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Pogosova NV, Boytsov SA. Preventive Cardiology 2024: State of Problem Perspectives of Development. KARDIOLOGIIA 2024; 64:4-13. [PMID: 38323439 DOI: 10.18087/cardio.2024.1.n2636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
This article presents the current relevance of preventive cardiology, substantiates the increasing importance of the prevention of cardiovascular diseases (CVD) to reduce mortality and the burden of CVD, including in the era of widespread use of modern high-tech methods and effective drug therapy for treating CVD in clinical practice. The article also addresses effectiveness of secondary prevention of CVD and approaches to its improvement. Particular attention is paid to the high importance of introducing into practice comprehensive programs for secondary prevention of CVD and cardiac rehabilitation. The principles of organizing such programs and their most important components are presented in detail.
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Affiliation(s)
- N V Pogosova
- Chazov National Medical Research Center of Cardiology, Moscow; "Russian Peoples' Friendship University named after. P. Lumumba", Moscow
| | - S A Boytsov
- Chazov National Medical Research Center of Cardiology, Moscow
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Reiter-Brennan C, Cainzos-Achirica M, Soroosh G, Saxon DR, Blaha MJ, Eckel RH. Cardiometabolic medicine - the US perspective on a new subspecialty. Cardiovasc Endocrinol Metab 2020; 9:70-80. [PMID: 32803138 PMCID: PMC7410029 DOI: 10.1097/xce.0000000000000224] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/03/2020] [Indexed: 12/19/2022]
Abstract
The high prevalence of cardiovascular disease and worldwide diabetes epidemic has created an ever-increasing burden on the healthcare system. This calls for the creation of a new medicine subspecialty: cardiometabolic medicine. Using information from review articles listed on PubMed and professional society guidelines, the authors advocate for a cardiometabolic medicine specialization training program. The curriculum would integrate relevant knowledge and skills of cardiology and endocrinology as well as content of other disciplines essential to the optimal care of cardiometabolic patients, such as epidemiology, biostatistics, behavioral science and psychology. Cardiometabolic medicine should be seen as an opportunity for life-long learning, with core concepts introduced in medical school and continuing through CME courses for practicing physicians. To improve care for complex patients with multiple co-morbidities, a paradigm shift must occur, transforming siloed education, and treatment and training to interdisciplinary and collaborative work.
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Affiliation(s)
- Cara Reiter-Brennan
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Radiology and Neuroradiology, Charité, Berlin, Germany
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Garshasb Soroosh
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David R. Saxon
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine
- Division of Endocrinology, Rocky Mountain Veterans Affairs Medical Center, Aurora, Colorado
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Robert H. Eckel
- Division of Endocrinology, Metabolism and Diabetes and Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Dehghani M, Cheraghi M, Namdari M, Roshan VD. Effects of Phase IV Pedometer Feedback Home-Based Cardiac Rehabilitation on Cardiovascular Functional Capacity in Patients With Myocardial Infarction: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF BASIC SCIENCE IN MEDICINE 2019. [DOI: 10.15171/ijbsm.2019.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Introduction: Pedometer feedback home-based cardiac rehabilitation (PFHCR) programs have been effective in augmenting exercise tolerance. Our aim was to investigate the effects of PFHCR on cardiovascular functional capacity in patients with myocardial infarction (MI).Methods: Forty MI patients were divided into two intervention and two control groups (n=10)in a randomized controlled trial. The intervention group received a PFHCR program including routine medications along with continuous exercise program, whereas the control group received traditional care without PFHCR. Baseline evaluations and cardiovascular stresses were controlled during the 8-week follow-up rehabilitation program in all patients. Data analysis was conducted using one-way ANOVA and paired sample student’s t-test (P ≤ 0.05).Results: At baseline, no significant differences were observed between the groups. After eight weeks of PFHCR, the intervention groups had significantly higher metabolic equivalent(P = 0.001), VO2max (P = 0.001), total exercise times (P = 0.001), and total distance traveled(P = 0.003) when compared with the control groups. However, no significant intra-group or inter-group differences in variables were observed between the men and women.Conclusion: Our results showed that PFHCR exhibited significant optimal effects on the cardiovascular functional capacity in MI patients.
