Physical Activity in the Prevention and Treatment of Coronary Artery Disease

Psychological Distress in Adults With Myocardial Infarction: Implications for Health Care Utilization and Expenditure

Background

Myocardial infarction (MI) poses a major financial burden on the U.S. health care system, but its impact on medical expenses and health care utilization when coupled with psychological distress remains unknown.

Objectives

The study aims to investigate the association between psychological distress and healthcare utilization and medical expenditures in adults with a history of MI.

Methods

We analyzed the 2017-2021 Medical Expenditure Panel Survey to identify 44,716 adults with a history of MI. Psychological distress was measured using the Kessler (K6) questionnaire, with a score of ≥13 indicating clinically significant distress. Differences in medical expenditures and health care utilization between patients with MI with and without psychological distress were assessed using weighted generalized linear and negative binomial regression models. Expenditures, medical visits, and prescribed medications are reported as means and 95% CI.

Results

Among 9,773,458 weighted adults, 970,049 experienced psychological distress. Adults with MI and psychological distress were younger, more likely to be female (51.1% vs 37.5%; P < 0.001), less educated (11.1 vs 12.5 years; P < 0.001), lower income, and were more likely to have public insurance, compared to those without psychological distress. Adults with psychological distress and a history of MI had higher average medical expenses ($31,577 vs $15,830; P < 0.001) and greater health care utilization including office visits (8.3 vs 5.7; P = 0.01), inpatient visits (0.6 vs 0.3; P < 0.001), emergency room visits (0.7 vs 0.3; P < 0.001), and prescribed medications including refills (42.3 vs 28; P < 0.001).

Conclusions

Psychological distress is correlated with increased medical expenditures and health care utilization in patients with MI. This research highlights the need for interventions addressing psychological needs in patients with MI.

The Role of Exercise-Based Cardiac Rehabilitation After Myocardial Infarction on Cholesterol Transfer to HDL

High-density lipoprotein (HDL) is associated with decreased incidence of cardiovascular events, and its functionality also influences prognosis. Exercise is an important tool to improve prognosis in the post-infarction (MI) population, but the role of exercise on HDL functionality is poorly understood. Sixty-two patients with acute MI were randomized in a supervised exercise program for 12-14 weeks (exercise group-EG) or a control group (CG). The main objective of the study was to analyze the role of exercise on esterified cholesterol (EC) and unesterified cholesterol (UC) transfer to HDL. For the total population, the baseline mean rate of EC transfer to HDL was 2.53 ± 0.83 and at the end of follow-up, it was 2.74 ± 0.64 (p = 0.03). The figures for UC were, respectively, 4.08 ± 1.2 and 4.4 ± 1.06 (p = 0.02). The difference (follow-up minus baseline) for EC was 0.15 ± 0.84 for the control group and 0.27 ± 0.69 for the exercise group (p = 0.53); for UC, the figures were 0.28 ± 1.14 and 0.35 ± 0.96 (p = 0.80), respectively, for the control and exercise groups. In post-MI patients, 12-14 weeks of supervised exercise did not improve HDL functionality.

Physical Activity Behaviour and Motivation During and Following Pulmonary and Cardiac Rehabilitation: A Repeated Measures Study

BACKGROUND

Exercise rehabilitation programmes are important for long-term health and wellbeing among people with cardiac and pulmonary diseases. Despite this, many people struggle to maintain their physical activity once rehabilitation ends. This repeated measures study tracked changes in physical activity behaviour and motivation during and after completing a community-based exercise rehabilitation programme.

METHODS

Cardiac and pulmonary exercise rehabilitation patients (N = 31) completed six once-monthly measures of physical activity (MET·min), self-determined motivation, intention, and habit strength for rehabilitation exercise (within rehabilitation sessions) and lifestyle physical activity (outside of rehabilitation sessions). Linear regression and random effects models with estimated marginal means were used to test for associations between physical activity motivation and behaviour and change during and post-rehabilitation.

RESULTS

Overall physical activity decreased after rehabilitation (823 MET·min) despite patients becoming more self-determined for lifestyle physical activity during rehabilitation. More self-determined motivation, stronger intentions, and stronger habits were associated with more lifestyle physical activity behaviour. However, none of these motivation variables were significantly associated with rehabilitation exercise behaviour.

CONCLUSIONS

Among community-based cardiac and pulmonary rehabilitation patients, physical activity levels decreased following exercise rehabilitation programmes. The findings revealed clear distinctions in the motivation of rehabilitation exercise compared to lifestyle physical activity. Exercise rehabilitation programmes might improve the longevity of outcomes by integrating approaches to enhance lifestyle physical activity beyond the clinic.

Sex Difference in 5-year Relative Survival Following Percutaneous Coronary Intervention

Background

Survival rates following percutaneous coronary intervention (PCI) show variability across studies, particularly regarding sex-specific outcomes. Relative survival analysis, which considers survival patterns in sex-and age-matched general populations, could help explain this variability.

Methods

In a 2011 nationwide South Korean PCI cohort study with 48,783 patients, all-cause death was assessed as the primary outcome over 5 years. Observed and relative survival rates at 5 years conditional on surviving 0 days, 30 days, 1 year, and 2 years were assessed. Sex-specific differences in clinical characteristics were adjusted using propensity score-matching.

Results

In the unadjusted analyses, 15,710 females had more cardiovascular risk factors than 33,073 males. Both observed survival (HR 1.28; 95% CI [1.22-1.34]) and relative survival (HR 1.21; 95% CI [1.16-1.27]) were lower in females than males (all p<0.001). In the analyses of 14,454 matched pairs, females showed higher observed survival (HR 0.78; 95% CI [0.74-0.82]), but lower relative survival (HR 1.19; 95% CI [1.13-1.26]), compared to males (all p<0.001). This trend was particularly notable in females aged 60 years or older. These findings persisted in analyses conditional on surviving 30 days, 1 year and 2 years.

Conclusion

The adjusted 5-year relative survival of older females was lower than that of age-matched males, highlighting the need for the excessive risk reduction in older females undergoing PCI.

A Retrospective Observational Study Examining Physical Activity Among Adults in the United States With Angina or Coronary Heart Disease

INTRODUCTION

 Coronary heart disease (CHD) involves inadequate blood supply to the myocardium by the coronary arteries due to the formation of atherosclerotic plaque in the vessel lumen. It has a complex etiopathogenesis. Physical activity (PA) and exercise lead to vascular remodeling and improved endothelial function, which, in turn, improves the arterial blood supply to the myocardium.

OBJECTIVES

The study aims to determine the prevalence of self-reported PA among CHD patients in the United States based on demographic, socioeconomic, and healthcare access variables for the year 2021.

METHODOLOGY

 The data for the study on CHD were extracted using the Behavioral Risk Factor Surveillance System (BRFSS) Web-Enabled Analysis Tool database of the U.S.

POPULATION

The control variables used broadly include demographics, socioeconomic, and healthcare access.

RESULTS

 In 2021, 433,615 people in the USA participated in the BRFSS study. Among them, 22,819 self-identified as having angina or CHD. In the past month, 62.2% of participants with the disease were involved in PA, and 37.8% were not. Among participants without angina or CHD, 76.5% were involved, and 23.5% were not involved in PA in the past month.

CONCLUSION

 This study highlights the need for specific interventions to overcome obstacles preventing PA among CHD patients.

Exposure to indoor air pollution and angina among aging adults in India: evidence from a large-scale nationwide study

This study tried to understand the association between exposure to indoor air pollution and angina among the aging population in India. We utilized the data from the Longitudinal Ageing Study in India (LASI) Wave-1 (2017-2018), with a sample of 62,846 aging adults. We applied Chi-square and multivariate logistic regression models. The odds of angina were higher among individuals living in households that used solid fuels for cooking (aOR = 1.15, 99% CI- 1.09-1.20), had someone smoked inside the house (aOR = 1.12, 99% CI- 1.07-1.18), and households that used of incenses inside the home (aOR = 1.11, 99% CI- 1.05-1.18). In addition, it was also found that work-limiting impairment, unhealthy behaviors, and poor health status increased the odds of angina. These results indicate the need to reduce in-house air pollution by promoting clean fuel usage and changing attitudes and practices. Other implications are discussed.

[Effects of Non-Pharmacological Interventions on Major Adverse Cardiac Events in Patients Underwent Percutaneous Coronary Intervention: Systematic Review and Meta-Analysis]

PURPOSE

In this study a systematic review and meta-analysis investigated the impact of non-pharmacological interventions on major adverse cardiac events (MACE) in patients with coronary artery disease who underwent percutaneous coronary intervention (PCI).

METHODS

A literature search was performed using PubMed, Cochrane Library, EMBASE, and Cumulative Index to Nursing & Allied Health Literature databases up to November 2023. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Effect sizes and 95% confidence intervals were calculated using R software (version 4.3.2).

RESULTS

Eighteen randomized studies, involving 2,898 participants, were included. Of these, 16 studies with 2,697 participants provided quantitative data. Non-pharmacological interventions (education, exercise, and comprehensive) significantly reduced the risk of angina, heart failure, myocardial infarction, restenosis, cardiovascular-related readmission, and cardiovascular-related death. The subgroup meta-analysis showed that combined interventions were effective in reducing the occurrence of myocardial infarction (MI), and individual and group-based interventions had significant effects on reducing the occurrence of MACE. In interventions lasting seven months or longer, occurrence of decreased by 0.16 times, and mortality related to cardiovascular disease decreased by 0.44 times, showing that interventions lasting seven months or more were more effective in reducing MI and cardiovascular disease-related mortality.

