Journal: Prog Cardiovasc Dis

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Abstract

Coconut oil intake and its effects on the cardiometabolic profile - A structured literature review.

Santos HO, Howell S, Earnest CP, Teixeira FJ

In recent years, health professionals and laypersons have disseminated misinformation regarding the consumption of coconut oil. Those encouraging the supplementation of coconut oil argue that it provides health benefits and protective cardiovascular effects. Our article examines the effects of coconut oil intake on the cardiometabolic profile by exploring various lipid indices, as well as potential non-lipid effects, such as weight loss. The majority of randomized controlled trials show that coconut oil intake or its supplementation increases low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDLC), and total cholesterol when compared with other vegetable oils. Lauric acid, a medium-chain fatty acid and the main constituent of coconut oil, increases LDL-C and HDL-C concentrations, since it plays a main role as a substrate for apolipoprotein (apo)A1 and apoB synthesis, which are the key molecules in HDL-C and LDL-C particles, respectively. Despite some findings demonstrating an increase in HDLC, definitive long-term clinical trials are imperative to ascertain whether this effect is clinically relevant given that the consumption of saturated fatty acids (SFA), independent of coconut oil, may also increase HDL-C concentrations. Despite the promotion in the mainstream media, coconut oil intake has failed as a weight loss strategy and should not be considered as a supplementation strategy to increase satiety and/or thermogenesis. If one desires to include coconut oil in the diet, then we suggest that it should be limited and encompassed within the current recommendations of SFA intake, which are up to 10% of total caloric intake.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 06 Nov 2019; epub ahead of print
Santos HO, Howell S, Earnest CP, Teixeira FJ
Prog Cardiovasc Dis: 06 Nov 2019; epub ahead of print | PMID: 31707063
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Abstract

Implications for REDUCE IT in clinical practice.

Bittner V

Statin therapy is effective in primary and secondary prevention, but substantial residual risk remains on statin treatment, especially among high risk and very high risk patients. Add-on therapy with ezetimibe and proprotein convertase subtilisin /kexin type 9 (PCSK9) inhibitors provides additional risk reduction through further reduction in low density lipoprotein cholesterol. Elevated triglycerides/triglyceride rich lipoproteins contribute to atherogenesis and to the residual risk on statin therapy. Addition of icosapent ethyl to statins has recently been shown to markedly lower risk of cardiovascular disease (CVD) events in patients with established atherosclerotic CVD (ASCVD) and high risk patients with type II diabetes mellitus. These data are discussed in the context of current guidelines and synthesized in a decision pathway to guide combination lipid-lowering therapy in patients at high ASCVD risk.

Copyright © 2019 Anesthesia History Association. Published by Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 08 Nov 2019; epub ahead of print
Bittner V
Prog Cardiovasc Dis: 08 Nov 2019; epub ahead of print | PMID: 31715195
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Abstract

Coronary artery calcium scoring for individualized cardiovascular risk estimation in important patient subpopulations after the 2019 AHA/ACC primary prevention guidelines.

Dzaye O, Dudum R, Reiter-Brennan C, Kianoush S, ... Cainzos-Achirica M, Blaha MJ

The 2018 and 2019 American Heart Association and American College of Cardiology (AHA/ACC) guidelines for primary prevention of atherosclerotic cardiovascular disease (ASCVD) recommend consideration of so-called \"risk-enhancing factors\" in borderline to intermediate risk individuals. These include high-risk race/ethnicity (e.g. South Asian origin), chronic kidney disease, a family history of premature ASCVD, the metabolic syndrome, chronic inflammatory disorders (e.g. rheumatoid arthritis [RA], psoriasis, or chronic human immunodeficiency virus [HIV]), and conditions specific to women, among others. Studies suggest, however, that risk may be highly heterogeneous within these subgroups. The AHA/ACC guidelines also recommend consideration of coronary artery calcium (CAC) scoring for further risk assessment in borderline to intermediate risk individuals in whom management is uncertain. Although the combination of risk enhancing factors and CAC burden (together with Pooled Cohort estimates) may lead to more accurate ASCVD risk assessment, few publications have closely examined the interplay between risk enhancing factors and CAC scoring for personalized risk estimation. Our aim is to review the relevant literature in this area. Although further research is clearly needed, CAC assessment seems a highly valuable option to inform individualized ASCVD risk management in these important, often highly heterogeneous patient subgroups.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 08 Nov 2019; epub ahead of print
Dzaye O, Dudum R, Reiter-Brennan C, Kianoush S, ... Cainzos-Achirica M, Blaha MJ
Prog Cardiovasc Dis: 08 Nov 2019; epub ahead of print | PMID: 31715194
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Abstract

Reducing cardiovascular risk in patients with familial hypercholesterolemia: Risk prediction and lipid management.

Miname MH, Santos RD

Familial hypercholesterolemia (FH) is a frequent genetic disorder characterized by elevated low-density lipoprotein (LDL)-cholesterol (LDL-C) levels and early onset of atherosclerotic cardiovascular disease. FH is caused by mutations in genes that regulate LDL catabolism, mainly the LDL receptor (LDLR), apolipoprotein B (APOB) and gain of function of proprotein convertase subtilisin kexin type 9 (PCSK9). However, the phenotype may be encountered in individuals not carrying the latter monogenic defects, in approximately 20% of these effects of polygenes predominate, and in many individuals no molecular defects are encountered at all. These so-called FH phenocopy individuals have an elevated atherosclerotic cardiovascular disease risk in comparison with normolipidemic individuals but this risk is lower than in those with monogenic disease. Individuals with FH are exposed to elevated LDL-C levels since birth and this explains the high cardiovascular, mainly coronary heart disease, burden of these subjects. However, recent studies show that this risk is heterogenous and depends not only on high LDL-C levels but also on presence of previous cardiovascular disease, a monogenic cause, male sex, smoking, hypertension, diabetes, low HDL-cholesterol, obesity and elevated lipoprotein(a). This heterogeneity in risk can be captured by risk equations like one from the SAFEHEART cohort and by detection of subclinical coronary atherosclerosis. High dose high potency statins are the main stain for LDL-C lowering in FH, however, in most situations these medications are not powered enough to reduce cholesterol to adequate levels. Ezetimibe and PCSK9 inhibitors should also be used in order to better treat LDL-C in FH patients.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 24 Oct 2019; epub ahead of print
Miname MH, Santos RD
Prog Cardiovasc Dis: 24 Oct 2019; epub ahead of print | PMID: 31669498
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Abstract

Assessment and procedural guidance with echocardiography for transcatheter tricuspid regurgitation devices.

Hahn RT

Echocardiographic imaging is an integral part of characterizing patients with tricuspid regurgitation (TR) and helps in determining the timing of intervention and procedural guidance for transcatheter interventions. The rapid advances in both two-dimensional and three-dimensional imaging however have facilitated the development and deployment of novel transcatheter devices to address the unmet need for patients with symptomatic severe TR.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 24 Oct 2019; epub ahead of print
Hahn RT
Prog Cardiovasc Dis: 24 Oct 2019; epub ahead of print | PMID: 31669497
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Abstract

Lipid management beyond the guidelines.

Robinson JG

The 2018 AHA/ACC cholesterol guideline builds on the 2013 ACC/AHA cholesterol guideline statin recommendations to provide more detailed recommendations for the use of nonstatin therapy risk stratification for primary prevention statin use. New information has become available after the development of the 2018 AHA/ACC cholesterol guideline that can further inform clinical practice. Proprotein convertase subtilisin kexin type-9 (PCSK9) monoclonal antibodies are now a reasonable or even good value following over 60% reductions in their acquisition price, and the identification of high risk patient groups most likely to benefit from further low-density lipoprotein cholesterol (LDL-C) lowering. Meta-analyses and clinical trial data now show that patients with LDL-C ≥ 100 mg/dl are more likely to experience progressively greater reductions in the risk of cardiovascular and total mortality and coronary heart disease events for progressively higher LDL-C levels. Icosapent ethyl, a highly concentrated form of modified EPA has been shown to reduce cardiovascular events in high risk patients with moderate hypertriglyceridemia on statin therapy. Comparisons with other statin guidelines revealed that statin initiation for those with ≥7.5% 10-year atherosclerotic cardiovascular disease (ASCVD) risk is the most effective strategy for reducing the most ASCVD events for the proportion of the population treated. Data from younger populations finally became available for coronary artery calcium (CAC) scoring (mean age of 51 years) which confirmed the value of CAC > 0 for identifying individuals at increased ASCVD risk most likely to benefit from statin initiation. This analysis also found that statins could keep CAC = 0 in those with risk factors. Epidemiologic pooling studies now clearly show that LDL-C and non-high-density lipoprotein cholesterol levels in young adulthood confer excess risk for ASCVD later in life. Accumulating data support earlier risk factor intervention trials as the next research priority.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 24 Oct 2019; epub ahead of print
Robinson JG
Prog Cardiovasc Dis: 24 Oct 2019; epub ahead of print | PMID: 31669499
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Abstract

Transcatheter repair of tricuspid regurgitation with MitraClip.

Sorajja P, Cavalcante J, Goessl M, Bae R

Transcatheter therapy with the MitraClip system (Abbott Structural, Menlo Park, CA) is the most commonly used transcatheter therapy for patients with tricuspid regurgitation, with over 1000 cases performed worldwide. The procedure is an off-label approach that requires meticulous attention to anatomical features obtained via comprehensive echocardiography and, in some cases, using cardiac computed tomography. Herein, we describe patient selection, procedural performance, and clinical outcomes of this therapy.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 22 Oct 2019; epub ahead of print
Sorajja P, Cavalcante J, Goessl M, Bae R
Prog Cardiovasc Dis: 22 Oct 2019; epub ahead of print | PMID: 31655080
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Abstract

Transcatheter innovations in tricuspid regurgitation: Navigate.

Elgharably H, Harb SC, Kapadia S, Svensson LG, Navia JL

Patients with isolated functional or recurrent tricuspid regurgitation are often considered high risk and denied surgery. There has been growing experience for transcatheter tricuspid valve implantation through valve-in-valve or valve-in-ring, and recently, but to a lesser extent, in native annulus. The NaviGate is a novel self-expanding valved-stent designed with unique features to treat tricuspid regurgitation, particularly, in the settings of severely dilated tricuspid annulus. Herein, we present the innovation facets and clinical application of the NaviGate system.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 06 Nov 2019; epub ahead of print
Elgharably H, Harb SC, Kapadia S, Svensson LG, Navia JL
Prog Cardiovasc Dis: 06 Nov 2019; epub ahead of print | PMID: 31707062
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Abstract

Tricuspid regurgitation is a public health crisis.

