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Armas-Padrón AM, Sicilia-Sosvilla M, Ruiz-Esteban P, Torres A, Hernández D. Cardiovascular health and target end-organ damage and comorbidities in hypertensive patients from a Spanish primary care urban population. Nefrologia 2024; 44:77-89. [PMID: 37150674 DOI: 10.1016/j.nefroe.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/09/2022] [Indexed: 05/09/2023] Open
Abstract
We hypothesized that a poorer cardiovascular health status is related to a higher risk of hypertension-mediated organ-damage (HMOD) or hypertension-related comorbidities (HRC). We assessed the relationship between cardiovascular health metrics (CVHM) and HMOD-HRC in 243 hypertensive patients from primary care center followed for two years. We recorded the baseline CVHM score (Life's Simple 7) plus clinical data, including prevalent and incident HMOD-HRC, hospitalization and mortality. The prevalence of ideal CVHM scores was very low in both men and women. The patients with healthier CVHM scores were younger, and had a lower prevalence of diabetes, cardiovascular disease and chronic kidney disease. We recorded 264 cases of HMOD-HRC (225 at baseline and 39 during follow-up). Nine patients died and 64 had any-cause hospitalization during follow-up. A lower prevalence of HMOD-HRC and unfavorable outcomes was observed as the number of ideal CVHM increased (P<0.05). Multivariate logistic regression adjusted for confounders showed a lower CVHM score (0-1) was associated with increased odds of HMOD-HRC (4.04, 95% CI 1.26-12.94; P=0.019) and composite endpoint (HMOD-HRC, death or all-cause hospitalization) (3.43, 95% CI 1.19-9.92; P=0.023). Individual components were less predictive than the cumulative CVHM score. Few hypertensive patients in this urban population had ideal CVHM scores. An inverse relationship between scores and outcomes (HMOD-HRC, death or hospitalizations) was observed. Interventions to increase this score may improve prognosis among community-based hypertensive patients.
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Affiliation(s)
- Ana María Armas-Padrón
- La Cuesta Primary Healthcare Centre, Universidad de la Laguna, La Laguna, E-38320 Tenerife, Spain
| | - Miriam Sicilia-Sosvilla
- La Cuesta Primary Healthcare Centre, Universidad de la Laguna, La Laguna, E-38320 Tenerife, Spain
| | - Pedro Ruiz-Esteban
- Nephrology Department, Hospital Regional Universitario de Málaga, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), REDinREN (RD16/0009/0006 and RICORS RD21/0005/0012), E-29010 Málaga, Spain
| | - Armando Torres
- Nephrology Department, Instituto de Tecnologías Biomédicas-Universidad La Laguna, Hospital Universitario de Canarias, REDinREN (RD16/0009/0031), E-38320 Tenerife, Spain
| | - Domingo Hernández
- Nephrology Department, Hospital Regional Universitario de Málaga, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), REDinREN (RD16/0009/0006 and RICORS RD21/0005/0012), E-29010 Málaga, Spain.
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Ribot-Rodríguez R, Higuera-Gómez A, San-Cristobal R, Micó V, Martínez JA. Comparison of Seven Healthy Lifestyle Scores Cardiometabolic Health: Age, Sex, and Lifestyle Interactions in the NutrIMDEA Web-Based Study. J Epidemiol Glob Health 2023; 13:653-663. [PMID: 37634195 PMCID: PMC10686948 DOI: 10.1007/s44197-023-00140-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/05/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Global health status concerns both the assessment of wellbeing as well as the associated individualized determinants including quality of life and lifestyle factors. This study aimed to evaluate seven cardiometabolic health related scores and the influence, as well as interactions of lifestyle, heart-related and health-related quality of life (HRQoL) factors in order to inform the future implementation of precision public health (PPH). METHODS Data collected from 17,333 participants who were enrolled of the NutrIMDEA study. The data collection period was between May 2020 and November 2020 through an online survey. The baseline questionnaire collected information on socio-demographic data, cardiometabolic history, anthropometric variables and lifestyle aspects. Also, physical and mental component scores of SF12 Health Survey (PCS12/MCS12) were assessed as HRQoL features, which were applied to estimated seven scores (LS7, HLS, 20-years DRS %, FBS, CLI, WAI derived, LWB-I). RESULTS Most indices (except FBS, CLI, 20-years DRS % and WAI derived) showed that cardiometabolic outcomes and HRQoL measures were dependent on interactions by age and sex. The largest ponderal effect was found in PA total and Mediterranean Diet Score (MEDAS-14) interaction using LS7 as reference. However, using LWB-I as standard, the greatest effect was found in the quality-of-life feature MCS12. Noteworthy, LS7 showed good discrimination against PCS12, while LWB-I demonstrated excellent discrimination to MCS12. CONCLUSIONS A major finding was the interplay between MEDAS-14 and PA on the LS7 scale as well as major effects of lifestyle factors and MCS12/PCS12 among scores, which need to be accounted with precision when implementing cardiometabolic screenings with PPH purposes.
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Affiliation(s)
- R Ribot-Rodríguez
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, 28049, Madrid, Spain
| | - A Higuera-Gómez
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, 28049, Madrid, Spain
| | - R San-Cristobal
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, 28049, Madrid, Spain.
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels de l'Université Laval (INAF), Université Laval, Quebec, QC, Canada.
- School of Nutrition, Université Laval, Quebec, QC, G1V 0A6, Canada.
| | - V Micó
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, 28049, Madrid, Spain
| | - J A Martínez
- Precision Nutrition and Cardiometabolic Health, IMDEA-Food Institute (Madrid Institute for Advanced Studies), Campus of International Excellence (CEI) UAM+CSIC, 28049, Madrid, Spain
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029, Madrid, Spain
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3
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Rojo-López MI, Bermúdez-López M, Castro E, Farràs C, Torres G, Pamplona R, Lecube A, Valdivielso JM, Fernández E, Julve J, Castelblanco E, Franch-Nadal J, Alonso N, Granado-Casas M, Mauricio D. Low adherence to the Mediterranean diet is associated with increased prevalence and number of atherosclerotic plaques in the ILERVAS cohort. Atherosclerosis 2023; 380:117191. [PMID: 37586219 DOI: 10.1016/j.atherosclerosis.2023.117191] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 07/12/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND AND AIMS Current research on the association between dietary patterns and subclinical atherosclerotic disease (SAD) is still limited, and published results are inconsistent and often consist of small population sizes. We aimed to evaluate the association between the Mediterranean diet (MDiet) and SAD in a large cohort of Mediterranean individuals. METHODS This was a cross-sectional study that included 8116 subjects from the ILERVAS cohort. The presence of atherosclerotic plaques (AP) was assessed by ultrasound examination. Adherence to the MDiet was assessed using the 14-item Mediterranean Diet Adherence Score (MEDAS). Inclusion criteria were subjects with at least one cardiovascular risk factor. Exclusion criteria were a clinical history of diabetes, chronic kidney disease, or a prior cardiovascular event. Bivariable and multivariable models were performed. RESULTS Compared with subjects without SAD, participants with SAD were older and had a higher frequency of smoking habit, hypertension, dyslipidemia, HbA1c and waist circumference. The adjusted multivariable analysis showed that a higher MEDAS was associated with a lower risk of AP (incidence rate ratios [IRR] 0.97, 95% CI [0.96-0.98]; p<0.001). Furthermore, moderate or high adherence to the MDiet was associated with a lower number of AP compared with a low MDiet adherence (IRR 0.90, 95% CI [0.87-0.94]; p<0.001). In both models, female sex was associated with a lower risk of AP. CONCLUSIONS Our findings point to a potentially protective role of MDiet for SAD in a Mediterranean population with low-to-moderate cardiovascular risk. Further research is needed to establish a causal relationship between both variables.
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Affiliation(s)
- Marina Idalia Rojo-López
- Research Group of Endocrinology, Diabetes and Nutrition, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Marcelino Bermúdez-López
- Vascular and Renal Translational Research Group, IRBLleida, Renal Research Network (RedInRen, ISCIII), Lleida, Spain
| | - Eva Castro
- Vascular and Renal Translational Research Group, IRBLleida, Renal Research Network (RedInRen, ISCIII), Lleida, Spain
| | - Cristina Farràs
- Cappont Primary Care Center. Territorial Management of Lleida, Catalan Institute of Health, Barcelona, Spain; Research Support Unit Lleida, Jordi Gol i Gorina Primary Health Care Research Institute Foundation (IDIAPJGol), Barcelona, Spain
| | - Gerard Torres
- Department of Respiratory Medicine, Arnau de Vilanova University Hospital, Translational Research Group Respiratory Medicine, IRBLleida, University of Lleida, Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | - Reinald Pamplona
- Department of Experimental Medicine, IRBLleida, University of Lleida, Lleida, Spain
| | - Albert Lecube
- Department of Endocrinology and Nutrition, Arnau de Vilanova University Hospital, Obesity and Metabolism Research Group (ODIM), IRBLleida, University of Lleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - José Manuel Valdivielso
- Vascular and Renal Translational Research Group, IRBLleida, Renal Research Network (RedInRen, ISCIII), Lleida, Spain
| | - Elvira Fernández
- Vascular and Renal Translational Research Group, IRBLleida, Renal Research Network (RedInRen, ISCIII), Lleida, Spain
| | - Josep Julve
- Research Group of Endocrinology, Diabetes and Nutrition, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Esmeralda Castelblanco
- Department of Internal Medicine, Endocrinology, Metabolism and Lipid Research Division, Washington University School of Medicine, St Louis, MO, 63110, USA; DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Josep Franch-Nadal
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain; DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Núria Alonso
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain; Endocrinology and Nutrition Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Minerva Granado-Casas
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain; Department of Nursing and Physiotherapy, Health Sciences Faculty, University of Lleida, Health Care Research Group (GRECS), IRBLleida, Lleida, Spain.
| | - Dídac Mauricio
- Research Group of Endocrinology, Diabetes and Nutrition, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain; DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Faculty of Medicine, University of Vic (UVIC/UCC), Vic, Spain.
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Bermúdez-López M, Martí-Antonio M, Castro-Boqué E, Bretones MDM, Farràs C, Gonzalez J, Pamplona R, Lecube A, Mauricio D, Cambray S, Valdivielso JM, Fernández E. Cumulative tobacco consumption has a dose-dependent effect on atheromatosis burden and improves severe atheromatosis prediction in asymptomatic middle-aged individuals: The ILERVAS study. Atherosclerosis 2023; 375:75-83. [PMID: 37276714 DOI: 10.1016/j.atherosclerosis.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND AIMS Sex-specific impact of cumulative tobacco consumption (CTC) on atheromatosis extension and total plaque area remains unknown. We aimed to determine the impact of CTC in atheromatosis localization and burden. METHODS We performed a cross-sectional analysis in 8330 asymptomatic middle-aged individuals. 12-territory vascular ultrasounds in carotid and femoral arteries were performed to detect atheromatous plaque presence and to measure total plaque area. Adjusted regressions and conditional predictions by smoking habit or CTC (stratified in terciles as low (≤13.53), medium (13.54-29.3), and high (>29.3 packs-year)) were calculated. Severe atheromatosis (SA, ≥3 territories with atheroma plaque) was predicted with the Systematic COronary Risk Evaluation 2 (SCORE2) model. The improvement of SA prediction after adding CTC was evaluated. RESULTS CTC was associated with an increased risk of atheromatosis, stronger in femoral than in carotid artery, but similar in both sexes. A dose-dependent effect of CTC on the number of territories with atheroma plaque and total plaque area was observed. Addition of CTC to the SCORE2 showed a higher sensitivity, accuracy, and negative predictive value in males, and a higher specificity and positive predictive value in females. In both sexes, the new SCORE2-CTC model showed a significant increase in AUC (males: 0.033, females: 0.038), and in the integrated discrimination index (males: 0.072; females: 0.058, p < 0.001). Age and CTC were the most important clinical predictors of SA in both sexes. CONCLUSIONS CTC shows a dose-dependent association with atheromatosis burden, impacts more strongly in femoral arteries, and improves SA prediction.
