Background: Ivabradine is a heart rate-lowering drug that selectively inhibits the funny (I f ) current of the sinoatrial node. It is currently recommended in patients with heart failure (HF) with reduced ejection fraction (HFrEF) in sinus rhythm and a heart rate of ≥ 70 beats per minute (bpm) at rest. To investigate whether ivabradine has an effect on diastolic dysfunction, exercise tolerance and quality of life (QOL), we conducted a systemic review and meta-analysis of randomized controlled trials (RCTs). Methods: We searched PubMed, EMBASE and Cochrane CentralRegister of Clinical Trials for studies on the effect of ivabradine on left ventricular (LV) diastolic dysfunction, exercise tolerance, QOL, readmission for worsening HF and mortality in both patients with HF with preserved ejection fraction (HFpEF) and HFrEF.Results: Thirteen RCTs with 881 patients met the inclusion criteria. According to the pooled analysis, for the HFpEF subgroup, treatment with ivabradine resulted in a decrease in early diastolic mitral inflow to late diastolic flow ratio (E/A) (standardized mean difference (SMD): -0.53; 95% confidence interval (CI): -0.99, -0.07; P < 0.000) and increase in peak oxygen uptake during exercise (VO 2 ) (SMD: 0.05; 95% CI: -0.35, 0.45; P < 0.00; I 2 = 95.1%). Similar effect was seen in the HFrEF subgroup with decrease in E/A ratio (SMD: -0.33; 95% CI: -0.59, -0.06; P < 0.000) and early diastolic mitral inflow to annular velocity ratio (E/e') (SMD: -1.01; 95% CI: -1.49, -0.54; P < 0.012). Ivabradine therapy increased peak VO 2 and 6-min walk test (6MWT) in HFrEF patients (SMD: 0.83; 95% CI: 0.35, 1.32; P < 0.00; I 2 = 97.5% and SMD: 1.11; 95% CI: 0.82, 1.41; P < 0.000, respectively). There was also significant reduction in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score (SMD: -0.68; 95% CI: -0.91, -0.45; P < 0.000). However, there was no significant difference in readmission for worsening HF and all-cause mortality between ivabradine and control (risk ratio (RR): 1.44; 95% CI: 0.73, 2.16; P < 0.148 and RR: 0.76; 95% CI: 0.19, 1.33; P < 0.907, respectively). Conclusions:Ivabradine therapy is associated with improved LV diastolic function, increases exercise tolerance and hence QOL, but it has no significant effect on readmission for worsening HF and allcause mortality.

