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Cardiovascular disease and multimorbidity: A new special issue of PLOS Medicine

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IMAGE: This week, publication of a special issue on cardiovascular disease (CVD) and multimorbidity begins in PLOS Medicine. view more 

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This week, publication of a special issue on cardiovascular disease (CVD) and multimorbidity begins in PLOS Medicine, advised by guest editors Carolyn S. P. Lam, Duke-NUS Medical School, Singapore, Kazem Rahimi, The George Institute for Global Health, University of Oxford, UK, and Steven Steinhubl, Scripps Translational Science Institute, USA.

CVD is the number one cause of death and disability globally, with an estimated 17.7 million deaths from CVD in 2015. The demographic shift towards older populations across the globe and the relatively slower decline in morbidity compared with mortality from CVD have resulted in increasing numbers of people with both CVD and other chronic and disabling conditions. Multimorbidity, commonly defined as the presence of two or more chronic medical conditions in an individual, is linked to poorer outcomes, lower quality of life, and increased healthcare utilization.

The Special Issue opens with publication of three original research articles:

In the first article, using data from the UK Clinical Practice Research Datalink, a population-based dataset including routinely collected data from 674 UK general practices, Kazem Rahimi of the George Institute for Global Health, Oxford, UK, and colleagues describe the prevalence of 56 clinically important and common comorbidities in 229,205 patients with newly diagnosed non-fatal CVD between 2000 and 2014. Using age- and sex-standardized estimates, the researchers found that while the incidence of CVD decreased by 34% between 2000 to 2014, the prevalence of having 5 or more comorbidities increased from 6.3% (95% CI 5.6%±17.0%) in 2000 to 24.3% (22.1%±34.8%) in 2014. The most common comorbidities were hypertension (28.9%), depression (23.0%), arthritis, (20.9%), asthma (17.7%), and anxiety (15.0%). While the findings rely on recorded diagnoses which could underestimate the actual prevalences in the general population, they emphasize the need to broaden the current single-disease paradigm in CVD management to account for the increasing burden of comorbidities.

In the second article, a population-based study using data from the Myocardial Ischaemia National Audit Project (England and Wales), Marlous Hall of the University of Leeds, UK, and colleagues identify multimorbidity patterns in patients admitted with acute myocardial infarction (heart attack) between 2003 and 2013. Of the 693,388 patients with AMI admitted over this period, 60% had at least one of the 7 conditions examined (diabetes, chronic obstructive pulmonary disease or asthma, heart failure, renal failure, stroke, peripheral vascular disease, or hypertension). The researchers identified 3 multimorbidity phenotype clusters: (1) a high multimorbidity class, with concomitant heart failure, peripheral vascular disease, and hypertension, (2) a medium multimorbidity class, with peripheral vascular disease and hypertension, and (3) a low multimorbidity class. They estimated that patients who had high and medium levels of multimorbidity had average reduced life expectancies of 2.9 (95% CI 2.6±3.2) and 1.5 years (95% CI 1.3±1.7), respectively, compared with patients who had few comorbidities. While the authors did not examine all common comorbid conditions (e.g. dementia and cancer), the findings suggest that development of treatment guidelines for multimorbidity patient groups, rather than those currently available for single-diseases, has the potential to substantially improve post-MI outcomes for patients with multimorbid conditions.

In the third aricle, using data from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K), Davide Vetrano of the Karolinska Institutet, Stockholm, Sweden, and colleagues examined trajectories of functional decline, measured by walking speed and activities of daily living (ADL), in 2,385 older adults with and without cardiovascular disease (e.g. ischemic heart disease, heart failure, and atrial fibrillation) and neuropsychiatric disease (e.g. mood disorders, dementia, and stroke). During the 9-year follow-up, individuals with multiple cardiovascular and neuropsychiatric diseases had the steepest declines in walking speed (up to 0.7 m/s; p < 0.001) and ADL independence (up to three impairments in ADL) compared with those without these diseases. The researchers observed significant declines over time for both walking speed and ADL in older adults with 1 or more neuropsychiatric diseases, but only for walking speed and those with cardiovascular multimorbidity. While the authors were not able to account for the specific contribution of individual diseases, these findings suggest that neuropsychiatric diseases may play a greater role in functional decline in older adults than cardiovascular disease.