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Affiliation(s)
- Mostafa Dehghani
- PhD cardiovascular and Respiratory physiology, University of Mazandaran, Babolsar, Iran
- Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan university of Medical Science, Khorramabad, Iran
| | - Mostafa Cheraghi
- Department of Cardiology, Lorestan University of Medical Sciences, Khorramabad, Iran
- Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan university of Medical Science, Khorramabad, Iran
| | - Mehrdad Namdari
- Department of Cardiology, Lorestan University of Medical Sciences, Khorramabad, Iran
- Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan university of Medical Science, Khorramabad, Iran
| | - Valiollah Dabidi Roshan
- Department of Sport Physiology, College of Physical Education and Sport Sciences, University of Mazandaran, Babolsar, Iran
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Complete Pocket Resection with Regional Flap Closure for Treatment of Cardiac Implantable Device Infections. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2204. [PMID: 31333937 PMCID: PMC6571307 DOI: 10.1097/gox.0000000000002204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/08/2019] [Indexed: 12/22/2022]
Abstract
Background: Cardiac implantable electronic device infections are associated with substantial morbidity and mortality. There are varied recommendations in the literature about treatment of the wound after extraction of all hardware, but only conservative, time-consuming approaches such as open packing and negative-pressure therapy along with a long interval before reimplanting any hardware have generally been recommended for the treatment.1–4 Methods: A retrospective review was performed of 42 patients treated at Jersey Shore University Medical Center for implantable cardioverter defibrillator and permanent pacemaker infections between July 2010 and April 2018 with an aggressive, multidisciplinary approach utilizing an invasive cardiologist and a plastic surgeon. Clinical and demographic data were collected, and a descriptive analysis was conducted. Results: A total of 42 patients, with a median age of 76 years, were selected for our treatment of pacemaker pocket infection. Patients underwent removal of all hardware followed by debridement and flap closure of the wound soon after extraction. Reimplantation was performed when indicated typically within a week after initial extraction and typically on the contralateral side. There were no reports of reinfection and no mortality in all 42 patients treated. Conclusion: We found that the aggressive removal of all hardware and excisional debridement of the entire capsule followed by flap coverage and closure of the wound allowed for a shortened interval to reimplantation with no ipsilateral or contralateral infections during the follow-up period.
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Irzmański R, Kapusta J, Obrębska-Stefaniak A, Urzędowicz B, Kowalski J. Cardiac rehabilitation in patients with ST-segment elevation myocardial infarction: can its failure be predicted? Ther Adv Cardiovasc Dis 2017; 11:177-184. [PMID: 28553755 DOI: 10.1177/1753944717706845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The prognosis in patients after acute coronary syndromes (ACS) is significantly burdened by coexisting anaemia, leukocytosis and low glomerular filtration rate (GFR). Hyperglycaemia in the early stages of ACS is a strong predictor of death and heart failure in non-diabetic subjects. This study aimed to evaluate the effect of hyperglycaemia, anaemia, leukocytosis, thrombocytopaenia and decreased GFR on the risk of the failure of cardiac rehabilitation (phase II at the hospital) in post-ST-segment elevation myocardial infarction (STEMI) patients. METHODS The study included 136 post-STEMI patients, 96 men and 40 women, aged 60.1 ± 11.8 years, admitted for cardiac rehabilitation (phase II) to the Department of Internal Medicine and Cardiac Rehabilitation, WAM University Hospital in Lodz, Poland. On admission fasting blood cell count was performed and serum glucose and creatinine level was determined (GFR assessment). The following results were considered abnormal: glucose ⩾ 100 mg/dl, GFR < 60 ml/min/1, 73 m², red blood cells (RBCs) < 4 × 106/μl, white blood cells (WBCs) > 10 × 103/μl; platelets (PLTs) < 150 × 10³/ml. In all patients an exercise test was performed twice, before and after the completion of the second stage of rehabilitation, to assess its effects. RESULTS Based on logistic regression analysis and the results of an individual odds ratio (OR) of the tested parameters, their prognostic impact was determined on the risk of failure of cardiac rehabilitation. This risk has been defined on the basis of the patient's inability to tolerate workload increment >5 Watt in spite of the applied program of cardiac rehabilitation. As a result of building a logistic regression model, the most statistically significant risk factors were selected, on the basis of which cardiac rehabilitation failure index was determined. leukocytosis and reduced GFR determined most significantly the risk of failure of cardiac rehabilitation (respectively OR = 6.42 and OR = 3.29, p = 0.007). These parameters were subsequently utilized to construct a rehabilitation failure index. CONCLUSIONS Peripheral blood cell count and GFR are important in assessing the prognosis of cardiac rehabilitation effects. leukocytosis and decreased GFR determine to the highest degree the risk of cardiac rehabilitation failure. Cardiac rehabilitation failure index may be useful in classifying patients into an appropriate model of rehabilitation. These findings support our earlier reports.
