Journal: Prog Cardiovasc Dis

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Abstract

Associations of total and aerobic steps with the prevalence and incidence of frailty in older adults with hypertension.

Lefferts EC, Bakker EA, Carbone S, Lavie CJ, Lee DC
Purpose
To examine the associations of total steps/day and faster aerobic steps/day (≥60 steps/min) with the development of frailty in older adults with hypertension (HTN) using a two-phased cross-sectional and prospective approach.
Methods
The sample consisted of 427 older adults with HTN from the Physical Activity and Aging Study (PAAS), aged ≥65 years, with valid step data from an accelerometer-based pedometer. Participants were classified into tertiles of total steps/day (low, mid, high) and three categories of aerobic steps/day (none, low, high). Frailty was defined using a modified Fried score with 5 subdomains including shrinking, weakness, slowness, low physical activity (PA), and exhaustion.
Results
We observed a negative dose-response relationship across categories of total steps/day and aerobic steps/day for the prevalence of frailty and the subdomains of slowness, low PA, and exhaustion (all p for trends <0.05). Greater aerobic steps/day, but not total steps/day, was associated with lower incidence of developing frailty in the 241 participants with a follow-up examination who had no frailty at baseline.
Conclusion
Higher aerobic steps/day were more strongly associated with the lower prevalence and incidence of frailty compared to total steps/day, suggesting that faster aerobic walking may potentially provide greater benefits regarding frailty in older adults with HTN.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 24 Feb 2021; epub ahead of print
Lefferts EC, Bakker EA, Carbone S, Lavie CJ, Lee DC
Prog Cardiovasc Dis: 24 Feb 2021; epub ahead of print | PMID: 33640357
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Abstract

Prognostic value of troponin I in atrial fibrillation.

Quesada A, López-Valero L, Marcaida-Benito G, Bello JJ, ... Lippi G, Sanchis-Gomar F
Objective
To evaluate whether circulating cardiac troponin I (cTnI) levels are associated with worst outcomes in patients with atrial fibrillation (AF).
Methods
Consecutive patients visiting the emergency room (ER) with a new episode of a previously diagnosed AF or a new diagnosis of AF during ER admission between January 1st, 2010 and December 31st, 2015, were enrolled in the study (n = 2617). After applying exclusion criteria and eliminating repeated episodes, 2013 patients were finally included. Of these, 1080 patients with at least one cTnI measurement in the ER were selected and classified into 4 groups according to cTnI quartiles: Q1 (n = 147) cTnI <10 ng/L (Group 1); Q2 (n = 254): 10-19 ng/L (Group 2); Q3 (n = 409): 20-40 ng/L (Group 3); and Q4 (n = 270): cTnI >40 ng/L (Group 4). The median follow-up period was 47.8 ± 32.8 months. The primary endpoint was all-cause death during the follow-up.
Results
A higher mortality was found in group 4 compared with the other groups (58.9% vs. 28.5%, respectively, p < 0.001), along with, hospitalizations (40.4% vs. 30.7%, p = 0.004), and readmissions due to decompensated heart failure (26.7% vs. 2.5%, p = 0.002). The probability of survival without AF recurrences was lower in the Q4 (p = 0.045). Moreover, cTnI levels >40 ng/L (Q4) were an independent risk factor of death (HR, 2.03; 95% CI, 1.64-2.51; p < 0.001).
Conclusion
The assessment of cTnI at ER admission could be a useful strategy for risk stratification of patients diagnosed with AF by identifying a subgroup with medium-term to long-term increased risk of adverse events and mortality.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 23 Feb 2021; epub ahead of print
Quesada A, López-Valero L, Marcaida-Benito G, Bello JJ, ... Lippi G, Sanchis-Gomar F
Prog Cardiovasc Dis: 23 Feb 2021; epub ahead of print | PMID: 33639172
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Abstract

Aorto-iliac peripheral artery disease.

Javed IN, Hawkins BM
Aorto-iliac disease is a common manifestation of atherosclerosis. Individuals with this condition are at heightened cardiovascular risk, and may have limb symptoms ranging from claudication to limb-threatening ischemia. A regimen of medical therapy, risk factor modification, and exercise is first line therapy. Revascularization is reserved for individuals with lifestyle-limiting claudication despite conservative therapy and in those with chronic limb-threatening ischemia . Multiple endovascular therapies are now available that enable even the most complex aorto-iliac lesions to be approached and treated with safe and durable results.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 21 Feb 2021; epub ahead of print
Javed IN, Hawkins BM
Prog Cardiovasc Dis: 21 Feb 2021; epub ahead of print | PMID: 33631164
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Abstract

Effects of statins on myocarditis: A review of underlying molecular mechanisms.

