Following on the heels of a special focus issue diving deeper into the latest Global Burden of Disease report on cardiovascular disease, a separate global health focus issue showcases important new scientific contributions from regions and countries like Africa, Japan, Pakistan and China that hold promise for reshaping the global understanding of cardiovascular disease.

"JACC exists to convene, to connect, and to champion science that helps patients everywhere – not because of where the research was done, but because of what it contributes to our collective understanding," writes JACC Editor-in-Chief Harlan M. Krumholz, MD, SM, FACC, in an Editor's Page introducing the issue. He highlights how the studies included within the special issue are examples of the "way forward," which is dependent on "sharing data, learning from one another, and creating solutions that work in the real world, not just the ideal one."

In one study out of Nigeria, Zainab Mahmoud, MD, et al., evaluated aspirin use among nearly 1,200 pregnant individuals at moderate to high risk for preeclampsia. Findings showed aspirin remains underutilized in the country due to barriers such as a lack of standardized national guidelines, late antenatal presentation, sociocultural norms and limited provider knowledge among the biggest barriers. The authors stress the urgent need for targeted implementation strategies that could include provider motivation, perceived ease of workflow integration and institutional support. Geoffrey D. Barnes, MD, MSc, FACC; HaEun Lee, PhD, BSN; and Kathryn L. Berlacher, MD, MS, FACC, comment: "Too often, implementation, rather than evidence, remains the main barrier to realizing high-quality, evidence-based health care. For expectant mothers at risk for [Hypertensive disorders of pregnancy], aspirin prophylaxis is an affordable, highly effective, and underused treatment worldwide."

In another study, Aboubakari Nambiema, PhD, et al., analyzed individual-level data from 61 different surveys spanning 37 World Health Organization African Region countries, emphasizes the substantial burden of hypertension throughout the region and the alarmingly low rates of treatment and control. As one of the first studies to broadly look at hypertension across the region, the authors say their findings highlight hypertension as "a major threat for the already fragile health infrastructures in the [African Region]." In a related editorial comment, Ethiopia D. Getachew, MD, and Oyere K. Onuma, MD, MSc, FACC, add, "Hypertension represents the single most important intervention to reduce the morbidity and mortality of cardiovascular disease across the continent. The cost of inaction will be measured in lives lost."

In a separate study, Shun Kohsaka, MD, FACC, et al., sought to understand changes in revascularization trends throughout Japan between 2017 and 2023. Although PCI and isolated CABG volumes declined from 2017, the downward trend plateaued starting in the third quarter of 2020, researchers said. In another study out of Korea by Hokyou Lee, MD, PhD, et al., evaluated the use of PREVENT equations to assess cardiovascular disease risk in a non-U.S. cohort of 7.7 million Korean adults, adding to the growing evidence surrounding accuracy and effectiveness of the new equations.

In addition to country-specific studies exploring cardiovascular trends, the Focus Issue also includes original research investigating the efficacy and safety of new and emerging treatments. For example, the InsightPFA trial out of China by Weidong Lin, MD, PhD, et al., found nanosecond pulsed field ablation "exhibited noninferior efficacy and comparable safety" to ablation index-guided radiofrequency ablation for symptomatic atrial fibrillation. In the PARTHENOPE trial out of Italy by Raffaele Piccolo, MD, et al., researchers compared personalized dual antiplatelet therapy with standard duration following PCI.

In the TADCLOT trial out of Pakistan by Abdul Hakeem, MBBS, FACC, et al., researchers found ticagrelor was not superior to twice-daily clopidogrel in reducing major adverse cardiovascular events (MACEs) at one month after primary PCI. However, event rates were lower than anticipated, and ticagrelor significantly reduced MACEs within the first two weeks compared with clopidogrel. In a JACC Editors' Note, Behnood Bikdel, MD, FACC, et al., said the findings are "worthy of dissemination to JACC readership where it can further the future pooled analyses and contribute to the evolving global dialogue on antiplatelet strategies in STEMI, particularly in under-represented populations and settings where therapeutic alternatives may be limited by pragmatic considerations such as availability and cost."

Clinical Topics: Cardiovascular Care Team

Keywords: Global Burden of Disease, Global Health, Public Health, ACC International