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Affiliation(s)
- Robert Irzmański
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, Poland
| | - Joanna Kapusta
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, Kościuszki 4, Lodz 90-419, Poland
| | | | - Beata Urzędowicz
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, Poland
| | - Jan Kowalski
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, Poland University of Social Science, Lodz, Poland
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Kinjo M, Chia-Cheng Lai E, Korhonen MJ, McGill RL, Setoguchi S. Potential contribution of lifestyle and socioeconomic factors to healthy user bias in antihypertensives and lipid-lowering drugs. Open Heart 2017; 4:e000417. [PMID: 28761670 PMCID: PMC5515136 DOI: 10.1136/openhrt-2016-000417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 10/13/2016] [Accepted: 10/18/2016] [Indexed: 01/11/2023] Open
Abstract
Objectives Healthy user bias arises when users of preventive medications such as lipid-lowering drugs (LLDs), hormone replacement therapy and antihypertensive (AH) medications are healthier than non-users due to factors other than medication effects, making the medications appear more beneficial in observational studies of effectiveness and safety. The purpose of the study is to examine factors contributing to healthy user effect in patients taking AHs or LLDs. Methods Among patients with hypertension or hyperlipidaemia in a population-based sample from the National Health and Nutrition Examination Survey (1999–2010), we assessed the association between socioeconomic and lifestyle factors and the use of AHs/LLDs by logistic regression with adjustment for demographics and comorbidities in a cross-sectional study. Results When 9715 AH/LLD users were compared with 3725 non-users, AH/LLD users were more likely to be: highly educated (OR 1.2, 95% CI 1.2 to 1.3), non-impoverished (OR 1.3, 95% CI 1.2 to 1.4), current non-smokers (OR 1.2, 95% CI 1.1 to 1.4), physically active (OR 1.1, 95% CI 1.0 to 1.2) and consume more calcium (OR 1.1, 95% CI 1.0 to 1.3) but less likely to have normal body mass index (OR 0.6, 95% CI 0.6 to 0.7) or to meet dietary sodium recommendations (OR 0.8, 95% CI 0.7 to 0.9). Conclusions We identified several salutary lifestyle factors associated with AH/LLD use in a representative US population. Healthy user effect may be partly explained by better socioeconomic profiles and lifestyles in AH/LLD users compared with non-users.