Enriquez-Sarano M, Messika-Zeitoun D, Topilsky Y, Tribouilloy C, Benfari G, Michelena H

Tricuspid regurgitation (TR) has long been a forgotten valve disease of benign reputation. However, TR deserves higher attention and represents a growing public health crisis. Indeed, recent epidemiological data suggest that 1.6 million US residents are affected by moderate or severe TR. Furthermore, large recent cohorts demonstrate that higher degrees of TR are associated with considerable excess mortality, independent of all background clinical and hemodynamic contexts. Finally, analysis of recent cohorts also shows that >90% of patients with moderate or severe TR are never offered surgical treatment and remain untreated. Therefore, TR is frequent, severely impacts outcomes, and is rarely treated, justifying the development of new strategies and methods for its treatment.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 06 Nov 2019; epub ahead of print
Enriquez-Sarano M, Messika-Zeitoun D, Topilsky Y, Tribouilloy C, Benfari G, Michelena H
Prog Cardiovasc Dis: 06 Nov 2019; epub ahead of print | PMID: 31707061
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Abstract

Understanding why REDUCE-IT was positive - Mechanistic overview of eicosapentaenoic acid.

Harris WS

The REDUCE-IT study found that patients at elevated risk for cardiovascular disease (CVD) who were already taking statins obtained a marked benefit by taking 4 g/d of eicosapentaenoic acid ethyl esters (icosapent ethyl, IPE; Vascepa) over about 5 years. Although approved for triglyceride (TG) lowering, IPE had only a modest TG-lowering effect in REDUCE-IT, largely because median TG levels were relatively low already. Hence the question of what mechanisms IPE might be working through is of great interest. At present, it appears that the best mechanistic candidates would be anti-platelet effects and/or anti-inflammatory effects. Whatever the cause, the powerful effects of IPE on CVD risk have renewed interest in the clinical utility of omega-3 fatty acids.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 26 Oct 2019; epub ahead of print
Harris WS
Prog Cardiovasc Dis: 26 Oct 2019; epub ahead of print | PMID: 31666183
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Abstract

New insights into managing symptoms during statin therapy.

Robinson JG

Symptoms during statin therapy are common and often attributed to statin intolerance. Recent data suggest few patients are truly intolerant to statins. Muscle symptoms are similar in statin and control groups in blinded treatment periods of clinical trials. The \"nocebo\" effect may occur during open-label statin treatment, when previously asymptomatic study participants report symptoms attributed to statin therapy, or during placebo-controlled trials. Most patients reporting statin intolerance can tolerate blinded moderate intensity statin therapy. In clinical practice the large majority of patients are willing to retry a statin, and of those who do, >80-90% successfully remain on statin therapy long-term. Emerging evidence from brain imaging studies and contemporary approaches to pain management suggests that building trust and managing patient expectations can minimize the \"nocebo\" effect in statin-treated patients.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 25 Oct 2019; epub ahead of print
Robinson JG
Prog Cardiovasc Dis: 25 Oct 2019; epub ahead of print | PMID: 31669768
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Abstract

Implications of cost-effectiveness analyses of lipid-lowering therapies: From the policy-maker\'s desk to the patient\'s bedside.

Kazi DS, Virani SS

In our increasingly cost-conscious health system, patients, clinicians, hospitals, and payers all agree about the urgent need to rein in runaway healthcare costs. High pharmaceutical costs make drugs unaffordable to many patients who may benefit from them, including some insured patients who face prohibitive out-of-pocket costs. Health systems and payers can use the systematic framework of cost-effectiveness analysis and estimated budgetary impact to prioritize the adoption of new therapies and technologies. In this review article, we discuss basic principles of cost-effectiveness research for practicing clinicians, the concept of cost-effectiveness versus affordability, other considerations relevant to resource allocation, and limitations of cost-effectiveness research. We use the example of lipid lowering therapies to discuss application of cost-effectiveness research in informing health care policy, its use for health care systems and in the development of clinical practice guidelines, and its implications for clinicians and patients. As clinicians and patients become more cognizant of the cost-implications of new therapies, professional societies can help improve the quality of decision-making by incorporating unbiased value statements into their expert guidelines.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 27 Oct 2019; epub ahead of print
Kazi DS, Virani SS
Prog Cardiovasc Dis: 27 Oct 2019; epub ahead of print | PMID: 31672610
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Abstract

Impact of fitness and changes in fitness on lipids and survival.

Lavie CJ, Kachur S, Sui X

In the past five decades, cardiorespiratory fitness (CRF) has become fairly established as an important risk factor or marker for cardiovascular disease (CVD), as well as CVD - and all-cause mortality. Substantial evidence supports a strong inverse association between baseline levels of CRF and the risk of developing CVD risk factors, including dyslipidemia. Additionally, accumulating evidence also supports that maintaining or improving a certain level of CRF over time leads to a lower rate of developing CVD risk factors, such as dyslipidemia, and also improves survival. Recent evidence also supports the role of resistance exercise and muscular strength to reduce the development of metabolic syndrome and hypercholesterolemia and potentially reduce development of diabetes as well, in addition to improving survival. Therefore, great efforts are needed to increase both CRF and muscle strength with aerobic exercise and resistance exercise in the primary and secondary prevention of CVD.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 07 Nov 2019; epub ahead of print
Lavie CJ, Kachur S, Sui X
Prog Cardiovasc Dis: 07 Nov 2019; epub ahead of print | PMID: 31711788
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Abstract

Transcatheter innovations in tricuspid regurgitation: Cardioband.

Mangieri A, Latib A

Functional tricuspid regurgitation (FTR) has been neglected for a long time, however its prevalence and clinical relevance is not negligible. In presence of FTR, a certain quote of annular dilatation is present thus contributing to the mechanism of regurgitation. Historically, surgical annuloplasty has been the main treatment to correct FTR; however surgical repair is limited by a high risk of mortality and morbidity. For this reason, percutaneous tricuspid annuloplasty is an attractive tool for the treatment of FTR in patients at high surgical risk. A number of both direct and indirect percutaneous annuloplasty systems are currently under pre-clinical and clinical development. This review will discuss the Cardioband system, a novel direct annuloplasty device with promising result in terms of clinical safety and efficacy.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 24 Oct 2019; epub ahead of print
Mangieri A, Latib A
Prog Cardiovasc Dis: 24 Oct 2019; epub ahead of print | PMID: 31669500
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Abstract

The 2018 AHA/ACC/Multi-Society Cholesterol guidelines: Looking at past, present and future.

Stone NJ, Grundy SM

The authors review more than three decades of progress in providing clinicians and patients with guidance on risk assessment, patient evaluation and cholesterol management. Beginning with the National Cholesterol Education Program\'s Initial Adult Treatment Panel report, the cholesterol guidelines increasingly reflect the progress made in understanding the benefits of improved lifestyle and nutrition to improve lipid profiles, major risk factors and reduce ASCVD risk. Moreover, they now provide qualitative and quantitative assessment tools to guide appropriate risk reduction LDL-C lowering therapy. Use of the Pooled Cohort Equations to determine Low, Borderline, Intermediate and High 10-year ASCVD risk is now joined by recognition of conditions and biomarkers that enhance ASCVD risk. This personalizes the risk discussion for the patient. An important addition is the selective use of coronary artery calcium (CAC) scoring to reclassify risk in patients at borderline or intermediate risk, but for whom a risk decision regarding statin therapy is uncertain. In secondary prevention, current guidelines provide criteria for determining a \"very high\" risk group in whom risk is especially high and in whom aggressive LDL-C lowering can be shown to provide increased absolute benefit. Current guidelines provide a comprehensive look at children and adolescents, young adults, elderly, women and issues specific to women through the life course. They provide guidance for those adults at risk due to severe hypercholesterolemia, persistent hypertriglyceridemia after secondary causes have been addressed, those with inflammatory disorders and HIV, those adults with chronic kidney disease, and those affected by issues of race/ethnicity. They conclude with a brief summary of recommendations emphasizing important concepts for providing safety with LDL-C lowering therapy. This combination of best external evidence and clinical expertise from the expert panel should provide a solid foundation for lipid management of patients at risk for or with clinical ASCVD.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 12 Nov 2019; epub ahead of print
Stone NJ, Grundy SM
Prog Cardiovasc Dis: 12 Nov 2019; epub ahead of print | PMID: 31733217
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Abstract

Endpoints for tricuspid regurgitation trans-catheter therapy trials.

Hahn RT, Ben-Yehuda O, Leon MB

Tricuspid regurgitation (TR), particularly functional or secondary TR, is increasingly recognized in clinical practice and when at least moderate in severity is associated with significant increase in mortality. In recent years multiple new trans-catheter devices have been developed to treat tricuspid regurgitation and are now undergoing clinical trial evaluations. The choice of appropriate endpoints in TR trials is particularly challenging as the disease is complex, often co-exists with left heart disease and pulmonary hypertension, and has not been extensively studied. Endpoints utilized in left heart disease trials have been applied with success to TR trials, and innovative trial designs will allow the initiation of pivotal randomized trials. Ultimately the development of TR specific endpoints may provide for more specific and robust assessment of these novel therapies.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 01 Dec 2019; epub ahead of print
Hahn RT, Ben-Yehuda O, Leon MB
Prog Cardiovasc Dis: 01 Dec 2019; epub ahead of print | PMID: 31805295
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Abstract

Patients\' selection for transcatheter tricuspid valve interventions: Who will benefit?

Harb SC, Kapadia SR

Tricuspid regurgitation (TR) is a common valvular pathology and is associated with significant morbidity and mortality. However, there is no currently defined optimal management strategy: medical therapy is limited to diuretics, and tricuspid valve surgery is rarely performed and associated with high risks. This has led to the emergence of numerous transcatheter therapies that are showing promising early results but are faced with multiple challenges. The tricuspid valve anatomy is complex and variable, imaging of tricuspid valve by echocardiography can be difficult, and current grading of TR severity and right ventricular size and function is mostly subjective. Also, the optimal timing of the intervention and appropriate selection of patients who will benefit remain topics of debate with limited supporting data. In this review, we present the current challenges and considerations in patients\' selection and propose a trial design and selection criteria aimed to address these limitations.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 10 Sep 2019; epub ahead of print
Harb SC, Kapadia SR
Prog Cardiovasc Dis: 10 Sep 2019; epub ahead of print | PMID: 31520604
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Abstract

Obesity, risk of diabetes and role of physical activity, exercise training and cardiorespiratory fitness.