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Affiliation(s)
- Marcelino Bermúdez-López
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain.
| | - Manuel Martí-Antonio
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain
| | - Eva Castro-Boqué
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain
| | - María Del Mar Bretones
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain
| | - Cristina Farràs
- Centre d'Atenció Primària Cappont. Gerència Territorial de Lleida, Institut Català de la Salut, Barcelona, Spain; Research Support Unit Lleida, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gorina (IDIAPJGol), Barcelona, Spain
| | - Jessica Gonzalez
- Departament de Medicina Respiratòria, Hospital Universitari Arnau de Vilanova, Grup Recerca Translational Medicina Respiratòria, IRBLleida, Universitat de Lleida, Lleida, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain
| | - Reinald Pamplona
- Departament de Medicina Experimental, IRBLleida, Universitat de Lleida, Lleida, Spain
| | - Albert Lecube
- Departament d'Endocrinologia i Nutrició, Hospital Universitari Arnau de Vilanova, Grup de Recerca Obesitat i Metabolisme (ODIM), IRBLleida, Universitat de Lleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Dídac Mauricio
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Departament d'Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain; Faculty of Medicine, University of Vic & Central University of Vic, Vic, Spain
| | - Serafi Cambray
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain
| | - José Manuel Valdivielso
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain.
| | - Elvira Fernández
- Grupo de Investigación Translacional vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen. ISCIII), Lleida, Spain
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Azcui Aparicio RE, Carrington MJ, Huynh Q, Ball J, Marwick TH. Association of cardiovascular health and risk prediction algorithms with subclinical atherosclerosis identified by carotid ultrasound. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2023; 4:91-100. [PMID: 37351332 PMCID: PMC10282005 DOI: 10.1016/j.cvdhj.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Background The requirement for laboratory tests to assess conventional cardiovascular disease (CVD) risk may be a barrier to the early detection and management of atherosclerosis in some population groups. A simpler risk assessment could facilitate detection of CVD. Objectives The association of the Fuster-BEWAT Score (FBS), Framingham Risk Score (FRS), and Pooled Cohort Equation (PCE) with the presence of carotid plaque was investigated, with the intention of developing a stepped screening process for the primary prevention of CVD. Methods Asymptomatic participants with a family history of premature CVD had an absolute cardiovascular disease risk (ACVDR) score calculated using the FBS, FRS, and PCE risk equations. This risk classification was compared with the presence or absence of carotid plaque on ultrasound. Prediction of carotid plaque presence by risk scores and risk factors was assessed by logistic regression and area under the curve (AUC) for discrimination and diagnostic performance. A classification and regression-tree (CART) model was obtained for stratification of risk assessment. Results Risk score calculation and ultrasound scanning were performed in 1031 participants, of whom 51 had carotid plaques. Participants with plaque and male sex showed higher risk (higher PCE and FRS and lower FBS, as higher scores of FBS indicate better cardiovascular health). Participants ≤50 years of age showed the FBS was a significant predictor; there was a reduced likelihood of plaque presence with a higher score (OR 0.54, 95% CI 0.39-0.75, P < .01). Higher ACVDR (evidenced by higher PCE and FRS scores and lower FBS score) was associated with an increased likelihood of carotid plaque; however, the FBS and the addition of risk factors not included in the equation showed the highest AUC (AUC = 0.76, P < .001). CART modeling showed that participants with FBS between 6 and 9 would be recommended for further risk stratification using the PCE, whereupon a PCE score ≥5% conferred an increased risk and greater possibility for plaque. Validation of the model using a different cohort showed similar risk stratification for plaque presence according to level of risk by CART analysis. Conclusion FBS was able to identify the presence of carotid plaque in asymptomatic individuals. Its use for initial risk delineation might improve the selection of patients for more specific and complex assessment, reducing cost and time.
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Affiliation(s)
| | - Melinda J. Carrington
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Torrens University Australia, Melbourne, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Jocasta Ball
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Torrens University Australia, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Thomas H. Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Torrens University Australia, Melbourne, Australia
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6
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van Dijk ML, te Loo LM, Vrijsen J, van den Akker-Scheek I, Westerveld S, Annema M, van Beek A, van den Berg J, Boerboom AL, Bouma A, de Bruijne M, Crasborn J, van Dongen JM, Driessen A, Eijkelenkamp K, Goelema N, Holla J, de Jong J, de Joode A, Kievit A, Klooster JV, Kruizenga H, van der Leeden M, Linders L, Marks-Vieveen J, Mulder DJ, Muller F, van Nassau F, Nauta J, Oostvogels S, Oude Sogtoen J, van der Ploeg HP, Rijnbeek P, Schouten L, Schuling R, Serné EH, Smuling S, Soeters MR, Verhagen EALM, Zwerver J, Dekker R, van Mechelen W, Jelsma JGM. LOFIT (Lifestyle front Office For Integrating lifestyle medicine in the Treatment of patients): a novel care model towards community-based options for lifestyle change-study protocol. Trials 2023; 24:114. [PMID: 36803271 PMCID: PMC9936650 DOI: 10.1186/s13063-022-06960-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/25/2022] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND A healthy lifestyle is indispensable for the prevention of noncommunicable diseases. However, lifestyle medicine is hampered by time constraints and competing priorities of treating physicians. A dedicated lifestyle front office (LFO) in secondary/tertiary care may provide an important contribution to optimize patient-centred lifestyle care and connect to lifestyle initiatives from the community. The LOFIT study aims to gain insight into the (cost-)effectiveness of the LFO. METHODS Two parallel pragmatic randomized controlled trials will be conducted for (cardio)vascular disorders (i.e. (at risk of) (cardio)vascular disease, diabetes) and musculoskeletal disorders (i.e. osteoarthritis, hip or knee prosthesis). Patients from three outpatient clinics in the Netherlands will be invited to participate in the study. Inclusion criteria are body mass index (BMI) ≥25 (kg/m2) and/or smoking. Participants will be randomly allocated to either the intervention group or a usual care control group. In total, we aim to include 552 patients, 276 in each trial divided over both treatment arms. Patients allocated to the intervention group will participate in a face-to-face motivational interviewing (MI) coaching session with a so-called lifestyle broker. The patient will be supported and guided towards suitable community-based lifestyle initiatives. A network communication platform will be used to communicate between the lifestyle broker, patient, referred community-based lifestyle initiative and/or other relevant stakeholders (e.g. general practitioner). The primary outcome measure is the adapted Fuster-BEWAT, a composite health risk and lifestyle score consisting of resting systolic and diastolic blood pressure, objectively measured physical activity and sitting time, BMI, fruit and vegetable consumption and smoking behaviour. Secondary outcomes include cardiometabolic markers, anthropometrics, health behaviours, psychological factors, patient-reported outcome measures (PROMs), cost-effectiveness measures and a mixed-method process evaluation. Data collection will be conducted at baseline, 3, 6, 9 and 12 months follow-up. DISCUSSION This study will gain insight into the (cost-)effectiveness of a novel care model in which patients under treatment in secondary or tertiary care are referred to community-based lifestyle initiatives to change their lifestyle. TRIAL REGISTRATION ISRCTN ISRCTN13046877 . Registered 21 April 2022.
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Affiliation(s)
- Marlinde L. van Dijk
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, VU University Medical Center, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, 1081BT Amsterdam, The Netherlands ,grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XQuality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Leonie M. te Loo
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.448984.d0000 0003 9872 5642Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
| | - Joyce Vrijsen
- grid.4494.d0000 0000 9558 4598Department of Orthopedics, Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- grid.4494.d0000 0000 9558 4598Department of Orthopedics, Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sanne Westerveld
- grid.4494.d0000 0000 9558 4598Department of Orthopedics, Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjan Annema
- Department of Orthopedics, Ommelander Hospital Groningen, Scheemda, Groningen, The Netherlands
| | - André van Beek
- grid.4494.d0000 0000 9558 4598Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jip van den Berg
- grid.4494.d0000 0000 9558 4598Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alexander L. Boerboom
- grid.4494.d0000 0000 9558 4598Department of Orthopedics, Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adrie Bouma
- grid.4494.d0000 0000 9558 4598Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martine de Bruijne
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XQuality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jeroen Crasborn
- grid.491477.80000 0004 4907 7789Health Insurance Expertise (formerly Zilveren Kruis), Utrecht, The Netherlands
| | - Johanna M. van Dongen
- grid.12380.380000 0004 1754 9227Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anouk Driessen
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Karin Eijkelenkamp
- grid.4494.d0000 0000 9558 4598Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nies Goelema
- Department of Orthopedics, Ommelander Hospital Groningen, Scheemda, Groningen, The Netherlands
| | - Jasmijn Holla
- grid.448984.d0000 0003 9872 5642Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands ,grid.418029.60000 0004 0624 3484Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Johan de Jong
- grid.411989.c0000 0000 8505 0496Institute of Sports Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Anoek de Joode
- grid.4494.d0000 0000 9558 4598Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arthur Kievit
- grid.7177.60000000084992262Department of Orthopedics, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Josine van’t Klooster
- grid.4494.d0000 0000 9558 4598Department of Strategy, Development and External Relations, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hinke Kruizenga
- grid.509540.d0000 0004 6880 3010Department of Nutrition & Dietetics, Amsterdam UMC location Vrije Universiteit, De Boelelaan, 1117 Amsterdam, The Netherlands
| | - Marike van der Leeden
- grid.16872.3a0000 0004 0435 165XDepartment of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands
| | - Lilian Linders
- grid.448984.d0000 0003 9872 5642Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
| | - Jenny Marks-Vieveen
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Department of Anesthesiology, Amsterdam UMC location Vrije Universiteit, De Boelelaan, 1117 Amsterdam, The Netherlands
| | - Douwe Johannes Mulder
- grid.4494.d0000 0000 9558 4598Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Femmy Muller
- grid.491477.80000 0004 4907 7789Zilveren Kruis, Leiden, The Netherlands
| | - Femke van Nassau
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Joske Nauta
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | | | - Hidde P. van der Ploeg
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Linda Schouten
- Team Sportservice Noord-Holland, Haarlem, The Netherlands
| | - Rhoda Schuling
- grid.411989.c0000 0000 8505 0496Institute of Sports Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Erik H. Serné
- grid.509540.d0000 0004 6880 3010Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit, De Boelelaan, 1117 Amsterdam, The Netherlands
| | - Simone Smuling
- Huis voor de Sport in Groningen, Groningen, The Netherlands
| | - Maarten R. Soeters
- grid.7177.60000000084992262Department of Internal Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Evert A. L. M. Verhagen
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Johannes Zwerver
- grid.4494.d0000 0000 9558 4598Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,grid.415351.70000 0004 0398 026XSports Valley, Sports Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Rienk Dekker
- grid.4494.d0000 0000 9558 4598Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Willem van Mechelen
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Judith G. M. Jelsma
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XQuality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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7
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Ramírez-Garza SL, Laveriano-Santos EP, Arancibia-Riveros C, Carrasco-Jimenez JC, Bodega P, de Cos-Gandoy A, de Miguel M, Santos-Beneit G, Fernández-Alvira JM, Fernández-Jiménez R, Martínez-Gómez J, Estruch R, Lamuela-Raventós RM, Tresserra-Rimbau A. Urinary Nitric Oxide Levels Are Associated with Blood Pressure, Fruit and Vegetable Intake and Total Polyphenol Excretion in Adolescents from the SI! Program. Antioxidants (Basel) 2022; 11:2140. [PMID: 36358511 PMCID: PMC9686949 DOI: 10.3390/antiox11112140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 08/27/2023] Open
Abstract
Nitric oxide (NO) is important to cardiovascular health (CVH), and its bioavailability could be regulated by the antioxidant effect of polyphenols, improving endothelial function and consequently blood pressure (BP). However, scant research has been carried out on NO and CVH correlates in adolescent populations. Therefore, our aim was to investigate the association between NO and the CVH status and other health factors in adolescents. NO, total polyphenol excretion (TPE), anthropometric measurements, BP, blood lipid profile, blood glucose, diet, physical activity, and smoking status were recorded, while CVH score was classified as ideal, intermediate, and poor. Negative associations were observed between NO and body mass index, body fat percentage, BP, and triglycerides; and positive associations between NO and skeletal muscle percentage, HDL-cholesterol, fruit and vegetable intake, and TPE was observed. To capture more complex interactions among different factors, multiple linear regression was performed, obtaining a significant association between NO and fruit and vegetable intake (β = 0.175), TPE (β = 0.225), and systolic BP (β = -0.235). We conclude that urinary NO levels are positively associated with the consumption of fruits and vegetables rich in antioxidants such as polyphenols and negatively associated with systolic BP.
