Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Analysis of moderate subclinical hypothyroid patients with homeostatic model assessment-Insulin resistance

Aim: Homeostatic Model Assessment -Insulin Resistance- 2 test findings in people with mild hypothyroidism should be analyzed. Introduction: Hypothyroidism is associated with an increased risk of cardiovascular disease and alterations in blood lipidshave also been related to subclinical hypothyroidism. Treating hypothyroidism with levothyroxine (LT4) may help to improve lipid profiles and heart health, particularly in those with a wider deviation from the normal and higher blood TSH levels. Materials and Methods:There was a wide range of TSH levels among the study's participants, all of whom were between the ages of 20 and 45 and had never been diagnosed with thyroid disease. The study also included 50 people who had recently been diagnosed with moderate SCH but had not earlier been diagnosed with thyroid disease. Results: The glucose metabolism and insulin resistance are strongly influenced by thyroid hormones. Thyroid hormones. Participants in SCH were found to be more likely to be overweight or obese than those who did not participate in the research. TSH (r = 0.290; P\0.01) and LDL (r = 0.210; P\0.052) were shown to be significantly related in this study. SCH individuals had considerably higher LDL-cholesterol levels, according to this research

Role of Circulating Oxidized LDL: A Useful Diagnostic Risk Marker in Cardiovascular Disease

The aim: to assess levels of circulating plasma ox-LDL in various subgroups with different CVD and their relationship with oxidative stress markers, MDA, catalase, and traditional coronary disease risk factors. Material and methods: a total of 215 subjects divided into four groups comprising 54 healthy controls, patients with the SAP were 52 persons, with the UAP 53 ones, and with the AMI there were 56 persons, respectively. Lipid profile parameters (TC, TG, HDL-C, LDL-C, and VLDL-C), plasma MDA, catalase were estimated by kit methods, TBARS method, and colorimetric assay respectively. Plasma Ox-LDL was estimation by competitive ELISA kit method (Mercodia) with the help of specific monoclonal antibody mAb4Eb. Results were present as mean ± SD, significance level at p-values<0.05 with Student's unpaired t-test. Data analysis was performed by software package SPSS version 17.0. Results: it showed a highly significant (p<0.001) correlation in SAP, UAP, and AMI except for age in the SAP subgroup, moderately significant (p<0.01). Lipid profile except HDL-C was found highly elevated (p<0.001) in subgroups than in healthy controls. HDL-C was higher (p<0.001) in controls with respect to patient subgroups. Comparison of oxidative stress markers (MDA and catalase) and ox-LDH in control with patient's subgroup indicates highly significant (p<0.001) correlation. The correlation between SAP & UAP was insignificant (p<0.05), SAP with AMI was significant (p<0.05), and UAP & AMI were highly significant (p<0.001). Large interquartile range in SAP subgroup suggesting scattered deviation in the mean value as compared to UAP and AMI showed in the box and whiskers plot and concluded that significantly elevated level of ox-LDL in SAP, UAP, and AMI subgroups indicate its diagnostic importance of CVD. Conclusions: study concluded that significantly elevated level of ox-LDL in SAP, UAP, and AMI subgroups indicate its diagnostic importance of CVD

Analysis of Serum Sodium and Potassium Levels in Preeclampsia: An Institutional Based Study

Background: Preeclampsia is a syndrome characterized by hypertension, proteinuria and oedema. The present study was conducted to analyse Serum Sodium and Potassium Levels in Preeclampsia. Materials and Methods: It were a retrospective cross-sectional clinical study, carried out to analyse Serum Sodium and Potassium Levels in Preeclampsia. The results of 100 blood samples each of normotensives and preeclamptics women were included in the study. The measurement of serum sodium and potassium level was done. Statistical analysis was done. Results: In the present study results of 100 blood samples each of normotensives and preeclamptics women which came in the clinical lab for analyzing serum sodium and potassium levels over a period of 6 months were included in the study. The mean serum sodium levels in normotensives were 130.6mmol/l and in women with preeclampsia levels were 143.5mmol/l. The mean serum potassium levels in normotensives were 3.57 mmol/l and in women with preeclampsia levels were 2.67mmol/l. Conclusion: The present study concluded that the mean sodium levels were more in preeclampsia patients whereas the mean serum potassium levels were more in normotensives