Carbone S, Del Buono MG, Ozemek C, Lavie CJ

The epidemic of obesity contributes to the burden of type 2 diabetes mellitus (T2DM) in the United States and worldwide. Importantly, obesity is not only preventable but can be treated, particularly with lifestyle modifications to forestall T2DM in those with excess adiposity. The mechanisms linking obesity to T2DM are numerous and involve adipose tissue remodeling as a result of unhealthy behaviors, including unhealthy diet, reduced physical activity (PA) and exercise training (ET), and increased sedentary behaviors. Taken together, these factors markedly reduce cardiorespiratory fitness (CRF), one of the strongest predictors for cardiovascular outcomes and all-cause mortality in the general population, but also in those with T2DM. In this review we describe the mechanisms leading to adipose tissue remodeling resulting in obesity, as well as the mechanisms linking excess adiposity to insulin resistance and, in turn, T2DM. We then present the therapeutic strategies that can be implemented in obesity to prevent T2DM, with a brief discussion on weight loss, and greater emphasis on PA and ET. We finally present the evidence to support the beneficial effects of such strategies in patients with established T2DM and discuss the importance of achieving improvements in CRF in this population to potentially improve clinical outcomes.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:327-333
Carbone S, Del Buono MG, Ozemek C, Lavie CJ
Prog Cardiovasc Dis: 30 Dec 1999; 62:327-333 | PMID: 31442513
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Abstract

Cross-country skiing and running\'s association with cardiovascular events and all-cause mortality: A review of the evidence.

Laukkanen JA, Kunutsor SK, Ozemek C, Mäkikallio T, ... Wisloff U, Lavie CJ

A large body of evidence demonstrates positive, graded effects of PA on cardiovascular disease (CVD) morbidity and mortality with increasing intensity compared with lower PA intensity. Running is often designated as a high-intensity PA with substantial evidence supporting its health benefits. Cross-country skiing is among the most demanding aerobic endurance exercises and requires engaging the upper- and lower-body. Cross-country skiing is often regarded as high-intensity PA, which has been associated with significant health benefits. However, a robust body of evidence identifying the dose-response relation between cross-country skiing volume and health outcomes is sparse. Therefore, this review aims to summarize the available evidence linking cross-country skiing with CVD morbidity and all-cause mortality; postulated pathways that may elucidate the relation between these associations; outline areas of ongoing uncertainty; and the implications for primary and secondary CVD prevention. To put the findings into perspective, we also summarized the evidence linking running with CVD morbidity and all-cause mortality. Though a head-to-head comparison is not available, the evidence indicates that performing PA as cross-country skiing associates with lower mortality risk when compared with that observed in those undertaking their PA as running. Potential adverse effects of extreme high weekly doses of cross-country skiing over decades may be cardiac arrhythmias, such as atrial fibrillation. Evidence suggests that cross-country skiing may reduce the risk of CVD events and all-cause mortality via anti-inflammatory pathways, improvements in endothelial function and reduced levels of CVD risk factors, such as lipids, glucose, and blood pressure; and enhancement of cardiorespiratory fitness.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 06 Sep 2019; epub ahead of print
Laukkanen JA, Kunutsor SK, Ozemek C, Mäkikallio T, ... Wisloff U, Lavie CJ
Prog Cardiovasc Dis: 06 Sep 2019; epub ahead of print | PMID: 31505192
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Abstract

Receipt and predictors of smoking cessation pharmacotherapy among veterans with and without HIV.

Shahrir S, Crothers K, McGinnis K, Chan G, ... Justice A, Williams EC

Smoking is highly prevalent among people living with HIV (PLWH) and increases cardiovascular risk. Pharmacotherapies such as nicotine replacement therapy (NRT), bupropion, and varenicline help to reduce smoking, though rates of receipt among PLWH compared with HIV-uninfected persons are unknown. Among 814 PLWH and 908 uninfected patients enrolled in the Veterans Aging Cohort Study (2012-2017) who reported current smoking, we used marginal multivariable log-linear regression models to calculate adjusted relative risks (ARR) of receiving pharmacotherapy by HIV status. We also assessed patient-level factors associated with pharmacotherapy receipt within each group. In multivariable analyses, receipt of NRT was less likely among PLWH relative to uninfected participants (ARR 0.77, 95% CI 0.67, 0.89). In both populations, documented mental health disorders and contemplation to quit were associated with greater likelihood of receiving pharmacotherapy. PLWH are less likely to receive NRT compared with uninfected persons. Further research is needed to explore potential treatment disparities.

Copyright © 2020. Published by Elsevier Inc.

Prog Cardiovasc Dis: 23 Jan 2020; epub ahead of print
Shahrir S, Crothers K, McGinnis K, Chan G, ... Justice A, Williams EC
Prog Cardiovasc Dis: 23 Jan 2020; epub ahead of print | PMID: 31987807
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Abstract

Transcatheter innovations in tricuspid regurgitation: FORMA device.

Muntané-Carol G, Del Val D, Bédard E, Philippon F, Rodés-Cabau J

Transcatheter tricuspid valve interventions (TTVIs) have arisen in recent years as an alternative treatment of tricuspid regurgitation (TR) in high risk patients. TTVIs can be classified as annuloplasty devices, caval valve implantation (CAVI), tricuspid valve replacement and coaptation devices. The FORMA repair system (Edwards Lifesciences, Irvine, CA, USA) aims to improve the coaptation of tricuspid leaflets by occupying the regurgitant orifice with a balloon spacer, which reduces the regurgitant orifice area. After the first-in-human reported case back in 2015, data from 18 patients treated under compassionate clinical use conditions and from 29 patients under the US early feasibility (EFS) trial have been published. The two studies included very high-risk surgical patients (Euroscore II >8 in both cohorts). Implantation success was achieved in 16 (89%) and 27 (93%) of patients, respectively. In the US EFS trial, results at 30 days showed improvements in New York Heart Association (NYHA) functional class (NYHA class ≥ III in 28% vs 84% at baseline, p = .0002), 6-minute walking test (increase by 21 m, p = .012) and in the Kansas City Cardiomyopathy Questionnaire (increase by 29 points, p < 0001). In addition, the Core Lab evaluation at 30 days showed statistically significant reductions in TR severity grading in the 25 available patients. Regarding the compassionate cohort, 15 patients had available data at 2-year follow-up. NYHA functional class ≥ III was reduced from 93% to 34% (p < .001). However, two-thirds of the patients remained with significant TR at last available follow-up, and there were no significant changes in EROA (0.92 vs. 0.77 cm; p = .516). In conclusion, this first experience with the FORMA device showed the feasibility of the procedure, albeit with a reasonable rate of device-related complications. Despite the magnitude of TR reduction was moderate at long-term, significant improvements in heart failure symptoms and quality of life were achieved.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 30 Nov 2019; epub ahead of print
Muntané-Carol G, Del Val D, Bédard E, Philippon F, Rodés-Cabau J
Prog Cardiovasc Dis: 30 Nov 2019; epub ahead of print | PMID: 31801698
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Abstract

Identification of novel genetic variants associated with cardiorespiratory fitness.

Bye A, Klevjer M, Ryeng E, Silva GJJ, ... Stensvold D, Wisløff U
Introduction
Low maximal oxygen uptake (VO) is a strong and independent risk factor for all-cause and cardiovascular disease (CVD) mortality. For other CVD risk factors, numerous genetic association studies have been performed, revealing promising risk markers and new therapeutic targets. However, large genomic association studies on VO are still lacking, despite the fact that VO has a large genetic component.
Methods
We performed a genetic association study on 123.545 single-nucleotide polymorphisms (SNPs) and directly measured VO in 3470 individuals (exploration cohort). Candidate SNPs from the exploration cohort were analyzed in a validation cohort of 718 individuals, in addition to 7 wild-card SNPs. Sub-analyses were performed for each gender. Validated SNPs were used to create a genetic score for VO. In silico analysis and genotype-phenotype databases were used to predict physiological function of the SNPs.
Results
In the exploration cohort, 41 SNPs were associated with VO (p < 5.0 ∗ 10). Six of the candidate SNPs were associated with VO also in the validation cohort, in addition to three wild-card SNPs (p < 0.05, in men, women or both). The cumulative number of high-VO SNPs correlated negatively with CVD risk factors, e.g. waist-circumference, visceral fat, fat %, cholesterol levels and BMI. In silico analysis indicated that several of the VO-SNPs influence gene expression in adipose tissue, skeletal muscle and heart.
Conclusion
We discovered and validated new SNPs associated with VO and proposed possible links between VO and CVD. Studies combining several large cohorts with directly measured VO are needed to identify more SNPs associated with this phenotype.

Copyright © 2020. Published by Elsevier Inc.

Prog Cardiovasc Dis: 04 Feb 2020; epub ahead of print
Bye A, Klevjer M, Ryeng E, Silva GJJ, ... Stensvold D, Wisløff U
Prog Cardiovasc Dis: 04 Feb 2020; epub ahead of print | PMID: 32035127
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Abstract

Hypertension in African Americans: Advances in community outreach and public health approaches.

Ferdinand D, Nedunchezhian S, Ferdinand KC

While there have been significant advances made towards controlling cardiovascular disease (CVD) morbidity and mortality in recent decades, African- Americans continue to experience a markedly elevated burden of CVD. Multiple factors have contributed to this major public health crisis, including medication adherence, racial inequities in diagnosis and treatment, lack of culturally competent care, and disparities in healthcare access. Historical approaches to reduce this burden are targeted towards community outreach by recruiting community partners and healthcare providers to disseminate health information on CVD awareness and prevention. Current community-based approaches, such as the barbershop programs and faith-based programs, have built upon previous approaches and incorporated novel ideas to increase community engagement in risk factor and disease reduction. Based on these models, future directions point to an increased usage of community partners, alongside health information technology and healthy behavior patient education, to reduce risk factors and prevalence of CVD in an ethnically vulnerable community.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 17 Dec 2019; epub ahead of print
Ferdinand D, Nedunchezhian S, Ferdinand KC
Prog Cardiovasc Dis: 17 Dec 2019; epub ahead of print | PMID: 31863786
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Abstract

Transcatheter therapy for tricuspid regurgitation: The surgical perspective.

Williams AM, Brescia AA, Watt TMF, Romano MA, Bolling SF

Tricuspid regurgitation (TR) remains a complex valve pathology affecting nearly two million people in the United States. Although it can present as a primary valve pathology, TR often presents as a late finding in patients with severe pulmonary disease or end-stage chronic heart failure. Surgical repair of isolated TR or TR from left-sided pathology has been associated with high morbidity and mortality. Furthermore, surgery for patients with TR and advanced cardiac disease has been associated with poor long-term outcomes. In recent years, transcatheter technology has emerged to target high-risk surgical patients with TR. Currently, multiple new transcatheter strategies to treat TR have shown initial benefit. However, further development of this technology is required. The aim of this perspective is to provide an overview of TR pathophysiology and to highlight the successful aspects of surgery for TR that provide insight for further translation of transcatheter strategies for patients with TR. These include replication of successful surgical techniques (ring-based annuloplasty and valve replacement) and the goal of achieving no to minimal residual TR following intervention. Earlier implementation of transcatheter valve repair to minimize TR progression and further development of transcatheter valve replacement strategies are also next steps in the translation of this technology.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 30 Nov 2019; epub ahead of print
Williams AM, Brescia AA, Watt TMF, Romano MA, Bolling SF
Prog Cardiovasc Dis: 30 Nov 2019; epub ahead of print | PMID: 31801700
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Abstract

Physical activity trends and metabolic health outcomes in people living with HIV in the US, 2008-2015.

