Journal: Prog Cardiovasc Dis

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Abstract

Benefits and drawbacks of statins and non-statin lipid lowering agents in carotid artery disease.

Paraskevas KI, Gloviczki P, Antignani PL, Comerota AJ, ... Veith FJ, Mikhailidis DP
International guidelines strongly recommend statins alone or in combination with other lipid-lowering agents to lower low-density lipoprotein cholesterol (LDL-C) levels for patients with asymptomatic/symptomatic carotid stenosis (AsxCS/SCS). Lowering LDL-C levels is associated with significant reductions in transient ischemic attack, stroke, cardiovascular (CV) event and death rates. The aim of this multi-disciplinary overview is to summarize the benefits and risks associated with lowering LDL-C with statins or non-statin medications for Asx/SCS patients. The cerebrovascular and CV beneficial effects associated with statins, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and other non-statin lipid-lowering agents (e.g. fibrates, ezetimibe) are reviewed. The use of statins and PCSK9 inhibitors is associated with several beneficial effects for Asx/SCS patients, including carotid plaque stabilization and reduction of stroke rates. Ezetimibe and fibrates are associated with smaller reductions in stroke rates. The side-effects resulting from statin and PCSK9 inhibitor use are also highlighted. The benefits associated with lowering LDL-C with statins or non-statin lipid lowering agents (e.g. PCSK9 inhibitors) outweigh the risks and potential side-effects. Irrespective of their LDL-C levels, all Asx/SCS patients should receive high-dose statin treatment±ezetimibe or PCSK9 inhibitors for reduction not only of LDL-C levels, but also of stroke, cardiovascular mortality and coronary event rates.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 19 May 2022; epub ahead of print
Paraskevas KI, Gloviczki P, Antignani PL, Comerota AJ, ... Veith FJ, Mikhailidis DP
Prog Cardiovasc Dis: 19 May 2022; epub ahead of print | PMID: 35605696
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Abstract

MitraClip for secondary mitral regurgitation: Patient selection.

Zalawadiya SK, Gonzales HM, Goel K, Lindenfeld J
Mitral regurgitation (MR) is one of the common valvular heart diseases and can be broadly categorized as primary or secondary. Primary MR occurs due to abnormalities of the valvular apparatus where surgical repair offers excellent outcomes. In contrast, the underlying degree of left ventricular dysfunction plays a major role in the development of secondary MR. Recently, two randomized controlled trials, the Percutaneous Repair with the MitraClip Device for Severe Functional/ Secondary Mitral Regurgitation (MITRA-FR) and the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT), evaluated the role of transcatheter edge-to-edge repair (TEER) using MitraClip device among heart failure patients with secondary MR and observed contradictory results; this has created a considerable dilemma among clinicians for an appropriate patient selection for the transcatheter mitral valve (MV) therapies. In this review, we highlight several important differences in patient characteristics between the COAPT and MITRA-FR trials that may help explain the differences observed in outcomes. We also reviewed several key clinical, echocardiographic, and procedural characteristics that may guide clinicians in improving patient selection for transcatheter MV therapies for better outcomes.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 19 May 2022; epub ahead of print
Zalawadiya SK, Gonzales HM, Goel K, Lindenfeld J
Prog Cardiovasc Dis: 19 May 2022; epub ahead of print | PMID: 35605697
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Abstract

Current state of unhealthy living characteristics in White, African American and Latinx populations.

Myers J, Harber MP, Johnson L, Arena R, Kaminsky LA
The United States (US) is similar to most industrialized countries in that it falls short on many of the basic metrics related to cardiovascular and overall health. These metrics include nutritional patterns, levels of physical activity (PA), cardiorespiratory fitness (CRF), and prevalence of overweight and obesity. These issues are even more apparent in underserved communities, among whom unhealthy living characteristics cluster and contribute to a disproportionate chronic disease burden. The reasons for these inequities are complex and include social and economic factors as well as reduced access to health care. CRF has been demonstrated to be a critically important risk factor that tends to be lower in disadvantaged groups. In this article we discuss the current state of health & lifestyle characteristics in the US, the impact of social inequality on health, and the particular role that CRF and PA patterns play in the current state of unhealthy living characteristics as they relate to underserved populations.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 16 May 2022; epub ahead of print
Myers J, Harber MP, Johnson L, Arena R, Kaminsky LA
Prog Cardiovasc Dis: 16 May 2022; epub ahead of print | PMID: 35594981
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Abstract

It still takes a village: Advocating healthy living medicine for communities through social justice action.

