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Baseline platelet count independently predicts long-term adverse outcomes in patients undergoing percutaneous coronary intervention: a single-center retrospective cohort study. CARDIOLOGY PLUS 2022. [DOI: 10.1097/cp9.0000000000000023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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2
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Electrocardiogram Risk Score and Prevalence of Subclinical Atherosclerosis: A Cross-Sectional Study. J Pers Med 2022; 12:jpm12030463. [PMID: 35330462 PMCID: PMC8948965 DOI: 10.3390/jpm12030463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 02/01/2023] Open
Abstract
Integrated abnormal electrocardiogram (ECG) parameters predict the risk of cardiovascular disease (CVD); however, its relationship with subclinical CVD is unknown. We aimed to evaluate the association between the integrated ECG risk score and the prevalence of coronary artery calcium (CAC). A cross-sectional study comprised 134,802 participants with no known CVD who underwent ECG and CAC computed tomography. The ECG risk score was the sum of five ECG abnormalities: heart rate of >80 beats, QRS of >110 ms, left ventricular hypertrophy, T-wave inversion, and prolonged QTc. A multinomial regression model was used to estimate the prevalence ratios (PRs) and their 95% confidence intervals (CIs) for prevalent CAC. The prevalence of CAC progressively increased as the ECG risk score increased. After adjustment for conventional CVD risk factors and other confounders, the multivariable-adjusted PRs (95% CI) for a CAC of 1−100 in the 1, 2, and ≥3 ECG risk score groups were 1.06 (1.02−1.10), 1.12 (1.03−1.22), and 1.19 (1.00−1.42), respectively, while the corresponding PRs for a CAC of >100 were 1.03 (0.95−1.12), 1.44 (1.25−1.66), and 1.75 (1.33−2.29), respectively. Integrative ECG scoring may help identify individuals requiring lipid-lowering medications, even in young and asymptomatic populations.
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Exercise after Breast Augmentation: A Randomized Controlled Trial. Plast Reconstr Surg 2022; 149:18e-24e. [PMID: 34936606 DOI: 10.1097/prs.0000000000008676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are limited scientific data regarding the impact of exercise after breast augmentation surgery. Recommendations range from a few weeks to a few months of physical activity avoidance. To decide whether early exercise after breast augmentation is safe, a prospective randomized trial was designed to measure complications, scar quality, and patient-reported outcomes in this setting. METHODS The present study was a randomized controlled trial to investigate the effects of early exercise (1 week after surgery) on postoperative complications, scar quality, and patient-reported outcome (BREAST-Q). All women undergoing primary breast augmentation surgery in the authors' institution were randomized to either standard restrictions or exercise. The three primary outcomes measured were the presence of a complication and reoperation, scar quality, and patient-reported outcome. RESULTS A total of 225 participants were included in the final analysis. No differences were found among the groups for age (p = 0.66), implant size (p = 0.56), or implant pocket (p = 0.29); complication rates did not change between the control (7.5 percent) and exercise groups (6.9 percent). When assessed 12 months after surgery, the scar quality was comparable between the groups (29.9 control and 29.6 exercise, p = 0.204). Intervention groups (exercise) performed better on the BREAST-Q Augmentation Module: Satisfaction with Outcome score (66.3 control and 83.4 exercise, p < 0.01). CONCLUSIONS Early exercise following primary breast augmentation does not increase complication or reoperation rates or cause a reduction in scar quality after 1 year. In addition, a patient-reported outcome showed improvement in the exercise groups. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Razon N, Hessler D, Bibbins-Domingo K, Gottlieb L. How Hypertension Guidelines Address Social Determinants of Health: A Systematic Scoping Review. Med Care 2021; 59:1122-1129. [PMID: 34779795 PMCID: PMC8597925 DOI: 10.1097/mlr.0000000000001649] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patient-level and community-level social and economic conditions impact hypertension risk and control. We examined adult hypertension management guidelines to explore whether and how existing guidelines refer to social care activities. OBJECTIVE The objective of this study was to explore how hypertension guidelines reference social care activities. RESEARCH DESIGN A systematic scoping review of clinical guidelines for adult hypertension management. We employed a PubMed search strategy to identify all hypertension guidelines published in the United States between 1977 and 2019. We reviewed all titles to identify the most updated versions focused on nonpregnant adults with hypertension. We extracted instances where guidelines referred to social determinants of health (SDH) or social care activities. The primary outcome was how guidelines covered social care activities, defined using a framework adapted from the National Academies of Sciences, Engineering, and Medicine (NASEM). RESULTS Search terms yielded 126 guidelines. Thirty-six guidelines met the inclusion criteria. Of those, 72% (26/36) recommended social care activities as part of hypertension management; 58% recommended clinicians change clinical practice based on social risk information. These recommendations often lacked specific guidance around how to directly address social risk factors or reduce the impact of these risks on hypertension management. When guidelines referred to specific social factors, patient financial security was the most common. Over time, hypertension guidelines have included more references to SDH. CONCLUSION Information about SDH is included in many hypertension guidelines, but few guidelines provide clear guidance for clinicians or health systems on how to identify and address social risk factors in the context of care delivery.
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Affiliation(s)
- Na'amah Razon
- Philip R. Lee Institute for Health Policy Studies & Family and Community Medicine
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Enablers of Patient Knowledge Empowerment for Self-Management of Chronic Disease: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052247. [PMID: 33668329 PMCID: PMC7956493 DOI: 10.3390/ijerph18052247] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 11/16/2022]
Abstract
The non-development of the concept of patient knowledge empowerment for disease self-management and the non-development of the theory of patient knowledge empowerment in patients with chronic diseases, cause methodological inconsistency of patient empowerment theory and does not provide a methodological basis to present patient knowledge empowerment preconditions. Therefore, the aim of the present integrative review was to synthesize and critically analyze the patient knowledge enablers distinguished in the public health management theory, the knowledge sharing enablers presented in the knowledge management theory and to integrate them by providing a comprehensive framework of patient knowledge enablers. To implement the purpose of the study, in answering the study question of what patient knowledge empowerments are and across which levels of patient knowledge empowerment they operate, an integrative review approach was applied as proposed by Cronin and George. A screening process resulted in a final sample of 78 papers published in open access, peer-review journals in the fields of public health management and knowledge management theories. Based on the results of the study, the Enablers of Patient Knowledge Empowerment for Self-Management of Chronic Disease Framework was created. It revealed that it is important to look at patient knowledge empowerment as a pathway across the empowerment levels through which both knowledge enablers identified in public health management theory and knowledge sharing enablers singled out in knowledge management theory operate. The integration of these two perspectives across patient empowerment levels uncovers a holistic framework for patient knowledge empowerment.