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Affiliation(s)
- Mitsuyo Kinjo
- Department of Medicine, Rheumatology, Okinawa Chubu Hospital, Uruma, Okinawa, Japan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Maarit Jaana Korhonen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
| | - Rita L McGill
- Department of Medicine, Nephrology, The University of Chicago, Chicago, USA
| | - Soko Setoguchi
- Department of Epidemiology, Rutgers School of Public Health, New Brunswick, USA
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Aerobic training enhances muscle deoxygenation in early post-myocardial infarction. Eur J Appl Physiol 2016; 116:673-85. [PMID: 26759155 PMCID: PMC4819748 DOI: 10.1007/s00421-016-3326-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 01/04/2016] [Indexed: 11/30/2022]
Abstract
Purpose Exercise-induced skeletal muscle deoxygenation is startling by its absence in early post-myocardial infarction (MI) patients. Exercise training early post-MI is associated with reduced cardiovascular risk and increased aerobic capacity. We therefore investigated whether aerobic training could enhance the muscle deoxygenation in early post-MI patients. Methods 21 ± 8 days after the first MI patients (n = 16) were divided into 12-week aerobic training (TR, n = 10) or non-training (CON, n = 6) groups. Before and after intervention, patients performed ramp bicycle exercise until exhaustion. Muscle deoxygenation was measured at vastus lateralis by near-infrared spectroscopy during exercise. Results Aerobic training significantly increased peak oxygen uptake (VO2) (18.1 ± 3.0 vs. 22.9 ± 2.8 mL/kg/min), decreased the change in muscle oxygen saturation from rest to submaximal and peak exercise (∆SmO2; 2.4 ± 5.7 vs. −7.0 ± 3.4 %), and increased the relative change in deoxygenated hemoglobin/myoglobin concentration from rest to submaximal (−1.5 ± 2.3 vs. 3.0 ± 3.6 μmol/L) and peak exercise (1.1 ± 4.5 vs. 8.2 ± 3.5 μmol/L). Change in total hemoglobin/myoglobin concentration in muscle was not significantly affected by training. In CON, no significant alterations were found after 12 weeks in either muscle deoxygenation or peak VO2 (18.6 ± 3.8 vs. 18.9 ± 4.6 mL/kg/min). An increase in peak VO2 was significantly negatively correlated with change in ∆SmO2 (r = −0.65) and positively associated with change in ∆deoxy-Hb/Mb at peak exercise (r = 0.64) in TR. Conclusions In early post-MI patients, aerobic training enhanced skeletal muscle deoxygenation, and the enhancement was related to increased aerobic capacity.
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Gidding SS, Champagne MA, de Ferranti SD, Defesche J, Ito MK, Knowles JW, McCrindle B, Raal F, Rader D, Santos RD, Lopes-Virella M, Watts GF, Wierzbicki AS. The Agenda for Familial Hypercholesterolemia: A Scientific Statement From the American Heart Association. Circulation 2015; 132:2167-92. [PMID: 26510694 DOI: 10.1161/cir.0000000000000297] [Citation(s) in RCA: 481] [Impact Index Per Article: 53.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Chen Z, Ding Z, Wang X, Zhang X, Ma G. Reduced heart function predicts drug-taking compliance and two-year prognosis in chinese patients with stable premature coronary artery disease. J Clin Med Res 2014; 7:154-60. [PMID: 25584100 PMCID: PMC4285061 DOI: 10.14740/jocmr2045w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 11/11/2022] Open
Abstract
Background The purpose of this study was to determine the association between heart function, compliance with drug administration, and the mid-term prognosis in Chinese patients with stable premature coronary artery disease (CAD) (male < 55 years and female < 65 years). Methods The study included 512 patients with stable premature CAD. An estimated glomerular filtration rate (eGFR) calculated using the MDRD formula, baseline clinical characteristics, use of medications for coronary secondary prevention therapies (aspirin, β-blocker, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers, or statins), and 2-year follow-up results, in particular major adverse cardiac events (MACEs), were collected and analyzed. Results Patients with reduced left ventricular ejection fraction (LVEF) (18.75%) were more prevalent among men, smokers, those with type 2 diabetes, with a family history of cardiovascular disease (CVD), and with higher white blood cells counts ((8.88 ± 0.35) × 109/L vs. (6.90 ± 0.17) × 109/L) (all P < 0.05) compared to those with preserved LVEF. There was no significant difference between creatinine or eGFR values in the two groups with reduced and preserved LVEF (all P > 0.05). Patients with LVEF < 50% in the MACEs group had a lower ratio of optimal drug administration compared to the MACEs-free group (Z = -0.228, P = 0.820 and Z = -2.167, P = 0.03 respectively). Patients with reduced LVEF had a significantly higher ratio of composite MACEs than patients with preserved LVEF during 2-year follow-up (47.13% vs. 33.50%, P < 0.05). Conclusions Stable premature CAD patients with reduced LVEF have more risk factors, lower medication compliance, and worse 2-year outcomes than those with preserved LVEF.