Hall G, Ozemek C, Argüelles L, Shaw S, Davis D
Countless individuals in the United States continue to experience effects related to the coronavirus disease 2019 (COVID-19) pandemic, such as job/business instability, the breaking down of school systems, isolation, and negative health consequences. There are, however, certain populations and communities that continue to be disproportionately affected, resulting in severe health outcomes, decreased quality of life, and alarmingly high death rates. These populations typically live in historically excluded communities and identify as persons of color. To advance health equity in these communities, healthy living (HL) strategies are paramount. In fact HL Medicine - getting sufficient physical activity, practicing good nutrition, maintaining a healthy body weight, and not smoking, can be a viable solution. Applying these concepts, particularly the promotion of physical activity, through community collaboration can advance the goals of social justice action.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 06 May 2022; epub ahead of print
Hall G, Ozemek C, Argüelles L, Shaw S, Davis D
Prog Cardiovasc Dis: 06 May 2022; epub ahead of print | PMID: 35533794
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Abstract

Where are we now? The intersection of healthy living medicine and social justice within our school systems.

Strieter L, Besana T, Arena R, Hall G
Alongside the tensions brought forth by the pandemic, such as health and safety concerns from transmission and economic insecurity, there was also a rise in racial and social tension, bringing issues of equity and justice to the forefront. Consequently, there has been a call for reform and an urgency for change in legal, political, economic, and healthcare spheres. Change only occurs through change, with a pivotal point to target the beginning stages in life which will have a greater likelihood to subsist throughout the lifecourse. The crossroads of healthy living medicine (HLM) and education are an appropriate context for necessary change. If healthy living medicine is to embody the ideals of social justice, then people need equal access to resources of well-being - physical, social, and emotional - in their school systems. This paper examines the current intersection of health and social justice within the school systems in the United States. It is both a critique of how school systems have not yet provided such an intersection and highlight those efforts that have proven valuable and successful in providing HLM resources to populations that are historically under-resourced and under-served. Ultimately, this paper looks to provide a path forward, providing ideas for sustainable, feasible, actionable change in school systems K-12 and in higher education.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 03 May 2022; epub ahead of print
Strieter L, Besana T, Arena R, Hall G
Prog Cardiovasc Dis: 03 May 2022; epub ahead of print | PMID: 35523310
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Abstract

Addressing social and racial justice in public policy for healthy living.

Whitsel LP, Johnson J
Long-standing health disparities stemming from the historical, inequitable distribution of wealth, power, and privilege in the United States exist across almost every health indicator and outcome. There is a need for equitable policy, systems, and environment changes that are rooted in an understanding of the historical arc of structural racism across obesity prevention and treatment, ending tobacco and nicotine addiction and increasing access to healthy, affordable foods and physical activity opportunities and infrastructure. This paper explores the influence of structural inequities on the proliferation of health-compromising social conditions, and opportunities to leverage the policymaking process at the local, state, and federal levels to cultivate environments that support healthy living. Policy makers, community change leaders and advocacy organizations, with powerful grassroots voices can catalyze movements, advocacy campaigns and equitable policy change that address race and social justice and support healthy living for all.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 28 Apr 2022; epub ahead of print
Whitsel LP, Johnson J
Prog Cardiovasc Dis: 28 Apr 2022; epub ahead of print | PMID: 35490866
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Abstract

Current state of unhealthy living characteristics in Black/African American and Latino populations: Tobacco use.

Sabado-Liwag M, Zamora M, El-Toukhy S
Over the past six decades, the United States has significantly improved tobacco-related health outcomes through mass efforts in policies, research, and behavioral and clinical interventions. Disparities persist, however, among communities of color who continue to suffer disproportionate rates of cardiovascular disease and other tobacco-related morbidity and mortality. In this review, we synthesize and discuss the tobacco use lifecycle across the lifespan, with special attention paid to socioecological determinants of tobacco-use behavior among Blacks and Latinos. This review summarizes the permeability of tobacco use and tobacco-related determinants across multiple levels of influence, from the individual to the societal, and highlights gaps in the tobacco control and prevention landscape. Given its continued evolution and impact on socially disadvantaged communities, we conclude with recommendations for improving current tobacco research and treatment and prevention efforts.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 28 Apr 2022; epub ahead of print
Sabado-Liwag M, Zamora M, El-Toukhy S
Prog Cardiovasc Dis: 28 Apr 2022; epub ahead of print | PMID: 35490867
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Abstract

The path forward: Highlighting social justice pearls in public health campaigns and initiatives to deliver equitable healthy living medicine.