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Cardiometabolic medicine: a review of the current proposed approaches to revamped training in the United States. Cardiovasc Endocrinol Metab 2021; 10:168-174. [PMID: 34386718 PMCID: PMC8352603 DOI: 10.1097/xce.0000000000000243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/17/2020] [Indexed: 11/26/2022]
Abstract
Cardiovascular disease (CVD) remains the leading cause of mortality in the United States, and the population of patients with cardiometabolic conditions, including obesity, metabolic syndrome and diabetes mellitus, continues to grow. There is a need for physicians with specific training in cardiometabolic medicine to provide a ‘medical home’ for patients with cardiometabolic disease, rather than the fractured care that currently exists in the United States. Cardiometabolic specialists will head multidisciplinary clinics, develop practice guidelines, and lead through research. Proposals for US training in cardiometabolic medicine include: maintain the current training model, a dedicated 2–3 year fellowship following internal medicine residency, a 1-year fellowship following either internal medicine residency or fellowship in cardiology or endocrinology, and certification available to any interested clinician. This review discusses the pros and cons of these approaches. The authors believe that a dedicated cardiometabolic training fellowship has significant advantages over the other options.
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Fang X, Liu L, Zhou S, Zhu M, Wang B. N‑acetylcysteine inhibits atherosclerosis by correcting glutathione‑dependent methylglyoxal elimination and dicarbonyl/oxidative stress in the aorta of diabetic mice. Mol Med Rep 2021; 23:201. [PMID: 33495825 PMCID: PMC7821347 DOI: 10.3892/mmr.2021.11840] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 12/08/2020] [Indexed: 12/25/2022] Open
Abstract
In diabetic animal models, high plasma/tissue levels of methylglyoxal (MG) are implicated in atherosclerosis. N-acetylcysteine (NAC) is a cysteine prodrug that replenishes intracellular glutathione (GSH) levels, which can increase the elimination of MG in diabetes mellitus (DM). The present study investigated the anti-atherosclerotic role of NAC in DM and aimed to determine whether the mechanism involved GSH-dependent MG elimination in the aorta. Apolipoprotein-E knockdown (ApoE−/−) mice injected with streptozotocin for 5 days exhibited enhanced atherosclerotic plaque size in the aortic root; notably, a high-lipid diet aggravated this alteration. NAC treatment in the drinking water for 12 weeks decreased the size of the atherosclerotic lesion, which was associated with a reduction in MG-dicarbonyl stress and oxidative stress, as indicated by decreased serum malondialdehyde levels, and increased superoxide dismutase-1 and glutathione peroxidase-1 levels in the diabetic aorta. Endothelial damage was also corrected by NAC, as indicated by an increase in the expression levels of phosphorylated (p-)Akt and p-endothelial nitric oxide synthase (eNOS) in the aorta, as well as nitric oxide (NO) in the serum. In addition, MG-treated human umbilical vein endothelial cells (HUVECs) exhibited increased reactive oxygen species and decreased antioxidant enzyme expression levels. NAC treatment corrected the alteration in HUVECs induced by MG, whereas the protective role of NAC was blocked via inhibition of GSH. These findings indicated that the diabetic aorta was more susceptible to atherosclerotic lesions compared with non-diabetic ApoE−/− mice. Furthermore, NAC may offer protection against atherosclerotic development in DM by altering aortic and systemic responses via correcting GSH-dependent MG elimination, leading to decreased oxidative stress and restoration of the p-Akt/p-eNOS pathway in the aorta.
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Affiliation(s)
- Xin Fang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Lihua Liu
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Shaoqiong Zhou
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Mengen Zhu
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Bin Wang
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
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Familial Hypercholesterolaemia in 2020: A Leading Tier 1 Genomic Application. Heart Lung Circ 2019; 29:619-633. [PMID: 31974028 DOI: 10.1016/j.hlc.2019.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 11/26/2019] [Accepted: 12/03/2019] [Indexed: 12/15/2022]
Abstract
Familial hypercholesterolaemia (FH) is caused by a major genetic defect in the low-density lipoprotein (LDL) clearance pathway. Characterised by LDL-cholesterol elevation from birth, FH confers a significant risk for premature coronary artery disease (CAD) if overlooked and untreated. With risk exposure beginning at birth, early detection and intervention is crucial for the prevention of CAD. Lowering LDL-cholesterol with lifestyle and statin therapy can reduce the risk of CAD. However, most individuals with FH will not reach guideline recommended LDL-cholesterol targets. FH has an estimated prevalence of approximately 1:250 in the community. Multiple strategies are required for screening, diagnosing and treating FH. Recent publications on FH provide new data for developing models of care, including new therapies. This review provides an overview of FH and outlines some recent advances in the care of FH for the prevention of CAD in affected families. The future care of FH in Australia should be developed within the context of the National Health Genomics Policy Framework.
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Lavie CJ, Laddu D, Arena R, Ortega FB, Alpert MA, Kushner RF. Healthy Weight and Obesity Prevention: JACC Health Promotion Series. J Am Coll Cardiol 2019; 72:1506-1531. [PMID: 30236314 DOI: 10.1016/j.jacc.2018.08.1037] [Citation(s) in RCA: 278] [Impact Index Per Article: 55.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 12/21/2022]
Abstract
Overweight and obesity have reached epidemic levels in the United States and worldwide, and this has contributed to substantial cardiovascular and other health risks. However, controversy exists concerning the causes of obesity and effective modalities for its prevention and treatment. There is also controversy related to the concept of metabolically healthy obesity phenotype, the "obesity paradox," and on the importance of fitness to protect individuals who are overweight or obese from cardiovascular diseases. In this state-of-the-art review, the authors focus on "healthy weight" with the emphasis on the pathophysiologic effects of weight gain on the cardiovascular system; mechanistic/triggering factors; and the role of preventive actions through personal, education/environment, and societal/authoritative factors, as well as factors to provide guidance for caregivers of health promotion. Additionally, the authors briefly review metabolically healthy obesity, the obesity paradox, and issues beyond lifestyle consideration for weight loss with medications and bariatric surgery.
