Topic: Journal Club Selection

Abstract

Environmental risk factors and cardiovascular diseases: a comprehensive expert review.

Münzel T, Hahad O, Sørensen M, Lelieveld J, ... Nieuwenhuijsen M, Daiber A
Non-communicable diseases (NCDs) are fatal for more than 38 million people each year and are thus the main contributors to the global burden of disease accounting for 70% of mortality. The majority of these deaths are caused by cardiovascular disease (CVD). The risk of NCDs is strongly associated with exposure to environmental stressors such as pollutants in the air, noise exposure, artificial light at night, and climate change, including heat extremes, desert storms, and wildfires. In addition to the traditional risk factors for CVD such as diabetes, arterial hypertension, smoking, hypercholesterolaemia, and genetic predisposition, there is a growing body of evidence showing that physicochemical factors in the environment contribute significantly to the high NCD numbers. Furthermore, urbanization is associated with accumulation and intensification of these stressors. This comprehensive expert review will summarize the epidemiology and pathophysiology of environmental stressors with a focus on cardiovascular NCDs. We will also discuss solutions and mitigation measures to lower the impact of environmental risk factors with focus on CVD.

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

Cardiovasc Res: 10 Nov 2022; 118:2880-2902
Münzel T, Hahad O, Sørensen M, Lelieveld J, ... Nieuwenhuijsen M, Daiber A
Cardiovasc Res: 10 Nov 2022; 118:2880-2902 | PMID: 34609502
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Abstract

High-frame-rate A-mode ultrasound for calibration-free cuffless carotid pressure: feasibility study using lower body negative pressure intervention.

Raj KV, Nabeel PM, Chandran D, Sivaprakasam M, Joseph J
Purpose
Existing technologies to measure central blood pressure (CBP) intrinsically depend on peripheral pressure or calibration models derived from it. Pharmacological or physiological interventions yielding different central and peripheral responses compromise the accuracy of such methods. We present a high-frame-rate ultrasound technology for cuffless and calibration-free evaluation of BP from the carotid artery. The system uses a pair of single-element ultrasound transducers to capture the arterial diameter and local pulse wave velocity (PWV) for the evaluation of beat-by-beat BP employing a novel biomechanical model.
Materials and methods
System\'s functionality assessment was conducted on eight male subjects (26 ± 4 years, normotensive and no history of cardiovascular risks) by perturbing pressure via short-term moderate lower body negative pressure (LBNP) intervention (-40 mmHg for 1 min). The ability of the system to capture dynamic responses of carotid pressure to LBNP was investigated and compared against the responses of peripheral pressure measured using a continuous BP monitor.
Results
While the carotid pressure manifested trends similar to finger measurements during LBNP, the system also captured the differential carotid-to-peripheral pressure response, which corroborates the literature. The carotid diastolic and mean pressures agreed with the finger pressures (limits-of-agreement within ±7 mmHg) and exhibited acceptable uncertainty (mean absolute errors were 2.4 ± 3.5 and 2.6 ± 4.0 mmHg, respectively). Concurrent to the literature, the carotid systolic and pulse pressures (PPs) were significantly lower than those of the finger pressures by 11.1 ± 9.4 and 11.3 ± 8.2 mmHg, respectively (p < .0001).
Conclusions
The study demonstrated the method\'s potential for providing cuffless and calibration-free pressure measurements while reliably capturing the physiological aspects, such as PP amplification and dynamic pressure responses to intervention.



Blood Pressure: 01 Dec 2022; 31:19-30
Raj KV, Nabeel PM, Chandran D, Sivaprakasam M, Joseph J
Blood Pressure: 01 Dec 2022; 31:19-30 | PMID: 35014940
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Abstract

Visit-to-visit blood pressure variability and mortality and cardiovascular outcomes after acute myocardial infarction.

Choo EH, Mok JS, Chung WB, Lim S, ... Ahn Y, Chang K
The relationship between visit-to-visit blood pressure variability (BPV) and cardiovascular outcomes remains unclear. Our study assessed the prognostic implications of visit-to-visit BPV in patients after acute myocardial infarction (AMI). The present study enrolled 7,375 patients who underwent percutaneous coronary intervention for AMI and at least five measurements of blood pressure after hospital discharge. Visit-to-visit BPV was estimated as variability independent of mean. The primary endpoint was all-cause mortality. The secondary endpoints were major cardiovascular events (the composite of cardiovascular death, myocardial infarction, and ischemic stroke) and hospitalization for heart failure. During a median follow-up of 5.8 years, adjusted risks of all-cause mortality, major cardiovascular events, and hospitalization for heart failure continuously increased as systolic BPV and diastolic BPV increased. Patients in the highest quartile of systolic BPV (versus lowest) had increased risk of all-cause mortality (adjusted hazard ratio (aHR) 1.51 [95% confidence interval (CI) 1.23-1.85]), major cardiovascular events (aHR 1.31 [95% CI 1.1-1.55]), and hospitalization for heart failure (aHR 2.15 [95% CI 1.49-3.1]). Patients in the highest quartile of diastolic BPV was also associated with all-cause mortality (aHR 1.39 [95% CI 1.14-1.7]), major cardiovascular events (aHR 1.29 [95% CI 1.08-1.53]), and hospitalization for heart failure (aHR 2.01[95% CI 1.4-2.87]). Both systolic and diastolic BPV improved the predictive ability of the GRACE (Global Registry of Acute Coronary Events) risk score for both all-cause mortality and major cardiovascular events. Higher visit-to-visit BPV was associated with increased risks of mortality and cardiovascular events in patients after AMI.

© 2021. The Author(s), under exclusive licence to Springer Nature Limited.

J Hum Hypertens: 01 Nov 2022; 36:960-967
Choo EH, Mok JS, Chung WB, Lim S, ... Ahn Y, Chang K
J Hum Hypertens: 01 Nov 2022; 36:960-967 | PMID: 34518618
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