The Special Issue will continue with further research and discussion articles appearing over the next several weeks.

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Research Article - Rahimi et al.

Funding:

This work was supported by grants from the Oxford Martin School and the National Institute for Health Research Oxford Biomedical Research Centre. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

KR receives a stipend as a specialty consulting editor for PLOS Medicine and serves on the journal's editorial board. KR also served as a guest editor on PLOS Medicine's Cardiovascular Disease Special Issue.

Citation:

Tran J, Norton R, Conrad N, Rahimian F, Canoy D, Nazarzadeh M, et al. (2018) Patterns and temporal trends of comorbidity among adult patients with incident cardiovascular disease in the UK between 2000 and 2014: A population-based cohort study. PLoS Med 15(3): e1002513. https://doi.org/10.1371/journal.pmed.1002513

Author Affiliations:

George Institute for Global Health, University of Oxford, Oxford, United Kingdom
Deep Medicine, Oxford Martin School, Oxford, United Kingdom
George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
Collaboration Center of Meta-Analysis Research, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom

In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002513

Research Article - Hall et al.

Funding:

MH was funded by the Wellcome Trust as a Sir Henry Wellcome Postdoctoral Fellow (reference: 206470/Z/17/Z). CPG received funding from the British Heart Foundation (Project Grant PG/13/81/30474). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

I have read the journal's policy and the authors of this manuscript have the following competing interests to disclose: CPG has received speaker and consulting honoraria from AstraZeneca and Novartis. KAAF reports grants and personal fees from AstraZeneca, personal fees from Sanofi/Regeneron, grants and personal fees from Bayer/Janssen, personal fees from GSK, grants and personal fees from Lilly outside of the submitted work. MAM reports unrestricted educational grants for Terumo, Daiichi Sankyo, and personal fees from AstraZeneca, Cordis outside of submitted work. TJ has received speaker and consulting honoraria from AstraZeneca, MSD and Aspen. HH is a National Institute for Health Research (NIHR) Senior Investigator (grant NF-SI-0616-10066) and is funded by awards from the Medical Research Council, Arthritis Research UK, British Heart Foundation, Cancer Research UK, Chief Scientist Office, Economic and Social Research Council, Engineering and Physical Sciences Research Council, NIHR, National Institute for Social Care and Health Research, and Wellcome Trust (grant MR/K006584/1).

Citation:

Hall M, Dondo TB, Yan AT, Mamas MA, Timmis AD, Deanfield JE, et al. (2018) Multimorbidity and survival for patients with acute myocardial infarction in England and Wales: Latent class analysis of a nationwide population-based cohort. PLoS Med 15(3): e1002501. https://doi.org/10.1371/journal.pmed.1002501

Author Affiliations:

Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, London, United Kingdom
National Institute for Cardiovascular Outcomes Research, University College London, London, United Kingdom
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
Farr Institute of Health Informatics Research, University College London, London, United Kingdom
NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, University College London, London, United Kingdom
Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
York Teaching Hospital NHS Foundation Trust, York, United Kingdom

In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002501

Research Article - Vetrano et al.

Funding:

This work was supported by the funders of the Swedish National study on Aging and Care, SNAC: the Ministry of Health and Social Affairs, Sweden, the participating County Councils and Municipalities, and the Swedish Research Council. Specific grants were received from the Swedish Research Council for Medicine (521-2013-8676) and the Swedish Research Council for Health, Working life and Welfare (2016-07175), Catholic University of Rome, Lindhés Advokatbyrå AB (LA2016-0450), Stiftelsen för Gamla Tjänarinnor (2016-00373), and Stonhes Stiftelse (4-3066/2016). No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

The authors have declared that no competing interests exist.

Citation:

Vetrano DL, Rizzuto D, Calderón-Larrañaga A, Onder G, Welmer A-K, Bernabei R, et al. (2018) Trajectories of functional decline in older adults with neuropsychiatric and cardiovascular multimorbidity: A Swedish cohort study. PLoS Med 15(3): e1002503. https://doi.org/10.1371/journal.pmed.1002503

Author Affiliations:

Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
Department of Geriatrics, Catholic University of Rome, Rome, Italy
Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
Karolinska University Hospital, Stockholm, Sweden
Stockholm Gerontology Research Center, Stockholm, Sweden
Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002503

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