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Affiliation(s)
- Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana.
| | - Deepika Laddu
- Department of Physical Therapy, College of Applied Health Science, University of Illinois at Chicago, Chicago, Illinois
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Science, University of Illinois at Chicago, Chicago, Illinois
| | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health through Physical Activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Martin A Alpert
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri
| | - Robert F Kushner
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Lan NSR, Martin AC, Brett T, Watts GF, Bell DA. Improving the detection of familial hypercholesterolaemia. Pathology 2018; 51:213-221. [PMID: 30579649 DOI: 10.1016/j.pathol.2018.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 02/03/2023]
Abstract
Familial hypercholesterolaemia (FH) is a dominantly inherited disorder of low-density lipoprotein (LDL) catabolism, which if untreated causes lifelong elevated LDL-cholesterol (LDL-c), accelerated atherosclerosis and premature cardiovascular disease. Recent evidence suggests the prevalence of heterozygous FH is ∼1:220, making FH the most common autosomal dominant condition. Lowering LDL-c with statin and lifestyle therapy reduces the risk of cardiovascular events. Furthermore, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors significantly lower LDL-c in addition to statin therapy, and early outcome data suggest improved vascular outcomes with these agents in FH patients in addition to statins. However, the vast majority of people with FH still remain undiagnosed. The onus is on clinicians to identify kindreds with FH, as PCSK9 inhibitors, although expensive, are funded for patients with FH in Australia. Multiple strategies for detecting FH have been proposed. The detection of index cases can be achieved through applying electronic screening tools to general practice databases, universal screening of children during immunisation, and targeted screening of patients with premature cardiovascular disease. Advances in genomic technology have decreased costs of genetic testing, improved the understanding of the pathogenesis of FH and facilitated cascade screening. However, awareness of FH amongst clinicians and the general public still requires optimisation. This review outlines recent advances in FH detection, including emerging strategies and challenges for the next decade.
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Affiliation(s)
- Nick S R Lan
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Andrew C Martin
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, WA, Australia
| | - Tom Brett
- Department of General Practice and Primary Health Care Research, School of Medicine, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Gerald F Watts
- Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Crawley, WA, Australia; Department of Cardiology, Lipid Disorders Clinic, Cardiometabolic Service, Royal Perth Hospital, Perth, WA, Australia
| | - Damon A Bell
- Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Crawley, WA, Australia; Department of Cardiology, Lipid Disorders Clinic, Cardiometabolic Service, Royal Perth Hospital, Perth, WA, Australia; Department of Clinical Biochemistry, PathWest Laboratory Medicine, Royal Perth Hospital, Perth, WA, Australia; Department of Clinical Biochemistry, Australian Clinical Laboratories, Perth, WA, Australia.
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Lavie CJ, Laddu D, Arena R, Ortega FB, Alpert MA, Kushner RF. Reprint of: Healthy Weight and Obesity Prevention. J Am Coll Cardiol 2018; 72:3027-3052. [DOI: 10.1016/j.jacc.2018.10.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 12/23/2022]
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12
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Fletcher GF, Landolfo C, Niebauer J, Ozemek C, Arena R, Lavie CJ. Reprint of: Promoting Physical Activity and Exercise. J Am Coll Cardiol 2018; 72:3053-3070. [DOI: 10.1016/j.jacc.2018.10.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 08/21/2018] [Indexed: 12/12/2022]
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13
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Fletcher GF, Landolfo C, Niebauer J, Ozemek C, Arena R, Lavie CJ. Promoting Physical Activity and Exercise. J Am Coll Cardiol 2018; 72:1622-1639. [DOI: 10.1016/j.jacc.2018.08.2141] [Citation(s) in RCA: 276] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 08/21/2018] [Indexed: 01/03/2023]
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How to implement clinical guidelines to optimise familial hypercholesterolaemia diagnosis and treatment. ATHEROSCLEROSIS SUPP 2018; 26:25-35. [PMID: 28434482 DOI: 10.1016/s1567-5688(17)30022-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS Familial hypercholesterolaemia (FH) is a genetic disorder associated with significantly elevated plasma low-density lipoprotein cholesterol (LDL-C) and premature coronary heart disease (CHD). Optimal management of FH relies on early identification and treatment with statins alone or in combination with other lipid-lowering therapies. A lack of awareness of FH and its manifestations among primary care physicians and specialists has led to many individuals being misdiagnosed in the early stages of the disease, further increasing the risk of CHD and requiring much more intensive lipid-lowering strategies. Therefore, implementing clinical guidelines to optimise the diagnosis and treatment of FH is essential. METHODS A working group of clinical experts managing FH patients in their daily practice collaborated in order to provide healthcare professionals with a practical evidence-based guide to streamline early diagnosis and treatment of FH. RESULTS Following thorough evaluation of available data and clinical guidelines, the expert working group provided recommendations on how to detect patients with a suspicion of FH; criteria for clinical and genetic diagnoses of FH; how to assess atherosclerosis in primary care and identify patients at the highest risk; follow-up approaches for patients' families; the most optimal treatment combinations; and when to start lipid-lowering therapy in children with FH. CONCLUSIONS The expert working group placed great importance on an individualised approach in the management of FH and highlighted the unmet need for both improved education and communication with the laboratory for physicians when LDL-C levels are significantly elevated. Screening high-risk individuals, or cascade screening, is the most cost-effective way of identifying FH cases and initiating adequate statin therapy alone or in combination with other lipid-lowering therapies. In the case of severe FH, where plasma LDL-C levels remain high following maximum-tolerated statin and ezetimibe treatment, PCSK9 inhibitors should be considered.