Parsamanesh N, Karami-Zarandi M, Banach M, Penson PE, Sahebkar A
Myocarditis refers to the clinical and histological characteristics of a diverse range of inflammatory cellular pathophysiological conditions which result in cardiac dysfunction. Myocarditis is a major cause of mortality in individuals less than 40 years of age and accounts for approximately 20% of cardiovascular disease (CVD) events. Myocarditis contributes to dilated cardiomyopathy in 30% of patients and can progress to cardiac arrest, which has a poor prognosis of <40% survival over 10 years. Myocarditis has also been documented after infection with SARS-CoV-2. The most commonly used lipid-lowering therapies, HMG-CoA reductase inhibitors (statins), decrease CVD-related morbidity and mortality. In addition to their lipid-lowering effects, increasing evidence supports the existence of several additional beneficial, \'pleiotropic\' effects of statins. Recently, several studies have indicated that statins may attenuate myocarditis. Statins modify the lipid oxidation, inflammation, immunomodulation, and endothelial activity of the pathophysiology and have been recommended as adjuvant treatment. In this review, we focus on the mechanisms of action of statins and their effects on myocarditis, SARS-CoV-2 and CVD.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 19 Feb 2021; epub ahead of print
Parsamanesh N, Karami-Zarandi M, Banach M, Penson PE, Sahebkar A
Prog Cardiovasc Dis: 19 Feb 2021; epub ahead of print | PMID: 33621589
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Abstract

Asymptomatic peripheral artery disease: Silent but deadly.

Behroozian AA, Beckman JA
Peripheral Artery Disease (PAD) is a manifestation of atherosclerosis characterized by diminished perfusion of the limb and a state of dysmetabolism. The asymptomatic PAD phenotype is a relatively recent classification. It is unknown how many people currently live with asymptomatic PAD because there are no universal screening recommendations for patients at risk for PAD. Patients with asymptomatic PAD suffer from a similar risk profile of morbidity and mortality as their counterparts with claudication. Despite this increased risk, there is a dearth of clinical investigations into therapies that specifically benefit the asymptomatic PAD population. At present, current pharmacotherapies that have been studied in PAD patient populations do not stratify by symptom status. We believe that further investigation of the impact of existing therapies in this unique population presents an opportunity to reduce morbidity and mortality due to PAD. This can only be achieved in combination with wide-spread adoption of screening for asymptomatic PAD.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 18 Feb 2021; epub ahead of print
Behroozian AA, Beckman JA
Prog Cardiovasc Dis: 18 Feb 2021; epub ahead of print | PMID: 33617896
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Abstract

Vertebral artery stenosis.

Madonis SM, Jenkins JS
Symptomatic vertebral artery stenosis is associated with high risk of early recurrent stroke. Vertebral artery stenosis can be treated with angioplasty and stenting with good technical results. In this review we outline the framework for the diagnosis and management of vertebral artery disease with focus on the emerging benefits of angiography and endovascular interventions.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 13 Feb 2021; epub ahead of print
Madonis SM, Jenkins JS
Prog Cardiovasc Dis: 13 Feb 2021; epub ahead of print | PMID: 33592207
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Abstract

Dialysis access intervention: Techniques for the interventional cardiologist.

Bittl JA
Interventional cardiologists who treat malfunctioning hemodialysis accesses play an important role in the life of patients with end-stage kidney disease (ESKD). By collaborating with interventional nephrologists who currently perform the bulk of routine access angiographic procedures, interventional cardiologists can fill an important gap in the care of ESKD patients by performing urgent or emergent procedures that fall outside the schedule of an outpatient interventional nephrology laboratory to ensure that hemodialysis patients will not miss a hemodialysis session or get a temporary catheter. This paper reviews the pathophysiology of dialysis access failure and illustrates the catheter-based approaches used by interventional cardiologists to treat malfunctioning dialysis accesses.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 12 Feb 2021; epub ahead of print
Bittl JA
Prog Cardiovasc Dis: 12 Feb 2021; epub ahead of print | PMID: 33587962
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Abstract

Femoral-popliteal peripheral artery disease: From symptom presentation to management and treatment controversies.