Role of Circulating Oxidized LDL: A Useful Diagnostic Risk Marker in Cardiovascular Disease

The aim: to assess levels of circulating plasma ox-LDL in various subgroups with different CVD and their relationship with oxidative stress markers, MDA, catalase, and traditional coronary disease risk factors. Material and methods: a total of 215 subjects divided into four groups comprising 54 healthy controls, patients with the SAP were 52 persons, with the UAP 53 ones, and with the AMI there were 56 persons, respectively. Lipid profile parameters (TC, TG, HDL-C, LDL-C, and VLDL-C), plasma MDA, catalase were estimated by kit methods, TBARS method, and colorimetric assay respectively. Plasma Ox-LDL was estimation by competitive ELISA kit method (Mercodia) with the help of specific monoclonal antibody mAb4Eb. Results were present as mean ± SD, significance level at p-values<0.05 with Student's unpaired t-test. Data analysis was performed by software package SPSS version 17.0. Results: it showed a highly significant (p<0.001) correlation in SAP, UAP, and AMI except for age in the SAP subgroup, moderately significant (p<0.01). Lipid profile except HDL-C was found highly elevated (p<0.001) in subgroups than in healthy controls. HDL-C was higher (p<0.001) in controls with respect to patient subgroups. Comparison of oxidative stress markers (MDA and catalase) and ox-LDH in control with patient's subgroup indicates highly significant (p<0.001) correlation. The correlation between SAP & UAP was insignificant (p<0.05), SAP with AMI was significant (p<0.05), and UAP & AMI were highly significant (p<0.001). Large interquartile range in SAP subgroup suggesting scattered deviation in the mean value as compared to UAP and AMI showed in the box and whiskers plot and concluded that significantly elevated level of ox-LDL in SAP, UAP, and AMI subgroups indicate its diagnostic importance of CVD. Conclusions: study concluded that significantly elevated level of ox-LDL in SAP, UAP, and AMI subgroups indicate its diagnostic importance of CVD

A multicentric randomized clinical trial of homoeopathic medicines in fifty millesimal potencies vis-à -vis centesimal potencies on symptomatic uterine fibroids

Objective: The primary objective was to evaluate the effects of homoeopathic medicines in fifty millesimal (LM) potencies vis-à -vis centesimal (CH) potencies on symptomatic uterine fibroids. Materials and Methods: A multicentric randomized clinical trial was conducted at six centers under the Central Council for Research in Homoeopathy. Patients were screened for symptomatic uterine fibroids with the preset inclusion and exclusion criteria. A consultant specialized in obstetrics and gynecology was engaged at each center to screen and follow-up the enrolled patients. Homoeopathic physicians engaged in the study were responsible for prescription and follow up for 12 months. The primary outcome was changes in symptoms of uterine fibroid on a visual analog scale (VAS) of 0–10 and findings through ultrasonography (USG) between LM and CH potencies. The secondary outcome was to assess the changes in uterine fibroid symptom quality of life questionnaire (UFSQOL). Data analysis was done as per intention to treat (ITT) analysis. Results: Of 216 patients enrolled in the study (LM: 108 and CH: 108), 209 patients were analyzed under modified ITT (LM: 106, CH: 103). Both LM and CH potencies were equally effective in reducing the symptoms (percentage change) due to uterine fibroid on VAS scale after 1 year of treatment (P > 0.05). The health-related quality of life (HRQOL) and subdomains of UFSQOL also showed equal effectiveness in both the groups (P = 0.05). However, no difference was observed in all the USG findings except for uterine volume (P = 0.03). There was overall difference before and after homoeopathic treatment irrespective of assigned groups, i.e., LM or CH (P < 0.05) in all the above parameters. The medicines frequently prescribed were: Pulsatilla, Sulphur, Lycopodium, Sepia, Phosphorus, Calcarea carbonica, and Natrum muriaticum. Conclusion: LM and CH potencies are equally effective in giving symptomatic relief to patients suffering from symptomatic uterine fibroids