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Affiliation(s)
- Birna Bjarnason-Wehrens
- Institute of Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport Medicine and Exercise Physiology, German Sport University Cologne, Germany
| | - Hans-Georg Predel
- Institute of Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport Medicine and Exercise Physiology, German Sport University Cologne, Germany
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Pang J, Lansberg PJ, Watts GF. International Developments in the Care of Familial Hypercholesterolemia: Where Now and Where to Next? J Atheroscler Thromb 2016; 23:505-19. [DOI: 10.5551/jat.34108] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jing Pang
- School of Medicine and Pharmacology, University of Western Australia
| | - Peter J Lansberg
- Center for Translational Molecular Medicine - Translational Research Infrastructure (CTMM-TraIT)
- Department of Vascular Medicine, Academic Medical Center
| | - Gerald F Watts
- School of Medicine and Pharmacology, University of Western Australia
- Lipid Disorders Clinic, Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital
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Smith SC, Bittner V, Gaziano JM, Giacomini JC, Pack QR, Polk DM, Stone NJ, Wang S. COCATS 4 Task Force 2: Training in Preventive Cardiovascular Medicine. J Am Coll Cardiol 2015; 65:1754-62. [DOI: 10.1016/j.jacc.2015.03.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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A framework for bridging the gap in the care of familial hypercholesterolaemia in the community. INT J EVID-BASED HEA 2014; 12:244-54. [DOI: 10.1097/xeb.0000000000000019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sipahioglu NT, Sipahioglu F. Closer look at white-coat hypertension. World J Methodol 2014; 4:144-150. [PMID: 25332913 PMCID: PMC4202453 DOI: 10.5662/wjm.v4.i3.144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 04/23/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
This review aims to clarify novel concepts regarding the clinical and laboratory aspects of white-coat hypertension (WCHT). Recent studies on the clinical and biological implications of WCHT were compared with existing knowledge. Studies were included if the WCHT patients were defined according to the 2013 European Society of Hypertension guidelines, i.e., an office blood pressure (BP) of ≥ 140/90 mmHg, a home BP of ≤ 135/85 mmHg, and a mean 24-h ambulatory BP of ≤ 130/80 mmHg. WCHT studies published since 2000 were selected, although a few studies performed before 2000 were used for comparative purposes. True WCHT was defined as normal ABPM and home BP readings, and partial WCHT was defined as an abnormality in one of these two readings. The reported prevalence of WCHT was 15%-45%. The incidence of WCHT tended to be higher in females and in non-smokers. Compared with normotensive (NT) patients, WCHT was associated with a higher left ventricular mass index, higher lipid levels, impaired fasting glucose, and decreased arterial compliance. The circadian rhythm in WCHT patients was more variable than in NT patient’s, with a higher pulse pressure and non-dipping characteristics. Compared with sustained hypertension patients, WCHT patients have a better 10-year prognosis; compared with NT patients, WCHT patients have a similar stroke risk, but receive more frequent drug treatment. There are conflicting results regarding WCHT and markers of endothelial damage, oxidative stress and inflammation, and the data imply that WCHT patients may have a worse prognosis. Nitric oxide levels are lower, and oxidative stress parameters are higher in WCHT patients than in NT patients, whereas the antioxidant capacity is lower in WCHT patients than in NT patients. Clinicians should be aware of the risk factors associated with WCHT and patients should be closely monitored especially to identify target organ damage and metabolic syndrome.
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Vickery AW, Bell D, Garton-Smith J, Kirke AB, Pang J, Watts GF. Optimising the detection and management of familial hypercholesterolaemia: central role of primary care and its integration with specialist services. Heart Lung Circ 2014; 23:1158-64. [PMID: 25130889 DOI: 10.1016/j.hlc.2014.07.062] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/09/2014] [Accepted: 07/11/2014] [Indexed: 10/25/2022]
Abstract
Familial hypercholesterolaemia (FH) is the most common monogenic lipid disorder associated with premature coronary heart disease (CHD). However, the majority of people with FH are undiagnosed or undertreated. Early cholesterol lowering therapy reduces cardiovascular disease mortality in FH. Low awareness and knowledge of FH in specialty and general practice highlights the need for strategies to improve the detection and management of FH. We present an algorithm describing a multidisciplinary approach to FH detection and management. We highlight the role of primary care, and where GPs can work with preventive cardiologists to improve care of FH. Novel strategies to detect index cases with FH are presented including the community laboratory, highlighting patients at high risk of FH, and targeted FH detection through searching the general practice database. General practitioners request over 90% of LDL cholesterol measurements in the community. Once an individual with FH is detected only a small proportion of patients require specialty management with the majority of patients suitably managed in primary care. However, it is crucial to screen family members, as 50% of first-degree family members are expected to have FH due to the autosomal dominant inheritance.
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Affiliation(s)
- Alistair W Vickery
- School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, Western Australia, Australia
| | - Damon Bell
- Clinical Biochemistry, PathWest Laboratory Medicine WA, Lipid Disorders Clinic, Royal Perth Hospital, University of Western Australia; Lipid Disorders Clinic, Cardiovascular Medicine, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | | | - Andrew B Kirke
- The Rural Clinical School of Western Australia (Bunbury) The University of Western Australia, Bunbury WA, Australia
| | - Jing Pang
- Lipid Disorders Clinic, Cardiovascular Medicine, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Gerald F Watts
- Lipid Disorders Clinic, Cardiovascular Medicine, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
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Integrated guidance on the care of familial hypercholesterolemia from the International FH Foundation. J Clin Lipidol 2014; 8:148-72. [DOI: 10.1016/j.jacl.2014.01.002] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 01/04/2014] [Indexed: 12/11/2022]
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Watts GF, Gidding S, Wierzbicki AS, Toth PP, Alonso R, Brown WV, Bruckert E, Defesche J, Lin KK, Livingston M, Mata P, Parhofer KG, Raal FJ, Santos RD, Sijbrands EJ, Simpson WG, Sullivan DR, Susekov AV, Tomlinson B, Wiegman A, Yamashita S, Kastelein JJ. Integrated guidance on the care of familial hypercholesterolaemia from the International FH Foundation. Int J Cardiol 2014; 171:309-25. [DOI: 10.1016/j.ijcard.2013.11.025] [Citation(s) in RCA: 221] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 11/02/2013] [Indexed: 12/18/2022]
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Vorderstrasse AA, Ginsburg GS, Kraus WE, Maldonado MCJ, Wolever RQ. Health coaching and genomics-potential avenues to elicit behavior change in those at risk for chronic disease: protocol for personalized medicine effectiveness study in air force primary care. Glob Adv Health Med 2014; 2:26-38. [PMID: 24416670 PMCID: PMC3833533 DOI: 10.7453/gahmj.2013.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Type 2 diabetes (T2D) and coronary heart disease (CHD) are prevalent chronic diseases from which military personnel are not exempt. While many genetic markers for these diseases have been identified, the clinical utility of genetic risk testing for multifactorial diseases such as these has not been established. The need for a behavioral intervention such as health coaching following a risk counseling intervention for T2D or CHD also has not been explored. Here we present the rationale, design, and protocol for evaluating the clinical utility of genetic risk testing and health coaching for active duty US Air Force (AF) retirees and beneficiaries. Primary Study Objectives: Determine the direct and interactive effects of health coaching and providing genetic risk information when added to standard risk counseling for CHD and T2D on health behaviors and clinical risk markers. Design: Four-group (2 X 2 factorial) randomized controlled trial. Setting: Two AF primary care clinical settings on the west coast of the United States. Participants: Adult AF primary care patients. Intervention: All participants will have a risk counseling visit with a clinic provider to discuss personal risk factors for T2D and CHD. Half of the participants (two groups) will also learn of their genetic risk testing results for T2D and CHD in this risk counseling session. Participants randomized to the two groups receiving health coaching will then receive telephonic health coaching over 6 months. Main Outcome Measures: Behavioral measures (self-reported dietary intake, physical activity, smoking cessation, medication adherence); clinical outcomes (AF composite fitness scores, weight, waist circumference, blood pressure, fasting glucose, lipids, T2D/CHD risk scores) and psychosocial measures (self-efficacy, worry, perceived risk) will be collected at baseline and 6 weeks, and 3, 6, and 12 months. Conclusion: This study tests novel strategies deployed within existing AF primary care to increase adherence to evidence-based diet, physical activity, smoking cessation, and medication recommendations for CHD and T2D risk reduction through methods of patient engagement and self-management support.
