Global burden of cardiovascular diseases and risk factors, 1990–2019: update from the GBD 2019 study

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases

Transesophageal Versus Intracardiac Atrial Stimulation in Assessing Electrophysiologic Parameters of the Sinus and AV Nodes and of the Atrial Myocardium

Electrophysiological porameters of the sinus and AV nodes and of the atrial myocardium were assessed with both transesophageal atrial stimulation (TAS) and intracardiac atrial stimulation (ICS) in the same patient during the same study. The study group was comprised of nine men and seven women, aged 45 to 79 years, referred for the evaluation of syncope of possible arrhythmogenic origin. Twelve patients were included for analysis. Autonomic inhibition (AI) was obtained in five patients. The most striking result was the significantly longer AERP with TAS (mean 286 ± 9 ms) than with ICS (mean 244 ± 12 ms; p &lt; 0.02). After AI, the AERP was even more prolonged with TAS (mean 332 ± 20 ms) than with ICS (mean 237 ± 8 ms; p &lt; 0.01). Intraatrial and AV nodal conduction times assessed at multiple paced cycle lengths were significantly shorter with TAS than with ICS. There was no difference between TAS and ICS with regard to AVERP, Wenckebach periodicity and H-V intervals. Although a tendency towards shorter sinus node recovery time (SNRT) and sinoatrial conduction time (SACT) was observed with TAS, the difference was not statistically significant. Possible mechanisms of the differences are discussed. It seemed clear that the site of origin of an atrial impulse can have definite effects upon excitability and conduction properties of atrial and AV nodal fibers. Enhanced sympathetic activity during TAS was also suggested. The electrophysiological properties inherent in the TAS technique warrant further elucidation.</p

Atrial pacing to estimate total sinoatrial conduction time in children

No data exist concerning the total sinoatrial conduction time (TSACT) in children that compare values determined by the atrial extrastimulation technique (TSACT S ) with those generated by the atrial pacing method (TSACT N ). In this study, TSACT in 55 patients, age 0.2–18.5, was measured using both techniques. TSACT N was performed at a mean 90% (TSACT N−90 ) ( n =32) or a mean 95% (TSACT N−95 and ( n =38) of sinus cycle length (SCL). When data generated during determination of TSACT N−90 and TSACT S were compared, SCL and recovery cycle length (REC) were similar for both techniques. Likewise, TSACT S (128±40 ms) and TSACT N−90 (126±74 ms) were not significantly different. Coefficient of correlation was r =0.82, p <0.001. Chi-square analysis demonstrated a strong association of normal and abnormal values between TSACT S and TSACT N−90 . In contrast, when values generated during TSACT N−95 and TSACT S were compared, TSACT S exceeded TSACT N−95 (137±38 vs 105±58 ms; p <0.001). Values for SCL and REC were similar while correlation between TSACT determined by the two techniques remained strong ( r =0.82, p <0.001). Despite a good correlation between TSACT N−90 and TSACT S , individual differences in magnitude and direction were noted between the two techniques.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/48109/1/246_2005_Article_BF02083705.pd