CONCLUSION

Further investigations are required to assess the cost-effectiveness of these interventions in patients undergoing PCI and validate their short- and long-term effects. This systematic review underscores the potential of non-pharmacological interventions in decreasing the incidence of MACE and highlights the importance of continued research in this area (PROSPERO registration number: CRD42023462690).

Association of resting heart rate and physical activity with cardiovascular mortality: A population-based cohort study of Korean adults

To examine the independent and combined association of resting heart rate (RHR) and physical activity (PA) with risk of cardiovascular disease (CVD) mortality. RHR was categorized as < 60, 60-69, 70-79, and ≥ 80 bpm. Meeting PA guidelines was defined as ≥ 150 min/week of moderate to vigorous physical activity (MVPA). Cox proportional hazard models were used to calculate hazard ratios (HRs) for CVD mortality associated with RHR and PA. Among 31,697 participants, 311 CVD deaths occurred during 9.2 years of follow-up. Compared to RHR of 60-69 bpm, the risk of CVD mortality was higher in RHR of < 60 bpm (HR, 1.48; 95% CI, 1.05-2.10) and ≥ 80 bpm (HR, 1.42; 95% CI, 1.06-1.91). Participants who met PA guidelines had a lower risk of CVD mortality (HR, 0.59; 95% CI, 0.44-0.78). Among physically inactive adults compared to participants in RHR of 60-69 bpm with meeting PA guidelines, the adjusted HR for CVD mortality was 2.41 (95% CI, 1.42-4.08) for RHR of < 60 bpm, 1.59 (95% CI, 1.01-2.49) for RHR of 60-69 bpm, 1.98 (95% CI, 1.23-3.20) for RHR of 70-79 bpm and 2.41 (95% CI, 1.50-3.89) for RHR of ≥ 80 bpm Exceeding the minimum level of PA guidelines may attenuate the risk of CVD mortality associated with RHR.

Physical Fitness as a Predictor of Disability Retirement: A 9-Year Register Linked Follow-Up Study

BACKGROUND

To prospectively examine the association between physical fitness and risk of disability retirement in a large population-based cohort.

METHODS

This study utilized data from Health 2011 survey Physical Activity subsample (n = 4898), combined with information on disability retirement derived from 2 national registers. In total, 2455 individuals aged 18-74 years underwent the physical fitness test protocol concerning measures of cardiorespiratory fitness, muscle strength, and balance. The outcome variable was disability retirement, during the follow-up period of 9 years. After excluding those not at risk of disability retirement (ie, age ≥63 y) or who had already been granted disability pension, and those who had not completed the fitness protocol, the analytical sample included 1381 participants. Data were analyzed using Cox regression model with SPSS (version 29).

RESULTS

During the 9-year follow-up period, 61 individuals (4.4%) transitioned to a disability retirement. Cox regression analysis showed an association between the various physical fitness subdomains and the risk of disability retirement. In model 1, all fitness tests were associated with the risk of disability retirement, except the one-leg stand test with hazard ratios ranging from 1.69 (95% CI, 0.86-3.34) to 5.75 (95% CI, 1.84-17.90). Further adjustment for sociodemographic, health behavior, and health-related covariates attenuated the associations and statistical significance was lost, except for the vertical jump test (hazard ratio = 4.33; 95% CI, 1.32-14.10) and 6-minute walk test (hazard ratio = 3.81; 95% CI, 1.35-10.70).

CONCLUSION

These findings highlight the importance of physical fitness for preventing work disability.

Using machine learning to predict acute myocardial infarction and ischemic heart disease in primary care cardiovascular patients

BACKGROUND

Early recognition, which preferably happens in primary care, is the most important tool to combat cardiovascular disease (CVD). This study aims to predict acute myocardial infarction (AMI) and ischemic heart disease (IHD) using Machine Learning (ML) in primary care cardiovascular patients. We compare the ML-models' performance with that of the common SMART algorithm and discuss clinical implications.

METHODS AND RESULTS

Patient-level medical record data (n = 13,218) collected between 2011-2021 from 90 GP-practices were used to construct two random forest models (one for AMI and one for IHD) as well as a linear model based on the SMART risk prediction algorithm as a suitable comparator. The data contained patient-level predictors, including demographics, procedures, medications, biometrics, and diagnosis. Temporal cross-validation was used to assess performance. Furthermore, predictors that contributed most to the ML-models' accuracy were identified. The ML-model predicting AMI had an accuracy of 0.97, a sensitivity of 0.67, a specificity of 1.00 and a precision of 0.99. The AUC was 0.96 and the Brier score was 0.03. The IHD-model had similar performance. In both ML-models anticoagulants/antiplatelet use, systolic blood pressure, mean blood glucose, and eGFR contributed most to model accuracy. For both outcomes, the SMART algorithm was substantially outperformed by ML on all metrics.

CONCLUSION

Our findings underline the potential of using ML for CVD prediction purposes in primary care, although the interpretation of predictors can be difficult. Clinicians, patients, and researchers might benefit from transitioning to using ML-models in support of individualized predictions by primary care physicians and subsequent (secondary) prevention.

Effects of a physical therapist-driven individualized hybrid model of the exercise component of cardiac rehabilitation on patient outcomes: a prospective single group, time-series design

PURPOSE

The aim of this prospective single group, time-series study was to determine the feasibility, adherence, and effectiveness of an individualized physical therapist (PT)-driven hybrid model of the exercise component of cardiac rehabilitation (CR) that uses a novel intensity-recovery progression protocol (IRPP) and cardiac testing template (CTT) to assess achieved heart rate (HR) intensity, HR recovery, and intensity-recovery total to guide treatment.

METHODS

Assessment of a questionnaire, treadmill 6-min walk (6MW), 1-min sit-to-stand (1STS), 1-min step, and 1-min agility square tests were assessed on 100 participants. Compared to traditional CR the 36-visit 1:1 hybrid model was individualized using the IRPP program and CTT.

RESULTS

Adherence was 35% (timely) and 44% (overall) completion. The per-protocol analysis (PPA) and intent-to-treat (ITT) analysis suggest significant improvement in objective assessments baseline to visit 15 (PPA = 11 of 14) (ITT = 13 of 14), baseline to visit 30 (PPA = 12 of 14) (ITT = 12 of 14) and visit 15 to visit 30 (PPA = 9 of 14) (ITT = 10 of 14). Improvement beyond the minimal clinically important difference (MCID) was 94.3% in the 6MW and 91.4% in the 1STS.

CONCLUSIONS

The PT-driven IRPP program was feasible in terms of adherence and safety, showing significant improvement in a majority of assessments. Analysis of HR using the CTT may help clinical decision making for progression in CR.Implications for rehabilitationCardiac rehabilitation (CR) is an underutilized means of improving health for people recovering from cardiac surgery.People recovering from cardiac surgery have complex reasons for why they choose to enroll in, drop out from, or complete a CR program.Reporting of outcomes in CR and progression in intensity is not often individualized.An individualized physical therapist driven CR program using both subjective and objective assessments may be successful at improving adherence and effectiveness in this cohort.

Prevalence of insufficient physical activity among adult residents of Tehran: a cross-sectional report from Tehran Cohort Study (TeCS)

BACKGROUND

Insufficient physical activity (PA) is a major risk factor for non-communicable diseases (NCDs) and one of the leading causes of premature mortality worldwide. This study examined the prevalence and independent determinants of insufficient PA among adults resident of Tehran utilizing Tehran Cohort Study Data (TeCS).

METHOD

We used the recruitment phase data from the TeCS with complete data on PA. PA was assessed through a Likert-scaled question and categorized into three groups. Utilizing data from the 2016 national census, the age- and sex-weighted prevalence of insufficient PA in Tehran was determined. The adjusted logistic regression model is used to neutralize influencing factors and determine the factors associated with insufficient PA.

RESULT

The weighted prevalence of insufficient PA was 16.9% among the 8213 adult citizens of Tehran, with a greater prevalence among females (19.0% vs. 14.8% among males). Additionally, older age groups, unemployed, housewives, and illiterate educated participants displayed a much higher prevalence of insufficient PA (p < 0.001). Moreover, Tehran's central and southern districts had higher rates of insufficient PA. Concerning the adjusted regression model, older age (Odds ratio [OR]: 4.26, 95% confidence interval [95% CI]: 3.24-5.60, p < 0.001), a lower education level (p < 0.001), unemployment (OR: 1.80, 95% CI: 1.28-2.55, p = 0.001), being a housewife (OR: 1.44, 95% CI: 1.15-1.80, p = 0.002), higher body mass index (BMI) (OR for BMI > 30: 1.85, 95% CI: 1.56-2.18, p < 0.001), opium consumption (OR: 1.92, 95% CI: 1.46-2.52, p < 0.001), diabetes mellitus (OR: 1.25, 95% CI: 1.06-1.48, p = 0.008), hypertension (OR: 1.29, 95% CI: 1.11-1.50, p = 0.001), and coronary artery diseases (OR: 1.30, 95% CI: 1.05-1.61, p = 0.018), were significantly associated with insufficient PA.

CONCLUSIONS

The identified associated factors serve as a valuable guide for policymakers in developing tailored intervention strategies to address the needs of high-risk populations, particularly among older adults and females.