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Affiliation(s)
| | | | - William E Kraus
- Division of Cardiology, Duke Schools of Medicine and Nursing, United States
| | | | - Ruth Q Wolever
- Duke Integrative Medicine, Department of Psychiatry & Behavioral Science, Duke School of Medicine, Center for Personalized Medicine, Duke University Health System, United States
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Premature coronary heart disease and traditional risk factors-can we do better? Int Cardiovasc Res J 2013; 7:46-50. [PMID: 24757620 PMCID: PMC3987428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/07/2013] [Accepted: 05/28/2013] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Traditional cardiovascular risk factors are strong predictors of an increased likelihood for premature CHD. Considering the benefits of risk factors᾿ management, it is imperative to find and treat them before looking for more unknown and weak risk factors. OBJECTIVES Limited information is available about the demographic and historical characteristics of the patients with premature Coronary Heart Disease (CHD) in IR Iran. The main objective of this study was to determine the prevalence of the traditional risk factors in these patients. Also, the researchers hypothesized that there are insufficient risk assessment and preventive intervention methods for the asymptomatic adult population. METHODS This study was conducted on 125 patients with premature CHD (age<50 years) who were admitted in two academic hospitals with acute coronary syndromes. The patients were accepted since they had a definite CHD on the basis of acute myocardial infarction (elevated cardiac enzymes) or documented CAD in coronary angiography. RESULTS The mean age of the study population was 42.50±5.65 (26 to 49 years). Among the patients,92 (73.6%) were male, 113 (90.4%) were married, 58 (46.4%) were smokers,19 (15.2%) were opium users, 97 (77.6%) had dyslipidemia, 44 (35.2%) had hypertension, and 33 (26.4%) had diabetes mellitus. In addition, family history was presented in 54 patients (43.2%). Among the study population, 120 patients (96%) had at least one of the traditional risk factors, including dyslipidemia, hypertension, diabetes mellitus, cigarette smoking, and family history of CHD. However, none of the dyslipidemic patients had controlled total cholesterol, LDL, HDL, and triglyceride. Also, none of the diabetic patients had hemoglobin A1C<7%. Among the 44 hypertensive patients, blood pressure of 15 ones (34%) was within the normal range. Besides, only 3 patients (2.4%) had regular physical activity (at least 30 minutes, three times a week). CONCLUSIONS Premature Coronary Heart Disease is a public health problem. However, there is lack of effective and intensive treatments of well-defined traditional risk factors and prevention methods for the majority of the patients experiencing premature CHD. In sum, there is still plenty of room for improvement of risk management in IR Iran.
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Medical director responsibilities for outpatient cardiac rehabilitation/secondary prevention programs: 2012 update: a statement for health care professionals from the American Association for Cardiovascular and Pulmonary Rehabilitation and the American Heart Association. J Cardiopulm Rehabil Prev 2013; 32:410-9. [PMID: 23096057 DOI: 10.1097/hcr.0b013e31826c727c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Medical directors of cardiac rehabilitation/secondary prevention (CR/SP) programs are responsible for the safe and effective delivery of high-quality CR/SP services to eligible patients. Yet, the training and resources for CR/SP medical directors are limited. As a result, there appears to be considerable variability throughout CR/SP programs in the United States in the roles, responsibilities, and engagement of CR/SP medical directors. Since the publication of the 2005 scientific statement from the American Heart Association and American Association of Cardiovascular and Pulmonary Rehabilitation regarding medical director responsibilities for outpatient CR/SP programs, significant changes have occurred. This statement updates the responsibilities of CR/SP medical directors, in view of changes in federal legislation and regulations and changes in health care delivery and clinical practice that impact the roles and responsibilities of CR/SP medical directors.
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Jiang W, Samad Z, Boyle S, Becker RC, Williams R, Kuhn C, Ortel TL, Rogers J, Kuchibhatla M, O'Connor C, Velazquez EJ. Prevalence and clinical characteristics of mental stress-induced myocardial ischemia in patients with coronary heart disease. J Am Coll Cardiol 2013; 61:714-22. [PMID: 23410543 DOI: 10.1016/j.jacc.2012.11.037] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 11/26/2012] [Accepted: 11/27/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The goal of this study was to evaluate the prevalence and clinical characteristics of mental stress-induced myocardial ischemia. BACKGROUND Mental stress-induced myocardial ischemia is prevalent and a risk factor for poor prognosis in patients with coronary heart disease, but past studies mainly studied patients with exercise-induced myocardial ischemia. METHODS Eligible patients with clinically stable coronary heart disease, regardless of exercise stress testing status, underwent a battery of 3 mental stress tests followed by a treadmill test. Stress-induced ischemia, assessed by echocardiography and electrocardiography, was defined as: 1) development or worsening of regional wall motion abnormality; 2) left ventricular ejection fraction reduction ≥ 8%; and/or 3) horizontal or downsloping ST-segment depression ≥ 1 mm in 2 or more leads lasting for ≥ 3 consecutive beats during at least 1 mental test or during the exercise test. RESULTS Mental stress-induced ischemia occurred in 43.45%, whereas exercise-induced ischemia occurred in 33.79% (p = 0.002) of the study population (N = 310). Women (odds ratio [OR]: 1.88), patients who were not married (OR: 1.99), and patients who lived alone (OR: 2.24) were more likely to have mental stress-induced ischemia (all p < 0.05). Multivariate analysis showed that compared with married men or men living with someone, unmarried men (OR: 2.57) and married women (OR: 3.18), or living alone (male OR: 2.25 and female OR: 2.72, respectively) had higher risk for mental stress-induced ischemia (all p < 0.05). CONCLUSIONS Mental stress-induced ischemia is more common than exercise-induced ischemia in patients with clinically stable coronary heart disease. Women, unmarried men, and individuals living alone are at higher risk for mental stress-induced ischemia. (Responses of Myocardial Ischemia to Escitalopram Treatment [REMIT]; NCT00574847).