Huizar MI, Alman R, Arena R, Laddu DR
The prevalence of unhealthy living behaviors is largely driven by environments that support them and has become a key concern at global, national, and individual (patient) levels. Healthy Living Medicine offers a compelling path forward to move people towards healthy living behaviors and better health outcomes when complemented by socially just and equitable public campaigns and initiatives. Some of the concepts that are critical for these campaigns and initiatives that will be discussed in this manuscript include the social determinants of health, the communication loop, health literacy, and implicit bias and discrimination. Considering what is practical and achievable, examples of actionable, socially-just strategies will be described to inform and encourage health professionals and other stakeholders to prioritize healthy living and reverse the poor health trajectory among our most vulnerable populations.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 28 Apr 2022; epub ahead of print
Huizar MI, Alman R, Arena R, Laddu DR
Prog Cardiovasc Dis: 28 Apr 2022; epub ahead of print | PMID: 35490868
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Abstract

Racial and ethnic disparities in cardiometabolic disease and COVID-19 outcomes in White, Black/African American, and Latinx populations: Physiological underpinnings.

Bunsawat K, Grosicki GJ, Jeong S, Robinson AT
Coronavirus disease 2019 (COVID-19) is a highly contagious respiratory illness caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that began spreading globally in late 2019. While most cases of COVID-19 present with mild to moderate symptoms, COVID-19 was the third leading cause of mortality in the United States in 2020 and 2021. Though COVID-19 affects individuals of all races and ethnicities, non-Hispanic Black and Hispanic/Latinx populations are facing an inequitable burden of COVID-19 characterized by an increased risk for hospitalization and mortality. Importantly, non-Hispanic Black and Hispanic/Latinx adults have also faced a greater risk of non-COVID-19-related mortality (e.g., from cardiovascular disease/CVD) during the pandemic. Contributors to the racial disparities in morbidity and mortality during the pandemic are multifactorial as we discuss in our companion article on social determinants of health. However, profound racial variation in the prevalence of CVD and metabolic diseases may serve as a key driver of worse COVID-19-related and non-COVID-19-related health outcomes among racial and ethnic minority groups. Within this review, we provide data emphasizing the inequitable burden of CVD and metabolic diseases among non-Hispanic Black and Hispanic/Latinx populations. We also discuss the pathophysiology of these conditions, with a focus on how aberrant physiological alterations in the context of CVD and metabolic diseases manifest to increase susceptibility to severe COVID-19.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 28 Apr 2022; epub ahead of print
Bunsawat K, Grosicki GJ, Jeong S, Robinson AT
Prog Cardiovasc Dis: 28 Apr 2022; epub ahead of print | PMID: 35490869
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Abstract

Racial and ethnic disparities in cardiometabolic disease and COVID-19 outcomes in white, black/African American, and Latinx populations: Social determinants of health.

Grosicki GJ, Bunsawat K, Jeong S, Robinson AT
Racial and ethnic-related health disparities in the United States have been intensified by the greater burden of Coronavirus Disease 2019 (COVID-19) in racial and ethnic minority populations. Compared to non-Hispanic White individuals, non-Hispanic Black and Hispanic/Latinx individuals infected by COVID-19 are at greater risk for hospitalization, intensive care unit admission, and death. There are several factors that may contribute to disparities in COVID-19-related severity and outcomes in these minority populations, including the greater burden of cardiovascular and metabolic diseases as discussed in our companion review article. Social determinants of health are a critical, yet often overlooked, contributor to racial and ethnic-related health disparities in non-Hispanic Black and Hispanic/Latinx individuals relative to non-Hispanic White individuals. Thus, the purpose of this review is to focus on the essential role of social factors in contributing to health disparities in chronic diseases and COVID-19 outcomes in minority populations. Herein, we begin by focusing on structural racism as a social determinant of health at the societal level that contributes to health disparities through downstream social level (e.g., occupation and residential conditions) and individual level health behaviors (e.g., nutrition, physical activity, and sleep). Lastly, we conclude with a discussion of practical applications and recommendations for future research and public health efforts that seek to reduce health disparities and overall disease burden.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 28 Apr 2022; epub ahead of print
Grosicki GJ, Bunsawat K, Jeong S, Robinson AT
Prog Cardiovasc Dis: 28 Apr 2022; epub ahead of print | PMID: 35490870
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Abstract