Comprehensive Strategies for Metabolic Syndrome: How Nutrition, Dietary Polyphenols, Physical Activity, and Lifestyle Modifications Address Diabesity, Cardiovascular Diseases, and Neurodegenerative Conditions

Several hallmarks of metabolic syndrome, such as dysregulation in the glucose and lipid metabolism, endothelial dysfunction, insulin resistance, low-to-medium systemic inflammation, and intestinal microbiota dysbiosis, represent a pathological bridge between metabolic syndrome and diabesity, cardiovascular, and neurodegenerative disorders. This review aims to highlight some therapeutic strategies against metabolic syndrome involving integrative approaches to improve lifestyle and daily diet. The beneficial effects of foods containing antioxidant polyphenols, intestinal microbiota control, and physical activity were also considered. We comprehensively examined a large body of published articles involving basic, animal, and human studie, as well as recent guidelines. As a result, dietary polyphenols from natural plant-based antioxidants and adherence to the Mediterranean diet, along with physical exercise, are promising complementary therapies to delay or prevent the onset of metabolic syndrome and counteract diabesity and cardiovascular diseases, as well as to protect against neurodegenerative disorders and cognitive decline. Modulation of the intestinal microbiota reduces the risks associated with MS, improves diabetes and cardiovascular diseases (CVD), and exerts neuroprotective action. Despite several studies, the estimation of dietary polyphenol intake is inconclusive and requires further evidence. Lifestyle interventions involving physical activity and reduced calorie intake can improve metabolic outcomes.

A multiple technology-based and individually-tailored Sit Less program for people with cardiovascular disease: A randomized controlled trial study protocol

Sedentary behavior, a key modifiable risk factor for cardiovascular disease, is prevalent among cardiovascular disease patients. However, few interventions target sedentary behavior in this group. This paper describes the protocol of a parallel two-group randomized controlled trial for a novel multi-technology sedentary behavior reduction intervention for cardiovascular disease patients (registered at Clinicaltrial.gov, NCT05534256). The pilot trial (n = 70) will test a 12-week "Sit Less" program, based on Habit Formation theory. The 35 participants in the intervention group will receive an instructional goal-setting session, a Fitbit for movement prompts, a smart water bottle (HidrateSpark) to promote hydration and encourage restroom breaks, and weekly personalized text messages. A control group of 35 will receive the American Heart Association's "Answers by Heart" fact sheets. This trial will assess the feasibility and acceptability of implementing the "Sit Less" program with cardiovascular disease patients and the program's primary efficacy in changing sedentary behavior, measured by the activPAL activity tracker. Secondary outcomes include physical activity levels, cardiometabolic biomarkers, and patient-centered outcomes (i.e. sedentary behavior self-efficacy, habit strength, and fear of movement). This study leverages commonly used mobile and wearable technologies to address sedentary behavior in cardiovascular disease patients, a high-risk group. Its findings on the feasibility, acceptability and primary efficacy of the intervention hold promise for broad dissemination.

Towards Optimal Cardiovascular Health: A Comprehensive Review of Preventive Strategies

Heart disease remains a prominent global health concern, with cardiovascular disease (CVD) standing as a leading cause of death worldwide. Preventing heart disease not only decreases the risk of premature death but also mitigates complications like heart attacks, strokes, and arrhythmias, thereby enhancing overall health and quality of life. The economic burden of heart disease treatment highlights the importance of implementing preventive measures, such as lifestyle changes and early interventions, which can alleviate healthcare costs. These strategies, targeting risk factors like hypertension (HTN), diabetes mellitus (DM), dyslipidemia, and obesity, not only prevent heart disease but also reduce the risk of other health issues. Herein, this review covers various preventive measures, including dietary interventions, exercise, controlling HTN, DM, cholesterol, and weight, smoking cessation, and pharmacological interventions. By critically analyzing the guidelines and leveraging robust data alongside variations in recommendations, this review aims to elucidate effective primary prevention strategies for CVD.

Associations between regular physical exercise and physical, emotional, and cognitive health of older adults in China: an 8-year longitudinal study with propensity score matching

Background

The importance of healthy aging is growing in China as it has the largest number of older adults in the world and is one of the fastest-aging countries. This study aimed to examine the predictive value of regular physical exercise in relation to the physical, emotional, and cognitive health among samples of adults aged ≥60 years in China during an 8-year period.

Methods

A total of 10,691 older adults were extracted from two waves of national data from the China Family Panel Studies in 2010 and 2018. To minimize the impact of selection bias on the findings, a longitudinal propensity score matching (LPSM) method was used to examine the relationships between regular physical exercise and emotional health (depression), between regular physical exercise and physical health (instrumental activities of daily living), and between regular physical exercise and cognitive health (cognitive ability) of older adults. After LPSM, 856 older adults were included in the study. In the regular physical exercise group, the average age of participants at baseline year was 65.67 years, with an average age of 65.90 years for 238 men and 65.45 years for 190 women, and in the non-physical exercise group, their average age at baseline year was 65.70 years, with an average age of 65.45 years for 253 men and 65.98 years for 175 women.

Results

LPSM indicated that regular physical exercise has been found to be effective in improving physical function and reducing depressive symptoms in old adults, even after controlling for background differences. However, the sensitivity analysis suggests that the positive association between regular physical exercise and cognitive function may not be sufficiently valid.

Conclusion

The findings of this study indicate that engaging in long-term structured and repetitive physical exercise can have a significant positive effect on reducing depressive symptoms and improving the physical function of older adults. As a result, incorporating regular physical exercise into the lifestyle of older adults is recognized as an effective strategy for promoting healthy aging and reducing the strain on public health resources.

Harmony in Motion: Unraveling the Nexus of Sports, Plant-Based Nutrition, and Antioxidants for Peak Performance

The intricate interplay between plant-based nutrition, antioxidants, and their impact on athletic performance forms the cornerstone of this comprehensive review. Emphasizing the pivotal importance of dietary choices in the realm of sports, this paper sets the stage for an in-depth exploration of how stress and physical performance are interconnected through the lens of nutrition. The increasing interest among athletes in plant-based diets presents an opportunity with benefits for health, performance, and recovery. It is essential to investigate the connection between sports, plants, and antioxidants. Highlighting the impact of nutrition on recovery and well-being, this review emphasizes how antioxidants can help mitigate oxidative stress. Furthermore, it discusses the growing popularity of plant-based diets among athletes. It elaborates on the importance of antioxidants in combating radicals addressing stress levels while promoting cellular health. By identifying rich foods, it emphasizes the role of a balanced diet in ensuring sufficient intake of these beneficial compounds. Examining stress within the context of sports activities, this review provides insights into its mechanisms and its impact on athletic performance as well as recovery processes. This study explores the impact of plant-based diets on athletes including their types, potential advantages and challenges. It also addresses the drawbacks of relying on plant-based diets, concerns related to antioxidant supplementation and identifies areas where further research is needed. Furthermore, the review suggests directions for research and potential innovations in sports nutrition. Ultimately it brings together the aspects of sports, plant-based nutrition, and antioxidants to provide a perspective for athletes, researchers and practitioners. By consolidating existing knowledge, it offers insights that can pave the way for advancements in the ever-evolving field of sports nutrition.

Lifestyle Medicine: An Antidote to Cardiovascular Diseases

Despite numerous advances in basic understanding of cardiovascular disease pathophysiology, pharmacology, therapeutic procedures, and systems improvement, there hasn't been much decline in heart disease related mortality in the US since 2010. Hypertension and diet induced risk continue to be the leading causes of cardiovascular morbidity. Even with the excessive mortality associated with the COVID-19 pandemic, in 2020, heart disease remained the leading cause of death. Given the degree of disease burden, morbidity, and mortality, there is an urgent need to redirect medical professionals' focus towards prevention through simple and cost effective lifestyle strategies. However, current practice paradigm and financial compensation systems are mainly centered disease management and not health promotion. For example, the financial value placed on 3-10 min smoking cessation counseling (.24RVUs) is 47-fold lower than an elective PCI (11.21 RVUs). The medical community seems to be enamored with the latest and greatest technology, new devices, and surgical procedures. What if the greatest technology of all was simply the way we live every day? Perhaps when this notion is known by enough, we will switch to this lifestyle medicine technology to prevent disease in the first place.

Physical activity and odds of coronary heart disease among Lebanese women

BACKGROUND

It is known that physical activity (PA) is protective against cardiovascular morbidity and mortality. However, few studies have examined the association between PA, sedentary lifestyle and coronary heart disease (CHD) in women. This case-control study investigates the relationship between PA and sedentary behavior on CHD odds in Lebanese women over forty.

METHODS

One thousand five hundred selected Lebanese women (300 cases and 1200 controls) were included between 2018-2019. Cases were hospitalized women newly diagnosed with CHD, whereas the control groups were free of any heart diseases. Data on socio-demographic, lifestyle, cardiovascular factors, PA and sedentary lifestyle were collected. Multivariate logistic regressions, adjusted for covariates, were performed to investigate the association of PA domains and sedentary behavior with CHD.

RESULTS

A sedentary lifestyle combined with low activity levels increased the odds of CHD. Among cases, 46.7% participated in moderate or vigorous PA against almost 60.3% of controls. 36.3% of coronary patients had more than 10 h/day of sedentary time, with a positive correlation with CHD (adjusted OR: 1.533, 95%CI: 1.046-2.247). Conversely, moderate and high levels (respectively 600-3000 and ≥ 3000 metabolic equivalents [MET]-minutes/week) of domestic/garden PA revealed lower CHD odds (OR: 0.566, 95%CI: 0.396-0.808 and 0.193, 0.065-0.578 respectively). The detrimental influence of sedentary lifestyle appeared to be significantly reversed by weekly moderate PA, especially as weekly sedentary time was less (OR: 0.616, 95%CI: 0.427-0.888/ 6 to10h of sedentary time and OR: 0.537, 95% CI: 0.37-0.779/ ≤ 6 h), and except sedentary time exceeding 10 h daily. Two PA patterns revealed lower CHD odds: transport-related and domestic/garden PA, as early as low amount, even after adjustment for possible confounders.