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Affiliation(s)
- Wei Jiang
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Li Q, Kang T, Tian X, Ma Y, Li M, Richards J, Bythwood T, Wang Y, Li X, Liu D, Ma L, Song Q. Multimeric stability of human C-reactive protein in archived specimens. PLoS One 2013; 8:e58094. [PMID: 23516433 PMCID: PMC3597618 DOI: 10.1371/journal.pone.0058094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 02/03/2013] [Indexed: 11/19/2022] Open
Abstract
Background C-reactive protein (CRP) is a marker of inflammation and a risk predictor of cardiovascular disease. Current CRP assays are focused on the quantification of the CRP levels as pentamers. However, CRP can be present as other multimeric forms. There will be a market need to measure the CRP multimeric structure in addition to the levels in human populations. To meet this need, we investigated whether the long-term archived samples could be used instead of freshly collected samples. Methodology/Principal Findings The specimens of serum, plasma and tissues were collected from transgenic rats expressing the human CRP. These samples were stored at 4°C, −20°C and −80°C for different periods. Non-denaturing Western blot analysis was used to observe the influence of storage conditions to multimeric structures of human CRP. Our results showed that there was no difference on multimeric structures of human CRP between samples stored at 4°C, −20°C and −80°C, between samples stored at −80°C for twenty-four hours and three months, and between plasma and serum. Conclusions/Significance This study implicated that archived samples stored at these conditions in those large longitudinal studies could be used for investigating the multimeric structures of CRP. Our report may speed up these researches and save labors and budget by enabling them to use currently available archived samples rather than freshly collected samples.
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Affiliation(s)
- Qiling Li
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, United States of America
| | - Ting Kang
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, United States of America
| | - Xiaohua Tian
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, United States of America
| | - Yamin Ma
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, United States of America
| | - Min Li
- School of Information Science and Engineering, Central South University, Changsha, China
| | - Jendai Richards
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, United States of America
| | - Tameka Bythwood
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, United States of America
| | - Yueling Wang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xu Li
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Dong Liu
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, United States of America
| | - Li Ma
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, United States of America
| | - Qing Song
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, United States of America
- * E-mail:
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A community and culture-centered approach to developing effective cardiovascular health messages. J Gen Intern Med 2012; 27:1308-16. [PMID: 22584728 PMCID: PMC3445691 DOI: 10.1007/s11606-012-2102-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 04/10/2012] [Accepted: 04/23/2012] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Little is known about how best to target cardiovascular health promotion messages to minorities. This study describes key lessons that emerged from a community and culture-centered approach to developing a multimedia, coronary heart disease (CHD) patient education program (PEP) for medically underserved South Asian immigrants. METHODS The prototype PEP integrated the surface structures (e.g. language) and deeper structures (e.g. explanatory models (EMs), values) of South Asians' socio-cultural context. Seven focus groups and 13 individual interviews were used to investigate South Asians' reactions and obtain qualitative feedback after viewing the culturally targeted PEP. Qualitative data were organized into emergent thematic constructs. RESULTS Participants (n=56) mean age was 51 years and 48 % were Hindi speakers. Community members had a strong, negative reaction to some of the targeted messages, "This statement is a bold attack. You are pin-pointing one community." Other important themes emerged from focus groups and interviews about the PEP: 1) it did not capture the community's heterogeneity; 2) did not sufficiently incorporate South Asians' EMs of CHD; and 3) did not address economic barriers to CHD prevention. Feedback was used to revise the PEP. CONCLUSION A community and culture-centered approach to developing cardiovascular health promotion messages revealed tensions between the researcher's vantage point of "cultural targeting" and the community's perceptions and reactions to these messages. Engaging communities in every phase of message design, incorporating their EMs, recognizing community heterogeneity, and addressing economic and structural barriers, are critical steps to ensuring that health promotion messages reach their intended audience and achieve true cultural appropriateness.
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A New Model of Care for Familial Hypercholesterolaemia: What is the Role of Cardiology? Heart Lung Circ 2012; 21:543-50. [DOI: 10.1016/j.hlc.2012.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 04/18/2012] [Indexed: 11/22/2022]
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Underdiagnosis and undertreatment of cardiovascular risk factors in patients with moderate to severe psoriasis. J Am Acad Dermatol 2012; 67:76-85. [DOI: 10.1016/j.jaad.2011.06.035] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 06/02/2011] [Accepted: 06/17/2011] [Indexed: 12/17/2022]
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Pack QR, Keteyian SJ, McBride PE, Weaver WD, Kim HE. Current status of preventive cardiology training among United States cardiology fellowships and comparison to training guidelines. Am J Cardiol 2012; 110:124-8. [PMID: 22482864 DOI: 10.1016/j.amjcard.2012.02.059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 02/21/2012] [Accepted: 02/21/2012] [Indexed: 10/28/2022]
Abstract
We evaluated preventive cardiology education in United States cardiology fellowship programs and their adherence to Core Cardiovascular Training Symposium training guidelines, which recommend 1 month of training, faculty with expertise, and clinical experience in cardiac rehabilitation, lipid disorder management, and diabetes management as a part of the prevention curricula. We sent an anonymous survey to United States cardiology program directors and their chief fellow. The survey assessed the program curricula, rotation structure, faculty expertise, obstacles, and recommended improvements. The results revealed that 24% of surveyed programs met the Core Cardiovascular Training Symposium guidelines with a dedicated 1-month rotation in preventive cardiology, 24% had no formalized training in preventive cardiology, and 30% had no faculty with expertise in preventive cardiology, which correlated with fewer rotations in prevention than those with specialized faculty (p = 0.009). Fellows rotated though the following experiences (% of programs): cardiac rehabilitation, 71%; lipid management, 37%; hypertension, 15%; diabetes, 7%; weight management/obesity, 6%; cardiac nutrition, 6%; and smoking cessation, 5%. The program directors cited "lack of time" as the greatest obstacle to providing preventive cardiology training and the chief fellows reported "lack of a developed curriculum" (p = 0.01). The most recommended improvement was for the American College of Cardiology to develop a web-based curriculum/module. In conclusion, most surveyed United States cardiology training programs currently do not adhere to basic preventive cardiovascular medicine Core Cardiovascular Training Symposium recommendations. Additional attention to developing curricular content and structure, including the creation of an American College of Cardiology on-line knowledge module might improve fellowship training in preventive cardiology.