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Affiliation(s)
- Sonia L. Ramírez-Garza
- Departament de Nutrició, Ciències de l’Alimentació i Gastronomia, Xarxa d’Innovació Alimentària (XIA), Facultat de Farmàcia i Ciències de l’Alimentació, Institut de Nutrició i Seguretat Alimentària (INSA-UB), Universitat de Barcelona (UB), 08028 Barcelona, Spain
| | - Emily P. Laveriano-Santos
- Departament de Nutrició, Ciències de l’Alimentació i Gastronomia, Xarxa d’Innovació Alimentària (XIA), Facultat de Farmàcia i Ciències de l’Alimentació, Institut de Nutrició i Seguretat Alimentària (INSA-UB), Universitat de Barcelona (UB), 08028 Barcelona, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28220 Madrid, Spain
| | - Camila Arancibia-Riveros
- Departament de Nutrició, Ciències de l’Alimentació i Gastronomia, Xarxa d’Innovació Alimentària (XIA), Facultat de Farmàcia i Ciències de l’Alimentació, Institut de Nutrició i Seguretat Alimentària (INSA-UB), Universitat de Barcelona (UB), 08028 Barcelona, Spain
| | | | - Patricia Bodega
- Foundation for Science, Health and Education (SHE), 08008 Barcelona, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
| | - Amaya de Cos-Gandoy
- Foundation for Science, Health and Education (SHE), 08008 Barcelona, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
| | - Mercedes de Miguel
- Foundation for Science, Health and Education (SHE), 08008 Barcelona, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
| | - Gloria Santos-Beneit
- Foundation for Science, Health and Education (SHE), 08008 Barcelona, Spain
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- Hospital Universitario Clinico San Carlos, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain
| | | | - Ramón Estruch
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28220 Madrid, Spain
- Department of Internal Medicine, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain
| | - Rosa M. Lamuela-Raventós
- Departament de Nutrició, Ciències de l’Alimentació i Gastronomia, Xarxa d’Innovació Alimentària (XIA), Facultat de Farmàcia i Ciències de l’Alimentació, Institut de Nutrició i Seguretat Alimentària (INSA-UB), Universitat de Barcelona (UB), 08028 Barcelona, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28220 Madrid, Spain
| | - Anna Tresserra-Rimbau
- Departament de Nutrició, Ciències de l’Alimentació i Gastronomia, Xarxa d’Innovació Alimentària (XIA), Facultat de Farmàcia i Ciències de l’Alimentació, Institut de Nutrició i Seguretat Alimentària (INSA-UB), Universitat de Barcelona (UB), 08028 Barcelona, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28220 Madrid, Spain
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8
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Huang B, Huang W, Allen JC, Sun L, Goh HJ, Kong SC, Lee D, Ding C, Bosco N, Egli L, Actis-Goretta L, Magkos F, Arigoni F, Leow MKS, Tan SY, Yeo KK. Prediction of subclinical atherosclerosis in low Framingham risk score individuals by using the metabolic syndrome criteria and insulin sensitivity index. Front Nutr 2022; 9:979208. [PMID: 36352897 PMCID: PMC9639788 DOI: 10.3389/fnut.2022.979208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/23/2022] [Indexed: 11/20/2022] Open
Abstract
Background Subclinical atherosclerosis can be present in individuals with an optimal cardiovascular risk factor profile. Traditional risk scores such as the Framingham risk score do not adequately capture risk stratification in low-risk individuals. The aim of this study was to determine if markers of metabolic syndrome and insulin resistance can better stratify low-risk individuals. Methods A cross-sectional study of 101 healthy participants with a low Framingham risk score and no prior morbidities was performed to assess prevalence of subclinical atherosclerosis using computed tomography (CT) and ultrasound. Participants were compared between groups based on Metabolic Syndrome (MetS) and Insulin-Sensitivity Index (ISI-cal) scores. Results Twenty three individuals (23%) had subclinical atherosclerosis with elevated CT Agatston score ≥1. Presence of both insulin resistance (ISI-cal <9.23) and fulfillment of at least one metabolic syndrome criterion denoted high risk, resulting in significantly improved AUC (0.706 95%CI 0.588–0.822) over the Framingham risk score in predicting elevated CT Agatston score ≥1, with net reclassification index of 50.9 ± 23.7%. High-risk patients by the new classification also exhibited significantly increased carotid intima thickness. Conclusions The overlap of insulin resistance and presence of ≥1 criterion for metabolic syndrome may play an instrumental role in identifying traditionally low-risk individuals predisposed to future risk of atherosclerosis and its sequelae.
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Affiliation(s)
- Benjamin Huang
- Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- *Correspondence: Benjamin Huang
| | - Weiting Huang
- Singapore General Hospital, Singapore, Singapore
- National Heart Center Singapore, Singapore, Singapore
| | | | - Lijuan Sun
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - Hui Jen Goh
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | | | - Dewaine Lee
- National Heart Center Singapore, Singapore, Singapore
| | - Cherlyn Ding
- Nestlé Institute of Health Sciences Singapore, Singapore, Singapore
| | - Nabil Bosco
- Nestlé Institute of Health Sciences Singapore, Singapore, Singapore
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Leonie Egli
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | | | | | - Fabrizio Arigoni
- Nestlé Institute of Health Sciences Singapore, Singapore, Singapore
| | - Melvin Khee-Shing Leow
- Duke-NUS Medical School, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Singapore, Singapore
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Swee Yaw Tan
- National Heart Center Singapore, Singapore, Singapore
| | - Khung Keong Yeo
- Duke-NUS Medical School, Singapore, Singapore
- National Heart Center Singapore, Singapore, Singapore
- Khung Keong Yeo
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9
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Armas-Padrón AM, Sicilia-Sosvilla M, Rodríguez-Bello S, López-Carmona MD, Ruiz-Esteban P, Hernández D. Abnormal ankle-brachial index, cardiovascular risk factors and healthy lifestyle factors in hypertensive patients: prospective cohort study from a primary care urban population. BMC PRIMARY CARE 2022; 23:232. [PMID: 36085011 PMCID: PMC9463763 DOI: 10.1186/s12875-022-01837-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022]
Abstract
Background Peripheral arterial disease (PAD) and arterial stiffness (AS) may be hypertension-mediated vascular lesions. Both are determined by an abnormal ankle-brachial index (ABI) and are predictors of cardiovascular disease (CVD) and mortality. We assessed the relationship in urban hypertensive patients between an abnormal ABI and an ideal cardiovascular health (CVH) score, plus other healthy factors, with unfavourable outcomes. Methods We studied 243 hypertensive patients from a primary care urban population, followed for two years. Clinical data, comorbid conditions, including hypertension-mediated organ damage (HMOD) and hypertension-related comorbidities (HRC), hospitalizations and mortality were also recorded. Results A low prevalence of ideal CVH was observed in urban hypertensive patients. The ABI ≤ 0.9 group (n = 16) showed a higher proportion of prior CVD other than PAD, mortality and hospitalizations than the ABI > 1.4 group (n = 41), and a poorer lipid, metabolic and renal profile. An inverse relationship between CVH score and ABI ≤ 0.9 and unfavourable outcomes (HMOD, HRC, death or hospitalization) was observed. Chronic kidney disease (CKD) and diabetes were independently associated with an ABI ≤ 0.9. Age, sex, diabetes, CKD, ABI ≤ 0.9 and ideal cholesterol were also associated with outcomes, but not other CVH metrics. Conclusions Besides a low prevalence of ideal CVH, an inverse relationship between CVH score and ABI ≤ 0.9 and unfavourable outcomes was observed in hypertensive patients from an urban population. Stronger efforts to promote ideal CVH may improve outcomes in this particular population. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01837-1.
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10
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Bermúdez-López M, Martí-Antonio M, Castro-Boqué E, Bretones MDM, Farràs C, Torres G, Pamplona R, Lecube A, Mauricio D, Valdivielso JM, Fernández E. Development and Validation of a Personalized, Sex-Specific Prediction Algorithm of Severe Atheromatosis in Middle-Aged Asymptomatic Individuals: The ILERVAS Study. Front Cardiovasc Med 2022; 9:895917. [PMID: 35928938 PMCID: PMC9344070 DOI: 10.3389/fcvm.2022.895917] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAlthough European guidelines recommend vascular ultrasound for the assessment of cardiovascular risk in low-to-moderate risk individuals, no algorithm properly identifies patients who could benefit from it. The aim of this study is to develop a sex-specific algorithm to identify those patients, especially women who are usually underdiagnosed.MethodsClinical, anthropometrical, and biochemical data were combined with a 12-territory vascular ultrasound to predict severe atheromatosis (SA: ≥ 3 territories with plaque). A Personalized Algorithm for Severe Atheromatosis Prediction (PASAP-ILERVAS) was obtained by machine learning. Models were trained in the ILERVAS cohort (n = 8,330; 51% women) and validated in the control subpopulation of the NEFRONA cohort (n = 559; 47% women). Performance was compared to the Systematic COronary Risk Evaluation (SCORE) model.ResultsThe PASAP-ILERVAS is a sex-specific, easy-to-interpret predictive model that stratifies individuals according to their risk of SA in low, intermediate, or high risk. New clinical predictors beyond traditional factors were uncovered. In low- and high-risk (L&H-risk) men, the net reclassification index (NRI) was 0.044 (95% CI: 0.020–0.068), and the integrated discrimination index (IDI) was 0.038 (95% CI: 0.029–0.048) compared to the SCORE. In L&H-risk women, PASAP-ILERVAS showed a significant increase in the area under the curve (AUC, 0.074 (95% CI: 0.062–0.087), p-value: < 0.001), an NRI of 0.193 (95% CI: 0.162–0.224), and an IDI of 0.119 (95% CI: 0.109–0.129).ConclusionThe PASAP-ILERVAS improves SA prediction, especially in women. Thus, it could reduce the number of unnecessary complementary explorations selecting patients for a further imaging study within the intermediate risk group, increasing cost-effectiveness and optimizing health resources.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [NCT03228459].