CONCLUSION

The current study highlights the importance of combating sedentary behaviors and engaging in regular, easily accessible PA to reduce the odds of coronary disease among aging women. Therefore, better information regarding the benefits of physical activities such as transportation-related activities or gardening would be helpful in enhancing the prevention of CHD in aging women.

Repeat Coronary Angiography in Patients Aged over 50 Years with Previously Normal/Non-Obstructive Coronary Angiogram-Insights from a Retrospective Study

(1) Introduction: A significant proportion of patients undergoing coronary angiography (CAG) have normal (NCA) or non-obstructive coronary artery disease (NOCAD). This study retrospectively tested the incidence of re-catheterization, and long-term outcomes of this population in patients aged over 50 years. (2) Methods: We identified all patients above 50 years of age with NOCAD who underwent their first CAG at our center between January 2008 and December 2019. Patients were evaluated for their baseline characteristics, risk factors profile, and indication for CAG. Patients undergoing repeat CAG after the index procedure were assessed for the above, including the primary preventive pharmacotherapy prescribed. (3) Results: A total of 1939 patients were reported to have NOCAD. Of these, 1756 (90%) patients (62% males, median age 66 (56-75) years) had no repeat angiography (group 1). Repeat angiography was performed in 10%: 136 (7%) proved futile (median time for repeat angiography 5 (3-8) years) (group 3), and 47 (3%) ended with angioplasty (median time for repeat angiography 4 (3-6) years) (group 2). Male gender, BMI above 30 (23% vs. 13%), hypertension (68% vs. 57%), diabetes (28% vs. 17%) and smoking (36% vs. 19%) were significantly higher in the interventional group. Regression analysis showed both paroxysmal atrial fibrillation and hyperlipidemia were significantly associated with repeat CAG. The indication for the first CAG was mainly symptoms related. In the interventional repeat angiography (n = 47) the incidence of troponin positive cases increased from 8.2% before intervention to 57.5%, 50% being ST elevation cases. The symptoms-related cases went from 36.7% to 18.4%. Intriguingly, 85% of the interventional group were not prescribed statin and/or aspirin on a regular basis, and/or did not adhere to treatment. (4) Conclusions: NOCAD is a frequent occurrence. The threshold for repeat angiography must be higher, better reserved to troponin positive cases. Moreover, patients must be handled according to their risk profile, not being mistakenly reassured by a snapshot benign coronary angiography.

Time trends in preeclampsia and gestational diabetes in Denmark and Alberta, Canada, 2005-2018-A population-based cohort study

INTRODUCTION

Preeclampsia and gestational diabetes mellitus share risk factors such as obesity and increased maternal age, which have become more prevalent in recent decades. We examined changes in the prevalence of preeclampsia and gestational diabetes between 2005 and 2018 in Denmark and Alberta, Canada, and investigated whether the observed trends can be explained by changes in maternal age, parity, multiple pregnancy, comorbidity, and body mass index (BMI) over time.

MATERIAL AND METHODS

This study was a register-based cohort study conducted using data from the Danish National Health Registers and the provincial health registers of Alberta, Canada. We included in the study cohort all pregnancies in 2005-2018 resulting in live-born infants and used binomial regression to estimate mean annual increases in the prevalence of preeclampsia and gestational diabetes in the two populations across the study period, adjusted for maternal characteristics.

RESULTS

The study cohorts included 846 127 (Denmark) and 706 728 (Alberta) pregnancies. The prevalence of preeclampsia increased over the study period in Denmark (2.5% to 2.9%) and Alberta (1.7% to 2.5%), with mean annual increases of 0.03 (95% confidence interval [CI] 0.02-0.04) and 0.06 (95% CI 0.05-0.07) percentage points, respectively. The prevalence of gestational diabetes also increased in Denmark (1.9% to 4.6%) and Alberta (3.9% to 9.2%), with average annual increases of 0.20 (95% CI 0.19-0.21) and 0.44 (95% CI 0.42-0.45) percentage points. Changes in the distributions of maternal age and BMI contributed to increases in the prevalence of both conditions but could not explain them entirely.

CONCLUSIONS

The prevalence of both preeclampsia and gestational diabetes increased significantly from 2005 to 2018, which portends future increases in chronic disease rates among affected women. Increasing demand for long-term follow up and care will amplify the existing pressure on healthcare systems.

Long-Term Mortality Risk According to Cardiorespiratory Fitness in Patients Undergoing Coronary Artery Bypass Graft Surgery

The aim of this study was to evaluate the association between cardiorespiratory fitness (CRF) and long-term survival in United States (US) Veterans undergoing CABG. We identified 14,550 US Veterans who underwent CABG at least six months after completing a symptom-limited exercise treadmill test (ETT) with no evidence of cardiovascular disease. During a mean follow-up period of 10.0 ± 5.4 years, 6502 (43.0%) died. To assess the association between CRF and risk of mortality, we formed the following five fitness categories based on peak workload achieved (metabolic equivalents or METs) prior to CABG: Least-Fit (4.3 ± 1.0 METs (n = 4722)), Low-Fit (6.8 ± 0.9 METs (n = 3788)), Moderate-Fit (8.3 ± 1.1 METs (n = 2608)), Fit (10.2 ± 0.8 METs (n = 2613)), and High-Fit (13.0 ± 1.5 METs (n = 819)). Cox proportional hazard models were used to calculate risk across CRF categories. The models were adjusted for age, body mass index, race, cardiovascular disease, percutaneous coronary intervention prior to ETT, cardiovascular medications, and cardiovascular disease risk factors. P-values < 0.05 using two-sided tests were considered statistically significant. The association between cardiorespiratory fitness and mortality was inverse and graded. For every 1-MET increase in exercise capacity, the mortality risk was 11% lower (HR = 0.89; CI: 0.88-0.90; p < 0.001). When compared to the Least-Fit category (referent), mortality risk was 22% lower in Low-Fit individuals (HR = 0.78; CI: 0.73-0.82; p < 0.001), 31% lower in Moderate-Fit individuals (HR = 0.69; CI: 0.64-0.74; p < 0.001), 52% lower in Fit individuals (HR = 0.48; CI: 0.44-0.52; p < 0.001), and 66% lower in High-Fit individuals (HR = 0.34; CI: 0.29-0.40; p < 0.001). Cardiorespiratory fitness is inversely and independently associated with long-term mortality after CABG in Veterans referred for exercise testing.

Cardiac Rehabilitation Program Effect on Health-Related Quality of Life Among Patients With Coronary Artery Bypass Grafts

Coronary artery bypass graft (CABG) necessitates modification in patients' lifestyle after discharge, which leads to a decrease in their health-related quality of life (HRQOL). Hence, cardiac rehabilitation programs (CRPs) are needed. This study aimed to explore the effect of a CRP on HRQOL and physiological factors on CABG patients after discharge. The study used a quasiexperimental pre-/posttest design. Two experimental and control groups tested with 30 patients with CABG surgery participated in a rehabilitation center after discharge. The Arabic version of the Nottingham Health Profile for measuring HRQOL was used. In addition to several sociodemographic and physiological variables, findings indicated a significant improvement in HRQOL and its domains for the experimental group after CRP (mean = 2.06, SD = 1.7) when compared with the control group (mean = 19.9, SD = 3.1; P = .01), as well as some physiological variables 3 months after surgery. The CRP is an important intervention that administrators and cardiologists should take into consideration for CABG patients. It improves not just their HRQOL but also many physiological indicators.

'Super Rehab': can we achieve coronary artery disease regression? A feasibility study protocol

INTRODUCTION

Patients diagnosed with coronary artery disease (CAD) are currently treated with medications and lifestyle advice to reduce the likelihood of disease progression and risk of future major adverse cardiovascular events (MACE). Where obstructive disease is diagnosed, revascularisation may be considered to treat refractory symptoms. However, many patients with coexistent cardiovascular risk factors, particularly those with metabolic syndrome (MetS), remain at heightened risk of future MACE despite current management.Cardiac rehabilitation is offered to patients post-revascularisation, however, there is no definitive evidence demonstrating its benefit in a primary prevention setting. We propose that an intensive lifestyle intervention (Super Rehab, SR) incorporating high-intensity exercise, diet and behavioural change techniques may improve symptoms, outcomes, and enable CAD regression.This study aims to examine the feasibility of delivering a multicentre randomised controlled trial (RCT) testing SR for patients with CAD, in a primary prevention setting.

METHODS AND ANALYSIS

This is a multicentre randomised controlled feasibility study of SR versus usual care in patients with CAD. The study aims to recruit 50 participants aged 18-75 across two centres. Feasibility will be assessed against rates of recruitment, retention and, in the intervention arm, attendance and adherence to SR. Qualitative interviews will explore trial experiences of study participants and practitioners. Variance of change in CAD across both arms of the study (assessed with serial CT coronary angiography) will inform the design and power of a future, multi-centre RCT.

ETHICS AND DISSEMINATION

Ethics approval was granted by South West-Frenchay Research Ethics Committee (reference: 21/SW/0153, 18 January 2022). Study findings will be disseminated via presentations to relevant stakeholders, national and international conferences and open-access peer-reviewed research publications.

TRIAL REGISTRATION NUMBER

ISRCTN14603929.