Willig AL, Webel AR, Westfall AO, Levitan EB, ... Bamman MM, Overton ET

Despite its potential to improve metabolic health outcomes, longitudinal physical activity (PA) patterns and their association with cardiometabolic disease among people living with HIV (PLWH) have not been well characterized. We investigated this relationship among PLWH in the Centers for AIDS Research Network of Integrated Clinical Systems with at least one PA self-report between 2008 and 2015. The 4-item Lipid Research Clinics PA instrument was used to categorize habitual PA levels as: Very Low, Low, Moderate, or High. We analyzed demographic differences in PA patterns. Multivariable generalized estimating equation regression models were fit to assess longitudinal associations of PA with blood pressure, lipid, and glucose levels. Logistic regression modeling was used to assess the odds of being diagnosed with obesity, cardiovascular disease (CVD), cerebrovascular disease, hypertension, diabetes, or multimorbidity. A total of 40,462 unique PA assessments were provided by 11,719 participants. Only 13% of PLWH reported High PA, while 68% reported Very Low/Low PA at baseline and did not increase PA levels during the study period. Compared to those reporting High PA, participants with Very Low PA had almost 2-fold increased risk for CVD. Very Low PA was also associated with several risk factors associated with CVD, most notably elevated triglycerides (odds ratio 25.4), obesity (odds ratio 1.9), hypertension (odds ratio 1.4), and diabetes (odds ratio 2.3; all p < 0.01). Low levels of PA over time among PLWH are associated with increased cardiometabolic disease risk.

Copyright © 2020. Published by Elsevier Inc.

Prog Cardiovasc Dis: 10 Feb 2020; epub ahead of print
Willig AL, Webel AR, Westfall AO, Levitan EB, ... Bamman MM, Overton ET
Prog Cardiovasc Dis: 10 Feb 2020; epub ahead of print | PMID: 32059838
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Abstract

Prevention of cardiovascular disease for historically marginalized racial and ethnic groups living with HIV: A narrative review of the literature.

Muiruri C, Longenecker CT, Meissner EG, Okeke NL, ... Velazquez E, Bloomfield GS

Despite developments to improve health in the United States, racial and ethnic disparities persist. These disparities have profound impact on the wellbeing of historically marginalized racial and ethnic groups. This narrative review explores disparities by race in people living with cardiovascular disease (CVD) and the Human Immunodeficiency Virus (HIV). We discuss selected common social determinants of health for both of these conditions which include; regional historical policies, incarceration, and neighborhood effects. Data on racial disparities for persons living with comorbid HIV and CVD are lacking. We found few published articles (n = 7) describing racial disparities for persons living with both comorbid HIV and CVD. Efforts to reduce CVD morbidity in historically marginalized racial and ethnic groups with HIV must address participation in clinical research, social determinants of health and translation of research into clinical practice.

Copyright © 2020. Published by Elsevier Inc.

Prog Cardiovasc Dis: 10 Feb 2020; epub ahead of print
Muiruri C, Longenecker CT, Meissner EG, Okeke NL, ... Velazquez E, Bloomfield GS
Prog Cardiovasc Dis: 10 Feb 2020; epub ahead of print | PMID: 32057785
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Abstract

Update on hypertension in African-Americans.

Gonzalez CM, Ferdinand KC

Uncontrolled hypertension (HTN) in the U.S. is particularly prevalent and devastating among black individuals, who disproportionately suffer the consequences of this condition to a greater extent compared with persons in other racial/ethnic groups. Furthermore, African Americans are often underrepresented in cardiovascular clinical trials, limiting the ability to reliably apply the results from many outcome studies in this specific population. In this review, we summarize and analyze the currently available evidence, specifically related to the risk factors, manifestations, complications and management of HTN in this often difficult-to-treat population. The aim of the review is to improve understanding of the underlying pathophysiologic mechanisms and identify the optimal approach to deliver the best care for African American patients.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 07 Dec 2019; epub ahead of print
Gonzalez CM, Ferdinand KC
Prog Cardiovasc Dis: 07 Dec 2019; epub ahead of print | PMID: 31825799
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Abstract

Current outcomes of tricuspid valve surgery.

Hamandi M, George TJ, Smith RL, Mack MJ

Surgical treatment of isolated and concomitant tricuspid disease remains underutilized. The gap between guidelines and clinical practice is reflective in large measure of the historically poor outcomes of tricuspid valve surgery. We reviewed our current surgical outcomes of tricuspid regurgitation to determine whether surgical outcomes have improved in the modern era.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 01 Dec 2019; epub ahead of print
Hamandi M, George TJ, Smith RL, Mack MJ
Prog Cardiovasc Dis: 01 Dec 2019; epub ahead of print | PMID: 31805294
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Abstract

Renal denervation: Alternative treatment options for hypertension?

Gupta A, Prince M, Bob-Manuel T, Jenkins JS

Hypertension affects millions of Americans and has adverse long-term consequences increasing morbidity and mortality. Resistant hypertension (RH) continues to be difficult to treat with medications alone which may be associated with significant side effects. Alternate therapies have been evaluated for treating RH and renal denervation has been investigated extensively. We review the data from renal denervation trials and other novel technologies which are not FDA approved to date.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 25 Dec 2019; epub ahead of print
Gupta A, Prince M, Bob-Manuel T, Jenkins JS
Prog Cardiovasc Dis: 25 Dec 2019; epub ahead of print | PMID: 31884099
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Abstract

Risk stratification for surgery in tricuspid regurgitation.

Rotar E, Lim DS, Ailawadi G

Tricuspid valve (TV) surgery carries high mortality and morbidity, and risk-adjusted mortality has not changed. Patients who can withstand the perioperative period benefit from symptomatic improvement as the right ventricle remodels. Risk stratification for patients undergoing surgical intervention is critically important. The Model for End-Stage Liver Disease (MELD) score is a reliable and accurate mortality risk predictor given the liver and kidney dysfunction that accompany tricuspid regurgitation. Novel clinical risk calculators for isolated TV surgery have also been developed to further guide patients with projected surgical outcomes and reinforce timeliness to intervention.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 04 Dec 2019; epub ahead of print
Rotar E, Lim DS, Ailawadi G
Prog Cardiovasc Dis: 04 Dec 2019; epub ahead of print | PMID: 31812512
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Abstract

Non-arrhythmic causes of sudden death: A comprehensive review.

Bob-Manuel T, Jenkins JS, Morin DP

Sudden cardiac death (SCD) is a major public health issue in the United States and worldwide. It is estimated to affect between 1 and 1.5 million patients worldwide annually, with the global burden expected to rise due to the concomitant rise in coronary artery disease in the developing world. Although arrhythmic causes of SCD such as ventricular tachycardia and ventricular fibrillation are common and well-studied, non-arrhythmic causes are also important, with diverse etiologies from ischemia-related structural heart disease to non-ischemic heart diseases, non-atherosclerotic coronary pathologies, and inflammatory states. Recent research has also found that risk factors and/or demographics predispose certain individuals to a higher risk of non-arrhythmia-related SCD. This review discusses the epidemiology, mechanisms, etiologies, and management of non-arrhythmic SCD.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:265-271
Bob-Manuel T, Jenkins JS, Morin DP
Prog Cardiovasc Dis: 30 Dec 1999; 62:265-271 | PMID: 31075277
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Abstract

Impact of therapeutic lifestyle changes in resistant hypertension.

Ozemek C, Tiwari SC, Sabbahi A, Carbone S, Lavie CJ

Hypertensive individuals are at an increased risk of developing heart disease and stroke. Adopting healthy lifestyles, such as being active on ≥4 days per week, weight-loss in the presence of obesity, consuming a diet rich in fruits and vegetables, and sodium below the recommended threshold, avoiding high alcohol consumption and refraining from smoking have been effective lifestyle therapies to prevent or control stage 1 hypertension (HTN). Among the 1 in 3 Americans who have HTN (systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 80 mmHg), 16% are diagnosed with resistant HTN (RHT). Although there are comparatively fewer studies examining the blood pressure lowering effects of therapeutic lifestyle interventions in patients with resistant HTN, the available literature appears promising. This paper reviews key studies that quantify the blood pressure lowering effects of certain therapeutic lifestyles in patients with RHT and highlights areas needing more attention.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 18 Nov 2019; epub ahead of print
Ozemek C, Tiwari SC, Sabbahi A, Carbone S, Lavie CJ
Prog Cardiovasc Dis: 18 Nov 2019; epub ahead of print | PMID: 31756356
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Abstract

Renal revascularization in resistant hypertension.

Prince M, Gupta A, Bob-Manuel T, Tafur J

Renal artery stenosis (RAS) is a common cause of secondary hypertension (HTN) and may lead to resistant (refractory) HTN despite guideline directed medical therapy. Although randomized controlled trials comparing medical therapy to medical therapy and renal artery stenting have shown no benefit with renal artery stenting, according to comparative effectiveness reviews by the Agency for Healthcare Research and Quality, the trials did not enroll patients with the most severe RAS who would be more likely to benefit from renal stenting. Because of limitations of conventional angiography, it is important to assess the hemodynamic severity of moderate (50%-70%) RAS lesions with a hemodynamic measurement. We review techniques to optimize patient selection, to minimize procedural complications, and to facilitate durable patency of renal stenting. We also review the current ACC/AHA Guidelines and SCAI Appropriate Use Criteria as they relate to renal stenting.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 06 Dec 2019; epub ahead of print
Prince M, Gupta A, Bob-Manuel T, Tafur J
Prog Cardiovasc Dis: 06 Dec 2019; epub ahead of print | PMID: 31821813
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Abstract

Exercise Reveals Proline Dehydrogenase as a Potential Target in Heart Failure.

Moreira JBN, Wohlwend M, Fenk S, Åmellem I, ... Bjørkøy G, Wisløff U

The benefits of physical activity in cardiovascular diseases have long been appreciated. However, the molecular mechanisms that trigger and sustain the cardiac benefits of exercise are poorly understood, and it is anticipated that unveiling these mechanisms will identify novel therapeutic targets. In search of these mechanisms we took advantage of unbiased RNA-sequencing (RNA-seq) technology to discover cardiac gene targets whose expression is disrupted in heart failure (HF) and rescued by exercise in a rat model. Upon exhaustive validation in a separate rat cohort (qPCR) and human datasets, we shortlisted 16 targets for a cell-based screening, aiming to evaluate whether targeted disruption of these genes with silencing RNA would affect the abundance of a CVD biomarker (BNP, B-type natriuretic peptide) in human cardiomyocytes. Overall, these experiments showed that Proline Dehydrogenase (PRODH) expression is reduced in human failing hearts, rescued by exercise in a rat model of HF, and its targeted knockdown increases BNP expression in human cardiomyocytes. On the other hand, overexpression of PRODH increases the abundance of metabolism-related gene transcripts, and PRODH appears to be crucial to sustain normal mitochondrial function and maintenance of ATP levels in human cardiomyocytes in a hypoxic environment, as well as for redox homeostasis in both normoxic and hypoxic conditions. Altogether our findings show that PRODH is a novel molecular target of exercise in failing hearts and highlight its role in cardiomyocyte physiology, thereby proposing PRODH as a potential experimental target for gene therapy in HF.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:193-202
Moreira JBN, Wohlwend M, Fenk S, Åmellem I, ... Bjørkøy G, Wisløff U
Prog Cardiovasc Dis: 30 Dec 1999; 62:193-202 | PMID: 30867130
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Abstract

Prevention of cardiovascular disease among people living with HIV in sub-Saharan Africa.