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Affiliation(s)
- Marcelino Bermúdez-López
- Grupo de Investigación Translacional Vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen-ISCIII), Lleida, Spain
| | - Manuel Martí-Antonio
- Grupo de Investigación Translacional Vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen-ISCIII), Lleida, Spain
| | - Eva Castro-Boqué
- Grupo de Investigación Translacional Vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen-ISCIII), Lleida, Spain
| | - María del Mar Bretones
- Grupo de Investigación Translacional Vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen-ISCIII), Lleida, Spain
| | - Cristina Farràs
- Centre d’Atenció Primària Cappont, Gerència Territorial de Lleida, Institut Català de la Salut, Barcelona, Spain
- Research Support Unit Lleida, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gorina (IDIAPJGol), Barcelona, Spain
| | - Gerard Torres
- Departament de Medicina Respiratòria, Hospital Universitari Arnau de Vilanova, Grup Recerca Translational Medicina Respiratòria, IRBLleida, Universitat de Lleida, Lleida, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Reinald Pamplona
- Departament de Medicina Experimental, IRBLleida, Universitat de Lleida, Lleida, Spain
| | - Albert Lecube
- Departament d’Endocrinologia i Nutrició, Hospital Universitari Arnau de Vilanova, Grup de Recerca Obesitat i Metabolisme (ODIM), IRBLleida, Universitat de Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Dídac Mauricio
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Departament d’Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - José Manuel Valdivielso
- Grupo de Investigación Translacional Vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen-ISCIII), Lleida, Spain
- *Correspondence: José Manuel Valdivielso,
| | - Elvira Fernández
- Grupo de Investigación Translacional Vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen-ISCIII), Lleida, Spain
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11
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Jaago M, Pupina N, Rähni A, Pihlak A, Sadam H, Vrana NE, Sinisalo J, Pussinen P, Palm K. Antibody response to oral biofilm is a biomarker for acute coronary syndrome in periodontal disease. Commun Biol 2022; 5:205. [PMID: 35246599 PMCID: PMC8897497 DOI: 10.1038/s42003-022-03122-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/08/2022] [Indexed: 12/15/2022] Open
Abstract
Cumulative evidence over the last decades have supported the role of gum infections as a risk for future major cardiovascular events. The precise mechanism connecting coronary artery disease (CAD) with periodontal findings has remained elusive. Here, we employ next generation phage display mimotope-variation analysis (MVA) to identify the features of dysfunctional immune system that associate CAD with periodontitis. We identify a fine molecular description of the antigenic epitope repertoires of CAD and its most severe form - acute coronary syndrome (ACS) by profiling the antibody reactivity in a patient cohort with invasive heart examination and complete clinical oral assessment. Specifically, we identify a strong immune response to an EBV VP26 epitope mimicking multiple antigens of oral biofilm as a biomarker for the no-CAD group. With a 2-step biomarker test, we stratify subjects with periodontitis from healthy controls (balanced accuracy 84%), and then assess the risk for ACS with sensitivity 71-89% and specificity 67-100%, depending on the oral health status. Our findings highlight the importance of resolving the immune mechanisms related to severe heart conditions such as ACS in the background of oral health. Prospective validation of these findings will support incorporation of these non-invasive biomarkers into clinical practice.
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Affiliation(s)
- Mariliis Jaago
- Protobios Llc, Mäealuse 4, 12618, Tallinn, Estonia.,Department of Chemistry and Biotechnology, Tallinn University of Technology, Akadeemia tee 15, 12618, Tallinn, Estonia
| | | | - Annika Rähni
- Protobios Llc, Mäealuse 4, 12618, Tallinn, Estonia.,Department of Chemistry and Biotechnology, Tallinn University of Technology, Akadeemia tee 15, 12618, Tallinn, Estonia
| | - Arno Pihlak
- Protobios Llc, Mäealuse 4, 12618, Tallinn, Estonia
| | - Helle Sadam
- Protobios Llc, Mäealuse 4, 12618, Tallinn, Estonia.,Department of Chemistry and Biotechnology, Tallinn University of Technology, Akadeemia tee 15, 12618, Tallinn, Estonia
| | - Nihal Engin Vrana
- Spartha Medical, 14B Rue de la Canardiere, 67100, Strasbourg, France
| | - Juha Sinisalo
- Heart and Lung Center, Helsinki University Hospital, and Helsinki University, Helsinki, Finland
| | - Pirkko Pussinen
- Oral and Maxillofacial Diseases, University of Helsinki, FI-00014, Helsinki, Finland
| | - Kaia Palm
- Protobios Llc, Mäealuse 4, 12618, Tallinn, Estonia. .,Department of Chemistry and Biotechnology, Tallinn University of Technology, Akadeemia tee 15, 12618, Tallinn, Estonia.
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12
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Alameri F, Aldaheri N, Almesmari S, Basaloum M, Albeshr NA, Simsekler MCE, Ugwuoke NV, Dalkilinc M, Al Qubaisi M, Campos LA, Almahmeed W, Alefishat E, Al Tunaiji H, Baltatu OC. Burnout and Cardiovascular Risk in Healthcare Professionals During the COVID-19 Pandemic. Front Psychiatry 2022; 13:867233. [PMID: 35444572 PMCID: PMC9014179 DOI: 10.3389/fpsyt.2022.867233] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/25/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The objective of this study was to investigate the psychosocial and cardiovascular markers in healthcare professionals during the COVID-19 pandemic. METHODS This was a STROBE compliant, blended exploratory study. Residents, staff physicians, nurses, and auxiliary healthcare professionals from both inpatient and outpatient medicine services were recruited using a planned random probability sample. The Maslach Burnout Inventory (MBI), Fuster-BEWAT score (FBS), and socio-demographic factors, as well as sleep quality, were studied. The correlations between burnout severity and cardiovascular risk were examined using multivariable linear regression models adjusted for confounding variables, such as sociodemographic and anthropometric characteristics. RESULTS The regression analysis with FBS as the outcome showed a negative association between cardiovascular health and emotional exhaustion [Coef.(95%CI): -0.029 (-0.048, -0.01), p = 0.002]. The higher the emotional exhaustion the lower the cardiovascular health. Further, the model showed a positive association between personal accomplishment and cardiovascular health [Coef.(95%CI): 0.045 (0.007, 0.082), p = 0.02]. Emotional exhaustion was significantly positive correlated with REM sleep and light average (Spearman's rank correlation: 0.37 and 0.35, respectively, with P < 0.05). CONCLUSION The data from this study show that healthcare practitioners who are with burnout and emotional exhaustion have an elevated cardiovascular risk, however, causality cannot be determined. As an adaptive response to stressful situations, REM sleep increases. The findings of this study may be relevant in creating preventive strategies for burnout and cardiovascular risk reduction or prevention. CLINICAL TRIAL REGISTRATION [www.ClinicalTrials.gov], identifier [NCT04422418].
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Affiliation(s)
- Fayeza Alameri
- Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Noura Aldaheri
- Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | | | - Manea Basaloum
- Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | | | | | - Nnamdi Valbosco Ugwuoke
- Department of Pharmacology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | | | - Mai Al Qubaisi
- Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Luciana Aparecida Campos
- Department of Public Health and Epidemiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates.,Center of Innovation, Technology and Education (CITE) at Anhembi Morumbi University - Anima Institute, São José dos Campos, Brazil
| | - Wael Almahmeed
- Heart and Vascular Institute - Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Eman Alefishat
- Department of Pharmacology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates.,Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan.,Center for Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Hashel Al Tunaiji
- Zayed Military Hospital, Abu Dhabi, United Arab Emirates.,Academic and Research Committee, Zayed Military University, Abu Dhabi, United Arab Emirates
| | - Ovidiu Constantin Baltatu
- Department of Pharmacology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates.,Department of Public Health and Epidemiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates.,Center of Innovation, Technology and Education (CITE) at Anhembi Morumbi University - Anima Institute, São José dos Campos, Brazil
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13
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Mishra PP, Mishra BH, Lyytikäinen LP, Hilvo M, Juonala M, Kähönen M, Hutri-Kähönen N, Fotiadis DI, Raitakari OT, Laaksonen R, Lehtimäki T. Assessment of plasma ceramides as predictor for subclinical atherosclerosis. ATHEROSCLEROSIS PLUS 2021; 45:25-31. [PMID: 36643994 PMCID: PMC9833256 DOI: 10.1016/j.athplu.2021.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 01/18/2023]
Abstract
Background and aims Ceramides have been identified as novel biomarkers for cardiovascular disease (CVD) related events and mortality but their role in etiology of subclinical atherosclerosis is unknown. We aimed to assess association between plasma ceramides and carotid intima-media thickness (CIMT) and evaluate predictive value of the ceramides for high CIMT over traditional CVD risk factors. Methods Association between plasma ceramides and CIMT in the Young Finns Study participants was analyzed with CIMT as outcome and ceramides along with traditional risk factors as predictors with regression model. Predictive value of the ceramides and related coronary event risk test (CERT) score for high CIMT as surrogate marker of subclinical atherosclerosis was assessed by comparing logistic regression-based prediction models including, i) traditional risk factors and ceramides, ii) traditional risk factors and CERT score, iii) age, sex and ceramides or alternatively CERT score with a reference model including only traditional risk factors. The prediction models were fitted to training data (70% data) and tested on test data (30% data). The predictive models were assessed with area under the receiver operating curve (AUC). The variance of AUC was estimated by repeating the model fitting and testing for 1000 bootstraps of the original data. Results Predictive models with plasma ceramides or alternatively with CERT score in addition to age and sex variables were able to predict high CIMT with AUC 0.726 and 0.720 respectively. However, the ceramides and CERT score did not have statistically significant added predictive value for high CIMT over traditional risk factors. Conclusions The new systemic biomarkers, high-risk plasma ceramides and CERT score, showed promising predictive performance for high CIMT with only age and sex as additional variables. This may help in predicting subclinical atherosclerosis for primary prevention.