Effects of exercise on platelet reactivity after myocardial infarction: a randomized clinical trial

Exercise training (ET) can lower platelet reactivity in patients with cardiovascular risk factors. However, the effects of ET on platelet reactivity in higher-risk patients is unknown. The aim of this study was to evaluate the effects of ET on platelet reactivity in patients with recent myocardial infarction (MI). Ninety patients were randomly assigned 1 month post-MI to the intervention (patients submitted to a supervised ET program) or control group. All patients were on dual antiplatelet therapy (DAPT). Platelet reactivity by VerifyNow-P2Y12 (measured by P2Y12 reaction units - PRUs) test was determined at baseline and at the end of 14 ± 2 weeks of follow-up at rest (primary endpoint), and multiplate electrode aggregometry (MEA) adenosine diphosphate (ADP) and aspirin (ASPI) tests were performed immediately before and after the maximal cardiopulmonary exercise test (CPET) at the same time points (secondary endpoints). Sixty-five patients (mean age 58.9 ± 10 years; 73.8% men; 60% ST elevation MI) completed follow-up (control group, n = 31; intervention group, n = 34). At the end of the follow-up, the mean platelet reactivity was 172.8 ± 68.9 PRUs and 166.9 ± 65.1 PRUs for the control and intervention groups, respectively (p = .72). Platelet reactivity was significantly increased after the CPET compared to rest at the beginning and at the end of the 14-week follow-up (among the intervention groups) by the MEA-ADP and MEA-ASPI tests (p < .01 for all analyses). In post-MI patients on DAPT, 14 weeks of supervised ET did not reduce platelet reactivity. Moreover, platelet reactivity was increased after high-intensity exercise (ClinicalTrials.gov: NCT02958657; https://clinicaltrials.gov/ct2/show/NCT02958657).

Cardiorespiratory fitness and the incidence of surgery for aortic valve stenosis-the HUNT study

OBJECTIVES

Aortic valve stenosis (AVS) shares many risk factors with coronary disease, the latter being strongly and inversely associated with physical activity (PA) and cardiorespiratory fitness (CRF). However, the relationship between PA, CRF and AVS needs to be established. We explored whether PA habits and estimated CRF affect the risk of developing AVS demanding aortic valve replacement (AVR) and how these factors affect postoperative mortality.

METHODS

Participants from the second and third waves of Trøndelag Health Study were cross-linked with a local heart surgery registry and the Norwegian Cause of Death Registry. Estimated CRF was calculated through a developed algorithm based on clinical and self-reported data. Fine-Gray competing risk analyses were used to investigate how PA habits and estimated CRF were associated with the risk of AVR across CRF quintiles, PA groups and per 1-metabolic equivalent task (MET) (3.5 ml/min/kg).

RESULTS

In a study population of 57 214 participants, we found a 15% [95% confidence interval (CI) 1-27] reduced risk of AVR per 1-MET estimated CRF increment. Those in the highest CRF quintile had a 56% (95% CI 14-77) lower risk of surgery compared to the lowest quintile. Analyses on PA groups did not show significant results. Finally, we found a 37% (95% CI 17-53) lower risk of postoperative mortality per 1-MET increased estimated CRF.

CONCLUSIONS

Our findings indicate a strong and inverse relationship between estimated CRF and incidence of AVR due to AVS. Higher estimated CRF was associated with lower mortality after surgery.

Concurrent changes in physical activity and physical functioning during retirement transition-a multi-trajectory analysis

BACKGROUND

Physical activity and physical functioning have been reported to change over retirement transition, but the results have been inconsistent, and the two constructs have not been studied concurrently. The objective of this study was to examine concurrent changes in physical activity and physical functioning during transition to retirement among public sector employees, and to examine if occupation, sex, marital status, body mass index (BMI), alcohol consumption and smoking status are associated with observed different multi-trajectory paths.

METHODS

3,550 participants of the Finnish Retirement and Aging study responded to an annual survey on physical activity and physical functioning (SF-36) before and after retirement. Group-based multi-trajectory analysis was used to identify clusters with dissimilar concurrent changes in physical activity and physical functioning. Multinomial regression analysis was used to describe the associations between covariates and the probability of being classified to a certain cluster.

RESULTS

Participants were 63.4 (SD 1.4) years old, 83% women, 65% professional workers. Four trajectories of concurrent changes in physical activity and physical functioning were identified, one with decreasing physical functioning and low activity, one with increasing high activity and stable high functioning and two with fluctuating moderate physical activity and stable high functioning. Single, women, obese participants and risk-users of alcohol were more likely to be classified into group with low physical activity and declining physical functioning.

CONCLUSIONS

Low physical activity below the level usually recommended was associated with lower physical functioning during retirement transition. These findings could be useful when planning interventions for retirees to maintain their physical functioning level.

Changes in Physical Activity and Incidence of Nonfatal Cardiovascular Events in 47 153 Survivors of Myocardial Infarction

Background The majority of patients survive the acute phase of myocardial infarction (MI) but have an increased risk of recurrent cardiovascular disease (CVD) events. To be regularly physically active or change activity level is associated with a lower risk of all-cause mortality. The objective was to explore to what extent physical activity (PA) levels or change in PA levels during the first year post-MI was associated with any recurrent nonfatal CVD events and specific CVD events (eg, MI, ischemic stroke, and vascular dementia). Methods and Results This cohort study among MI survivors was based on Swedish national registries between 2005 and 2020. PA levels were self-rated at 2 and 12 months post-MI, and patients were classified into remaining physically inactive, increasing, decreasing, or remaining active. A total of 6534 nonfatal CVD events occurred during 6 years of follow-up among the 47 153 included patients. In fully adjusted analyses, the risk of any nonfatal CVD event was lower (P<0.05) among patients remaining active (37%), increasing (22%), or decreasing (18%) PA level compared with remaining inactive. Compared with remaining inactive, the risk of recurring MI and stroke was lower (P>0.05) among remaining active (41% versus 52%, respectively), increasing (20% versus 35%, respectively), or decreasing PA level (24% versus 34%, respectively). For vascular dementia, patients remaining physically active had an 80% lower risk compared with remaining inactive (P<0.05). Conclusions Remaining physically active or change in PA levels during the first year post-MI was associated with a lower risk of recurrent nonfatal CVD events. This emphasizes the importance of supporting patients to continue to be or become physically active.

Six-month effects of supervised exercise on walking ability and health-related factors in peripheral arterial disease: a pilot study

BACKGROUND

In peripheral arterial disease (PAD) patients with intermittent claudication (IC), the combination of aerobic and resistance exercises could counteract muscle loss and attenuate disease progression. This study analyzed the effects of six months of a combined exercise program on walking ability, lower limb body composition, cardiovascular risk factors, and Ankle-Brachial Index (ABI).

METHODS

Twenty-three patients (age 63.2±1.5 years and ABI 0.58±0.07) with PAD and IC were allocated to a control group (CG) or a supervised exercise group (SUP). Ten patients underwent six months of treadmill walking combined with resistance exercises, three times a week. The CG (N.=13) received a recommendation for walking. All patients were measured at baseline (M0), after three months (M3), and six months (M6).

RESULTS

During constant treadmill protocol, the claudication onset time/distance (COT/COD), absolute claudication time/distance (ACT/ACD), and number of pauses of overall patients significantly improved at M3 and M6. Between groups were found significant differences in COT and COD at M6 (P=0.005 and P=0.007, respectively); and in ACT and ACD at M3 (P=0.003 for both) and at M6 (P=0.005 and P=0.005, respectively), with major improvements in the SUP. Over the six months, a significant group effect was found in fat-free mass (P=0.041) and predicted muscle mass (P=0.039) of the lower ABI leg, with greater improvements in the SUP.

CONCLUSIONS

A supervised exercise program that combines aerobic and resistance training improves PAD symptoms and has additional benefits for patients. Patients in the program showed improvements in walking ability, lower-limb body composition, perceived exertion, and heart rate during treadmill walking.

The Impact of Physical Activity Intensity on the Dynamic Progression of Cardiometabolic Multimorbidity: Prospective Cohort Study Using UK Biobank Data

BACKGROUND

Although many studies have reported on the associations between the amount of physical activity (PA) and the transitions of cardiometabolic multimorbidity (CMM), the evidence for PA intensity has not been fully evaluated.

OBJECTIVE

This study aimed to explore the impact of PA intensity on the dynamic progression of CMM.

METHODS

The prospective cohort of this study using data from the UK Biobank included 359,773 participants aged 37-73 years who were recruited from 22 centers between 2006 and 2010. The diagnoses of CMM, which included the copresence of type 2 diabetes (T2D), ischemic heart disease, and stroke, were obtained from first occurrence fields provided by the UK Biobank, which included data from primary care, hospital inpatient record, self-reported medical condition, and death registers. The PA intensity was assessed by the proportion of vigorous PA (VPA) to moderate to vigorous PA (MVPA). Multistate models were used to evaluate the effect of PA intensity on the dynamic progression of CMM. The first model (model A) included 5 transitions, namely free of cardiometabolic disease (CMD) to first occurrence of CMD (FCMD), free of CMD to death, FCMD to CMM, FCMD to mortality, and CMM to mortality. The other model (model B) used specific CMD, namely T2D, ischemic heart disease, and stroke, instead of FCMD and included 11 transitions in this study.

RESULTS

The mean age of the included participants (N=359,773) was 55.82 (SD 8.12) years at baseline, and 54.55% (196,271/359,773) of the participants were female. Compared with the participants with no VPA, participants with intensity levels of >0.75 to <1 for VPA to MVPA had a 13% and 27% lower risk of transition from free of CMD to FCMD (hazard ratio [HR] 0.87, 95% CI 0.83-0.91) and mortality (HR 0.73, 95% CI 0.66-0.79) in model A, respectively. The HR for the participants with no moderate PA was 0.82 (95% CI 0.73-0.92) compared with no VPA. There was a substantially protective effect of higher PA intensity on the transitions from free of CMD to T2D and from T2D to mortality, which reveals the importance of PA intensity for the transitions of T2D. More PA and greater intensity had a synergistic effect on decreasing the risk of the transitions from free of CMD to FCMD and mortality. Male participants, younger adults, adults with a higher BMI, current or previous smokers, and excessive alcohol drinkers could obtain more benefits from higher PA intensity for the lower risk of at least 1 transition from free of CMD, then to CMM, and finally to mortality.