Okello S, Amir A, Bloomfield GS, Kentoffio K, ... Peck R, Siedner MJ

As longevity has increased for people living with HIV (PLWH) in the United States and Europe, there has been a concomitant increase in the prevalence of cardiovascular disease (CVD) risk factors and morbidity in this population. Whereas the availability of HIV antiretroviral therapy has resulted in dramatic increases in life expectancy in sub-Saharan Africa (SSA), where over two thirds of PLWH reside, if and how these trends impact the epidemiology of CVD is less clear. In this review, we describe the current state of the science on how both HIV and its treatment impact CVD risk factors and outcomes among PLWH in sub-Saharan Africa, including regional factors (unique to SSA) likely to differentiate these relationships from the global North. We then outline how current regional guidelines address CVD prevention among PLWH and which clinical and structural interventions are best poised to confront the co-epidemics of HIV and CVD in the region. We conclude with a discussion of key research gaps that need to be addressed to optimally develop an actionable public health response.

Copyright © 2020. Published by Elsevier Inc.

Prog Cardiovasc Dis: 04 Feb 2020; epub ahead of print
Okello S, Amir A, Bloomfield GS, Kentoffio K, ... Peck R, Siedner MJ
Prog Cardiovasc Dis: 04 Feb 2020; epub ahead of print | PMID: 32035126
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Abstract

Essential roles for CT and MRI in timing of therapy in tricuspid regurgitation.

Hashimoto G, Fukui M, Sorajja P, Cavalcante JL

The rapid development of transcatheter tricuspid valve intervention (TTVI) therapies has quickly provided the opportunity to improve patient selection and procedural planning for patients with significant tricuspid regurgitation (TR) considered at high surgical risk. This review focuses on the contributions which both computed tomography angiography and cardiac magnetic resonance can provide in the better understanding of the natural history of TR, in the comprehensive anatomical and functional assessment of right heart involvement and in the timing and planning for TTVI. We also discuss areas of potential importance such as the quantification of response to TTVI, which will be informative for future trials.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 01 Dec 2019; epub ahead of print
Hashimoto G, Fukui M, Sorajja P, Cavalcante JL
Prog Cardiovasc Dis: 01 Dec 2019; epub ahead of print | PMID: 31801699
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Abstract

Targeted temperature management for cardiac arrest.

Mody P, Kulkarni N, Khera R, Link MS

Therapeutic hypothermia, or targeted temperature management (TTM), is a strategy of reducing the core body temperature of survivors of sudden cardiac arrest (SCA) to minimize neurological damage caused by severe hypoxia. Initial clinical trials examining this technique demonstrated significant improvement in neurological function among survivors of out-of-hospital SCA with an initial shockable rhythm. Since then, TTM has become an integral part of the care provided to comatose survivors of SCA. However, multiple questions persist regarding the target cooling temperature, duration of cooling, and utility of TTM in patient populations such as survivors of out-of-hospital SCA with non-shockable rhythms or in-hospital SCA. This review article summarizes the current evidence regarding optimal application of TTM and compares the recommendations for TTM in current guidelines.

Published by Elsevier Inc.

Prog Cardiovasc Dis: 30 Dec 1999; 62:272-278
Mody P, Kulkarni N, Khera R, Link MS
Prog Cardiovasc Dis: 30 Dec 1999; 62:272-278 | PMID: 31078561
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Abstract

Improving reference equations for cardiorespiratory fitness using multiplicative allometric rather than additive linear models: Data from the Fitness Registry and the Importance of Exercise National Database Registry.

Nevill AM, Myers J, Kaminsky LA, Arena R

New improved reference equations for cardiorespiratory fitness have recently been published, using Data from the Fitness Registry and the Importance of Exercise National Database (FRIEND Registry). The new linear equation for VO (ml.kg.min) was additive, derived using multiple-linear regression. An alternative multiplicative allometric model has also been published recently, thought to improve further the quality of fit. The purpose of the current study was to compare the accuracy and quality/goodness-of-fit of the linear, additive model with the multiplicative allometric model using the FRIEND database. The results identified that the allometric model out performs the linear model based on all model-comparison criteria. The allometric model demonstrates; 1) greater explained variance (R = 0.645; R = 0.803) vs. (R = 0.62; R = 0.79), 2) residuals that were more normally distributed, 3) residuals that yielded less evidence of curvature, 4) superior goodness-of-fit statistics i.e., greater maximum log-likelihood (MLL) and smaller Akaike Information Criterion (AIC) statistics, 5) less systematic bias together with smaller unexplained standard error of estimates. The Bland and Altman plots also confirmed little or no evidence of curvature with the allometric model, but systematic curvature (lack-of-fit) in the linear model. The multiplicative allometric model to predict VO was; VO (ml.kg.min) = M · H · exp. (0.424-0.346 · (sex) -0.011.age), where M = body mass and H = height (R = 0.645; R = 0.803) and sex is entered as a [0,1] indicator variable (male = 0 and female = 1). Another new insight obtained from the allometric model (providing construct validity) is that the height-to-body-mass ratio is similar to inverse body mass index or the lean body mass index, both associated with leanness when predicting VO. In conclusion adopting allometric models will provide more accurate predictions of VO (ml.kg.min) using more plausible, biologically sound and interpretable models.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 20 Nov 2019; epub ahead of print
Nevill AM, Myers J, Kaminsky LA, Arena R
Prog Cardiovasc Dis: 20 Nov 2019; epub ahead of print | PMID: 31759954
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Abstract

Systemic hemodynamic atherothrombotic syndrome (SHATS) - Coupling vascular disease and blood pressure variability: Proposed concept from pulse of Asia.

Kario K, Chirinos JA, Townsend RR, Weber MA, ... Park JB, Wang JG

Hypertension (HTN) is an important risk factor for cardiovascular disease (CVD) but the association between HTN and CVD cannot be explained by average blood pressure (BP) alone. BP variability (BPV) is another important factor, along with the effects of HTN on the vasculature. The concept of systemic hemodynamic atherothrombotic syndrome (SHATS) has been proposed, describing an age-related and synergistic vicious cycle of hemodynamic stress and vascular disease. The importance of SHATS is based on the assumption that the assessment of BPV and arterial disease is likely to provide an effective opportunity to intervene early to reduce progression to HTN in younger patients or to CVD events and organ damage in older patients. In addition to providing an overview of current evidence for the mechanisms and clinical data related to SHATS, this article proposes a new SHATS score for use to diagnose and assess the severity of SHATS. The score includes two components - a BP score and a vascular score - which are multiplied to generate the SHATS score. This reflects the synergistic, rather than additive, effects of BP and vascular disease on target organ damage and CVD events. Although it requires refinement and validation in future studies, early detection of SHATS using tools such as the proposed score, combined with population-based stratification and technology-based anticipation medicine incorporating real-time individual data, has the potential to contribute to meaningful reductions in rates of CVD events and target organ damage.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 02 Dec 2019; epub ahead of print
Kario K, Chirinos JA, Townsend RR, Weber MA, ... Park JB, Wang JG
Prog Cardiovasc Dis: 02 Dec 2019; epub ahead of print | PMID: 31810526
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Abstract

Resistant hypertension-defining the scope of the problem.

Chia R, Pandey A, Vongpatanasin W

The updated scientific statement by the American Heart Association has defined resistant hypertension (HTN;RH) as uncontrolled blood pressure (BP) ≥ 130/80 mmHg, despite concurrent use of 3 anti-HTN drug classes comprising a calcium channel blocker, a blocker of renin-angiotensin system, and a thiazide diuretic, preferably chlorthalidone. Using the updated BP criteria, the prevalence of RH in the United States is found to be modestly increased by approximately 3-4% among treated population. Meta-analysis of observational studies have demonstrated that pseudo-RH from white coat HTN or medication nonadherence is as much common as the truly RH. Thus, screening for pseudo-resistance in the evaluation of all apparent RH is of utmost importance as diagnosis of white-coat HTN requires no treatment, while medication nonadherence would benefit from identifying and targeting barriers to adherence.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 17 Dec 2019; epub ahead of print
Chia R, Pandey A, Vongpatanasin W
Prog Cardiovasc Dis: 17 Dec 2019; epub ahead of print | PMID: 31863785
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Abstract

Can cardiac resynchronization therapy be used as a tool to reduce sudden cardiac arrest risk?

Galand V, Singh JP, Heist EK

Patients with cardiomyopathy and reduced left ventricular (LV) ejection fraction are at risk of heart failure (HF) symptoms and sudden cardiac arrest (SCA). In selected HF patients, cardiac resynchronization therapy (CRT) provides LV reverse remodeling and improves the cellular and molecular function. However controversial results have been published regarding the effect of CRT on the residual ventricular arrhythmia risk. Indeed, the decrease in SCA risk is inconsistent and some factors strongly influence the residual post implantation arrhythmic risk. Conversely, proarrhythmic effect of CRT has been previously described. In this review we aim to describe the relationship between CRT implantation and the SCA risk decrease and discuss the patients who only require cardiac resynchronization therapy-pacemaker and those who need a concomitant implantable cardioverter defibrillator.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 30 Dec 1999; 62:242-248
Galand V, Singh JP, Heist EK
Prog Cardiovasc Dis: 30 Dec 1999; 62:242-248 | PMID: 31004607
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Abstract

Cardiovascular outcome trials of the newer anti-diabetic medications.