Krawisz AK, Raja A, Secemsky EA
Peripheral artery disease (PAD) is a common condition with increasing prevalence domestically and worldwide. Patients with PAD have a poor prognosis, as PAD is associated with high rates of myocardial infarction, ischemic stroke, and cardiovascular disease death. The primary symptom of PAD, claudication, significantly reduces quality of life and functional status and is associated with depression. In addition to several advances in medications for PAD over the last decade, endovascular device therapy has seen a significant breakthrough in the form of paclitaxel-coated devices (PCDs), which significantly reduce rates of restenosis relative to non-PCDs, a finding which has been demonstrated in numerous randomized clinical trials. After their introduction to the market in 2012 (paclitaxel-eluting stents) and 2014 (paclitaxel-coated balloons) their use surged as they replaced non-PCDs and were designated the first-line endovascular therapy by society guidelines. This trend was abruptly reversed, however, after a meta-analysis of summary-level data was published in December of 2018 that reported an elevated mortality associated with PCDs compared with non-PCDs 2-5 years after treatment. This meta-analysis has been criticized for considerable methodological flaws. The Food and Drug Administration conducted a review and concluded that insufficient data existed to make a definitive statement regarding the safety of PCDs. They called for restriction of the use of PCDs to the highest-risk patient populations. At the same time, the FDA deemed pursuing new RCTs to better evaluate PCDs unfeasible due to the high numbers of patients and long follow-up time that would be required. In this setting, real-world data emerged as a powerful source of information for the evaluation of PCDs. Real-world data offers advantages over randomized-controlled trials including expeditious access to and analysis of data and the availability of large numbers of patients. Several retrospective observational studies demonstrate no difference in long-term all-cause mortality in patients treated with PCDs relative to those treated with non-PCDs. This paclitaxel controversy has illustrated the critical role that real-world data is assuming in long-term safety monitoring of medical devices.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 12 Feb 2021; epub ahead of print
Krawisz AK, Raja A, Secemsky EA
Prog Cardiovasc Dis: 12 Feb 2021; epub ahead of print | PMID: 33592208
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Abstract

The current status of drug-coated devices in lower extremity peripheral artery disease interventions.

Amlani V, Falkenberg M, Nordanstig J
Lower limb peripheral artery disease is a leading cause of cardiovascular disease morbidity and mortality. Endovascular revascularization is often indicated to improve walking function and to prevent limb loss but restenosis in the treated vessel segment remains a concern that limits the overall effectiveness of the treatment. The most promising technique to prevent restenosis is the use of drug-coated devices, and the most common drug used to coat lower limb balloon angioplasty balloons and stents is paclitaxel. A systematic review and meta-analysis in 2018 reported a possible increase in late mortality attributable to paclitaxel-coated devices. Since then, their use has been brought into question. Here, we present an update of data focusing on the efficacy and safety of paclitaxel-coated devices in lower limb treatment applications. While paclitaxel-coated devices appear to reduce restenosis rates it is still unclear how these surrogate marker improvements translate to direct patient benefits and uncertainty remains as to whether paclitaxel-coated devices confer an increased risk of long-term mortality. Available randomized clinical data is hampered by trial heterogeneity, insufficient power, potential attrition bias and the lack of a plausible mechanistic explanation. An important step forward is that the ongoing trials that were temporarily halted due to the Katsanos et al. report have now both commenced recruitment and may ultimately resolve this clinical dilemma by virtue of their larger sample sizes. Other possible ways forward are the ongoing investigation of alternative anti-proliferative coating agents and use of new sophisticated vascular imaging techniques to more clearly identify patients at risk of restenosis already in the preoperative setting.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 11 Feb 2021; epub ahead of print
Amlani V, Falkenberg M, Nordanstig J
Prog Cardiovasc Dis: 11 Feb 2021; epub ahead of print | PMID: 33587964
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Abstract

The current status of renal denervation for the treatment of arterial hypertension.