CONCLUSIONS

This study suggests that higher PA intensity is an effective measure for preventing CMM and mortality in the early period of CMM development. Relevant interventions related to higher PA intensity should be conducted.

Prognosis and Personalized In Silico Prediction of Treatment Efficacy in Cardiovascular and Chronic Kidney Disease: A Proof-of-Concept Study

(1) Background: Kidney and cardiovascular diseases are responsible for a large fraction of population morbidity and mortality. Early, targeted, personalized intervention represents the ideal approach to cope with this challenge. Proteomic/peptidomic changes are largely responsible for the onset and progression of these diseases and should hold information about the optimal means of treatment and prevention. (2) Methods: We investigated the prediction of renal or cardiovascular events using previously defined urinary peptidomic classifiers CKD273, HF2, and CAD160 in a cohort of 5585 subjects, in a retrospective study. (3) Results: We have demonstrated a highly significant prediction of events, with an HR of 2.59, 1.71, and 4.12 for HF, CAD, and CKD, respectively. We applied in silico treatment, implementing on each patient's urinary profile changes to the classifiers corresponding to exactly defined peptide abundance changes, following commonly used interventions (MRA, SGLT2i, DPP4i, ARB, GLP1RA, olive oil, and exercise), as defined in previous studies. Applying the proteomic classifiers after the in silico treatment indicated the individual benefits of specific interventions on a personalized level. (4) Conclusions: The in silico evaluation may provide information on the future impact of specific drugs and interventions on endpoints, opening the door to a precision-based medicine approach. An investigation into the extent of the benefit of this approach in a prospective clinical trial is warranted.

LncRNA CASC11 upregulation promotes HDAC4 to alleviate oxidized low-density lipoprotein-induced injury of cardiac microvascular endothelial cells

Long noncoding RNAs (LncRNAs) are essential to regulate the pathogenesis of coronary artery disease (CAD). This study was conducted to analyze the functionality of long noncoding RNA cancer susceptibility candidate 11 (lncRNA CASC11) in oxidized low-density lipoprotein (ox-LDL)-induced injury of cardiac microvascular endothelial cells (CMECs). CMECs were treated with ox-LDL to induce the CAD cell model. The cellular expression levels of CASC11 and histone deacetylase 4 (HDAC4) were determined by real-time quantitative polymerase chain reaction or Western blot assay. Cell absorbance, apoptosis, angiogenesis, and inflammation were evaluated by cell counting kit-8, flow cytometry, tube formation, and enzyme-linked immunosorbent assays. The subcellular localization of CASC11 was examined by the nuclear/cytoplasmic fractionation assay. The binding of human antigen R (HuR) to CASC11 and HDAC4 was analyzed by RNA immunoprecipitation. HDAC4 stability was determined after actinomycin D treatment. CASC11 was found to be decreased in the CAD cell model. CASC11 upregulation increased cell viability and angiogenesis and reduced apoptosis and inflammation. CASC11 bound to HuR and improved HDAC4 expression. HDAC4 downregulation counteracted the protective role of CASC11 overexpression in CMECs. In summary, CASC11 alleviated ox-LDL-induced injury of CMECs by binding to HuR and stabilizing HDAC4.

Global Alliance for the Promotion of Physical Activity: the Hamburg Declaration

Non-communicable diseases (NCDs), including coronary heart disease, stroke, hypertension, type 2 diabetes, dementia, depression and cancers, are on the rise worldwide and are often associated with a lack of physical activity (PA). Globally, the levels of PA among individuals are below WHO recommendations. A lack of PA can increase morbidity and mortality, worsen the quality of life and increase the economic burden on individuals and society. In response to this trend, numerous organisations came together under one umbrella in Hamburg, Germany, in April 2021 and signed the 'Hamburg Declaration'. This represented an international commitment to take all necessary actions to increase PA and improve the health of individuals to entire communities. Individuals and organisations are working together as the 'Global Alliance for the Promotion of Physical Activity' to drive long-term individual and population-wide behaviour change by collaborating with all stakeholders in the community: active hospitals, physical activity specialists, community services and healthcare providers, all achieving sustainable health goals for their patients/clients. The 'Hamburg Declaration' calls on national and international policymakers to take concrete action to promote daily PA and exercise at a population level and in healthcare settings.

Wearable technology and the cardiovascular system: the future of patient assessment

The past decade has seen a dramatic rise in consumer technologies able to monitor a variety of cardiovascular parameters. Such devices initially recorded markers of exercise, but now include physiological and health-care focused measurements. The public are keen to adopt these devices in the belief that they are useful to identify and monitor cardiovascular disease. Clinicians are therefore often presented with health app data accompanied by a diverse range of concerns and queries. Herein, we assess whether these devices are accurate, their outputs validated, and whether they are suitable for professionals to make management decisions. We review underpinning methods and technologies and explore the evidence supporting the use of these devices as diagnostic and monitoring tools in hypertension, arrhythmia, heart failure, coronary artery disease, pulmonary hypertension, and valvular heart disease. Used correctly, they might improve health care and support research.

New Approaches in Heart Research: Prevention Instead of Cardiomyoplasty?

Cardiovascular diseases are the leading cause of death in industrialized nations. Due to the high number of patients and expensive treatments, according to the Federal Statistical Office (2017) in Germany, cardiovascular diseases account for around 15% of total health costs. Advanced coronary artery disease is mainly the result of chronic disorders such as high blood pressure, diabetes, and dyslipidemia. In the modern obesogenic environment, many people are at greater risk of being overweight or obese. The hemodynamic load on the heart is influenced by extreme obesity, which often leads to myocardial infarction (MI), cardiac arrhythmias, and heart failure. In addition, obesity leads to a chronic inflammatory state and negatively affects the wound-healing process. It has been known for many years that lifestyle interventions such as exercise, healthy nutrition, and smoking cessation drastically reduce cardiovascular risk and have a preventive effect against disorders in the healing process. However, little is known about the underlying mechanisms, and there is significantly less high-quality evidence compared to pharmacological intervention studies. Due to the immense potential of prevention in heart research, the cardiologic societies are calling for research work to be intensified, from basic understanding to clinical application. The topicality and high relevance of this research area are also evident from the fact that in March 2018, a one-week conference on this topic with contributions from top international scientists took place as part of the renowned "Keystone Symposia" ("New Insights into the Biology of Exercise"). Consistent with the link between obesity, exercise, and cardiovascular disease, this review attempts to draw lessons from stem-cell transplantation and preventive exercise. The application of state-of-the-art techniques for transcriptome analysis has opened new avenues for tailoring targeted interventions to very individual risk factors.

Physical Activity and Mortality in Patients with Coronary Artery Disease

PURPOSE OF REVIEW

Coronary artery disease (CAD) accounts for half of heart-related mortalities. Secondary prevention measures are aimed at enhancing the probability of survival in acute and chronic heart diseases. Physical activity (PA) has been shown to effectively reduce all-cause and cardiovascular (CV) mortality rates. This article reviews the relationship between PA and mortality in patients with CAD. Additionally, we discuss the process of vascular changes that contributes to survival benefits in physically active CAD patients, along with exercise dosing and guideline recommendations.

RECENT FINDINGS

Recent studies have shown that physical inactivity poses a modifiable risk factor that impedes favorable vasculature remodeling, unlike active individuals. Recent meta-analyses provide strong evidence of the multifaceted advantages of PA in lowering mortality rates in patients with CAD, as opposed to physically inactive participants. In summary, substantial evidence indicates that PA is significantly associated with reduction in all-cause and CV mortality in CAD patients, with a dose-response relationship.

Physical exercise, health, and disease treatment: The role of macrophages

Subclinical inflammation is linked to comorbidities and risk factors, consolidating the diagnosis of chronic non-communicable diseases, such as insulin resistance, atherosclerosis, hepatic steatosis, and some types of cancer. In this context, the role of macrophages is highlighted as a marker of inflammation as well as for the high power of plasticity of these cells. Macrophages can be activated in a wide range between classical or proinflammatory, named M1, and alternative or anti-inflammatory, also known as M2 polarization. All nuances between M1 and M2 macrophages orchestrate the immune response by secreting different sets of chemokines, while M1 cells promote Th1 response, the M2 macrophages recruit Th2 and Tregs lymphocytes. In turn, physical exercise has been a faithful tool in combating the proinflammatory phenotype of macrophages. This review proposes to investigate the cellular and molecular mechanisms in which physical exercise can help control inflammation and infiltration of macrophages within the non-communicable diseases scope. During obesity progress, proinflammatory macrophages predominate in adipose tissue inflammation, which reduces insulin sensitivity until the development of type 2 diabetes, progression of atherosclerosis, and diagnosis of non-alcoholic fatty liver disease. In this case, physical activity restores the balance between the proinflammatory/anti-inflammatory macrophage ratio, reducing the level of meta-inflammation. In the case of cancer, the tumor microenvironment is compatible with a high level of hypoxia, which contributes to the advancement of the disease. However, exercise increases the level of oxygen supply, favoring macrophage polarization in favor of disease regression.

Association of Time-of-Day Physical Activity With Incident Cardiovascular Disease: The UK Biobank Study

INTRODUCTION

Early morning is characterized by an increased risk of cardiovascular events, a sudden rise in blood pressure, impaired endothelial function, and exacerbated hemodynamic changes during physical activity. The study aims to examine whether the time of day of physical activity is associated with incident cardiovascular disease (CVD).