Acharya T, Deedwania P

Concerns of elevated cardiovascular disease (CVD) risk with some anti-diabetic medications warranted phase 4 clinical trials to demonstrate CVD safety of newly marketed anti-diabetic drugs. Although initially designed to evaluate safety, some of these CVD outcome trials (CVOTs) have in fact shown CVD benefits. New medication classes, like glucagon-like peptide 1 (GLP-1) analogues and sodium-glucose co-transporter 2 (SGLT2) inhibitors, have shown reductions in the risk of major adverse cardiovascular events (MACE) including, myocardial infarction, stroke, CV death, and heart failure (HF). Perhaps more importantly, SGLT2 inhibitors demonstrated reduction in the risk of HF hospitalizations, being the first class of anti-diabetic drugs to do so. Conversely, dipeptidyl peptidase 4 (DPP-4) inhibitors did not significantly affect atherosclerotic CVD end-points and some actually increased the risk of HF hospitalizations. Further, the adverse/beneficial CVD effects of these medications may not be class specific. This review focuses on the main results of these CVOTs while highlighting the heterogeneity of CVD end-points within each class and discusses important mechanistic insights and adverse effect profiles.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:342-348
Acharya T, Deedwania P
Prog Cardiovasc Dis: 30 Dec 1999; 62:342-348 | PMID: 31442511
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Abstract

The elephant in the room: Why cardiologists should stop ignoring type 2 diabetes.

O\'Keefe JH, Nassif ME, Magwire ML, O\'Keefe EL, Lavie CJ

Type 2 Diabetes (T2D) is a growing public health threat that is evolving into a global pandemic with debilitating, expensive and often lethal complications. Even when hemoglobin A1c (HbA1C) levels are well controlled, and concomitant cardiovascular (CV) risk factors are effectively treated, two out of every three patients with T2D are destined to die from CV complications. Several large randomized controlled trials (RCT) indicate that two classes of glucose-lowering medications, oral sodium-glucose cotransporter type 2 inhibitors (SGLT2-i) and injectable glucagon-like peptide-1 receptor agonists (GLP-1RA), confer significant CV benefits, including reductions in: hospitalizations for heart failure (HF), progression of diabetic kidney disease, atherosclerotic CV events, and (with some agents) CV death. These CV benefits appear to be independent of the glucose-lowering effects of these agents. These compelling findings are triggering a fundamental paradigm shift in T2D management whereby the focus is no longer on HbA1c alone, but instead on implementing a comprehensive CV risk reduction strategy prioritizing the use of these evidence-based therapies (along with other evidence-based treatment strategies) with the objective of reducing the risk of morbid complications, and improving the quantity and quality of life of patients with T2D. Cardiologists are uniquely positioned to become more involved in the management of T2D and established CV disease, which at this time should include initiation (either by prescribing or by making recommendations) of agents proven to reduce CV risk. Specifically, SGLT2-is and/or GLP-1RA have now been shown to have a favorable risk-benefit balance, and are being increasingly emphasized by the practice guidelines as preferable treatment options in vulnerable patients with T2D. The cardiology community should collaborate with other care providers to ensure that when and where appropriate these new T2D therapies are used along with other evidence-based therapies to improve patient outcomes.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 30 Dec 1999; 62:364-369
O'Keefe JH, Nassif ME, Magwire ML, O'Keefe EL, Lavie CJ
Prog Cardiovasc Dis: 30 Dec 1999; 62:364-369 | PMID: 31408637
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Abstract

Is sauna bathing protective of sudden cardiac death? A review of the evidence.

Laukkanen JA, Kunutsor SK

Sudden cardiac death (SCD) is a global public health burden accounting for 15-20% of all deaths. Though established atherosclerotic risk factors explain a large proportion of the risk of SCD, these factors are often absent in a large proportion of SCD victims and the pathogenesis of SCD is still not fully established. It therefore appears that additional factors may be involved. Sauna bathing is a traditional Finnish activity that is mainly used for the purposes of relaxation and pleasure. Beyond its use for these purposes, sauna bathing has been linked with several health benefits. Emerging evidence suggests that sauna bathing is associated with reduced risk of adverse cardiovascular (CV) disease (CVD) and non-CVD outcomes as well as mortality. A number of reports have linked sauna bathing with reduced or increased risk of SCD, but the evidence is uncertain. This review summarizes available studies linking sauna bathing with SCD, the postulated mechanistic pathways underlying these associations, outlines areas of outstanding uncertainty, and the implications for prevention. We employed a comprehensive search for observational studies, randomized controlled trials (RCTs), and non-RCTs from MEDLINE and Embase since their inception until March 2019. Observational data suggest that regular sauna bathing is associated with a substantial risk reduction in SCD. Furthermore, the data suggest that a combination of regular physical activity and sauna baths confers substantial risk reduction for SCD compared with either modality alone. Few reports have linked sauna baths with SCDs, but these single case incidents have been attributed to the effects of dehydration, hypotension, and cardiac arrhythmias due to a combination of sauna exposure and alcohol consumption. Sauna bathing is generally safe for most healthy people and even among patients with stable CVD, if used sensibly and with caution. Plausible pathways underlying the protective effect of sauna bathing on SCD may be linked to the impact on CV function via reduced arterial stiffness, decreases in inflammation and oxidative stress, stabilization of the autonomic nervous system, beneficial changes in circulating lipid profiles and other CVD risk markers, and lowering of systemic blood pressure. Sauna is a potential novel tool to promote SCD prevention in addition to other known means, being an enjoyable way to take care of general health and well-being.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:288-293
Laukkanen JA, Kunutsor SK
Prog Cardiovasc Dis: 30 Dec 1999; 62:288-293 | PMID: 31102597
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Abstract

Sudden death related cardiomyopathies - Hypertrophic cardiomyopathy.

Goff ZD, Calkins H

Hypertrophic cardiomyopathy (HCM) is a form of inherited cardiomyopathy. Most individuals with HCM experience minimal symptoms throughout their lifetime. However, those with HCM are at risk of ventricular arrhythmias and sudden cardiac death (SCD), the most feared complication of HCM. Implantable cardioverter defibrillator (ICD) implantation has played a large role in transforming this disease from one with an ominous prognosis to one with mortality rates that are on par with the general public. Since the early 2000s, balance between SCD prevention and unnecessary ICD placement has been sought, this is reflected in the evolution of SCD risk stratification models for patients with HCM. This review discusses key concepts pertaining to HCM, with emphasis on prevention of SCD, and summarizes and compares the recommendations for ICD implantation in current guidelines.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:212-216
Goff ZD, Calkins H
Prog Cardiovasc Dis: 30 Dec 1999; 62:212-216 | PMID: 31004609
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Abstract

The Contribution of Psychosocial Interventions to Precision Medicine for Heart Health.

Flynn M, Moran C, Rash JA, Campbell TS

This paper reviews the value of incorporating psychosocial interventions into precision medicine for heart health. First, we review the empirical literature on prevalence of common mental health comorbidities among individuals with cardiovascular disease (CVD). We then review transdiagnostic approaches for conceptualization and treatment of mental health in individuals with CVD. We highlight recent studies that have used novel methods to individualize psychosocial interventions. Finally, we propose a preliminary framework intended to support Health Care Providers in individualizing treatment, which includes: 1) assessment of patient risk factors, characteristics, and expectations; 2) consideration of transdiagnostic processes underlying several psychiatric symptoms that contribute to CVD risk; 3) patient engagement in shared decision-making for psychosocial treatment; and 4) ongoing outcome monitoring to evaluate treatment responsiveness. We anticipate that the proposed framework will evolve with the emergence of new empirical evidence; as such, future directions and challenges for research are discussed.

Copyright © 2018 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:21-28
Flynn M, Moran C, Rash JA, Campbell TS
Prog Cardiovasc Dis: 30 Dec 1999; 62:21-28 | PMID: 30576681
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Abstract

An update on pharmacotherapies in diabetic dyslipidemia.

Gupta M, Tummala R, Ghosh RK, Blumenthal C, ... Ventura H, Deedwania P

Hyperlipidemia plays a crucial role in the underlying pathogenesis of multiple cardiovascular diseases (CVD), including coronary artery disease, peripheral arterial disease, carotid stenosis, and heart failure. The risk of developing such diseases in the diabetic population is relatively high. Diabetes mellitus (DM) is an independent risk factor for premature atherosclerosis. The hallmark of DM dyslipidemia is a demonstrably high level of atherogenic triglyceride rich lipids including very low-density lipoprotein, chylomicrons, and small dense low-density lipoprotein (LDL). Moderate to high intensity statins, targeting LDL cholesterol reduction, remain the cornerstone in the management of this unique disorder. Many \'non-statin\' drugs have recently been studied in the DM patients who were either on a \'maximally tolerated statin\' or \'statin intolerant\'. Ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are particularly important and were incorporated in the recent guidelines by the European Society of Cardiology, American College of Cardiology, American Heart Association, and American Diabetes Association. Icosapent Ethyl has garnered huge interest this year following publication of the REDUCE-IT trial. There are several newer hypolipidemic drugs, including Bempedoic acid, Inclisiran and RVX-208, that are in different phases of clinical trials. In this article, we review the underlying pathophysiology of DM dyslipidemia, existing guidelines related to its management, and the potential of newer hypolipidemic and anti-inflammatory drugs being incorporated in the management of DM.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:334-341
Gupta M, Tummala R, Ghosh RK, Blumenthal C, ... Ventura H, Deedwania P
Prog Cardiovasc Dis: 30 Dec 1999; 62:334-341 | PMID: 31442512
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Abstract

Active 10 - A new approach to increase physical activity in inactive people in England.

Brannan MGT, Foster CE, Timpson CM, Clarke N, ... Amlani A, Murphy MH

Public health physical activity (PA) guidelines are failing to increase levels of population PA, requiring a new approach. A national integrated marketing campaign was developed based on published literature and ethnographic research to get inactive lower socioeconomic 40-60 year olds to walk briskly for bouts of 10 or more minutes per day and move towards recommended levels of PA. National and local communications campaigns and partnerships promoted key messages and directed people to a free mobile phone app that provided the user with time, intensity and periodicity of walking, and included goal setting and encouragement to support behaviour change. Campaigns in the summers of 2017 and 2018 achieved around 500,000 downloads of the mobile phone app, with evaluation suggesting increases in brand and app awareness, and those taking action. Active 10 is a promising example of a physical activity promotion campaign based on evidence-based messages tailored for a target audience to change social norms rather than guidelines, an approach recognised as an effective population intervention for increasing walking.

Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:135-139
Brannan MGT, Foster CE, Timpson CM, Clarke N, ... Amlani A, Murphy MH
Prog Cardiovasc Dis: 30 Dec 1999; 62:135-139 | PMID: 30796943
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Impact:
Abstract

The NEW-HOPE study and emerging therapies for difficult-to-control and resistant hypertension.

Ferdinand KC, Harrison D, Johnson A

Despite the availability of numerous approved antihypertensive drugs, difficult-to-control and resistant hypertension are persistent and are major risk factors for cardiovascular disease. Emerging and investigational treatments that are currently being explored to target hypertension include firibrastat, empagliflozin and interventional procedures, including improved approaches to renal artery denervation and a novel baroreceptor device implantation. Firibrastat is an investigational drug that specifically and selectively inhibits aminopeptidase A leading to decreased formation of angiotensin III in the brain, resulting in decreased blood pressure. Sodium-glucose cotransporter-2 inhibitors, such as empagliflozin used to treat type 2 diabetes, may be beneficial as antihypertensive agents. Empagliflozin in a recent study demonstrated significant reductions in high blood pressure in an African American population. Advances in renal artery denervation and an investigational baroreceptor device implantation also show promise as potential interventions in patients with difficult-to-control and resistant hypertension.