Lauder L, Böhm M, Mahfoud F
Despite the availability of safe and effective antihypertensive drugs, blood pressure (BP) control to guideline-recommended target values is poor. Several device-based therapies have been introduced to lower BP. The most extensively investigated approach is catheter-based renal sympathetic denervation (RDN), which aims to interrupt the activity of afferent and efferent renal sympathetic nerves by applying radiofrequency energy, ultrasound energy, or injection of alcohol in the perivascular space. The second generation of placebo-controlled trials have provided solid evidence for the BP-lowering efficacy of radiofrequency- and ultrasound-based RDN in patients with and without concomitant pharmacological therapy. In addition, the safety profile of RDN appears to be excellent in all registries and clinical trials. However, there remain unsolved issues to be addressed. This review summarizes the rationale as well as the current evidence and discusses open questions and possible future indications of catheter-based RDN.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 11 Feb 2021; epub ahead of print
Lauder L, Böhm M, Mahfoud F
Prog Cardiovasc Dis: 11 Feb 2021; epub ahead of print | PMID: 33587963
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Abstract

Navigating between the science and art of acute limb ischemia treatment.

Low M, Gray BH
The diagnosis and treatment of acute limb ischemia (ALI) has long been a fierce adversary that has evolved over the last several decades with scientific advancements in endovascular therapy. History and physical examination remain the mainstay of diagnosis enhanced by detailed imaging to guide therapy. Many endovascular tools are available for prompt restoration of flow that compliment traditional surgical options. These devices incorporate the mechanical removal of thrombus and the chemical dissolution of thrombus . Medical decision-making for ALI patients must take into account the patient characteristics, anatomic variables, mechanism of ischemia, degree of ischemia, and operator skill to employ the right strategy for the right patient. This moving target challenges scientific study, making the therapeutic bedside decision making an artform. We present an overview of the field, supportive data, and a treatment algorithm that hopefully captures this delicate balance.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 11 Feb 2021; epub ahead of print
Low M, Gray BH
Prog Cardiovasc Dis: 11 Feb 2021; epub ahead of print | PMID: 33587961
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Abstract

Prioritizing movement to address the frailty phenotype in heart failure.

Laddu DR, Ozemek C, Sabbahi A, Severin R, Phillips SA, Arena R
Frailty is a highly prevalent multisystem syndrome in older adults with heart failure (HF) and is associated with poor clinical prognosis and increased complexity of care. While frailty is neither disease nor age specific, it is a clinical manifestation of aging-related processes that reflects a reduced physiological ability to tolerate and recover from stress associated with aging, disease, or therapy. Within this context, physical frailty, which is distinctly oriented to physical functional domains (e.g., muscle weakness, slowness, and low activity), has been recognized as a critical vital sign in older persons with HF. Identification and routine assessment of physical frailty, using objective physical performance measures, may guide the course of patient-centered treatment plans that maximize the likelihood of improving clinical outcomes in older HF patients. Exercise-based rehabilitation is a primary therapy to improve cardiovascular health in patients with HF; however, the limited evidence supporting the effectiveness of exercise tailored to older and frail HF patients underscores the current gaps in management of their care. Interdisciplinary exercise interventions designed with consideration of physical frailty as a therapeutic target may be an important strategy to counteract functional deficits characteristic of frailty and HF, and to improve patient-centered outcomes in this population. The purpose of this current review is to provide a better understanding of physical frailty and its relation to management of care in older patients with HF. Implications of movement-based interventions, including exercise and physical rehabilitation, to prevent or reverse physical frailty and improve clinical outcomes will further be discussed.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 05 Feb 2021; epub ahead of print
Laddu DR, Ozemek C, Sabbahi A, Severin R, Phillips SA, Arena R
Prog Cardiovasc Dis: 05 Feb 2021; epub ahead of print | PMID: 33556427
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Abstract

The need for exercise sciences and an integrated response to COVID-19: A position statement from the international HL-PIVOT network.

Faghy MA, Arena R, Stoner L, Haraf RH, ... Ashton REM, HL-PIVOT Network
COVID-19 is one of the biggest health crises that the world has seen. Whilst measures to abate transmission and infection are ongoing, there continues to be growing numbers of patients requiring chronic support, which is already putting a strain on health care systems around the world and which may do so for years to come. A legacy of COVID-19 will be a long-term requirement to support patients with dedicated rehabilitation and support services. With many clinical settings characterized by a lack of funding and resources, the need to provide these additional services could overwhelm clinical capacity. This position statement from the Healthy Living for Pandemic Event Protection (HL-PIVOT) Network provides a collaborative blueprint focused on leading research and developing clinical guidelines, bringing together professionals with expertise in clinical services and the exercise sciences to develop the evidence base needed to improve outcomes for patients infected by COVID-19.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 03 Feb 2021; epub ahead of print
Faghy MA, Arena R, Stoner L, Haraf RH, ... Ashton REM, HL-PIVOT Network
Prog Cardiovasc Dis: 03 Feb 2021; epub ahead of print | PMID: 33549590
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Abstract

Exercise blood pressure, cardiorespiratory fitness and mortality risk.