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Affiliation(s)
- Pashupati P. Mishra
- Department of Clinical Chemistry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Finnish Cardiovascular Research Centre, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland,Corresponding author. Faculty of Medicine and Health Technology, Tampere University, Tampere, 33520, Finland.
| | - Binisha H. Mishra
- Department of Clinical Chemistry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Finnish Cardiovascular Research Centre, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Finnish Cardiovascular Research Centre, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | | | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Mika Kähönen
- Finnish Cardiovascular Research Centre, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Department of Clinical Physiology, Tampere University Hospital, Tampere Finland
| | - Nina Hutri-Kähönen
- Department of Paediatrics, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Dimitrios I. Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece,Foundation for Research and Technology-Hellas, Institute of Molecular Biology and Biotechnology, Department of Biomedical Research, Ioannina, Greece
| | - Olli T. Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland,Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku Finland
| | - Reijo Laaksonen
- Department of Clinical Chemistry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Finnish Cardiovascular Research Centre, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Zora Biosciences Oy, Espoo, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Finnish Cardiovascular Research Centre, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
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14
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Michos ED, Khan SS. Further understanding of ideal cardiovascular health score metrics and cardiovascular disease. Expert Rev Cardiovasc Ther 2021; 19:607-617. [PMID: 34053373 DOI: 10.1080/14779072.2021.1937127] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The American Heart Association (AHA) introduced the construct of 'cardiovascular health (CVH)', to focus on primordial prevention to reduce the burden of cardiovascular disease (CVD). The CVH score includes seven health and behavioral metrics (smoking, physical activity, body mass index, diet, total cholesterol, blood pressure, blood glucose), which are characterized as being ideal, intermediate, or poor. AREAS COVERED In this review, we describe the utility of the CVH score for monitoring and promoting wellness, overall and by key sociodemographic groups, and for tracking of temporal trends. EXPERT OPINION Notably, the seven factors are all modifiable, which differs from 10-year CVD risk scores that include non-modifiable components such as age, sex, and race. Numerous epidemiological studies have shown that achievement of a greater number of ideal CVH metrics is associated with lower incidences of CVD, cardiovascular mortality, and all-cause mortality. Longer duration of favorable CVH is associated with greater longevity and compressed morbidity. Nevertheless, the prevalence of favorable CVH is low, with <20% of U.S. adults meeting ≥5 metrics at ideal levels and significant racial/ethnic disparities persist. Many challenges must be overcome to improve CVH at individual and societal levels if the AHA Impact Goals are to be fully realized.
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Affiliation(s)
- Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sadiya S Khan
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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15
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Raposeiras-Roubin S, Rosselló X, Oliva B, Fernández-Friera L, Mendiguren JM, Andrés V, Bueno H, Sanz J, Martínez de Vega V, Abu-Assi E, Iñiguez A, Fernández-Ortiz A, Ibáñez B, Fuster V. Triglycerides and Residual Atherosclerotic Risk. J Am Coll Cardiol 2021; 77:3031-3041. [PMID: 34140107 PMCID: PMC8215641 DOI: 10.1016/j.jacc.2021.04.059] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/05/2021] [Accepted: 04/16/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Even when low-density lipoprotein-cholesterol (LDL-C) levels are lower than guideline thresholds, a residual risk of atherosclerosis remains. It is unknown whether triglyceride (TG) levels are associated with subclinical atherosclerosis and vascular inflammation regardless of LDL-C. OBJECTIVES This study sought to assess the association between serum TG levels and early atherosclerosis and vascular inflammation in apparently healthy individuals. METHODS An observational, longitudinal, and prospective cohort study, including 3,754 middle-aged individuals with low to moderate cardiovascular risk from the PESA (Progression of Early Subclinical Atherosclerosis) study who were consecutively recruited between June 2010 and February 2014, was conducted. Peripheral atherosclerotic plaques were assessed by 2-dimensional vascular ultrasound, and coronary artery calcification (CAC) was assessed by noncontrast computed tomography, whereas vascular inflammation was assessed by fluorine-18 fluorodeoxyglucose uptake on positron emission tomography. RESULTS Atherosclerotic plaques and CAC were observed in 58.0% and 16.8% of participants, respectively, whereas vascular inflammation was evident in 46.7% of evaluated participants. After multivariate adjustment, TG levels ≥150 mg/dl showed an association with subclinical noncoronary atherosclerosis (odds ratio [OR]: 1.35; 95% confidence interval [CI]: 1.08 to 1.68; p = 0.008). This association was significant for groups with high LDL-C (OR: 1.42; 95% CI: 1.11 to 1.80; p = 0.005) and normal LDL-C (OR: 1.85; 95% CI: 1.08 to 3.18; p = 0.008). No association was found between TG level and CAC score. TG levels ≥150 mg/dl were significantly associated with the presence of arterial inflammation (OR: 2.09; 95% CI: 1.29 to 3.40; p = 0.003). CONCLUSIONS In individuals with low to moderate cardiovascular risk, hypertriglyceridemia was associated with subclinical atherosclerosis and vascular inflammation, even in participants with normal LDL-C levels. (Progression of Early Subclinical Atherosclerosis [PESA]; NCT01410318).
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Affiliation(s)
- Sergio Raposeiras-Roubin
- National Center for Cardiovascular Research (CNIC), Madrid, Spain; Department of Cardiology, Álvaro Cunqueiro University Hospital, Vigo, Spain. https://twitter.com/Borjaibanez1
| | - Xavier Rosselló
- National Center for Cardiovascular Research (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red Consortium for Cardiovascular Diseases (CIBERCV), Madrid, Spain; Department of Cardiology, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Belén Oliva
- National Center for Cardiovascular Research (CNIC), Madrid, Spain
| | - Leticia Fernández-Friera
- National Center for Cardiovascular Research (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red Consortium for Cardiovascular Diseases (CIBERCV), Madrid, Spain; Comprehensive Cardiovascular Diseases Center, HM Montepríncipe University Hospital, Madrid, Spain
| | | | - Vicente Andrés
- National Center for Cardiovascular Research (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red Consortium for Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Héctor Bueno
- National Center for Cardiovascular Research (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red Consortium for Cardiovascular Diseases (CIBERCV), Madrid, Spain; Health Research Institute, October 12 Hospital (imas12), Madrid, Spain
| | - Javier Sanz
- National Center for Cardiovascular Research (CNIC), Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vicente Martínez de Vega
- National Center for Cardiovascular Research (CNIC), Madrid, Spain; Quirón University Hospital, Madrid, Spain
| | - Emad Abu-Assi
- Department of Cardiology, Álvaro Cunqueiro University Hospital, Vigo, Spain; Centro de Investigación Biomédica en Red Consortium for Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Andrés Iñiguez
- Department of Cardiology, Álvaro Cunqueiro University Hospital, Vigo, Spain; Centro de Investigación Biomédica en Red Consortium for Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Antonio Fernández-Ortiz
- National Center for Cardiovascular Research (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red Consortium for Cardiovascular Diseases (CIBERCV), Madrid, Spain; Health Research Institute Clínico San Carlos Hospital, Complutense University, Madrid, Spain
| | - Borja Ibáñez
- National Center for Cardiovascular Research (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red Consortium for Cardiovascular Diseases (CIBERCV), Madrid, Spain; Health Research Institute, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
| | - Valentin Fuster
- National Center for Cardiovascular Research (CNIC), Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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16
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Xia C, Vonder M, Sidorenkov G, Den Dekker M, Oudkerk M, van Bolhuis JN, Pelgrim GJ, Rook M, de Bock GH, van der Harst P, Vliegenthart R. Cardiovascular Risk Factors and Coronary Calcification in a Middle-aged Dutch Population: The ImaLife Study. J Thorac Imaging 2021; 36:174-180. [PMID: 33060489 PMCID: PMC8132906 DOI: 10.1097/rti.0000000000000566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess the presence of coronary artery calcium (CAC) and its association with cardiovascular risk factors and Systematic COronary Risk Evaluation (SCORE) risk in a middle-aged Dutch population. METHODS Classic cardiovascular risk factors and CAC were analyzed in 4083 participants aged 45 to 60 years (57.9% women) from the population-based ImaLife study. CAC scores were quantified on noncontrast cardiac CT scans. Age-specific and sex-specific distribution of CAC categories (0, 1 to 99, 100 to 299, ≥300) and percentiles were determined. SCORE risk categories (<1%, ≥1% to 5%, and ≥5%) were compared with CAC distribution. Population attributable fractions (PAFs) of classic risk factors for CAC were estimated. RESULTS CAC was present in 54.5% male and 26.5% female participants. The percentage of individuals with CAC increased with increasing age. Mean SCORE was 2.0% in men and 0.7% in women. In SCORE <1%, 32.7% of men and 17.1% of women had CAC. In men with SCORE ≥5%, 26.9% had no CAC. Only 0.1% of women had SCORE ≥5%. PAF of classic risk factors for CAC was 18.5% in men and 31.4% in women. PAF was highest for hypertension (in men 8.0%, 95% confidence interval, 4.2%-11.8%; in women 13.1%, 95% confidence interval, 7.9%-18.2%) followed by hypercholesterolemia and obesity. CONCLUSION In this middle-aged cohort, more than half of the men and a quarter of the women had CAC. One out of 4 men at high risk (SCORE ≥5%) could be placed into a lower risk category owing to absence of CAC. Thus, adding CAC scoring to SCORE could have considerable effect on cardiovascular risk classification. Elimination of exposure to classic risk factors could reduce limited proportion of CAC in a middle-aged population.
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Affiliation(s)
| | | | | | | | | | | | | | - Mieneke Rook
- Department of Radiology, Martini Hospital Groningen, Groningen, The Netherlands
| | | | - Pim van der Harst
- Cardiology, University Medical Center Groningen, University of Groningen
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17
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Aguilar-Palacio I, Malo S, Jarauta E, Moreno-Franco B, Maldonado L, Compés L, Rabanaque MJ, Casasnovas JA. Pharmacological Primary Cardiovascular Prevention and Subclinical Atherosclerosis in Men: Evidence from the Aragon Workers' Health Study. J Clin Med 2021; 10:jcm10050945. [PMID: 33804382 PMCID: PMC7957801 DOI: 10.3390/jcm10050945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 11/16/2022] Open
Abstract
The objective of this study is to describe the profile of primary preventive treatment for cardiovascular disease in adult males and to analyze the association between treatment profile and subclinical atherosclerosis. We selected male workers who had undergone ultrasound imaging and had no previous history of cardiovascular disease (n = 2138). Data on the consumption of primary cardiovascular drugs from the previous year were obtained. We performed bivariate analyses to compare patient characteristics according to cardiovascular treatment and the presence of subclinical atherosclerosis, and logistic regression models to explore the association between these two variables. Among participants with no personal history of cardiovascular disease, subclinical atherosclerosis was present in 77.7% and 31.2% had received some form of preventive treatment. Of those who received no preventive treatment, 73.6% had subclinical atherosclerosis. Cardiovascular preventive treatment was associated only with CACS > 0 (odds ratio (OR), 1.37; 95% confidence interval (95% CI), 1.06-1.78). Statin treatment was associated with a greater risk of any type of subclinical atherosclerosis (OR, 1.73) and with CACS > 0 (OR, 1.72). Subclinical atherosclerosis existed in almost 75% of men who had no personal history of cardiovascular disease and had not received preventive treatment for cardiovascular disease.
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Affiliation(s)
- Isabel Aguilar-Palacio
- Preventive Medicine and Public Health Department, University of Zaragoza, 50009 Zaragoza, Spain; (I.A.-P.); (B.M.-F.); (M.J.R.)
- Instituto Aragonés de Ciencias de Salud, IIS Aragón, 50009 Zaragoza, Spain; (E.J.); (J.A.C.)
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA) IIS Aragón, 50009 Zaragoza, Spain;
| | - Sara Malo
- Preventive Medicine and Public Health Department, University of Zaragoza, 50009 Zaragoza, Spain; (I.A.-P.); (B.M.-F.); (M.J.R.)
- Instituto Aragonés de Ciencias de Salud, IIS Aragón, 50009 Zaragoza, Spain; (E.J.); (J.A.C.)