Copyright © 2020. Published by Elsevier Inc.

Prog Cardiovasc Dis: 06 Jan 2020; epub ahead of print
Ferdinand KC, Harrison D, Johnson A
Prog Cardiovasc Dis: 06 Jan 2020; epub ahead of print | PMID: 31923435
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Impact:
Abstract

Prevention of stroke in people living with HIV.

Nguyen I, Kim AS, Chow FC

In the era of effective antiretroviral therapy (ART), HIV has become a manageable disease marked by an elevated risk of non-AIDS-related comorbidities, including stroke. Rates of stroke are higher in people living with HIV (PLWH) compared with the general population. Elevated stroke risk may be attributable to traditional risk factors, HIV-associated chronic inflammation and immune dysregulation, and possible adverse effects of long-standing ART use. Tailoring stroke prevention strategies for PLWH requires knowledge of how stroke pathogenesis may differ from non-HIV-associated stroke, knowledge of long-term stroke outcomes in HIV, and accurate stroke risk assessment tools. As a result, the approach to primary and secondary stroke prevention in PLWH relies heavily on guidelines developed for the general population, with an emphasis on optimization of traditional vascular risk factors and early initiation of ART. This review summarizes existing evidence on HIV-associated stroke mechanisms and considerations for stroke prevention for PLWH.

Copyright © 2020. Published by Elsevier Inc.

Prog Cardiovasc Dis: 30 Jan 2020; epub ahead of print
Nguyen I, Kim AS, Chow FC
Prog Cardiovasc Dis: 30 Jan 2020; epub ahead of print | PMID: 32014514
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Impact:
Abstract

The wearable cardioverter-defibrillator vest: Indications and ongoing questions.

Sandhu U, Rajyaguru C, Cheung CC, Morin DP, Lee BK

Multiple clinical trials have demonstrated the efficacy of implantable cardioverter-defibrillators (ICDs) for the prevention of sudden cardiac death (SCD) among specific high-risk populations. However, it remains unclear how to optimally treat those patients who are at elevated risk of cardiac arrest but are not among the presently identified groups proven to benefit from an ICD, are unable to tolerate surgical device implantation, or refuse invasive therapies. The wearable cardioverter-defibrillator (WCD) is an alternative antiarrhythmic device that provides continuous cardiac monitoring and defibrillation capabilities through a noninvasive, electrode-based system. The WCD has been shown to be highly effective at restoration of sinus rhythm in patients with a ventricular tachyarrhythmia, and one randomized trial using the WCD in patients with recent myocardial infarction at elevated risk for arrhythmic death reported a decrease in overall mortality despite no SCD mortality benefit. The current clinical indications for WCD use are varied and continue to evolve as experience with this technology increases.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:256-264
Sandhu U, Rajyaguru C, Cheung CC, Morin DP, Lee BK
Prog Cardiovasc Dis: 30 Dec 1999; 62:256-264 | PMID: 31077726
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Abstract

Sudden cardiac death in nonischemic cardiomyopathy.

Kadakia RS, Link MS, Dominic P, Morin DP

Sudden cardiac death (SCD) is a major cause of mortality in patients with nonischemic cardiomyopathy (NICM). Identifying patients who are at highest risk for SCD is an ongoing challenge. At present, guidelines recommend the use of an implantable cardioverter-defibrillator (ICD) in patients with NICM with a reduced left ventricular ejection fraction (LVEF) and heart failure (HF) symptoms. Some recent data, however, suggest that ICDs may not increase longevity in this population. Conversely, community-based studies have demonstrated that many at-risk individuals who may benefit from ICD therapy remain unprotected. Current recommendations for ICD implantation are continually debated, justifying comprehensive individualized risk assessment. Various promising techniques for further risk stratification are under evaluation, including cardiac magnetic resonance imaging, electrocardiographic assessment of electrical instability, and genetic testing. However, none of these strategies has been fully adapted into guidelines. Hence, clinical risk stratification practice today depends on LVEF and HF symptoms, which have poor sensitivity and specificity for predicting SCD risk.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:235-241
Kadakia RS, Link MS, Dominic P, Morin DP
Prog Cardiovasc Dis: 30 Dec 1999; 62:235-241 | PMID: 31075279
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Impact:
Abstract

Sudden death related cardiomyopathies - Arrhythmogenic right ventricular cardiomyopathy, arrhythmogenic cardiomyopathy, and exercise-induced cardiomyopathy.

Goff ZD, Calkins H

Sudden cardiac death (SCD) is a devastating possible outcome of all cardiomyopathies. The risk of SCD is increased in patients with structural heart disease and continues to increase as ventricular dysfunction worsens. There is, however, a subset of cardiomyopathy, so-called \"arrhythmogenic cardiomyopathy\" (ACM), that carries an inherent propensity for arrhythmia in all stages of the disease, even preceding ventricular dysfunction. The aim of this review is to identify cardiomyopathies, other than ischemic and dilated cardiomyopathies, that are associated with ventricular arrhythmias (VAs) and SCD. We discuss prevalence, diagnosis, natural history and management of arrhythmogenic right ventricular dysplasia/cardiomyopathy, ACM, and exercise-induced cardiomyopathy, with emphasis on the morbidity and mortality of VAs associated with these cardiomyopathies and how they can be mitigated through lifestyle modification, medical management, and implantation of cardioverter defibrillators.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:217-226
Goff ZD, Calkins H
Prog Cardiovasc Dis: 30 Dec 1999; 62:217-226 | PMID: 31004608
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Abstract

Global physical activity levels - Need for intervention.

Ozemek C, Lavie CJ, Rognmo Ø

Substantial evidence shows that physical inactivity (PI) and sedentary behavior (SB) increases the risk of many chronic diseases and shortens life expectancy. We describe evidence that certain domains of physical activity (PA) in the United States (US) population have declined substantially over 5 decades. The prevalence of PI is very high worldwide, which has contributed to 6%-10% of the burden of many chronic diseases and premature mortality. Reduction or elimination of PI would likely produce substantial increases in life expectancy of the world\'s population. Great efforts are needed to reduce PI and SB and increase levels of PA in the US and worldwide.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:102-107
Ozemek C, Lavie CJ, Rognmo Ø
Prog Cardiovasc Dis: 30 Dec 1999; 62:102-107 | PMID: 30802461
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Abstract

Personal Activity Intelligence (PAI): A new standard in activity tracking for obtaining a healthy cardiorespiratory fitness level and low cardiovascular risk.

Nauman J, Nes BM, Zisko N, Revdal A, ... Kaminsky LA, Wisløff U

Despite all the evidence of health benefits related to physical activity (PA) and cardiorespiratory fitness (CRF), low levels of PA have reached pandemic proportions, and inactivity is the fourth leading cause of death worldwide. Lack of time, and inability to self-manage are often cited as main barriers to getting adequate PA. Recently, a new personalized metric for PA tracking named Personal Activity Intelligence (PAI) was developed with the aim to make it easier to quantify how much PA per week is needed to reduce the risk of premature mortality from non-communicable diseases. PAI can be integrated in self-assessment heart rate devices and defines a weekly beneficial heart rate pattern during PA by considering the individual\'s sex, age, and resting and maximal heart rates. Among individuals ranging from the general population to subgroups of patients with cardiovascular disease (CVD), 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 death from CVD and all causes, regardless of whether or not the current PA recommendations were met. Importantly, a PAI score ≥100 at baseline, maintaining ≥100 PAIs and an increasing PAI score over time was associated with multiple years of life gained. Moreover, obtaining a weekly PAI ≥100 attenuated the deleterious association between CVD risk factor clustering and prolonged sitting time. PAI and objectively measured CRF (as indicated by VO) were positively associated in a graded fashion, and individuals with a PAI score between 100 and 150 had expected age and sex specific average VO values. A PAI score ≥100 was associated with higher VO in both men (4.1 mL·kg·min; 95% CI, 3.5 to 4.6) and women (2.9 mL·kg·min; 95% CI, 2.4 to 3.3), compared to the reference group of <100 PAI. The combined analysis of PAI, PA and VO demonstrated that a PAI score ≥100 was associated with high VO values regardless of meeting or not meeting the current PA recommendations. Collectively, these findings suggest that PAI has the potential to be a useful tool to motivate people to become and stay physically active by quantifying the amount of PA needed to produce significant health benefits.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:179-185
Nauman J, Nes BM, Zisko N, Revdal A, ... Kaminsky LA, Wisløff U
Prog Cardiovasc Dis: 30 Dec 1999; 62:179-185 | PMID: 30797801
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Abstract

Non-alcoholic fatty liver disease: Prevalence and all-cause mortality according to sedentary behaviour and cardiorespiratory fitness. The HUNT Study.

Croci I, Coombes JS, Bucher Sandbakk S, Keating SE, ... Macdonald GA, Wisloff U
Purpose
Sedentary behaviour (SB) and low physical activity (PA) are independently associated with non-alcoholic fatty liver disease (NAFLD). Compared to PA, high cardiorespiratory fitness (CRF) has been associated with a higher protection against all-cause mortality and a number of specific diseases. However, this relationship has not been investigated in NAFLD. This study examined the roles of SB and CRF on: i) the likelihood of having NAFLD in the general population, and ii) the risk of mortality over 9 years within individuals having NAFLD.
Methods
A cross-sectional analysis of 15,781 adults (52% female; age range 19-95 years) was conducted. Self-reported SB was divided into tertiles. CRF was estimated using validated non-exercise models, and the presence of NAFLD from the Fatty Liver Index. Adjusted Odds Ratios and 95% Confidence Intervals for NAFLD were estimated using logistic regression analyses. Hazard Ratios for all-cause mortality were estimated using Cox proportional hazard regression in individuals with NAFLD.
Results
For each additional 1 h/d of SB, the likelihood of having NAFLD was significantly increased by 4% (CI, 3-6%). In combined analyses, compared with the reference group [high CRF and low (≤4 h/d) SB], individuals with low CRF had a markedly higher likelihood of having NAFLD (OR, 16.9; CI 12.9-22.3), even if they had SB ≤ 4 h/d. High CRF attenuated the negative role of SB up to 7 h/d on NAFLD. Over 9.4 ± 1.3 years of follow-up, individuals with NAFLD and low CRF had the risk of mortality increased by 52% (CI, 10-106%) compared to those with high CRF, regardless of SB or meeting PA guidelines.
Conclusions
Low CRF increases the risk of premature death in individuals with NAFLD, and is strongly associated with higher likelihood of having NAFLD, outweighing the influence of SB.

Copyright © 2019. Published by Elsevier Inc.

