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Education Posts

Group PH: Global Health Issues

Targeting Pulmonary Vascular Disease to Improve Global Health: Pulmonary Vascular Disease: The Global Perspective

This paper presents an argument for taking a global view of the problem of pulmonary vascular disease. Since pulmonary hypertension may be a marker for advanced cardiac and pulmonary diseases, it emphasizes the need to educate health care leaders to begin establishing regional centers of excellence so that a worldwide approach can be applied that will benefit all.

Citation
Rich S, Herskowitz A. Targeting pulmonary vascular disease to improve global health: pulmonary vascular disease: the global perspective. Chest. 2010 Jun;137(6 Suppl):1S-5S.
Source: https://pubmed.ncbi.nlm.nih.gov/20522574/

Pulmonary Hypertension In Heart Failure With Preserved Ejection Fraction: A Community-based Study

This is one of the first studies to attempt to determine the prevalence of pulmonary hypertension in a community setting. The target population was patients diagnosed with HFpEF and followed over 3 years. They determined that pulmonary hypertension highly prevalent (83%), indicating the urgent need for a broader scale effort to screen for pulmonary hypertension. In addition, they show that pulmonary hypertension was strongly associated with mortality, underscoring the unmet need for therapies.

Citation
Lam CS, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM. Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study. J Am Coll Cardiol. 2009 Mar 31;53(13):1119-26
Source: https://pubmed.ncbi.nlm.nih.gov/19324256/

A Global View of Pulmonary Hypertension

This is one of the more in-depth reviews of the global burden of pulmonary hypertension. They estimate a prevalence of 1% of the world population having pulmonary hypertension from any cause. They also estimate that the large majority of these patients (80%) live in developing countries, which emphasizes the challenge for both preventive and treatment strategies that will be affordable and accessible.

Citation
Hoeper MM, Humbert M, Souza R, Idrees M, Kawut SM, Sliwa-Hahnle K, Jing ZC, Gibbs JS. A global view of pulmonary hypertension. Lancet Respir Med. 2016 Apr;4(4):306-22.
Source: https://pubmed.ncbi.nlm.nih.gov/26975810/

Threshold Of Pulmonary Hypertension Associated With Increased Mortality

This screening study of more that 150,000 adults found a prevalence of pulmonary hypertension of greater than 18% ranging from mild to severe. In addition, they were able to show increasing mortality with the severity of pulmonary hypertension, beginning at the very lowest levels.

Citation
Strange G, Stewart S, Celermajer DS, Prior D, Scalia GM, Marwick TH, Gabbay E, Ilton M, Joseph M, Codde J, Playford D; NEDA Contributing Sites. Threshold of Pulmonary Hypertension Associated With Increased Mortality. J Am Coll Cardiol. 2019 Jun 4;73(21):2660-2672.
Source: https://pubmed.ncbi.nlm.nih.gov/31146810/

Mild Pulmonary Hypertension and Premature Mortality Among 154 956 Men and Women Undergoing Routine Echocardiography

This large study of over 150,000 adults from the NEDA goes into deeper analysis to show how mild levels of elevation in pulmonary arterial pressure is associated with increased mortality in the general population. They conclude that notional screening strategies should be considered in as part of clinical surveillance programs.

Citation
Stewart S, Chan YK, Playford D, Strange GA; NEDA investigators. Mild pulmonary hypertension and premature mortality among 154 956 men and women undergoing routine echocardiography. Eur Respir J. 2021 May 28:2100832.
Source: https://pubmed.ncbi.nlm.nih.gov/34049952/

Increasing Incidence and Prevalence of World Health Organization Groups 1 to 4 Pulmonary Hypertension: A Population-based Cohort Study in Ontario, Canada

This Canadian study includes a cohort of over 50,000 patients with pulmonary hypertension over a 10-year period. They confirm that the incidence and prevalence of pulmonary hypertension is increasing, with Group 2 and group 3 associated with the highest mortality.

Citation
Wijeratne DT, Lajkosz K, Brogly SB, Lougheed MD, Jiang L, Housin A, Barber D, Johnson A, Doliszny KM, Archer SL. Increasing Incidence and Prevalence of World Health Organization Groups 1 to 4 Pulmonary Hypertension: A Population-Based Cohort Study in Ontario, Canada. Circ Cardiovasc Qual Outcomes. 2018 Feb;11(2):e003973.
Source: https://pubmed.ncbi.nlm.nih.gov/29444925/

Association Of Borderline Pulmonary Hypertension With Mortality And Hospitalization In A Large Patient Cohort: Insights From The Veterans Affairs Clinical Assessment, Reporting, And Tracking Program

This is a retrospective study of over 20,000 patients with pulmonary hypertension confirmed by cardiac catheterization, from any cause who were followed for clinical outcomes. Like other studies it confirmed the increasing mortality beginning at the mildest levels of increased pulmonary artery pressure. The case can be made for screening programs to detect early disease to initiate treatments.

Citation
Maron BA, Hess E, Maddox TM, Opotowsky AR, Tedford RJ, Lahm T, Joynt KE, Kass DJ, Stephens T, Stanislawski MA, Swenson ER, Goldstein RH, Leopold JA, Zamanian RT, Elwing JM, Plomondon ME, Grunwald GK, Barón AE, Rumsfeld JS, Choudhary G. Association of Borderline Pulmonary Hypertension With Mortality and Hospitalization in a Large Patient Cohort: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. Circulation. 2016 Mar 29;133(13):1240-8
Source: https://pubmed.ncbi.nlm.nih.gov/26873944/

Pulmonary Hypertension: From An Orphan Disease To A Global Epidemic

This review from a leader in the global aspects of pulmonary hypertension describes how what has been considered a rare disease, pulmonary hypertension, is actually quite common when one looks beyond the Western Countries and considers low-middle income countries.

Citation
Butrous G. Pulmonary hypertension: From an orphan disease to a global epidemic. Glob Cardiol Sci Pract. 2020 Apr 30;2020(1):e202005.
Source: https://pubmed.ncbi.nlm.nih.gov/33150150/
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