ACCF/AHA/ACP 2009 Competence and Training Statement: A Curriculum on Prevention of Cardiovascular Disease

Preventive Cardiology 2024: State of Problem Perspectives of Development

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.

Cardiometabolic medicine - the US perspective on a new subspecialty

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.

Effects of Phase IV Pedometer Feedback Home-Based Cardiac Rehabilitation on Cardiovascular Functional Capacity in Patients With Myocardial Infarction: A Randomized Controlled Trial

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.

Complete Pocket Resection with Regional Flap Closure for Treatment of Cardiac Implantable Device Infections

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.

Cardiac rehabilitation in patients with ST-segment elevation myocardial infarction: can its failure be predicted?

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.

Potential contribution of lifestyle and socioeconomic factors to healthy user bias in antihypertensives and lipid-lowering drugs

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.

Aerobic training enhances muscle deoxygenation in early post-myocardial infarction

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.

Reduced heart function predicts drug-taking compliance and two-year prognosis in chinese patients with stable premature coronary artery disease

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.

Medical Director Responsibilities for Outpatient Cardiac Rehabilitation/Secondary Prevention Programs: 2012 Update

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.

Efeitos do exercício físico no controle da hipertensão arterial em idosos: uma revisão sistemática

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.

Fluvastatin-induced alterations of skeletal muscle function in hypercholesterolaemic rats

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.