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Patients' experiences with symptoms and needs in the early rehabilitation phase after coronary artery bypass grafting. Eur J Cardiovasc Nurs 2012; 11:14-24. [PMID: 21030311 DOI: 10.1016/j.ejcnurse.2010.09.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The first month after discharge for Coronary artery bypass graft (CABG) is particularly challenging for the patients. A larger interview study is warranted to elicit CABG patients' detailed experiences, and give direction for future clinical practice. AIM To explore the CABG patients' symptoms and needs in the early rehabilitation phase. METHODS A qualitative, mixed method design integrating qualitative and quantitative approaches was used. Ninety-three CABG patients aged 39-77, participated in interviews at home after 2 and 4 weeks. The semi-structured interview guide covered: experiences of relief of angina pectoris after surgery, experiences with prescribed discharge medications, psychological experiences: anxiety, depression, sexuality, health professional contact persons, and patient defined experiences. RESULTS Two weeks after CABG the patients symptoms and needs were characterised by a substantial amount of uncertainty and worries related to what to expect and what was normal for postoperative pain, assessment and sensation of surgical site, different experiences with physical activity/exercise, uncertainty about medications, difficulties with sleep pattern, irritability, postoperative complications,uncertainty about return to work, and insufficient information at discharge. Four weeks after surgery the patients' symptom level was decreased, and they experienced life beginning to return back to normal. Patency with grafts after CABG, decision to drive a car, impotence (erectile dysfunction), and a missing link to the hospital remained challenges. CONCLUSION CABG patients' experiences indicate a need to extend the hospital's discharge care to the first month after surgery for specific themes to promote rehabilitation outcomes.
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Carraro CI, Machado R, Espindola V, Campagnol PCB, Pollonio MAR. The effect of sodium reduction and the use of herbs and spices on the quality and safety of bologna sausage. FOOD SCIENCE AND TECHNOLOGY 2012. [DOI: 10.1590/s0101-20612012005000051] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In this study, the replacement of 50% NaCl by KCl in Bologna sausage with the addition of herbs and spice blends (coriander, onion, white pepper, cardamom, and Jamaican pepper) was evaluated. The formulations tested showed a significant reduction in the sodium content with no major alterations in the emulsion stability, texture, and microbiological characteristics. The use of 50% KCl caused a reduction in the sensory quality leading to a significant decrease in the consumers' purchase intention. The formulations with the addition of herbs and spice blends presented better results in the sensory evaluation indicating that this strategy can reduce the negative effects resulting from the use of KCl.
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Pack QR, Keteyian SJ, McBride PE. Subspecialty training in preventive cardiology: the current status and discoverable fellowship programs. Clin Cardiol 2012; 35:286-90. [PMID: 22570190 DOI: 10.1002/clc.21959] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 12/03/2011] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Preventive cardiology is currently not an American Board of Medical Specialties-recognized subspecialty. However, several programs offer non-accredited fellowships throughout the country. No source currently exists listing all available programs, and finding programs requires time-intensive search strategies. Our aim was to find all current preventive cardiology fellowships in the United States and describe their basic structure, duties, and faculty. METHODS We searched the Internet, contacted national organizations, and networked through any institution thought likely to have a fellowship. RESULTS We found 15 programs currently offering subspecialty training in preventive cardiology but with considerably different styles, structures, duties, clinical time, lengths, and hosting departments. CONCLUSIONS We provided a list of these programs and discussed the implications for the future of formal subspecialty preventive cardiology education.
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Affiliation(s)
- Quinn R Pack
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA.
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Bugiardini R, Yan AT, Yan RT, Fitchett D, Langer A, Manfrini O, Goodman SG. Factors influencing underutilization of evidence-based therapies in women. Eur Heart J 2011; 32:1337-1344. [DOI: 10.1093/eurheartj/ehr027] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Affiliation(s)
- Barry A. Franklin
- From the Departments of Medicine and Cardiology, Cardiac Rehabilitation and Exercise Laboratories, William Beaumont Hospital, Royal Oak, MI (B.A.F.); and Departments of Medicine and Pathology, University of Vermont College of Medicine, Burlington (M.C.). Dr Franklin is Immediate Past Chair, American Heart Association Council on Nutrition, Physical Activity, and Metabolism. Dr Cushman is Immediate Past Chair, American Heart Association Council on Epidemiology and Prevention
| | - Mary Cushman
- From the Departments of Medicine and Cardiology, Cardiac Rehabilitation and Exercise Laboratories, William Beaumont Hospital, Royal Oak, MI (B.A.F.); and Departments of Medicine and Pathology, University of Vermont College of Medicine, Burlington (M.C.). Dr Franklin is Immediate Past Chair, American Heart Association Council on Nutrition, Physical Activity, and Metabolism. Dr Cushman is Immediate Past Chair, American Heart Association Council on Epidemiology and Prevention
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Core competencies for cardiac rehabilitation/secondary prevention professionals: 2010 update: position statement of the American Association of Cardiovascular and Pulmonary Rehabilitation. J Cardiopulm Rehabil Prev 2011; 31:2-10. [PMID: 21217254 DOI: 10.1097/hcr.0b013e318203999d] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiac rehabilitation/secondary prevention (CR/SP) services are typically delivered by a multidisciplinary team of health care professionals. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recognizes that to provide high-quality services, it is important for these health care professionals to possess certain core competencies. This update to the previous statement identifies 10 areas of core competencies for CR/SP health care professionals and identifies specific knowledge and skills for each core competency. These core competency areas are consistent with the current list of core components for CR/SP programs published by the AACVPR and the American Heart Association and include comprehensive cardiovascular patient assessment; management of blood pressure, lipids, diabetes, tobacco cessation, weight, and psychological issues; exercise training; and counseling for psychosocial, nutritional, and physical activity issues.