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA) IIS Aragón, 50009 Zaragoza, Spain;
- Correspondence:
| | - Estibaliz Jarauta
- Instituto Aragonés de Ciencias de Salud, IIS Aragón, 50009 Zaragoza, Spain; (E.J.); (J.A.C.)
- Hospital Universitario Miguel Servet, IIS Aragón, 50009 Zaragoza, Spain
| | - Belén Moreno-Franco
- Preventive Medicine and Public Health Department, University of Zaragoza, 50009 Zaragoza, Spain; (I.A.-P.); (B.M.-F.); (M.J.R.)
- Instituto Aragonés de Ciencias de Salud, IIS Aragón, 50009 Zaragoza, Spain; (E.J.); (J.A.C.)
| | - Lina Maldonado
- Department of Economic Structure, Economic History and Public Economics, University of Zaragoza, 50009 Zaragoza, Spain;
| | - Luisa Compés
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA) IIS Aragón, 50009 Zaragoza, Spain;
- Dirección General de Salud Pública, Gobierno de Aragón, 50009 Zaragoza, Spain
| | - Mª José Rabanaque
- Preventive Medicine and Public Health Department, University of Zaragoza, 50009 Zaragoza, Spain; (I.A.-P.); (B.M.-F.); (M.J.R.)
- Instituto Aragonés de Ciencias de Salud, IIS Aragón, 50009 Zaragoza, Spain; (E.J.); (J.A.C.)
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA) IIS Aragón, 50009 Zaragoza, Spain;
| | - José Antonio Casasnovas
- Instituto Aragonés de Ciencias de Salud, IIS Aragón, 50009 Zaragoza, Spain; (E.J.); (J.A.C.)
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18
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Lee MT, Mahtta D, Alam M, Ullah W, Nasir K, Hanif B, Virani SS. Contemporary outcomes studies to identify and mitigate the risk in patients with premature cardiovascular disease. Expert Rev Pharmacoecon Outcomes Res 2021; 21:559-570. [DOI: 10.1080/14737167.2021.1888718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Michelle T. Lee
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, USA
| | - Dhruv Mahtta
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, USA
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, USA
| | - Mahboob Alam
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, USA
| | - Waqas Ullah
- Department of Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Khurram Nasir
- Department of Cardiology, Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
- Division of Cardiovascular Prevention and Wellness, Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Bashir Hanif
- Section of Cardiology, Tabba Heart Institute, Karachi, Pakistan
| | - Salim S. Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, USA
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, USA
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19
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Colonnello E, Ciocca G, Limoncin E, Sansone A, Jannini EA. Redefining a sexual medicine paradigm: subclinical premature ejaculation as a new taxonomic entity. Nat Rev Urol 2021; 18:115-127. [PMID: 33442049 DOI: 10.1038/s41585-020-00417-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 01/29/2023]
Abstract
Premature ejaculation (PE) and poor ejaculatory control are multidimensional sexual symptoms estimated to affect almost one-third of men, severely impairing the overall quality of life of patients and their partners. However, patients who do not completely fulfil the definition criteria for PE rarely receive a diagnosis or adequate treatment, with the risk of subsequent progression from initial, subclinical symptoms to clinically overt PE, frequently with other sexual comorbidities. Thus, the current definitions of PE warrant review, in order to consider and propose a new taxonomy encompassing other unaddressed, crucial clinical aspects of PE. These newly proposed criteria include the recommendation for a primary screening for erectile dysfunction (ED), as PE and ED can be comorbid in up to 50% of patients but have never before been considered as a unified clinical entity. In order to facilitate clinical practice and improve clinical management of men with PE and comorbid conditions, we propose and define the new taxonomic clinical entities of subclinical PE (SPE) and loss of control of erection and ejaculation (LCEE). Application of these diagnoses to men who meet the criteria for SPE and/or LCEE, but not the overt conditions, could improve access to treatment for these patients and reduce progression to the more serious clinical disorder.
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Affiliation(s)
- Elena Colonnello
- Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giacomo Ciocca
- Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Clinical Psychosexology, Department of Dynamic and Clinical Psychology, University of Rome Sapienza, Rome, Italy
| | - Erika Limoncin
- Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Sansone
- Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Emmanuele A Jannini
- Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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20
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Wu YJ, Mar GY, Wu MT, Wu FZ. A LASSO-Derived Risk Model for Subclinical CAC Progression in Asian Population With an Initial Score of Zero. Front Cardiovasc Med 2021; 7:619798. [PMID: 33521068 PMCID: PMC7843450 DOI: 10.3389/fcvm.2020.619798] [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: 10/21/2020] [Accepted: 12/11/2020] [Indexed: 01/03/2023] Open
Abstract
Background: This study is aimed at developing a prediction nomogram for subclinical coronary atherosclerosis in an Asian population with baseline zero score, and to compare its discriminatory ability with Framingham risk score (FRS) and atherosclerotic cardiovascular disease (ASCVD) models. Methods: Clinical characteristics, physical examination, and laboratory profiles of 830 subjects were retrospectively reviewed. Subclinical coronary atherosclerosis in term of Coronary artery calcification (CAC) progression was the primary endpoint. A nomogram was established based on a least absolute shrinkage and selection operator (LASSO)-derived logistic model. The discrimination and calibration ability of this nomogram was evaluated by Hosmer-Lemeshow test and calibration curves in the training and validation cohort. Results: Of the 830 subjects with baseline zero score with the average follow-up period of 4.55 ± 2.42 year in the study, these subjects were randomly placed into the training set or validation set at a ratio of 2.8:1. These study results showed in the 612 subjects with baseline zero score, 145 (23.69%) subjects developed CAC progression in the training cohort (N = 612), while in the validation cohort (N = 218), 51 (23.39%) subjects developed CAC progression. This LASSO-derived nomogram included the following 10 predictors: "sex," age," "hypertension," "smoking habit," "Gamma-Glutamyl Transferase (GGT)," "C-reactive protein (CRP)," "high-density lipoprotein cholesterol (HDL-C)," "cholesterol," "waist circumference," and "follow-up period." Compared with the FRS and ASCVD models, this LASSO-derived nomogram had higher diagnostic performance and lower Akaike information criterion (AIC) and Bayesian information criterion (BIC) value. The discriminative ability, as determined by the area under receiver operating characteristic curve was 0.780 (95% confidence interval: 0.731-0.829) in the training cohort and 0.836 (95% confidence interval: 0.761-0.911) in the validation cohort. Moreover, satisfactory calibration was confirmed by Hosmer-Lemeshow test with P-values of 0.654 and 0.979 in the training cohort and validation cohort. Conclusions: This validated nomogram provided a useful predictive value for subclinical coronary atherosclerosis in subjects with baseline zero score, and could provide clinicians and patients with the primary preventive strategies timely in individual-based preventive cardiology.
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Affiliation(s)
- Yun-Ju Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Health Care Administration, Chang Jung Christian University, Tainan, Taiwan
| | - Guang-Yuan Mar
- Physical Examination Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ming-Ting Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Fu-Zong Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
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21
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Al Tunaiji H, Al Qubaisi M, Dalkilinc M, Campos LA, Ugwuoke NV, Alefishat E, Aloum L, Ross R, Almahmeed W, Baltatu OC. Impact of COVID-19 Pandemic Burnout on Cardiovascular Risk in Healthcare Professionals Study Protocol: A Multicenter Exploratory Longitudinal Study. Front Med (Lausanne) 2020; 7:571057. [PMID: 33415114 PMCID: PMC7783289 DOI: 10.3389/fmed.2020.571057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/23/2020] [Indexed: 01/19/2023] Open
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic has created new and unpredictable challenges for healthcare systems. Healthcare professionals are heavily affected by this rapidly changing situation, especially frontline healthcare professionals who are directly engaged in the diagnosis, treatment, and care of patients with COVID-19 and may experience psychological burdens. The objective of this study is to explore the evolution of psychosocial, cardiovascular, and immune markers in healthcare professionals with different levels of exposure to the COVID-19 pandemic. Methods and Analysis: This is a STROBE compliant, blended, exploratory study involving online and onsite approaches that use wearable monitoring. A planned random probability sample of residents, staff physicians, nurses, and auxiliary healthcare professionals will be recruited. The study sample will be stratified by exposure to the COVID-19 pandemic. As a first step, recruitment will be conducted online, with e-consent and using e-surveys with Maslach Burnout Inventory, Fuster-BEWAT score, and sociodemographic characteristics. Onsite visits will be planned for the second step where participants will receive a wearable setup that will measure heart rate, actimetry, and sleep quality monitoring, which will be used together with blood sampling for immune biomarkers. Steps 1 and 2 will then be repeated at 2-3 months, and 6 months. Power BI and Tableau will be used for data visualization, while front-end data capture will be used for data collection using specific survey/questionnaires, which will enable data linkage between e-surveys, internet of things wearable devices, and clinical laboratory data. Clinical Trial Registration: ClinicalTrials.gov; Identifier: NCT04422418.
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Affiliation(s)
| | - Mai Al Qubaisi
- Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | | | - Luciana Aparecida Campos
- College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates.,Center of Innovation, Technology and Education (CITE), Sao Jose dos Campos Technology Park, Sao Jose dos Campos, Brazil.,Institute of Biomedical Engineering, Anhembi Morumbi University-Laureate International Universities, Sao Jose dos Campos, Brazil
| | | | - Eman Alefishat
- College of Medicine & Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Lujain Aloum
- College of Medicine & Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Ramzy Ross
- Myriad Global Solutions, Abu Dhabi, United Arab Emirates
| | - Wael Almahmeed
- Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Ovidiu Constantin Baltatu
- Center of Innovation, Technology and Education (CITE), Sao Jose dos Campos Technology Park, Sao Jose dos Campos, Brazil.,Institute of Biomedical Engineering, Anhembi Morumbi University-Laureate International Universities, Sao Jose dos Campos, Brazil.,College of Medicine & Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
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22
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de Yébenes VG, Briones AM, Martos-Folgado I, Mur SM, Oller J, Bilal F, González-Amor M, Méndez-Barbero N, Silla-Castro JC, Were F, Jiménez-Borreguero LJ, Sánchez-Cabo F, Bueno H, Salaices M, Redondo JM, Ramiro AR. Aging-Associated miR-217 Aggravates Atherosclerosis and Promotes Cardiovascular Dysfunction. Arterioscler Thromb Vasc Biol 2020; 40:2408-2424. [PMID: 32847388 PMCID: PMC7505150 DOI: 10.1161/atvbaha.120.314333] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Supplemental Digital Content is available in the text. Objective: microRNAs are master regulators of gene expression with essential roles in virtually all biological processes. miR-217 has been associated with aging and cellular senescence, but its role in vascular disease is not understood. Approach and Results: We have used an inducible endothelium-specific knock-in mouse model to address the role of miR-217 in vascular function and atherosclerosis. miR-217 reduced NO production and promoted endothelial dysfunction, increased blood pressure, and exacerbated atherosclerosis in proatherogenic apoE−/− mice. Moreover, increased endothelial miR-217 expression led to the development of coronary artery disease and altered left ventricular heart function, inducing diastolic and systolic dysfunction. Conversely, inhibition of endogenous vascular miR-217 in apoE−/− mice improved vascular contractility and diminished atherosclerosis. Transcriptome analysis revealed that miR-217 regulates an endothelial signaling hub and downregulates a network of eNOS (endothelial NO synthase) activators, including VEGF (vascular endothelial growth factor) and apelin receptor pathways, resulting in diminished eNOS expression. Further analysis revealed that human plasma miR-217 is a biomarker of vascular aging and cardiovascular risk. Conclusions: Our results highlight the therapeutic potential of miR-217 inhibitors in aging-related cardiovascular disease.
