagnosis. Patients with cancer had the highest travel distances (161 km/patient/year for men; 139 km/patient/year for women), followed by RA (approximately 78 km/patient/year). The matched control group travelled <2 km/patient/year on average. Assuming 100% petrol car use, estimated condition-specific emissions ranged from 16.5 kg CO2/patient/year to 8.0 kg CO2/patient/year. Bus travel resulted in intermediate emissions, estimated between 10.5 and 8.0 kg CO2/patient. When travel was modelled using electric vehicles, emissions dropped between 3.5 and 2.7 kg for all conditions. Train travel produced similarly low emissions. Reducing petrol car travel from 100% to 60% lowered emissions up to 6.6 kg CO2/patient.ConclusionsCondition-specific estimates of healthcare-related travel emissions provide baseline understanding of the opportunities and challenges for decarbonising healthcare. Emission reduction is most achievable through modal shift, yet such shifts depend on factors beyond NHS control—such as transport infrastructure, digital access and social equity. Multisectoral strategies, including targeted telemedicine and integrated transport and urban planning, are critical to achieving net-zero healthcare while maintaining equitable access to care.

IntroductionSocioeconomic deprivation is a major driver of multimorbidity (multiple long-term conditions, MLTCs) and polypharmacy in ageing populations. However, it is unclear how these inequalities evolve over time or influence early disease progression.MethodsWe conducted a population-based longitudinal study of 414 746 adults aged ≥51 years in Greater Glasgow and Clyde, Scotland, using linked administrative health records. Participants were followed at three timepoints (2016, 2019, 2021), with socioeconomic status defined by Scottish Index of Multiple Deprivation (SIMD) deciles. Outcomes included prevalence and progression of MLTCs and medication burden. Zero-inflated negative binomial (ZINB) models estimated the burden of disease and prescribing, and the likelihood of remaining disease-free or prescription-free, adjusted for age and sex.ResultsMultimorbidity and prescription burden increased over time across all groups. In 2021, 26.0% of individuals in the most deprived decile (SIMD1) had ≥5 conditions compared with 13.8% in the least deprived (SIMD10). From 2016 to 2021, individuals in SIMD10 were nearly 40% less likely to progress from a single condition to five or more (risk ratio=0.62 (0.60 to 0.63)) compared with SIMD1. ZINB models showed lower expected MLTC counts (incidence rate ratio (IRR)=0.59 (0.58 to 0.60)) and medication burden (IRR=0.91 (0.90 to 0.91)) in SIMD10, but also lower odds of remaining completely disease-free (OR=0.65 (0.63 to 0.68)) or prescription-free (OR=0.44 (0.41 to 0.47)). Findings were consistent in survivor-only sensitivity analyses (n=360 683).ConclusionsSocioeconomic deprivation shapes disease and treatment trajectories from the earliest stages. Individuals in deprived areas experience faster accumulation of conditions and medications. These disparities are not explained by survival differences and highlight the need for equity-focused prevention, tailored care pathways and systems that address the social complexity of multimorbidity.

ObjectiveHistorical reductions in cardiovascular disease (CVD) due to lifestyle and treatment improvements are now threatened by factors such as increasing obesity and diabetes, but the relative importance of different risk factors varies by CVD condition. This study describes secular trends in CVD events by individual condition from 2012 to 2022.MethodsIn a cohort of 452 094 Greater Glasgow and Clyde residents aged ≥51 years, linked hospital admission and death data were used to ascertain total annual events for ischaemic heart disease (IHD), myocardial infarction (MI), heart failure (HF), atrial fibrillation (AF), stroke, abdominal aortic aneurysm (AAA) and peripheral artery disease (PAD). Poisson regressions with robust standard errors were used to examine the relative change in event rates over time, overall and by subgroup.ResultsOverall, the event rate ratios (RRs) for IHD, MI, AF and AAA all fell between 2012 and 2021 after adjustment for age, sex and deprivation. However, on subgroup analysis, the RRs increased between 2012 and 2022 among those aged 51–64 years for HF (RR 1.5), stroke (RR 1.4) and PAD (RR 1.8).ConclusionsOverall declines in most types of CVD mask an increasing burden of events relating to HF, stroke and PAD among individuals aged 51–64 years.

Abstract Context Hypogonadism is a common endocrine disorder in aging men, associated with adverse cardiometabolic outcomes. Concerns about the cardiovascular (CV) safety of testosterone, an important therapy option for the condition, may be disproportionately influencing treatment decisions. Objective This work aimed to investigate the association between long-term testosterone therapy and major adverse CV events (MACE) in men aged 51 years and older. Methods This retrospective cohort study used linked health data from the National Health Service Greater Glasgow and Clyde population, accessed via the West of Scotland Safe Haven. Men aged 51 years and older as of January 1, 2012, were included. Testosterone exposure was defined as having at least a 2-year interval between the first and last prescription during a 5-year exposure window (2012-2016). Individuals were followed from January 1, 2017, to December 31, 2022. The primary outcome was time to first MACE, defined as a composite of acute myocardial infarction, unstable angina, stroke, heart failure, or CV death. Cox proportional hazards models were used to estimate associations, adjusting for age, ethnicity, socioeconomic deprivation, and comorbidities. Results The study included 440 testosterone-exposed and 136 051 unexposed men. Testosterone exposure was associated with a 54% increased risk of MACE in the unadjusted analysis (hazard ratio [HR]: 1.54; 95% CI, 1.18-2.00), and a 55% increased risk after adjustment (HR: 1.55; 95% CI, 1.19-2.01). Conclusion In this real-world cohort, long-term testosterone therapy was associated with increased CV risk. While recent trials inform short- to medium-term CV safety, this study underscores the need for more longer-term data to fully ascertain the effect of testosterone therapy.