Title Burden of cardiometabolic risk factors and preclinical target organ damage among adults in Freetown, Sierra Leone: a community-based health-screening survey. Abstract Objective The aim of the study was to investigate the prevalence of cardiometabolic risk factors (CMRFs), target organ damage and its associated factors among adults in Freetown, Sierra Leone. Design This community-based cross-sectional study used a stratified multistage random sampling method to recruit adult participants. Setting The health screening study was conducted between October 2019 and October 2021 in Western Area Urban, Freetown, Sierra Leone. Participants A total of 2394 adults Sierra Leoneans aged 20 years, or more were enrolled. Outcome measure Anthropometric data, fasting lipid profiles, fasting plasma glucose, target organ damage, clinical profiles and demographic characteristics of participants were described. The cardiometabolic risks were further related to target organ damage. Results The prevalence of known CMRFs was 35.3% for hypertension, 8.3% for diabetes mellitus, 21.1% for dyslipidemia, 10.0% for obesity, 13.4% for smoking and 37.9% for alcohol. Additionally, 16.1% had left ventricular hypertrophy (LVH) by electrocardiogram (ECG), 14.2% had LVH by 2D Echo, and 11.4% had chronic kidney disease. The odds of developing ECG-LVH were higher with diabetes [OR = 1.255, 95% C.I. (0.822 - 1.916) and dyslipidaemia [OR = 1.449, 95% C.I. (0.834 - 2.518). The association factors for higher odds of LVMI by echo were dyslipidemia [OR = 1.844, 95% C.I (1.006-3.380)] and diabetes mellitus [OR =1.176, 95% C.I. (0.759-1.823)]. The odds of having CKD were associated with diabetes mellitus [OR =1.212, 95% CI (0.741-1.983)] and hypertension [OR =1.163, 95% CI (0.887-1.525)]. A low optimal cut-off point for ECG-LVH (male 24.5mm vs female 27.5mm) as a target organ damage was required to maximize sensitivity and specificity by a receiver operating characteristic (ROC) curve since the odds for LVH by ECG was low. Conclusions This study provides novel data-driven information on the burden of cardiometabolic risks and its association with preclinical target organ damage in a resource-limited setting. It illustrates the need for interventions in improving cardiometabolic health screening and management among adults in Sierra Leoneans Close Window * Abstract Write or Paste Abstract Preview Ω Special Characters 319 OUT OF 300 WORDS Objective The aim of the study was to investigate the prevalence of cardiometabolic risk factors (CMRFs), target organ damage and its associated factors among adults in Freetown, Sierra Leone. Design This community-based cross-sectional study used a stratified multistage random sampling method to recruit adult participants. Setting The health screening study was conducted between October 2019 and October 2021 in Western Area Urban, Freetown, Sierra Leone. Participants A total of 2394 adults Sierra Leoneans aged 20 years, or more were enrolled. Outcome measure Anthropometric data, fasting lipid profiles, fasting plasma glucose, target organ damage, clinical profiles and demographic characteristics of participants were described. The cardiometabolic risks were further related to target organ damage. Results The prevalence of known CMRFs was 35.3% for hypertension, 8.3% for diabetes mellitus, 21.1% for dyslipidemia, 10.0% for obesity, 13.4% for smoking and 37.9% for alcohol. Additionally, 16.1% had left ventricular hypertrophy (LVH) by electrocardiogram (ECG), 14.2% had LVH by 2D Echo, and 11.4% had chronic kidney disease. The odds of developing ECG-LVH were higher with diabetes [OR = 1.255, 95% C.I. (0.822 - 1.916) and dyslipidaemia [OR = 1.449, 95% C.I. (0.834 - 2.518). The association factors for higher odds of LVMI by echo were dyslipidemia [OR = 1.844, 95% C.I (1.006-3.380)] and diabetes mellitus [OR =1.176, 95% C.I. (0.759-1.823)]. The odds of having CKD were associated with diabetes mellitus [OR =1.212, 95% CI (0.741-1.983)] and hypertension [OR =1.163, 95% CI (0.887-1.525)]. A low optimal cut-off point for ECG-LVH (male 24.5mm vs female 27.5mm) as a target organ damage was required to maximize sensitivity and specificity by a receiver operating characteristic (ROC) curve since the odds for LVH by ECG was low. Conclusions This study provides novel data-driven information on the burden of cardiometabolic risks and its association with preclinical target organ damage in a resource-limited setting. It illustrates the need for interventions in improving cardiometabolic health screening and management among adults in Sierra Leoneans.

Objectives: to evaluate the association of sex-and-gender-specific cardiovascular disease risk factors, their prevalence, and correlates among adults in Sierra Leone. Study design: This community-based cross-sectional study used a stratified multistage random sampling. Methods: the survey was conducted in eight (8) selected randomized sub-zonal communities across the western urban area in Sierra Leone, with an included sampling of 2394 adults. The WHO stepwise approach for non-communicable diseases was utilized. Multivariable logistic regression was done to determine associations between demographic characteristics and cardiovascular risk factors. Results: The prevalence of hypertension (33.4% vs 37.4%, p=0.068), diabetes mellitus (7.4% vs 9.2%, p=0.101), overweight (32.3% vs 34.2%, p=0.323) and obesity (9.9% vs 10.2%, p=0.818) were higher among males in comparison to females. Body Mass Index (BMI) (25.0 -/+ 5.0 vs 24.6 -/+ 4.4, p = 0.029), waist circumference (WC) (93.6 -/+ 4.5 vs 80.0 -/+ 5.0, p < 0.001), triglyceride (1.7 -/+ 0.35 vs 1.6 -/+ 0.32, p=0.013), total cholesterol (5.1 -/+ 0.77 vs 4.9 -/+ 0.66, p < 0.001) and low HDL-C (1.28 -/+ 0.29 vs 1.3 -/+ 0.24, p = 0.016) were significantly higher among females as compared to males. The odds of having dyslipidemia [OR = 1.339; 95% C.I: (1.101-1.629), p=0.003] and consuming alcohol [OR = 1.229; 95% C.I: (1.026-1.472), p=0.025] were higher among females. Women had 1.8 times greater odds [AOR=1.849; 95% C.I: (0.713 - 1.010), p=0.030] of being hypertensive, 1.4 times greater odds [AOR=1.441; 95% C.I: (1.176 - 1.765), p=<0.001] of being dyslipidemic and 1.2 times greater odds [AOR = 1.225, 95% C.I: (1.0123-1.481), p=0.037] of consuming alcohol compared to men. BMI, WC, and raised blood sugar had a strong correlation among women than men. Conclusion: Being female was associated with a high prevalence of cardiovascular health risks in Sierra Leone. This study emphasizes the importance of reducing the CVD burden among females through policies related to public health education and screening strategies.

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