METHODS

We prospectively analyzed 83,053 participants in the UK Biobank with objectively measured physical activity and initially free of CVD. Based on the diurnal patterns of physical activity, participants were categorized into 4 groups: early morning (n = 15,908), late morning (n = 22,371), midday (n = 24,764), and evening (n = 20,010). Incident CVD was defined as the first diagnosis of coronary heart disease or stroke.

RESULTS

During 197.4 million person-years of follow-up, we identified 3454 CVD cases. After adjusting for the overall acceleration average, the hazard ratios and 95% confidence intervals were 0.95 (0.86-1.07) for late morning, 1.15 (1.03-1.27) for midday, and 1.03 (0.92-1.15) for evening, as compared with the early morning group. In the joint analyses, higher levels of physical activity were associated with a lower risk of incident CVD in a similar manner across the early morning, late morning, and evening groups. However, the beneficial association was attenuated in the midday group.

CONCLUSION

In conclusion, early morning, late morning, and evening are all favorable times of day to engage in physical activity for the primary prevention of CVD, while midday physical activity is associated with an increased risk of CVD compared with early morning physical activity after controlling for the levels of physical activity.

Ethnic differences in the lifestyle behaviors and premature coronary artery disease: a multi-center study

BACKGROUND

Diverse ethnic groups that exist in Iran may differ regarding the risk factors such as hypertension, hyperlipidemia, dyslipidemia, diabetes mellitus, and family history of non-communicable disease. Premature Coronary Artery Disease (PCAD) is more endemic in Iran than before. This study sought to assess the association between ethnicity and lifestyle behaviors in eight major Iranian ethnic groups with PCAD.

METHODS

In this study, 2863 patients aged ≤ 70 for women and ≤ 60 for men who underwent coronary angiography were recruited in a multi-center framework. All the patients' demographic, laboratory, clinical, and risk factor data were retrieved. Eight large ethnicities in Iran, including the Farses, the Kurds, the Turks, the Gilaks, the Arabs, the Lors, the Qashqai, and the Bakhtiari were evaluated for PCAD. Different lifestyle components and having PCAD were compared among the ethnical groups using multivariable modeling.

RESULTS

The mean age of the 2863 patients participated was 55.66 ± 7.70 years. The Fars ethnicity with 1654 people, was the most subject in this study. Family history of more than three chronic diseases (1279 (44.7%) was the most common risk factor. The Turk ethnic group had the highest prevalence of ≥ 3 simultaneous lifestyle-related risk factors (24.3%), and the Bakhtiari ethnic group had the highest prevalence of no lifestyle-related risk factors (20.9%). Adjusted models showed that having all three abnormal lifestyle components increased the risk of PCAD (OR = 2.28, 95% CI: 1.04-1.06). The Arabs had the most chance of getting PCAD among other ethnicities (OR = 2.26, 95%CI: 1.40-3.65). While, the Kurds with a healthy lifestyle showed the lowest chance of getting PCAD (OR = 1.96, 95%CI: 1.05-3.67)).

CONCLUSIONS

This study found there was heterogeneity in having PACD and a diverse distribution in its well-known traditional lifestyle-related risk factors among major Iranian ethnic groups.

High prevalence of cardiometabolic risk factors amongst young adults in the United Arab Emirates: the UAE Healthy Future Study

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death in the world. In the United Arab Emirates (UAE), it accounts for 40% of mortality. CVD is caused by multiple cardiometabolic risk factors (CRFs) including obesity, dysglycemia, dyslipidemia, hypertension and central obesity. However, there are limited studies focusing on the CVD risk burden among young Emirati adults. This study investigates the burden of CRFs in a sample of young Emiratis, and estimates the distribution in relation to sociodemographic and behavioral determinants.

METHODS

Data was used from the baseline data of the UAE Healthy Future Study volunteers. The study participants were aged 18 to 40 years. The study analysis was based on self-reported questionnaires, anthropometric and blood pressure measurements, as well as blood analysis.

RESULTS

A total of 5167 participants were included in the analysis; 62% were males and the mean age of the sample was 25.7 years. The age-adjusted prevalence was 26.5% for obesity, 11.7% for dysglycemia, 62.7% for dyslipidemia, 22.4% for hypertension and 22.5% for central obesity. The CRFs were distributed differently when compared within social and behavioral groups. For example, obesity, dyslipidemia and central obesity in men were found higher among smokers than non-smokers (p < 0.05). And among women with lower education, all CRFs were reported significantly higher than those with higher education, except for hypertension. Most CRFs were significantly higher among men and women with positive family history of common non-communicable diseases.

CONCLUSIONS

CRFs are highly prevalent in the young Emirati adults of the UAE Healthy Future Study. The difference in CRF distribution among social and behavioral groups can be taken into account to target group-specific prevention measures.

Obstructive Sleep Apnea as a Predictor of a Higher Risk of Significant Coronary Artery Disease Assessed Non-Invasively Using the Calcium Score

The aim of this study was to assess the coronary artery calcium score in patients with obstructive sleep apnea (OSA). The study group (group A) consisted of 62 patients with diagnosed obstructive sleep apnea (mean age: 59.12 ± 9.09 years, mean AHI index in polysomnography: 20.44 ± 13.22/h), and 62 people without diagnosed obstructive sleep apnea (mean age 59.50 ± 10.74 years) constituted the control group (group B). The risk of significant coronary artery disease was assessed in all patients, based on the measurement of the coronary artery calcium score (CACS) using computed tomography. The following cut-off points were used to assess the risk of significant coronary artery disease: CACS = 0—no risk, CACS 1–10—minimal risk, CACS 11–100—low risk, CACS 101–400—moderate risk, and CACS > 400—high risk. Group A was characterized by statistically significantly higher CACS than group B (550.25 ± 817.76 vs. 92.59 ± 164.56, p < 0.05). No risk of significant coronary artery disease was statistically significantly less frequent in group A than in group B (0.0% vs. 51.6%, p < 0.05). A high risk of significant coronary artery disease was statistically significantly more frequent in group A than in group B (40.3% vs. 4.8%, p < 0.05). In group A, patients with severe OSA and patients with moderate OSA had statistically significantly higher CACS than patients with mild OSA (910.04 ± 746.31, 833.35 ± 1129.87, 201.66 ± 192.04, p < 0.05). A statistically significant positive correlation was found between the AHI and CACS (r = 0.34, p < 0.05). The regression analysis showed that OSA, male gender, older age, type 2 diabetes, peripheral arterial disease, and smoking were independent risk factors for higher CACS values. AHI ≥ 14.9 was shown to be a predictor of a high risk of significant coronary artery disease with a sensitivity and specificity of 62.2% and 80.0%, respectively. In summary, obstructive sleep apnea should be considered an independent predictive factor of a high risk of significant coronary artery disease (based on the coronary artery calcium score).

Reducing the Threshold of Primary Prevention of Cardiovascular Disease to 10% Over 10 Years: The Implications of Altered Intensity "Statin" Therapy Guidance

Cardiovascular disease (CVD) is a significant noncommunicable disease associated with high long-term mortality. In addition to more effective secondary therapies, the primary prevention of CVD has developed markedly in the past several years. This study aims to investigate the evidence and impact of reducing the threshold for primary CVD risk management to 10% over 10 years with "statin" therapy. To conduct research a systematic review utilizing 5 electronic database searches was completed for studies, analyzing the clinical effect of reducing the threshold of CVD risk to 10% over 10 years for primary prevention with statin therapy. The study included six (6) trials. Statin therapy was allocated to 31,018 participants. The mean age was 61 years and the mean follow-up was 4.6 years. The mean relative reduction in total cholesterol was 19% (from an average of), low-density lipoprotein cholesterol was 28.3% (from mmol/L to mmol/L) and triglycerides were 14.8% (from mmol/L to mmol/L). High-density lipoprotein cholesterol was observed to increase by a mean of 3.3% (from mmol/L to mmol/L). When examining all-cause mortality, statin therapy was associated with a 12% relative risk reduction compared with control, where overall rates were reduced from 1.4% to 1. % There is a 30% risk reduction in general major coronary events (from to %). There is a 19% risk reduction in general major cerebrovascular events with the statin group. While there is undoubtedly statistical evidence that supports the observation of the effectiveness of statin therapy for primary prevention, there is a risk that many hundreds of patients need to be treated to avoid a single adverse clinical outcome.

Efficient Data-Driven Machine Learning Models for Cardiovascular Diseases Risk Prediction

Cardiovascular diseases (CVDs) are now the leading cause of death, as the quality of life and human habits have changed significantly. CVDs are accompanied by various complications, including all pathological changes involving the heart and/or blood vessels. The list of pathological changes includes hypertension, coronary heart disease, heart failure, angina, myocardial infarction and stroke. Hence, prevention and early diagnosis could limit the onset or progression of the disease. Nowadays, machine learning (ML) techniques have gained a significant role in disease prediction and are an essential tool in medicine. In this study, a supervised ML-based methodology is presented through which we aim to design efficient prediction models for CVD manifestation, highlighting the SMOTE technique's superiority. Detailed analysis and understanding of risk factors are shown to explore their importance and contribution to CVD prediction. These factors are fed as input features to a plethora of ML models, which are trained and tested to identify the most appropriate for our objective under a binary classification problem with a uniform class probability distribution. Various ML models were evaluated after the use or non-use of Synthetic Minority Oversampling Technique (SMOTE), and comparing them in terms of Accuracy, Recall, Precision and an Area Under the Curve (AUC). The experiment results showed that the Stacking ensemble model after SMOTE with 10-fold cross-validation prevailed over the other ones achieving an Accuracy of 87.8%, Recall of 88.3%, Precision of 88% and an AUC equal to 98.2%.