Kokkinos P, Faselis C, Sidossis L, Zhang J, ... Rosenberg S, Myers J
Objective
To assess the cardiorespiratory fitness (CRF) impact on the association between exercise blood pressure (BP) and mortality risk.
Patients and methods
We assessed CRF in 15,004 US Veterans (mean age 57.5 ± 11.2 years) who completed a standardized treadmill test between January 1, 1988 and July 28, 2017 and had no evidence of ischemia. They were classified as Unfit or Fit according to the age-specific metabolic equivalents (METs) achieved <50% (6.2 ± 1.6 METs; n = 8440) or ≥ 50% (10.5 ± 2.4 METs; n = 6264). To account for the impact of resting systolic BP (SBP) on outcomes, we calculated the difference (Peak SBP-Resting SBP) and termed it SBP-Reserve. We noted a significant increase in mortality associated with SBP-Reserve ≤52 mmHg and stratified the cohort accordingly (SBP-Reserve ≤52 mmHg and > 52 mmHg). We applied multivariable Cox models to estimate hazard ratios (HR) and 95% confidence interval (CIs) for outcomes.
Results
Mortality risk was significantly elevated only in Unfit individuals with SBP-Reserve ≤52 mmHg compared to those with SBP-Reserve >52 mmHg (HR = 1.35; CI: 1.24-1.46; P < 0.001). We then assessed the CRF and SBP-Reserve interaction on mortality risk with Fit individuals with SBP-Reserve >52 mmHg serving as the referent. Mortality risk was 92% higher (HR = 1.92%; 95% CI: 1.77-2.09; P < 0.001) in Unfit individuals with SBP-Reserve ≤52 mmHg and 47% higher (HR = 1.47; 95% CI: 1.33-1.62; P < 0.001) in those with SBP-Reserve >52 mmHg.
Conclusion
Low CRF was associated with increased mortality risk regardless of peak exercise SBP. The risk was substantially higher in individuals unable to augment their exercise SBP >52 mmHg beyond resting levels.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 25 Jan 2021; epub ahead of print
Kokkinos P, Faselis C, Sidossis L, Zhang J, ... Rosenberg S, Myers J
Prog Cardiovasc Dis: 25 Jan 2021; epub ahead of print | PMID: 33513410
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Abstract

The physiological benefits of sitting less and moving more: Opportunities for future research.

Hwang CL, Chen SH, Chou CH, Grigoriadis G, ... Arena R, Phillips SA
Sedentary behavior (SB) and physical activity (PA) are important risk factors of cardiovascular disease morbidity and mortality. In addition to increasing the amount of moderate-to-vigorous PA (MVPA), the current PA guidelines recommend that adults should reduce SB, or any waking activity performed while sitting, reclining, or lying, with low energy expenditure. While mounting evidence has emphasized the benefits of increasing MVPA, little has focused on the effect of SB on health. Therefore, this review discusses the pathophysiological effects of SB and the potential physiological benefits of reducing/breaking up SB at the levels below the current guidelines for PA. Such knowledge is important, given that the majority of the United States population performs insufficient or no MVPA and is at high risk of being negatively impacted by SB. Interventions targeting sedentary time, such as breaking up SB by standing and moving, may be safe, feasible, and applicable to execute daily for a wide range of the population. This review also discusses the importance of monitoring SB in the era of the coronavirus disease 2019 (COVID-19) pandemic and the clinical implications of sitting less and moving more.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 12 Jan 2021; epub ahead of print
Hwang CL, Chen SH, Chou CH, Grigoriadis G, ... Arena R, Phillips SA
Prog Cardiovasc Dis: 12 Jan 2021; epub ahead of print | PMID: 33453285
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Abstract

The role of the built environment in promoting movement and physical activity across the lifespan: Implications for public health.