Social justice equity in healthy living medicine - An international perspective.

Jayasinghe S, Faghy MA, Hills AP
Irrespective of geographical location, disadvantaged people are disproportionately affected by unnecessary disease and suffering caused by inequalities in health. Although equal access to opportunities for healthy living medicine regardless of legal, political, economic, or other circumstances should be a basic human right, it is increasingly improbable for scores of people, particularly in Africa, Asia, Latin America, and the Caribbean, to acquire this. In recent times, global initiatives have attempted to make \'healthy lifestyles\' more equitable by pledging to be relevant to all economies, promoting prosperity, environmental protection, climate change interventions, and purposeful action to meet the needs of vulnerable populations, including women and children. Yet there remains much to be done to address and reduce the substantial international health equity gaps. Reducing disparities that disproportionately affect the lower end of social strata must entail collaborative and systemic action from important stakeholders across the whole system, an approach that translates theory and research into practice. Ideally, realist approaches that appreciate the importance of the context of problems and assume nothing works everywhere or for everyone, should be prioritised over linear/simple and non-scalable intervention strategies.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 28 Apr 2022; epub ahead of print
Jayasinghe S, Faghy MA, Hills AP
Prog Cardiovasc Dis: 28 Apr 2022; epub ahead of print | PMID: 35490871
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Abstract

COVID-19 seen from a syndemic perspective: Impact of unhealthy habits and future perspectives to combat these negative interactions in Latin America.

Borghi-Silva A, Back GD, Garcia de Araújo AS, Oliveira MR, ... Mendes RG, Arena R
COVID-19 has to this point led to more than 5 million deaths and has imposed numerous measures restricting populations worldwide, including Latin America (LA). However, analyzing COVID-19 from the perspective of a syndemic, it demonstrates the relationship between the interaction of multiple comorbidities and the increase of contagion in people who are socially vulnerable. The number of deaths by COVID-19 in LA is strongly associated with multi-morbidities (diabetes, obesity, sedentary, smoking, among others) and disproportionately attacks communities located in poorer, low-income regions and ethnic minorities. This review aims to revisit the relationship between COVID-19 and both unhealthy living habits (i.e., sedentary lifestyle, poor nutritional habits, overweight and obesity, smoking) and cardiovascular disease in Latin American countries. In addition, this review aims to introduce strategies and policies that combat social inequalities and enable healthy living behaviors in LA countries. If LA countries do not work on public policies that decrease multi-morbidities and social inequalities, we will be unable to eliminate COVID-19, as well as possible other outbreaks that may arise in the future.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 28 Apr 2022; epub ahead of print
Borghi-Silva A, Back GD, Garcia de Araújo AS, Oliveira MR, ... Mendes RG, Arena R
Prog Cardiovasc Dis: 28 Apr 2022; epub ahead of print | PMID: 35490872
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Abstract

Assessing race and ethnicity differences in outcomes based on GDMT and target NT-proBNP in patients with heart failure with reduced ejection fraction: An analysis of the GUIDE-IT study.