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Affiliation(s)
- Virginia G de Yébenes
- Department of Vascular Physiopathology, B Lymphocyte Biology Lab (V.G.d.Y., I.M.-F., S.M.M., F.B., A.R.R.), Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.,Department of Immunology, Ophthalmology and ENT, Complutense University School of Medicine, 12 de Octubre Health Research Institute, Madrid, Spain (V.G.d.Y.)
| | - Ana M Briones
- Departamento de Farmacología, Facultad de Medicina, Universidad Autónoma de Madrid, Instituto de Investigación Hospital Universitario La Paz, Spain (A.M.B., M.G.-A., M.S.).,CIBER de Enfermedades Cardiovasculares, Spain (A.M.B., M.G.-A., M.S., J.M.R.)
| | - Inmaculada Martos-Folgado
- Department of Vascular Physiopathology, B Lymphocyte Biology Lab (V.G.d.Y., I.M.-F., S.M.M., F.B., A.R.R.), Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Sonia M Mur
- Department of Vascular Physiopathology, B Lymphocyte Biology Lab (V.G.d.Y., I.M.-F., S.M.M., F.B., A.R.R.), Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Jorge Oller
- Gene Regulation in Cardiovascular Remodelling and Inflammation Lab (J.O., N.M.-B., J.M.R.), Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Faiz Bilal
- Department of Vascular Physiopathology, B Lymphocyte Biology Lab (V.G.d.Y., I.M.-F., S.M.M., F.B., A.R.R.), Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - María González-Amor
- Departamento de Farmacología, Facultad de Medicina, Universidad Autónoma de Madrid, Instituto de Investigación Hospital Universitario La Paz, Spain (A.M.B., M.G.-A., M.S.).,CIBER de Enfermedades Cardiovasculares, Spain (A.M.B., M.G.-A., M.S., J.M.R.)
| | - Nerea Méndez-Barbero
- Gene Regulation in Cardiovascular Remodelling and Inflammation Lab (J.O., N.M.-B., J.M.R.), Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Juan Carlos Silla-Castro
- Bioinformatics Unit, Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (J.C.S.-C., F.W., F.S.-C.)
| | - Felipe Were
- Bioinformatics Unit, Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (J.C.S.-C., F.W., F.S.-C.)
| | | | - Fátima Sánchez-Cabo
- Bioinformatics Unit, Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (J.C.S.-C., F.W., F.S.-C.)
| | - Héctor Bueno
- Department of Cell & Developmental Biology, Multidisciplinary Translational Cardiovascular Research (H.B.), Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Mercedes Salaices
- Departamento de Farmacología, Facultad de Medicina, Universidad Autónoma de Madrid, Instituto de Investigación Hospital Universitario La Paz, Spain (A.M.B., M.G.-A., M.S.).,CIBER de Enfermedades Cardiovasculares, Spain (A.M.B., M.G.-A., M.S., J.M.R.)
| | - Juan Miguel Redondo
- Gene Regulation in Cardiovascular Remodelling and Inflammation Lab (J.O., N.M.-B., J.M.R.), Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.,Departamento de Farmacología, Facultad de Medicina, Universidad Autónoma de Madrid, Instituto de Investigación Hospital Universitario La Paz, Spain (A.M.B., M.G.-A., M.S.).,CIBER de Enfermedades Cardiovasculares, Spain (A.M.B., M.G.-A., M.S., J.M.R.)
| | - Almudena R Ramiro
- Department of Vascular Physiopathology, B Lymphocyte Biology Lab (V.G.d.Y., I.M.-F., S.M.M., F.B., A.R.R.), Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
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23
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Mahtta D, Khalid U, Misra A, Samad Z, Nasir K, Virani SS. Premature Atherosclerotic Cardiovascular Disease: What Have We Learned Recently? Curr Atheroscler Rep 2020; 22:44. [PMID: 32671484 DOI: 10.1007/s11883-020-00862-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW In contrast to patients with non-premature atherosclerotic cardiovascular disease (ASCVD), patients with premature ASCVD have not observed a similar decline in cardiovascular mortality and recurrent adverse events. We sought to review the underlying risk factors, potential gaps in medical management, associated outcomes, and tools for risk prognostication among patients with premature ASCVD. RECENT FINDINGS In addition to traditional cardiovascular risk factors (i.e., diabetes, familial hypercholesterolemia), non-traditional risk factors such as chronic inflammatory conditions, recreational drug use, genetics, and pregnancy-related complications play a key role in development and progression of premature ASCVD. Patients with premature ASCVD, and especially women, receive less optimal medical management as compared to their non-premature counterparts. There is an increasing prevalence of cardiovascular risk factors among young adults. Hence, this population remains at an elevated risk for premature ASCVD and subsequent adverse cardiovascular events. Future studies evaluating different risk assessment tools and focusing on young patients across all three major domains of ASCVD are needed.
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Affiliation(s)
- Dhruv Mahtta
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA.,Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Umair Khalid
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA
| | - Arunima Misra
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA
| | - Zainab Samad
- Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Khurram Nasir
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Salim S Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA. .,Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA. .,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.
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24
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Marin M, Bia D, Zócalo Y. Carotid and Femoral Atherosclerotic Plaques in Asymptomatic and Non-Treated Subjects: Cardiovascular Risk Factors, 10-Years Risk Scores, and Lipid Ratios´ Capability to Detect Plaque Presence, Burden, Fibro-Lipid Composition and Geometry. J Cardiovasc Dev Dis 2020; 7:E11. [PMID: 32204546 PMCID: PMC7151111 DOI: 10.3390/jcdd7010011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 12/24/2022] Open
Abstract
Carotid and/or femoral atherosclerotic plaques (AP) assessment through imaging studies is an interesting strategy for improving individual cardiovascular risk (CVR) stratification and cardiovascular disease (CVD) and/or events prediction. There is no consensus on who would benefit from image screening aimed at determining AP presence, burden, and characteristics. AIMS (1) to identify, in asymptomatic and non-treated subjects, demographic factors, anthropometric characteristics and cardiovascular risk factors (CRFs), individually or grouped (e.g., CVR equations, pro-atherogenic lipid ratios) associated with carotid and femoral AP presence, burden, geometry, and fibro-lipid content; (2) to identify cut-off values to be used when considering the variables as indicators of increased probability of AP presence, elevated atherosclerotic burden, and/or lipid content, in a selection scheme for subsequent image screening. METHODS CRFs exposure and clinical data were obtained (n = 581; n = 144 with AP; 47% females). Arterial (e.g., ultrasonography) and hemodynamic (central [cBP] and peripheral blood pressure; oscillometry/applanation tonometry) data were obtained. Carotid and femoral AP presence, burden (e.g., AP number, involved territories), geometric (area, width, height) and fibro-lipid content (semi-automatic, virtual histology analysis, grayscale analysis and color mapping) were assessed. Lipid profile was obtained. Lipid ratios (Total cholesterol/HDL-cholesterol, LDL-cholesterol/HDL-cholesterol, LogTryglicerides(TG)/HDL-cholesterol) and eight 10-years [y.]/CVR scores were quantified (e.g., Framingham Risk Scores [FRS] for CVD). RESULTS Age, 10-y./CVR and cBP showed the highest levels of association with AP presence and burden. Individually, classical CRFs and lipid ratios showed almost no association with AP presence. 10-y./CVR levels, age and cBP enabled detecting AP with large surfaces (˃p75th). Lipid ratios showed the largest association with AP fibro-lipid content. Ultrasound evaluation could be considered in asymptomatic and non-treated subjects aiming at population screening of AP (e.g., ˃ 45 y.; 10-y./FRS-CVD ˃ 5-8%); identifying subjects with high atherosclerotic burden (e.g., ˃50 y., 10-y./FRS-CVD ˃ 13-15%) and/or with plaques with high lipid content (e.g., LogTG/HDL ˃ 0.135).
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25
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Impacto de Life's Simple 7 en la incidencia de eventos cardiovasculares mayores en adultos españoles con alto riesgo de la cohorte del estudio PREDIMED. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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26
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Latina J, Fernandez-Jimenez R, Bansilal S, Sartori S, Vedanthan R, Lewis M, Kofler C, Hunn M, Martin F, Bagiella E, Farkouh M, Fuster V. Grenada Heart Project-Community Health ActioN to EncouraGe healthy BEhaviors (GHP-CHANGE): A randomized control peer group-based lifestyle intervention. Am Heart J 2020; 220:20-28. [PMID: 31765932 DOI: 10.1016/j.ahj.2019.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 08/28/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence of cardiovascular (CV) risk factors is increasing globally, with a disproportionate burden in the low and low-middle income countries (L/LMICs). Peer support, as a low-cost lifestyle intervention, has succeeded in managing chronic illness. For global CV risk reduction, limited data exists in LMICs. AIM The GHP-CHANGE was designed as a community-based randomized trial to test the effectiveness of peer support strategy for CV risk reduction in the island of Grenada, a LMIC. METHODS We recruited 402 adults from the Grenada Heart Project (GHP) Cohort Study of 2827 subjects with at least two CV risk factors. Subjects were randomized in a 1:1 fashion to a peer-group based intervention group (n = 206) or a self-management control group (n = 196) for 12 months. The primary outcome was the change from baseline in a composite score related to Blood pressure, Exercise, Weight, Alimentation and Tobacco (FBS, Fuster-BEWAT Score), ranging from 0 to 15 (ideal health = 15). Linear mixed-effects models were used to test for intervention effects. RESULTS Participants mean age was 51.4 years (SD 14.5) years, two-thirds were female, and baseline mean FBS was 8.9 (SD 2.6) and 8.5 (SD 2.6) in the intervention and control group, respectively (P = .152). At post intervention, the mean FBS was higher in the intervention group compared to the control group [9.1 (SD 2.7) vs 8.5 (SD 2.6), P = .028]. When balancing baseline health profile, the between-group difference (intervention vs. control) in the change of FBS was 0.31 points (95% CI: -0.12 to 0.75; P = .154). CONCLUSIONS The GHP-CHANGE trial showed that a peer-support lifestyle intervention program was feasible; however, it did not demonstrate a significant improvement in the FBS as compared to the control group. Further studies should assess the effects of low-cost lifestyle interventions in LMICs.