Laddu D, Paluch AE, LaMonte MJ
Engaging in regular physical activity (PA) and reducing time spent in sedentary behaviors is critically important to prevent and control non-communicable diseases (NCDs). However, global public health efforts to promote and encourage maintenance of PA behavior on a population level remains challenging. To address what is now described as a global physical inactivity pandemic, a breadth of research has focused on understanding the relation of built environment characteristics, including aspects of urban design, transportation and land-use planning, to PA behavior across multiple domains in life, and subsequently how changes in environmental attributes influence changes in PA patterns in diverse populations and subgroups. This review describes the role the built environment has on improving the promotion and the engagement of PA, particularly in the context of active transportation and leisure time domains of PA. An additional focus will be on the disparities in access to activity-promoting environments and the differential effects of environmental interventions in disadvantaged populations. This paper will further discuss opportunities for public health and policy to advocate for and prioritize the implementation of equitable and effective interventions that aim to expand/improve activity-supportive infrastructures within neighborhoods and communities with the ultimate goal of meaningful population-level increases in PA.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 08 Jan 2021; epub ahead of print
Laddu D, Paluch AE, LaMonte MJ
Prog Cardiovasc Dis: 08 Jan 2021; epub ahead of print | PMID: 33428966
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Abstract

Promoting adherence to physical activity among individuals with cardiovascular disease using behavioral counseling: A theory and research-based primer for health care professionals.

Williamson TM, Moran C, McLennan A, Seidel S, ... Koerner ML, Campbell TS
Physical activity (PA) promotion remains a cornerstone of primary and secondary prevention efforts to reduce morbidity and mortality from cardiovascular disease (CVD). While frontline health care providers (HCPs; e.g., family physicians, cardiologists, registered nurses, nurse practitioners, etc.) are in an optimal position to administer PA-promoting interventions to their patients, many HCPs may feel ill-equipped to address common obstacles to implementing and maintaining complex health behavior change. Behavioral counseling refers to a collection of theory- and empirically-supported strategies and approaches to health behavior promotion that can be learned and applied by HCPs for CVD prevention and treatment. In this selective review, we discuss prominent theories of health behavior change and the empirical intervention literature regarding PA promotion in community and CVD-samples and provide practical recommendations for integrating effective behavioral counseling strategies to clinical practice for frontline HCPs. We argue that behavioral counseling interventions for PA can be effectively executed within the contextual constraints of health settings through subtle shifts in communication strategies and brief counseling approaches. The administration of behavioral counseling for PA by HCPs has enormous potential to reduce CVD incidence and progression at a population level.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 28 Dec 2020; epub ahead of print
Williamson TM, Moran C, McLennan A, Seidel S, ... Koerner ML, Campbell TS
Prog Cardiovasc Dis: 28 Dec 2020; epub ahead of print | PMID: 33385411
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Abstract

How much should LDL cholesterol be lowered in secondary prevention? Clinical efficacy and safety in the era of PCSK9 inhibitors.

Cybulska B, Kłosiewicz-Latoszek L, Penson PE, Nabavi SM, ... Banach M, International Lipid Expert Panel (ILEP)
There is a strong evidence that more marked lowering of low-density lipoprotein cholesterol (LDL-C) leads to progressively lower risk of cardiovascular disease (CVD) events. The evidence on validity of this hypothesis comes from epidemiological, genetic and clinical studies. The hypothesis \"the lower the better\" has been recently strongly supported by the results of secondary prevention trials with PCSK9 inhibitors. The combination of PCSK9 inhibitors and statins has resulted in achieving extremely low LDL-C levels with additional reduction of CVD events in secondary prevention. However, despite large clinical benefits, the safety of aggressive LDL-C lowering should be always taken into consideration, and there is still an ongoing discussion on whether very low LDL-C might result in some non-CVD adverse events. However, based on the available knowledge, so far the serious adverse events associated with achieving of very low LDL-C levels or intensive drug therapy have not been noted. These positive clinical effects were reflected in current ESC/EAS Guidelines (2019) for dyslipidaemia management. The experts strongly recommended the LDL-C lowering to levels that have been achieved in trials of PCSK9 inhibitors. In this state of the art review, we aimed to finally justify the critical need for LDL-C reduction to very low levels in secondary prevention patients in order to be as low as possible, as early as possible, and preferably lifelong.

Copyright © 2021. Published by Elsevier Inc.

Prog Cardiovasc Dis: 27 Dec 2020; epub ahead of print
Cybulska B, Kłosiewicz-Latoszek L, Penson PE, Nabavi SM, ... Banach M, International Lipid Expert Panel (ILEP)
Prog Cardiovasc Dis: 27 Dec 2020; epub ahead of print | PMID: 33383060
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Abstract

Training health professionals to provide physical activity counselling.