Pahuja M, Leifer ES, Clarke JD, Ahmad T, ... Felker GM, Piña IL
Background
The GUIDE-IT trial was, a multicenter, randomized, parallel group, unblinded study that randomized patients to having heart failure therapy titrated to achieve an NT-proBNP <1000 pg/mL or to usual clinical care.
Methods and results
We performed pre-specified subgroup analysis to look for the race and ethnicity-based differences in clinical outcomes of patients who were able to achieve GDMT or target NT-proBNP concentration of ≤1000 pg/mL at 90 days of follow-up. There were 894 patients enrolled in GUIDE-IT study. Of these, 733 participants had available data on 90-day guideline directed triple therapy and 616 on NT-proBNP. 35% of the patients were Black and 6% were Hispanic. Black patients were younger, had more comorbidities, lower EF, and higher NYHA class compared with non-Black. Adjusting for 90-day NT-proBNP and important baseline covariates, Black patients were at a higher risk than non-Black patients for HF hospitalization [HR, 2.19; 95% CI, 1.51-3.17; p < 0.0001], but at a similar risk for mortality [HR, 0.85.; 95% CI, 0.44-1.66; p = 0.64]. Similar results were seen adjusting for 90-day GDMT [HF hospitalization: Black vs non-Black, HR: 1.97; 1.41-2.77, P < 0.0001; mortality: HR: 0.70; 0.39-1.26, p = 0.23]. There were no significant differences between Hispanic and non-Hispanic patients with respect to heart failure hospitalization, cardiovascular or all-cause mortality. Over the study period, Black and Hispanic patients experienced smaller changes in physical function and quality of life as measured by the Kansas City Cardiomyopathy Questionnaire overall score.
Conclusion
Compared to non-Black patients, Black patients in GUIDE-IT study had a higher risk of heart failure hospitalization, but a comparable risk of mortality, despite improved use of GDMT and achievement of similar biomarker targets.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 28 Apr 2022; epub ahead of print
Pahuja M, Leifer ES, Clarke JD, Ahmad T, ... Felker GM, Piña IL
Prog Cardiovasc Dis: 28 Apr 2022; epub ahead of print | PMID: 35490873
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Abstract

TAVR - From inoperable to younger, lower-risk patients: A slippery slope?

Unbehaun A, Abdullah M, Hooda A, Gedela M, ... Klein C, Tang GHL
Despite current valve guidelines recommending both transcatheter and surgical aortic valve replacement (TAVR and SAVR, respectively) in patients with symptomatic severe aortic stenosis (AS), TAVR has recently become the preferred treatment over SAVR, driven by its minimal invasiveness, faster recovery and earlier improvement in quality of life. However, several limitations and unresolved issues remain with TAVR, including stroke, conduction system disorder, durability, bicuspid anatomy, coronary reaccess and lifetime management with aortic valve reintervention. Our review aims to highlight the above issues and discuss them in depth, to demonstrate the complementary role of TAVR and SAVR in the treatment of AS.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 06 Apr 2022; epub ahead of print
Unbehaun A, Abdullah M, Hooda A, Gedela M, ... Klein C, Tang GHL
Prog Cardiovasc Dis: 06 Apr 2022; epub ahead of print | PMID: 35398162
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Abstract

Prosthesis-patient mismatch following aortic and mitral valves replacement - A comprehensive review.

Joury A, Duran A, Stewart M, Gilliland YE, Spindel SM, Qamruddin S
Prothesis-patient mismatch (PPM) occurs when there is a mismatch between the effective orifice area (EOA) of the prosthetic valve and the required cardiac output to meet the need of the patient\'s body surface area (BSA). The clinical threshold for PPM occurs when the indexed effective orifice area (iEOA) is ≤0.65 cm2/m2 for the aortic valve prosthesis, and ≤ 1.20 cm2/m2 for the mitral valve prosthesis. The wide variation of reported incidence of PPM is most likely attributed to the variation in the methods of calculating iEOA [(for e.g., using continuity equation across the prosthesis versus using projected EOA (generated by the industry)]. Newer generation mechanical valves have shown less PPM than older generation, and stentless bioprosthesis have less PPM than stented prosthesis. Long-term clinical outcome of PPM is associated with adverse cardiovascular events especially in the presence of pre-existing left ventricle dysfunction or with concomitant procedure such as coronary artery bypass graft surgery. Strategies to mitigate the risk of PPM such as aortic root replacement in patients with the small aortic annulus should be utilized. Accurate assessment of the patient\'s annular size and indexing the effective orifice area (EOA) of the prosthesis to patient\'s BSA at the time of prosthesis implantation are important steps to preventing future PPM.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 26 Feb 2022; epub ahead of print
Joury A, Duran A, Stewart M, Gilliland YE, Spindel SM, Qamruddin S
Prog Cardiovasc Dis: 26 Feb 2022; epub ahead of print | PMID: 35235847
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This program is still in alpha version.