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Affiliation(s)
- Zhong Chen
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai 200233,China
| | - Zhen Ding
- Department of Cardiology, Zhenjiang First People's Hospital, Zhenjiang 212002, China
| | - Xin Wang
- Department of Cardiology, The Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Nanjing 210009, China
| | - Xiaofeng Zhang
- Department of Cardiology, The Affiliated Nanjing Second Hospital of Southeast University, Nanjing 210009, China
| | - Genshan Ma
- Department of Cardiology, The Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Nanjing 210009, China
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King M, Bittner V, Josephson R, Lui K, Thomas RJ, Williams MA. Medical Director Responsibilities for Outpatient Cardiac Rehabilitation/Secondary Prevention Programs: 2012 Update. Circulation 2012; 126:2535-43. [PMID: 23091064 DOI: 10.1161/cir.0b013e318277728c] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Medical directors of cardiac rehabilitation/secondary prevention (CR/SP) programs are responsible for the safe and effective delivery of high-quality CR/SP services to eligible patients. Yet, the training and resources for CR/SP medical directors are limited. As a result, there appears to be considerable variability throughout CR/SP programs in the United States in the roles, responsibilities, and engagement of CR/SP medical directors. Since the publication of the 2005 scientific statement from the American Heart Association and American Association of Cardiovascular and Pulmonary Rehabilitation regarding medical director responsibilities for outpatient CR/SP programs, significant changes have occurred. This statement updates the responsibilities of CR/SP medical directors, in view of changes in federal legislation and regulations and changes in health care delivery and clinical practice that impact the roles and responsibilities of CR/SP medical directors.
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Affiliation(s)
- Marjorie King
- From Helen Hayes Hospital, West Haverstraw, New York, and Columbia University, New York, New York (M.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (V.B.); Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, and Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio (R.J.); Governmental Representation with Quality, LLC, Vienna, Virginia (K.L.); Cardiovascular Health Clinic,
| | - Vera Bittner
- From Helen Hayes Hospital, West Haverstraw, New York, and Columbia University, New York, New York (M.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (V.B.); Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, and Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio (R.J.); Governmental Representation with Quality, LLC, Vienna, Virginia (K.L.); Cardiovascular Health Clinic,
| | - Richard Josephson
- From Helen Hayes Hospital, West Haverstraw, New York, and Columbia University, New York, New York (M.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (V.B.); Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, and Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio (R.J.); Governmental Representation with Quality, LLC, Vienna, Virginia (K.L.); Cardiovascular Health Clinic,
| | - Karen Lui
- From Helen Hayes Hospital, West Haverstraw, New York, and Columbia University, New York, New York (M.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (V.B.); Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, and Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio (R.J.); Governmental Representation with Quality, LLC, Vienna, Virginia (K.L.); Cardiovascular Health Clinic,
| | - Randal J. Thomas
- From Helen Hayes Hospital, West Haverstraw, New York, and Columbia University, New York, New York (M.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (V.B.); Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, and Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio (R.J.); Governmental Representation with Quality, LLC, Vienna, Virginia (K.L.); Cardiovascular Health Clinic,
| | - Mark A. Williams
- From Helen Hayes Hospital, West Haverstraw, New York, and Columbia University, New York, New York (M.K.); Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham (V.B.); Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, and Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio (R.J.); Governmental Representation with Quality, LLC, Vienna, Virginia (K.L.); Cardiovascular Health Clinic,
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Nogueira IC, Santos ZMDSA, Mont'Alverne DGB, Martins ABT, Magalhães CBDA. Efeitos do exercício físico no controle da hipertensão arterial em idosos: uma revisão sistemática. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2012. [DOI: 10.1590/s1809-98232012000300019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
O exercício físico é uma das principais terapêuticas utilizadas para o paciente hipertenso, pois reduz a pressão arterial (PA) e os fatores de risco cardiovasculares, diminuindo a morbimortalidade. OBJETIVO: Analisar os efeitos do exercício físico na PA de idosos hipertensos, com base nos resultados de pesquisas empíricas realizadas no período de 2000 a 2010. METODOLOGIA: Revisão sistemática de estudos experimentais, em inglês, português e espanhol, nas bases eletrônicas MEDLINE, PubMed, Lilacs, Cochrane e PEDro, publicados entre 2000 e 2010, utilizando os descritores hipertensão, atividade física, exercício físico, idoso, exercício aeróbio e treinamento de resistência. RESULTADOS: Foram encontrados 19 artigos e incluídos 12 artigos, sendo divididos em categorias temáticas: exercício aeróbico (6 artigos), exercício resistido (4), exercício aeróbico associado ao resistido (2). Entre os exercícios aeróbicos, três artigos evidenciaram redução na pressão arterial sistólica (PAS) e pressão arterial diastólica (PAD). Três artigos afirmam que treinamento resistido reduz significativamente os valores de PAS em repouso e pressão arterial média (PAM), apenas um artigo não registrou uma redução significativa na PAD e frequência cardíaca (FC) de repouso. A utilização dos exercícios aeróbicos associados aos resistidos foram superiores aos demais, pois apontaram reduções significativas na PAS, PAD, PAM e FC de repouso, confirmando as recomendações da VI Diretriz Brasileira de Hipertensão Arterial, mas os estudos em idosos são escassos. CONCLUSÃO: Esta revisão confirma os benefícios oriundos da prática do exercício físico na redução da PA após o exercício em idosos hipertensos.