Coombes JS, Williams A, Radford J
There is strong evidence that physical activity (PA) counselling from a health professional (HPs) leads to increased PA of their patients. Despite this, there remains a large evidence-practice gap between HP knowledge of the contribution of physical inactivity to chronic disease prevention and management, and routine effective assessment and prescription of PA. This article will present evidence on the effectiveness of HP- PA counselling and suggested behaviour change frameworks that can be used by HP. Four case studies are provided as examples of programs integrated into current HP student and post-graduate training programs.

Copyright © 2020 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 27 Dec 2020; epub ahead of print
Coombes JS, Williams A, Radford J
Prog Cardiovasc Dis: 27 Dec 2020; epub ahead of print | PMID: 33383059
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Abstract

Physical activity assessment, prescription and referral in US healthcare: How do we make this a standard of clinical practice?

Whitsel LP, Bantham A, Jarrin R, Sanders L, Stoutenberg M
Numerous guidelines and recommendations reinforce the important role of healthcare providers promoting physical activity (PA) through assessment, prescription, and referral. This paper summarizes what is required to accomplish these actions as a standard of care. The sections describe the importance of measurement development and standardization, the integration of PA into the care continuum, suggested roles and responsibilities for the healthcare team, the role of technology and telehealth in promoting PA, connecting patients to different PA modalities and settings, a summary of the overall regulatory and policy plan to accomplish integration of PA into delivery of care, and areas for future research. Integrating PA assessment, prescription, and referral into delivery of care requires a multi-stakeholder, coordinated effort with government agencies, payers, non-governmental organizations, professional societies, the United States Congress, state legislatures, healthcare systems, and the healthcare industry.

Copyright © 2020 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 27 Dec 2020; epub ahead of print
Whitsel LP, Bantham A, Jarrin R, Sanders L, Stoutenberg M
Prog Cardiovasc Dis: 27 Dec 2020; epub ahead of print | PMID: 33383058
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Abstract

Evidence supporting moving more and sitting less.

Ozemek C, Arena R
High levels of sedentary time and physical inactivity independently contribute to the development of noncommunicable diseases and premature mortality. Engaging in at least 150 min of moderate or 75 min of vigorous physical activity (PA) is globally recognized as conferring substantial health benefits. However, setting these distinct thresholds and promoting them may have inadvertently created perceptions among the general public that an all or nothing phenomenon exists. Yet, the PA guidelines and a growing body of evidence highlights the robust health benefits associated with becoming more active from a previously sedentary lifestyle, even if the volume of PA performed is below current ideal recommendations. Practitioners providing PA recommendations are encouraged to initially highlight the benefits of moving more and sitting less rather than initially setting lofty, perhaps unachievable, PA goals for inactive individuals. Taking this approach may increase the likelihood of adopting a more physically active lifestyle and ultimately progressing to meet the PA guidelines.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 25 Dec 2020; epub ahead of print
Ozemek C, Arena R
Prog Cardiovasc Dis: 25 Dec 2020; epub ahead of print | PMID: 33373619
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Abstract

Temporal changes in personal activity intelligence and mortality: Data from the aerobics center longitudinal study.

