CVD News and Research Updates 4 August 2016 Below is a summary of the latest research, reviews and reports in the field of cardiovascular disease, gathered by the Heart and Stroke Foundation South Africa. If you have any additions or comments, please get in touch.

SOUTH AFRICAN MEDICAL JOURNAL Asymptomatic rheumatic heart disease in South African schoolchildren: Implications for addressing chronic health conditions through a school health service M Shung-King M, Zühlke L, Engel ME, Mayosi BM. August 2016 Link to full text This article examines recent research evidence on the prevalence of asymptomatic rheumatic heart disease in South Africa and considers the implications for the Integrated School Health Programme.

Rheumatic Heart Disease (RHD) is still a major burden of disease in developing countries, and elimination of this preventable condition ranks high among World Heart Federation goals. If left untreated, it becomes a chronic health condition that individuals have to cope with into their adult lives. The ISHP regards the health needs of children with chronic health conditions, which include conditions such as RHD, as a key service component. However, the chronic health component of the Integrated School Health Programme (ISHP) is still poorly developed and can benefit from good evidence to guide implementation. A recent study to ascertain the prevalence of RHD in asymptomatic schoolchildren through mass screening affords an opportunity to reflect on whether, and how, asymptomatic chronic health conditions in schoolchildren could be addressed, and what the implications would be if this were done through a school-based programme such as the ISHP. The study convincingly showed that the detection of asymptomatic disease requires a screening process and tools that are effective and easy to administer, with high sensitivity and specificity, to appropriately identify children with the condition of interest.

INTERNATIONAL JOURNAL OF CARDIOLOGY Prevalence of rheumatic heart disease among school children in Ethiopia: A multisite echocardiography-based screening Yadeta D, et al. July 2016 Link to abstract This study demonstrated a consistent pattern of high prevalence of asymptomatic RHD with definite disease predominating over borderline involvement across six regions of Ethiopia. Auscultation-based surveys in Ethiopia conducted in the late 1990's reported a rural prevalence of 4.6/1000 and an urban prevalence of 6.4/1000 of rheumatic heart disease (RHD). Using echocardiographic screening, this cross-sectional study the authors aimed to estimate the national prevalence of RHD in school children by taking school-based samples from six regions across the country using the 2012 World Heart Federation (WHF) echocardiographic criteria. The total sample comprised 3 238 children (48.5% females) aged 6–18 years from 28 randomly selected primary and secondary schools found in six different geographic regions of Ethiopia. The mean age was 13.2±3.2 years. Of these, 44 patients (1.4%) met the WHF criteria for definite RHD, while 15 (0.5%) met the criteria for borderline disease, yielding a prevalence of 19 [13.9–23.4, 95% CI] cases per 1000 school children between the ages of 6–18 years. The majority of those who tested positive were girls (26/44). The prevalence was lowest in children aged 6–9 years and otherwise uniformly distributed across ages 10–18 years. Definite RHD involved the mitral valve in 42 subjects, 39 of whom had mitral regurgitation and 3 with mitral stenosis. The aortic valve was affected in 6 children. The ratio of definite to borderline cases was 2.9.

CIRCULATION Long-Term outcomes from acute rheumatic fever and rheumatic heart disease: a data-linkage and survival analysis approach

Vincent YF, et al. July 2016 Link to abstract This study provides important new prognostic information for acute rheumatic fever (ARF) and rheumatic heart disease (RHD), emphasising the need for integrated chronic disease management strategies for patients with ARF/ RHD.

This study investigated adverse outcomes for people with acute rheumatic fever (ARF) and rheumatic heart disease (RHD) and the effect of comorbidities and demographic factors on these outcomes. Using linked data (RHD register, hospital, and mortality data) for residents of the Northern Territory of Australia, ARF recurrence rates, rates of progression from ARF to RHD to severe RHD, RHD complication rates (heart failure, endocarditis, stroke, and atrial fibrillation), and mortality rates were calculated for 572 individuals diagnosed with ARF and 1 248 with RHD in 1997 to 2013 (94.9% Indigenous). ARF recurrence was highest (incidence, 3.7 per 100 person-years) in the first year after the initial ARF episode, but low-level risk persisted for >10 years. Progression to RHD was also highest (incidence, 35.9) in the first year, almost 10 times higher than ARF recurrence. The median age at RHD diagnosis in Indigenous people was young, especially among males (17 years). The development of complications was highest in the first year after RHD diagnosis (heart failure incidence rate per 100 person-years, 9.09; atrial fibrillation, 4.70; endocarditis, 1.00; and stroke, 0.58). Mortality was higher among Indigenous than non-Indigenous RHD patients (hazard ratio, 6.55; 95% confidence interval, 2.45–17.51), of which 28% was explained by comorbid renal failure and hazardous alcohol use. RHD complications and mortality rates were higher for urban than for remote residents. The residual Indigenous survival disparity in RHD patients, which persisted after accounting for comorbidities, suggests that other factors contribute to mortality, warranting further research.

HYPERTENSION Association of parental hypertension with arterial stiffness in non-hypertensive offspring: The Framingham Heart Study Andersson C, et al. July 2016 Link to abstract In a sample of young, non-hypertensive adults, greater arterial stiffness was observed in offspring of parents with hypertension. These observations are consistent with higher vascular stiffness at an early stage in the pathogenesis of hypertension.

High arterial stiffness seems to be causally involved in the pathogenesis of hypertension. This study hypothesized that offspring of parents with hypertension may display higher arterial stiffness before clinically manifest hypertension, given that hypertension is a heritable condition. Arterial tonometry measures were compared in a sample of 1 564 non-hypertensive Framingham Heart Study thirdgeneration cohort participants (mean age: 38 years; 55% women) whose parents were enrolled in the Framingham Offspring Study. A total of 468, 715, and 381 participants had 0 (referent), 1, and 2 parents with hypertension. Parental hypertension was associated with greater offspring mean arterial pressure (multivariable-adjusted estimate=2.9 mm Hg; 95% confidence interval, 1.9–3.9, and 4.2 mm Hg; 95% confidence interval, 2.9–5.5, for 1 and 2 parents with hypertension, respectively; P