Prevalence of physical activity levels and perceived benefits of and barriers to physical activity among Jordanian patients with coronary heart disease: A cross-sectional study

Background

Many studies published in other countries have identified certain perceived benefits of and barriers to physical activity among patients with coronary heart disease. Nevertheless, there is no data about the issue relating to Jordanian patients with coronary heart disease.

Objective

This study aimed to describe the prevalence of levels of physical activity, the benefits of and barriers to physical activity as perceived by Jordanian patients with coronary heart disease, and the relationship between physical activity and perceived benefits of and barriers to physical activity. In addition, it focused on examining the influence of selected sociodemographic and health characteristics on physical activity and the perceived benefits of and barriers to physical activity.

Methods

A cross-sectional design was performed on a sample of 400 patients with coronary heart disease. They were given a list of perceived benefits of and barriers to physical activity and asked to what extent they disagreed or agreed with each.

Results

Jordanian patients with coronary heart disease perceived various benefits of and barriers to physical activity. Most of these benefits were physiologically related (average mean = 5.7, SD = 0.7). The most substantial barriers to physical activity as perceived by the patients were "feeling anxiety," "not enough time," "lack of interest," "bad weather," and "feeling of being uncomfortable." Sociodemographic and health characteristics that significantly influenced perceived barriers to physical activity were age, gender, health perception, chest pain frequency, education, job, caring responsibilities, ability to travel alone, smoking, and previous and current physical activity behavior.

Conclusion

This study demonstrates that patients with coronary heart disease have perceived physiological benefits of physical activity and have perceived motivational, physical health, and environmental barriers to physical activity, which is significant in developing intervention strategies that aim to maximize patients' participation in physical activity and overcome barriers to physical activity.

Effects of Multidisciplinary Rehabilitation Program in Patients with Long COVID-19: Post-COVID-19 Rehabilitation (PCR SIRIO 8) Study

Up to 80% of COVID-19 survivors experience prolonged symptoms known as long COVID-19. The aim of this study was to evaluate the effects of a multidisciplinary rehabilitation program in patients with long COVID-19. The rehabilitation program was composed of physical training (aerobic, resistance, and breathing exercises), education, and group psychotherapy. After 6 weeks of rehabilitation in 97 patients with long COVID-19, body composition analysis revealed a significant decrease of abdominal fatty tissue (from 2.75 kg to 2.5 kg; p = 0.0086) with concomitant increase in skeletal muscle mass (from 23.2 kg to 24.2 kg; p = 0.0104). Almost 80% of participants reported dyspnea improvement assessed with the modified Medical Research Council scale. Patients’ physical capacity assessed with the 6 Minute Walking Test increased from 320 to 382.5 m (p < 0.0001), the number of repetitions in the 30 s Chair Stand Test improved from 13 to 16 (p < 0.0001), as well as physical fitness in the Short Physical Performance Battery Test from 14 to 16 (p < 0.0001). The impact of fatigue on everyday functioning was reduced in the Modified Fatigue Impact Scale from 37 to 27 (p < 0.0001). Cardiopulmonary exercise test did not show any change. The multidisciplinary rehabilitation program has improved body composition, dyspnea, fatigue and physical capacity in long COVID-19 patients.

Physical Activity Is Inversely Associated With Severe Intracranial Stenosis in Stroke-Free Participants of NOMAS

BACKGROUND

Although protective in secondary stroke prevention of intracranial arterial stenosis (ICAS), it is uncertain if the benefits of leisure time physical activity (LTPA) extend to asymptomatic ICAS or extracranial carotid stenosis (ECAS). Therefore, we sought to determine LTPA's relationship with ECAS and ICAS in a stroke-free, race-ethnically diverse cohort.

METHODS

This cross-sectional study included participants from the magnetic resonance imaging substudy of the Northern Manhattan Study, of whom 1274 had LTPA assessments at enrollment. LTPA was represented continuously as metabolic equivalent score (MET-score) and ordinally as model-based cluster analysis (LTPA-cluster), both based on the same LTPA assessments. We evaluated ECAS sonographically using carotid intima-media thickening and number of carotid plaques. ICAS was assessed with time-of-flight magnetic resonance angiograph and defined as ≥50% or ≥70% stenosis. We applied regression analyses to evaluate the association between LTPA with ECAS and ICAS, adjusting for confounders.

RESULTS

Of 1274 included participants (mean age 71±9 years; 60% women; 65% Hispanic), the mean MET-score was 10±16 and 60% were in a LTPA-cluster with any activity. Among those with carotid ultrasound (n=1234), the mean carotid intima-media thickening was 0.97±0.09 mm, and 56% of participants had at least one carotid plaque identified. Among those with magnetic resonance angiograph (n=1211), 8% had ≥50% ICAS and 5% had ≥70% ICAS. For ICAS, MET-score was associated with ≥70% ICAS (adjusted odds ratio per unit increase in MET-score [95% CI, 0.97 [0.94-0.99]) but not with ECAS measures (carotid intima-media thickening, adjusted β-estimate per unit increase in MET-score [95% CI], 0.002 [-0.003 to 0.006] or number of plaques, adjusted β-estimate [95% CI], 0.0001 [-0.0001 to 0.0003]). Substituting MET-score with LTPA-clusters replicated the association between ≥70% ICAS and LTPA (adjusted odds ratio per each increased LTPA-cluster [95% CI], 0.83 [0.70-0.99]).

CONCLUSIONS

In this diverse stroke-free population, we found LTPA most strongly associated with asymptomatic ≥70% ICAS. Given the high-risk nature of ≥70% ICAS, these findings may emphasize the role of LTPA in people at risk for ICAS.

Image quality and diagnostic accuracy of different dosages of iodixanol in computed tomography angiography and perfusion of overweight patients with coronary artery stenosis: A feasibility study

OBJECTIVES

Iodixanol contrast media with different doses using computed tomography angiography (CTA) and perfusion (CTP) to diagnose coronary artery disease (CAD) in overweight patients lacks assessment. Our study compared iodixanol 320 mg I/ml and 270 mg I/ml on image quality and accuracy of CTA combined CTP (CTA-CTP) to diagnose CAD.

METHODS

Overweight patients with suspected of CAD were randomized into iodixanol 270 group (received iodixanol 270 mg I/ml) and iodixanol 320 group (received iodixanol 320 mg I/ml). Based on these characteristics data, receiver operating characteristic (ROC) curve and corresponding area under the curve (AUC) were plotted to assess the sensitivity and specificity of the two administrations.

RESULTS

The subjective definition score, signal to noise ratio, and CT value of aorta in iodixanol 320 group were higher than iodixanol 270 group. In iodixanol 270 group: the image exhibited a normal state of both vessels and myocardial perfusion; and the AUC, specificity, and sensitivity were 0.376, 66.67, and 80.46, respectively. In iodixanol 320 group: the image exhibited a diameter stenosis in right coronary artery and myocardial infarction of inferior wall and proximal inferior wall septum, as well as myocardial perfusion defects; and the AUC, specificity, and sensitivity in iodixanol 320 group were 0.824, 75.00, and 89.87, respectively.

CONCLUSION

Accuracy and image quality of iodixanol 320 mg I/ml in the diagnosis of CAD with CTA-CTP was higher than using iodixanol 270 mg I/ml.

Psychometric Testing of the Self-Care of Coronary Heart Disease Inventory Version 3.0

BACKGROUND

In this updated Self-Care of Coronary Heart Disease Inventory (SC-CHDI) v3.0, items were added to better reflect the theory of self-care of chronic illness and revised based on recent research. The expanded SC-CHDI now reflects the theoretical concepts of self-care maintenance, monitoring, and management.

OBJECTIVE

The aim of this study was to evaluate the psychometric properties of the SC-CHDI v3.0.

METHODS

In a sample of adults with coronary heart disease, we tested the SC-CHDI v3.0 validity with confirmatory factor analysis. Reliability was calculated using Cronbach α, factor score determinacy coefficient, and global reliability index for multidimensional scales, with values > 0.70 considered adequate.

RESULTS

The sample (n = 205) was predominantly male (79%) with a mean age of 65.3 ± 11.1 years. The self-care maintenance scale encompassed 2 distinct behaviors, namely, "illness related behaviors" and "health promoting behaviors," which reflect consulting and autonomous dimensions, respectively. The goodness-of-fit indices were adequate: χ2(25, N = 205) =31.86, P = .16, comparative fit index = 0.97, Tucker-Lewis Index = 0.95, root mean square error of approximation = 0.04 (90% confidence interval, 0.00-0.07), P = .705, and standardized root mean square residual = 0.045. Analysis of the new self-care monitoring scale yielded a single factor; goodness-of-fit indices were excellent: χ2(12, N = 205) =11.56, P = .48, comparative fit index = 1.00, Tucker-Lewis Index = 1.00, root mean square error of approximation < 0.001 (90% confidence interval, 0.000-0.07), P = .86, and standardized root mean square residual = 0.02. The self-care management scale had 2 dimensions of autonomous and consulting behavior with strong goodness-of-fit indices: χ2(7, N = 205) =6.57, P = .47, comparative fit index = 1.00, Tucker-Lewis Index = 1.00, root mean square error of approximation ≤ 0.001 (90% confidence interval, 0.00-0.08), P = .76, and standardized root mean square residual = 0.02. Reliability estimates were ≥0.80 for all scales.

CONCLUSIONS

Our testing suggests that the SC-CHDI v3.0 is a sound measure of the essential elements of self-care for adults with coronary heart disease.