Nauman J, Arena R, Zisko N, Sui X, ... Whitsel LP, Wisløff U
Background
Personal activity intelligence (PAI) is a metric developed to simplify a physically active lifestyle for the participants. Regardless of following today\'s advice for physical activity, a PAI score ≥100 per week at baseline, an increase in PAI score, and a sustained high PAI score over time were found to delay premature cardiovascular disease (CVD) and all-cause mortality in a large population of Norwegians. However, the association between long-term temporal change in PAI and mortality in other populations have not been investigated.
Objective
To test whether temporal change in PAI is associated with CVD and all-cause mortality in a large population from the United States.
Methods
We studied 17,613 relatively healthy participants who received at least two medical examinations in the Aerobics Center Longitudinal Study between 1974 and 2002. The participant\'s weekly PAI scores were estimated twice, and adjusted hazard ratios (AHR) and 95% confidence intervals (CI) for CVD and all-cause mortality related to changes in PAI between baseline and last examination were assessed using Cox proportional hazard regression analyses.
Results
During a median follow-up time of 9.3 years [interquartile range, 2.6-16.6; 181,765 person-years], there were 1144 deaths, including 400 CVD deaths. We observed an inverse linear association between change in PAI and risk of CVD mortality (P=0.007 for linear trend, and P=0.35 for quadratic trend). Compared to participants with zero PAI at both examinations, multivariable-adjusted analyses demonstrated that participants who maintained high PAI scores (≥100 PAI at both examinations) had a 51% reduced risk of CVD mortality [AHR, 0.49: 95% CI, 0.26-0.95)], and 42% reduced risk of all-cause mortality [AHR, 0.58: 95% CI, 0.41-0.83)]. For participants who increased their PAI scores over time (PAI score of zero at first examination and ≥100 at last examination), the AHRs were 0.75 (95% CI, 0.55-1.02) for CVD mortality, and 0.82 (95% CI, 0.69-0.99) for all-cause mortality. Participants who maintained high PAI score had 4.8 (95% CI, 3.3-6.4) years of life gained. For those who increased their PAI score over time, the corresponding years gained were 1.8 years (95% CI, 0.1-3.5).
Conclusion
Among relatively healthy participants, an increase in PAI and maintaining a high PAI score over time was associated with reduced risk of CVD and all-cause mortality.
Condensed abstract
Our objective was to investigate the association between temporal changes in PAI and mortality in a large population from the United States. In this prospective cohort study of 17,613 relatively healthy participants at baseline, maintaining a high PAI score and an increase in PAI score over an average period of 6.3 years was associated with a significant reduction in CVD and all-cause mortality. Based on our results, clinicians can easily recommend that patients obtain at least 100 PAI for most favourable protection against CVD- and all-cause mortality, but can also mention that significant benefits also occur at maintaining low-to-moderate PAI levels.

Copyright © 2021 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 24 Dec 2020; epub ahead of print
Nauman J, Arena R, Zisko N, Sui X, ... Whitsel LP, Wisløff U
Prog Cardiovasc Dis: 24 Dec 2020; epub ahead of print | PMID: 33370551
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Abstract

Moving more and sitting less in schools: What\'s the next step?

Strieter L, Arena R, Huizar M
Schools serve as the ideal location for implementing interventions to increase physical activity (PA) as children spend most of their day in the school setting. As adolescents become more and more sedentary and obesity statistics become more dire, efforts to increase physical literacy and PA should be heightened. Physical literacy is the ability for a child to understand the movement of their body and how it can be manipulated to increase activity for recreation or sports movement. When physical literacy is paired with school-based multi-component programs, children are more likely to make a behavior change. As educators know, children are more likely to make a behavior change when mastery of content is achieved, and the lesson is tailored to their needs. Even small changes, like moving a little more or adding an additional serving of vegetables to the diet, can make a profound impact. In the current review we discuss: 1) the state of PA within school systems; 2) provide a rationale for why school systems fail to meet said guidelines; and 3) suggest how guidelines can eventually be achieved through the promotion of physical literacy and effective school-based multi component programs.

Copyright © 2020 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 24 Dec 2020; epub ahead of print
Strieter L, Arena R, Huizar M
Prog Cardiovasc Dis: 24 Dec 2020; epub ahead of print | PMID: 33359568
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Abstract

Improving gait efficiency to increase movement and physical activity - The impact of abnormal gait patterns and strategies to correct.

Slater L, Gilbertson NM, Hyngstrom AS
Increasing daily steps is important to maintain health and prevent both initial and subsequent cardiovascular (CV) disease (CVD) events. Even 5000 steps have been associated with reduced risk of CVD, however many adults and those with CVD walk fewer than 5000 daily steps. Reduced gait speed is a precursor to decreased physical engagement and is associated with biomarker changes linked to higher risk of CVD. Gait speed is decreased in those with CVD, which may be from changes in biomechanics including reduced step length and increased gait variability. Changes in gait and daily steps are often most discernable post-stroke, which may be from limitations of the CV system in meeting the metabolic demands of walking and the nervous system in exciting motoneuron pools to generate muscle force. This leads to gait asymmetries and decreased speed. Information regarding the effects of rehabilitation interventions (e.g., physical therapy) to increase physical activity (PA) in stroke survivors is limited. Current interventions include high intensity gait training and ischemic conditioning to improve walking speed and fatigability. Given the potential benefits of increased PA and daily steps following stroke, there is a need for more research investigating optimal dosage of daily steps and interventions to improve PA.

Copyright © 2020 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 23 Dec 2020; epub ahead of print
Slater L, Gilbertson NM, Hyngstrom AS
Prog Cardiovasc Dis: 23 Dec 2020; epub ahead of print | PMID: 33359569
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This program is still in alpha version.