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Incidence of subclinical atherosclerosis in asymptomatic type-2 diabetic patients: the potential of multi-slice computed tomography coronary angiography. Coron Artery Dis 2011; 22:26-31. [PMID: 20881481 DOI: 10.1097/mca.0b013e328340233b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Type-2 diabetic patients constitute a high-risk population for atherosclerosis. Primary prevention, although recommended, is not well funded. Our aim was to evaluate the degree of subclinical atherosclerosis, in asymptomatic diabetic patients, using coronary multi-slice computed tomography (MSCT) angiography. METHODS We prospectively studied 71 diabetic patients without any symptoms or documentation of atherosclerotic disease. Coronary MSCT angiography was performed in all patients and coronary artery calcium score (CACS) was evaluated. The number of diseased coronary segments was determined and classified as obstructive or nonobstructive and fibrolipid or calcified lesions. The mean follow-up was 29.5±6.6 months. Major adverse cardiovascular events were registered. RESULTS The mean age was 59±10 years, 48% were female patients. The duration of diabetes was 12.5±8.7 years. CACS ranged from 0 to 1293 Agatston units (153±269.1). Image quality was generally good, allowing satisfactory evaluation of most of the coronary artery segments. CACS was 0 in 28 patients, but in nine patients MSCT angiography showed fibrolipid plaques. Obstructive coronary artery disease was present in 26.7% of the patients (5.6% with multivessel disease). During the follow-up period, six major adverse cardiovascular events were detected in patients, five of whom had a CACS more than 100 Agatston units. CONCLUSION This study shows a high prevalence of silent atherosclerotic lesions in type-2 diabetic patients, reinforcing the importance of risk factor modification even when calcified disease is absent. Coronary MSCT angiography can be performed to identify the atherosclerotic burden and may be an important test in selecting the patients who are benefiting the most from primary prevention.
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Zwisler AD, Bjarnason-Wehrens B, McGee H, Piepoli MF, Benzer W, Schmid JP, Dendale P, Pogosova NGV, Zdrenghea D, Niebauer J, Mendes M, Doherty P, Garcia-Porrero E, Rauch B, Gaita D. Can level of education, accreditation and use of databases in cardiac rehabilitation be improved? Results from the European Cardiac Rehabilitation Inventory Survey. Eur J Prev Cardiol 2011; 19:143-50. [PMID: 21450586 DOI: 10.1177/1741826711398847] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Professional skills, education and accreditation, along with clinical outcome assessment, are considered important factors to achieve comprehensive delivery and quality of cardiac rehabilitation (CR). This study assessed professional educational programmes, accreditation and use of databases in CR across the European countries. MATERIALS AND METHODS Questions on professional education, accreditation and clinical databases from the European Cardiac Rehabilitation Inventory Survey, which is a postal questionnaire survey, conducted from November 2007 to January 2009 among national CR-related organizations in Europe; 28 countries responded (72%) to this survey. RESULTS Among the participating countries, 32% had guidelines on professional CR skills, 61% had formal educational programmes and 29% had accreditation systems for professional CR skills. One hundred and seventy-four ad-hoc educational and scientific activities were registered during 2005-2007. Forty-three percent of the countries had established CR programme accreditation systems, primarily aimed at phase 2. One in three (35%) countries had established clinical CR databases with a further 25% planning to do so. CONCLUSION More than half of the European countries had developed formal CR educational programmes. Furthermore, many ad-hoc CR-related meetings and conference activities take place across Europe. Although only a quarter of countries had developed accreditation systems aimed at professionals, programme accreditation was somewhat more widespread with over a third having programme accreditation systems. Clinical databases were underdeveloped. A greater focus on education, accreditation and database implementation is needed to promote CR availability and the quality of CR services for the benefit of cardiac patients across Europe.
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Affiliation(s)
- Ann-Dorthe Zwisler
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark.
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Cano O, Osca J, Sancho-Tello MJ, Olagüe J, Castro JE, Salvador A. Morbidity associated with three different antiplatelet regimens in patients undergoing implantation of cardiac rhythm management devices. Europace 2010; 13:395-401. [PMID: 21131650 DOI: 10.1093/europace/euq431] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Perioperative management of antiplatelet (AP) therapy in patients undergoing implantation of cardiac rhythm management devices (CRMD) remains an issue of concern that has not been prospectively evaluated in a large series. We sought to describe the morbidity associated with three different AP regimens in this setting. METHODS AND RESULTS We conducted a prospective observational study including 849 consecutive patients who were classified in three groups according to the presence of any AP treatment: Group 1 (n= 220): single AP therapy; Group 2 (n= 60): dual AP therapy; and Group 3 (n= 40): oral anticoagulant (OAC) + enoxaparin 'bridging' + AP therapy. Two other groups served as controls: Group 4 (n= 375): no AP or OAC therapy; and Group 5 (n= 154): OAC + enoxaparin 'bridging'. The incidence of pocket haematoma, pocket revisions, hospital stays duration, and unscheduled follow-up visits due to pocket-related complications were compared. Patients on Groups 2, 3 and 5 had significantly higher incidences of pocket haematoma (13.3, 15, and 14.9%, respectively) when compared with Groups 1 and 4 (3.2 and 2.4%, respectively), as well as longer hospital stays and more unscheduled follow-up visits. Of note, only patients on enoxaparin 'bridging' required surgical revision of the pocket. Dual AP therapy (P< 0.001), enoxaparin 'bridging' (P< 0.001) and renal insufficiency (P= 0.02) were independent predictors of pocket haematoma in multivariate analysis. CONCLUSION Dual AP therapy and OAC + AP therapy is strongly associated with a significant risk of pocket haematoma, longer hospital stays, and unscheduled follow-up visits. Importantly, surgical revision of the pocket was associated with enoxaparin 'bridging' strategy but was never necessary in patients taking exclusively antiaggregant agents.
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Affiliation(s)
- Oscar Cano
- Electrophysiology Section, Cardiology Department, Hospital Universitario La Fe, C/ Lope de Rueda, 48, 3, 46001 Valencia, Spain.
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Abstract
In this issue, Wakkee and colleagues report a self-described exploratory cohort study and conclude that psoriasis may not be an independent risk factor for ischemic heart disease (IHD) hospitalization and that there is only a slight and borderline increased risk of ischemic heart disease among psoriasis patients. This negative result should be interpreted in light of the study's limitations, the complex relationship among levels of psoriasis severity, patient age, and cardiovascular (CV) risk, and the context of the rapidly growing literature.
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Black HR. Leadership Message. J Clin Hypertens (Greenwich) 2010. [DOI: 10.1111/j.1751-7176.2010.00280.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Black HR. 25 Years of the American Society of Hypertension-where we have been and where should we be going. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2010; 4:53-55. [PMID: 20400048 DOI: 10.1016/j.jash.2010.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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