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27
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Different Lifestyle Interventions in Adults From Underserved Communities. J Am Coll Cardiol 2020; 75:42-56. [DOI: 10.1016/j.jacc.2019.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 11/19/2022]
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28
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Lifetime cardiovascular risk is associated with a multimarker score of systemic oxidative status in young adults independently of traditional risk factors. Transl Res 2019; 212:54-66. [PMID: 31295436 DOI: 10.1016/j.trsl.2019.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 12/28/2022]
Abstract
Cardiovascular risk (CVR) tends to be estimated in the short-term, which underestimates lifetime (LT)-CVR of young subjects. We determined whether LT-CVR is associated with a multimarker score of oxidative status in young adults and whether this association is independent of traditional CVR factors. Seventy-two young adults were stratified into: (1) low or (2) high LT-CVR, and (3) stable coronary artery disease (SCAD). CVR was estimated with QRisk and atherosclerotic CV disease (ASCVD) risk estimators, or second manifestations of arterial disease (SMART). Risk score. oxidative damage was determined by measuring carbonyls, oxidized LDL (oxLDL), 8-hydroxy-2'-deoxyguanosine (8-OHdG), and xanthine oxidase activity. Antioxidant defence was determined by total antioxidant capacity (TAC), catalase (CAT) activity and superoxide dismutase (SOD) activity. Multimarker scores of systemic oxidative damage (OxyScore) and antioxidant defence (AntioxyScore) were computed as standardized variables. Subjects with high LT-CVR had significantly higher levels of oxLDL, 8-OHdG, TAC, and CAT activity than subjects with low LT-CVR or with SCAD. QRisk and ASCVD estimators correlated positively with oxLDL, TAC, and CAT activity, while SMART Risk Score correlated with carbonyls and SOD activity. OxyScore and AntioxyScore were significantly higher in subjects with high LT-CVR than with low LT-CVR or with SCAD. OxyScore, but not AntioxyScore, was associated with LT-CVR independently of each traditional CVR factor. This study for the first time demonstrates a positive association between oxidative stress and the risk of first and recurrent CV events in young adults.
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Díez-Espino J, Buil-Cosiales P, Babio N, Toledo E, Corella D, Ros E, Fitó M, Gómez-Gracia E, Estruch R, Fiol M, Lapetra J, Alonso-Gómez A, Serra-Majem L, Pintó X, Sorlí JV, Muñoz MA, Basora J, Martínez-González MÁ. Impact of Life's Simple 7 on the incidence of major cardiovascular events in high-risk Spanish adults in the PREDIMED study cohort. ACTA ACUST UNITED AC 2019; 73:205-211. [PMID: 31501028 DOI: 10.1016/j.rec.2019.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 05/21/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND OBJECTIVES The Life's Simple 7 strategy of the American Heart Association proposes 7 metrics of ideal cardiovascular health: body mass index (BMI) <25mg/m2, not smoking, healthy diet, moderate physical activity ≥ 150min/wk, total blood cholesterol <200mg/dL, systolic and diastolic blood pressures <120 and <80mmHg, respectively, and fasting blood glucose <100mg/dL. It is important to assess the combined effect of these 7 metrics in the Spanish population. We prospectively analyzed the impact of baseline Life's Simple 7 metrics on the incidence of major cardiovascular events in the PREDIMED cohort (57.5% women, average baseline age, 67 years). METHODS The healthy diet metric was defined as attaining ≥ 9 points on a validated 14-item Mediterranean diet adherence screener. An incident major cardiovascular event was defined as a composite of myocardial infarction, stroke, or cardiovascular death. Cox regression was used to calculate multivariable adjusted hazard ratios (HR) and their 95% confidence intervals (95%CI) for successive categories of health metrics. RESULTS After a median follow-up of 4.8 years in 7447 participants, there were 288 major cardiovascular events. After adjustment for age, sex, center, and intervention group, HRs (95%CI) were 0.73 (0.54-0.99), 0.57 (0.41-0.78), and 0.34 (0.21-0.53) for participants with 2, 3, and ≥ 4 metrics, respectively, compared with participants with only 0 to 1 metrics. CONCLUSIONS In an elderly Spanish population at high cardiovascular risk, better adherence to Life's Simple 7 metrics was progressively associated with a substantially lower rate of major cardiovascular events.
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Affiliation(s)
- Javier Díez-Espino
- Servicio Navarro de Salud-Osasunbidea-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarre, Spain; Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarre, Spain.
| | - Pilar Buil-Cosiales
- Servicio Navarro de Salud-Osasunbidea-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarre, Spain; Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarre, Spain
| | - Nancy Babio
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Tarragona, Spain
| | - Estefanía Toledo
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarre, Spain
| | - Dolores Corella
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Departamento de Medicina Preventiva, Universidad de Valencia, Valencia, Spain
| | - Emilio Ros
- Clínica de Lipids, Departament de Endocrinologia y Nutrició, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Fitó
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Grupo de Investigación Cardiovascular y Nutrición (Grupo de estudio REGICOR), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | | | - Ramón Estruch
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Departament de Medicina Interna, Departament de Endocrinologia y Nutrició, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Miquel Fiol
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Hospital Son Espases, Palma, Balearic Islands, Spain
| | - José Lapetra
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Departamento de Medicina Familiar, Unidad de Investigación, Distrito Sanitario Atención Primaria Sevilla, Centro de Salud Universitario San Pablo, Seville, Spain
| | - Angel Alonso-Gómez
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Departamento de Medicina Familiar, Unidad de Investigación, Distrito Sanitario Atención Primaria Sevilla, Centro de Salud Universitario San Pablo, Seville, Spain; Departamento de Cardiología, Hospital Universitario de Álava, Vitoria, Álava, Spain
| | - Lluis Serra-Majem
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de Las Palmas, Las Palmas de Gran Canaria, Las Palmas, Spain; Servicio de Medicina Preventiva, Complejo Hospitalario Universitario Insular Materno Infantil (CHUIMI), Servicio Canario de Salud, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Xavier Pintó
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Unidad de Lípidos y Riesgo Cardiovascular, Medicina Interna, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José V Sorlí
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Departamento de Medicina Preventiva, Universidad de Valencia, Valencia, Spain
| | - Miguel A Muñoz
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Gerencia de Atención Primaria de Barcelona, Institut Català de la Salut e Institut d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain
| | - Josep Basora
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Tarragona, Spain
| | - Miguel Á Martínez-González
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra-Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarre, Spain; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States
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Al Rifai M, Cainzos-Achirica M, Blaha MJ, Arps K, Wood DA, Blumenthal RS, McEvoy JW. Health Factors Associated with Cardiovascular Wellness. Curr Atheroscler Rep 2019; 21:10. [PMID: 30747344 DOI: 10.1007/s11883-019-0771-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW In this review, we discuss a new paradigm for atherosclerotic cardiovascular disease (ASCVD) prevention that is focused on cultivating cardiovascular wellness through the promotion of "health factors." RECENT FINDINGS Cardiovascular prevention efforts have contributed to falling rates of ASCVD over the past five decades. However, contemporary increases in obesity and diabetes have led to a recent slowing in the annual decline of ASCVD death rates. This slowing represents an opportunity for new thinking to change the current ASCVD prevention paradigm, i.e., the identification and treatment or control of risk factors for disease. Indeed, a new paradigm focusing on cultivating cardiovascular wellness in addition to preventing disease is gaining increased traction. With this approach, the goal of ASCVD prevention is shifting to include consideration of both treating "risk factors" and cultivating health factors. Importantly, cardiovascular wellness is more than just the absence of disease and, therefore, risk factors and health factors are not always mere opposites. We review healthy lifestyle tools such as the American Heart Association Life's simple 7 and Fuster-BEWAT score. We summarize landmark studies of interventions aimed at improving adherence to health factors. We highlight the inherent limitations of current studies to adequately examine cardiovascular wellness. We propose new study designs that are required to identify novel health factors and measures of wellness. We conclude with recommendations regarding the utility of health factors and cardiovascular wellness in current practice.
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Affiliation(s)
- Mahmoud Al Rifai
- Department of Internal Medicine, University of Kansas School of Medicine, Wichita, KS, USA.,Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Kelly Arps
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - David A Wood
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.,National University of Ireland, Galway Campus, Galway, Ireland.,National Institute for Preventive Cardiology; and Saolta University Healthcare Group, University College Hospital Galway, Newcastle Rd, Galway, Ireland
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - John W McEvoy
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. .,National University of Ireland, Galway Campus, Galway, Ireland. .,National Institute for Preventive Cardiology; and Saolta University Healthcare Group, University College Hospital Galway, Newcastle Rd, Galway, Ireland.
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Buckley LF, Carbone S, Aldemerdash A, Fatani N, Fanikos J. Novel and Emerging Therapeutics for Primary Prevention of Cardiovascular Disease. Am J Med 2019; 132:16-24. [PMID: 30201240 DOI: 10.1016/j.amjmed.2018.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 01/01/2023]
Abstract
Cardiovascular disease is responsible for 205 deaths per 100,000 persons annually and is the leading cause of death worldwide. The public health burden of cardiovascular disease is expected to continue to grow as the prevalence of many cardiovascular risk factors increases. Several novel classes of glucose-lowering, lipid-lowering, and weight-loss therapeutics have shown mortality benefits in outcomes trials. However, a large proportion of subjects in those trials had established cardiovascular disease, so, as a result, the role of these novel therapeutics in primary cardiovascular prevention is controversial. In this review, we highlight recent advances in the pharmacotherapeutic management of the cardiovascular risk factors of hyperglycemia, dyslipidemia, and obesity. We examine key subgroups within recent cardiovascular outcome trials, weigh the risks and benefits of several novel therapeutics, and provide practical insight into the use of these agents. Our article concludes with a look toward the future and provides the practitioner and scientist with an early view of emerging therapeutics that may play an important role in primary cardiovascular prevention.
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Affiliation(s)
- Leo F Buckley
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Mass; Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass.
| | - Salvatore Carbone
- VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond
| | - Ahmed Aldemerdash
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Nayyra Fatani
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Mass; Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Science, Boston; Department of Clinical Pharmacy, College of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - John Fanikos
- Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Mass
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Domínguez F, Fuster V, Fernández-Alvira JM, Fernández-Friera L, López-Melgar B, Blanco-Rojo R, Fernández-Ortiz A, García-Pavía P, Sanz J, Mendiguren JM, Ibañez B, Bueno H, Lara-Pezzi E, Ordovás JM. Association of Sleep Duration and Quality With Subclinical Atherosclerosis. J Am Coll Cardiol 2019; 73:134-144. [DOI: 10.1016/j.jacc.2018.10.060] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/09/2018] [Accepted: 10/12/2018] [Indexed: 12/22/2022]
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Fuster V. Editor-in-Chief's Top Picks From 2017. J Am Coll Cardiol 2018; 71:890-934. [PMID: 29471941 DOI: 10.1016/j.jacc.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Each week, I record audio summaries for every article in JACC, as well as an issue summary. While this process has been time-consuming, I have become quite familiar with every paper that we publish. Thus, I personally select papers (both original investigations and review articles) from 15 distinct specialties each year for your review. In addition to my personal choices, I have included manuscripts that have been the most accessed or downloaded on our websites, as well as those selected by the JACC Editorial Board members. In order to present the full breadth of this important research in a consumable fashion, we will present these manuscripts in this issue of JACC. The highlights comprise the following sections: Basic & Translational Research, Cardiac Failure, Cardiomyopathies/Myocardial & Pericardial Diseases, Cardio-oncology, Congenital Heart Disease, Coronary Disease & Interventions, CVD Prevention & Health Promotion, Hypertension, Imaging, Metabolic & Lipid Disorders, Rhythm Disorders, Valvular Heart Disease, and Vascular Medicine (1-110).
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Mehta SR, Anand SS. Identifying and Treating Young Patients at Risk for Cardiovascular Events. J Am Coll Cardiol 2018; 71:303-305. [DOI: 10.1016/j.jacc.2017.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 12/03/2017] [Indexed: 11/26/2022]
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Blumenthal RS, Ambinder DI, McEvoy JW. Cardiovascular Health, Simplified. J Am Coll Cardiol 2017; 70:2474-2475. [PMID: 29145947 DOI: 10.1016/j.jacc.2017.09.1084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
| | - Daniel I Ambinder
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - J William McEvoy
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
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