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Affiliation(s)
- Joseph A. Vita
- From the Evans Department of Medicine and the Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
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Füzi M, Palicz Z, Vincze J, Cseri J, Szombathy Z, Kovács I, Oláh A, Szentesi P, Kertai P, Paragh G, Csernoch L. Fluvastatin-induced alterations of skeletal muscle function in hypercholesterolaemic rats. J Muscle Res Cell Motil 2011; 32:391-401. [PMID: 22068225 DOI: 10.1007/s10974-011-9272-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 10/25/2011] [Indexed: 01/29/2023]
Abstract
Although statins, the most widely used drugs in the treatment of hyperlipidaemia, are generally accepted as efficient and safe drugs their side-effects on skeletal muscle have been reported with increasing frequency. The lack of an animal model in which these side effects would consistently be observed is one of the important drawbacks in studying statin associated myopathy. To overcome this and enable the studying of the effects of fluvastatin on skeletal muscles an animal model with high blood cholesterol levels was developed. In these animals cholesterol levels rose more than seven fold (from 1.5 ± 0.1 to 10.7 ± 2.0 mmol/l; n = 15 and 16) with a dramatic increase in low density lipoprotein/high density lipoprotein ratio (from 0.29 ± 0.02 to 1.56 ± 0.17). While the latter was reversed by statin treatment, an elevation in blood creatine kinase (CK) level indicated the presence of muscle wasting. Fibers from m. extensor digitorum longus (EDL) showed significant reduction in cross sectional area in the statin treated groups. Statin treatment also decreased the proliferation and fusion of skeletal myotubes in culture. In line with this, resting intracellular calcium concentration ([Ca(2+)](i)) was reduced in statin treated satellite cells and myotubes. On the other hand, in adult skeletal muscle fibers statin treatment increased resting [Ca(2+)](i) (116 ± 4 nM vs. 151 ± 5 nM; n = 33 and 34) and decreased both twitch and tetanic force both in EDL and m. soleus. In addition, in m. soleus the duration of twitch and tetanic force was shortened. These results clearly indicate that statin administration in these animals results in a myopathy characterized by decreased muscle force and elevated plasma CK level.
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Affiliation(s)
- Márta Füzi
- Department of Physiology, MHSC, University of Debrecen, Debrecen 4012, Hungary
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Madden M, Furze G, Lewin RJ. Complexities of patient choice in cardiac rehabilitation: qualitative findings. J Adv Nurs 2011; 67:540-9. [DOI: 10.1111/j.1365-2648.2010.05509.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Simpson RJ, Mendys P. The effects of adherence and persistence on clinical outcomes in patients treated with statins: A systematic review. J Clin Lipidol 2010; 4:462-71. [DOI: 10.1016/j.jacl.2010.08.026] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 08/30/2010] [Accepted: 08/30/2010] [Indexed: 01/06/2023]
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16
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Koenig W. Integrating biomarkers: The new frontier? Scandinavian Journal of Clinical and Laboratory Investigation 2010; 242:117-23. [DOI: 10.3109/00365513.2010.493427] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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