Prog Cardiovasc Dis: 30 Dec 1999; 62:127-134
Croci I, Coombes JS, Bucher Sandbakk S, Keating SE, ... Macdonald GA, Wisloff U
Prog Cardiovasc Dis: 30 Dec 1999; 62:127-134 | PMID: 30796942
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Abstract

Guidelines for the delivery and monitoring of high intensity interval training in clinical populations.

Taylor JL, Holland DJ, Spathis JG, Beetham KS, ... Keating SE, Coombes JS

High intensity interval training (HIIT) is now recognized in international clinical-based exercise guidelines as an appropriate and beneficial adjunct to moderate intensity continuous training. HIIT involves alternating periods of high intensity aerobic exercise with light recovery exercise or no exercise, allowing for greater physiological stimulus and adaptation than moderate intensity continuous training (MICT) for cardiorespiratory fitness and other cardiometabolic processes. However, there is no universal criteria or framework for the prescription and monitoring of HIIT in clinical populations, and safety concerns remain a common barrier for implementing HIIT as standard care. Historically, exercise intensity has been prescribed using heart rate (HR) targets derived from either a predicted maximal HR (HR) or from an attempt to objectively measure HR. However, using this approach alone has a number of limitations. Here we provide guidelines to improve the delivery of HIIT in cardiometabolic populations using 1) a framework for HIIT prescription using a combination of objective and subjective measures of exercise intensity, and 2) clinical considerations for assessment and monitoring to maximize patient safety. The framework involves an individualized step-by-step process to calculate, validate, and calibrate HR target zones for HIIT training to allow for appropriate workload prescription and progression. We strongly recommend this framework be used in future clinical trials investigating HIIT.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:140-146
Taylor JL, Holland DJ, Spathis JG, Beetham KS, ... Keating SE, Coombes JS
Prog Cardiovasc Dis: 30 Dec 1999; 62:140-146 | PMID: 30685470
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Impact:
Abstract

Precision Medicine in Weight Loss and Healthy Living.

Severin R, Sabbahi A, Mahmoud AM, Arena R, Phillips SA

Obesity affects 600 million people globally and over one third of the American population. Along with associated comorbidities, including cardiovascular disease, stroke, diabetes, and cancer; the direct and indirect costs of managing obesity are 21% of the total medical costs. These factors shed light on why developing effective and pragmatic strategies to reduce body weight in obese individuals is a major public health concern. An estimated 60-70% of obese Americans attempt to lose weight each year, with only a small minority able to achieve and maintain long term weight loss. To address this issue a precision medicine approach for weight loss has been considered, which places an emphasis on sustainability and real-world application to individualized therapy. In this article we review weight loss interventions in the context of precision medicine and discuss the role of genetic and epigenetic factors, pharmacological interventions, lifestyle interventions, and bariatric surgery on weight loss.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 30 Dec 1999; 62:15-20
Severin R, Sabbahi A, Mahmoud AM, Arena R, Phillips SA
Prog Cardiovasc Dis: 30 Dec 1999; 62:15-20 | PMID: 30610881
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Impact:
Abstract

Echocardiography in Congenital Heart Disease.

Mcleod G, Shum K, Gupta T, Chakravorty S, ... White M, Shah SB

As the prevalence of adult congenital heart disease continues to grow secondary to advances in surgical and diagnostic techniques, it is important for a physician to supplement their examinations with non-invasive imaging techniques to assess their patients. Although a number of these patients have regular cardiology followup, some may be new patients that do not even know their cardiac history. Echocardiography has proven to be a useful tool for this purpose and its utility has expanded drastically with the development of better technology and newer techniques. In this article, we highlight some of these advancements including 2D echocardiography, agitated saline, contrast echocardiography, stress, and 4D, in addition to how each modality can help assess key aspects of the structure and function of a congenital heart defect.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 30 Dec 1999; 61:468-475
Mcleod G, Shum K, Gupta T, Chakravorty S, ... White M, Shah SB
Prog Cardiovasc Dis: 30 Dec 1999; 61:468-475 | PMID: 30445162
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Impact:
Abstract

Diabetes, heart failure, and renal dysfunction: The vicious circles.

Braunwald E

The prevalence of Type 2 diabetes mellitus (T2DM) has reached pandemic proportions. T2DM frequently causes macrovascular and/or microvascular pathologic changes and thereby increases the risks for the development of myocardial infarction, heart failure, stroke, renal failure, and reduced survival. This article describes the important interactions between T2DM, heart failure, and renal dysfunction, forming vicious circles. The interruption of these circles represents important therapeutic goals.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:298-302
Braunwald E
Prog Cardiovasc Dis: 30 Dec 1999; 62:298-302 | PMID: 31377223
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Impact:
Abstract

Atherosclerotic cardiovascular disease and heart failure: Determinants of risk and outcomes in patients with diabetes.

Nelson AJ, Peterson ED, Pagidipati NJ

Cardiovascular disease (CVD) is the most common cause of morbidity and mortality for patients with diabetes mellitus (DM). Although the burden of atherosclerotic CVD (ASCVD) is well documented, heart failure (HF) has been an under-appreciated CVD complication of DM. However, as more patients with DM live longer and survive acute ASCVD events, the distribution of CVD complications has evolved. This review summarizes the epidemiology of DM, the relative risk and prognosis of both ASCVD and HF following a diagnosis of DM, and the likelihood of cause-specific CVD mortality in patients with DM.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:306-314
Nelson AJ, Peterson ED, Pagidipati NJ
Prog Cardiovasc Dis: 30 Dec 1999; 62:306-314 | PMID: 31301314
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Impact:
Abstract

Evolution of extravascular implantable defibrillator technologies.

Pfenniger A, Knight BP

The implantable cardioverter-defibrillator (ICD) has been successfully treating patients with lethal ventricular arrhythmias for decades. The main acute and chronic complications of this therapy modality are related to the use of a transvenous lead. An entirely extravascular ICD concept was developed over the last 20 years, with emergence of the subcutaneous ICD (S-ICD). This device was approved for clinical use seven years ago, and accumulating real-life experience confirms its safety and efficacy. The main limitations related to this system include the lack of pacing capabilities for bradycardia, tachycardia or resynchronization therapy, a large size, and relatively high energy requirements for effective defibrillation. This review article summarizes current knowledge and potential future developments of the extravascular ICD technologies.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:249-255
Pfenniger A, Knight BP
Prog Cardiovasc Dis: 30 Dec 1999; 62:249-255 | PMID: 31004606
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Abstract

Are the neuroprotective effects of exercise training systemically mediated?

Tari AR, Norevik CS, Scrimgeour NR, Kobro-Flatmoen A, ... Moreira JBN, Wisløff U

To date there is no cure available for dementia, and the field calls for novel therapeutic targets. A rapidly growing body of literature suggests that regular endurance training and high cardiorespiratory fitness attenuate cognitive impairment and reduce dementia risk. Such benefits have recently been linked to systemic neurotrophic factors induced by exercise. These circulating biomolecules may cross the blood-brain barrier and potentially protect against neurodegenerative disorders such as Alzheimer\'s disease. Identifying exercise-induced systemic neurotrophic factors with beneficial effects on the brain may lead to novel molecular targets for maintaining cognitive function and preventing neurodegeneration. Here we review the recent literature on potential systemic mediators of neuroprotection induced by exercise. We focus on the body of translational research in the field, integrating knowledge from the molecular level, animal models, clinical and epidemiological studies. Taken together, the current literature provides initial evidence that exercise-induced, blood-borne biomolecules, such as BDNF and FNDC5/irisin, may be powerful agents mediating the benefits of exercise on cognitive function and may form the basis for new therapeutic strategies to better prevent and treat dementia.

Copyright © 2019 The Author. Published by Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:94-101
Tari AR, Norevik CS, Scrimgeour NR, Kobro-Flatmoen A, ... Moreira JBN, Wisløff U
Prog Cardiovasc Dis: 30 Dec 1999; 62:94-101 | PMID: 30802460
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Impact:
Abstract

Precision medicine and healthy living: The importance of the built environment.

Hills AP, Farpour-Lambert NJ, Byrne NM

The built environment encompasses the major physical spaces, including buildings, streets, homes, schools, parks, playgrounds and other infrastructure in which we live, work and play. In an ideal world, the built environment should support and facilitate a healthy engagement in physical activity across the lifespan. However, in the context of an environment characterized by increased mechanization and urbanization, physical inactivity and higher levels of overweight and obesity, too many settings are not conducive to physical activity and/or are not safe and walkable. In the knowledge that there are multiple challenges to redress the low levels of physical activity seen in many parts of the world, this paper provides some examples of opportunities for healthy living (HL) in a built environment characteristic of an increasingly urbanized world. Particular foci include opportunities for HL fostered in child-friendly cities, in which walkability is high, and active transport is encouraged and supported.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:34-38
Hills AP, Farpour-Lambert NJ, Byrne NM
Prog Cardiovasc Dis: 30 Dec 1999; 62:34-38 | PMID: 30639136
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Impact:
Abstract

Furthering Precision Medicine Genomics With Healthy Living Medicine.

Standley RA, Vega RB

The Precision Medicine Initiative seeks to develop new approaches for disease treatment and prevention that considers the individual variation in genes, environment, and lifestyle for each person. To date, the focus has been on genetic drivers of disease risk and development but has now begun to incorporate lifestyle induced changes in phenotype to enhance treatments. Healthy Living Medicine is an emerging paradigm that focuses on moving more and sitting less, consuming a healthy diet, maintaining body weight and not smoking. A wealth of clinical trials has demonstrated the protective effects of high cardiorespiratory fitness, physical activity (PA), and exercise on all-cause mortality, and prevention of developing cardiovascular disease (CVD), obesity and type 2 diabetes (T2D). This review will summarize the impact of PA and exercise on modifying risk of disease from genetics in the general population and those with CVD, obesity and T2D.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:60-67
Standley RA, Vega RB
Prog Cardiovasc Dis: 30 Dec 1999; 62:60-67 | PMID: 30610883
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Impact:
Abstract

Precision Measurements to Assess Baseline Status and Efficacy of Healthy Living Medicine.

Hwang CL, Bishop J, Ching J, Elokda A, ... Laddu D, Phillips SA

Precision medicine recently has gained popularity, calling for more individualized approaches to prevent and/or reduce chronic-disease risk and to reduce non-communicable diseases such as cardiovascular disease (CVD). Encompassed under Precision medicine initiatives is the concept of healthy living medicine (HLM), which emphasizes the promotion of lifestyle and behavioral practices including physical activity and healthy dietary pattern. Precision measurements have the potential to improve the understanding of how risk factors influence disease trajectory, and further inform on how to precisely tailor clinical strategies to manage risk factors to prevent disease manifestation, and refine therapies according the patient\'s demographic, environment, and disease etiology. The purpose of this review is to summarize the application of established and emerging measurements that may be used in HLM to manage and optimize care in CVD prevention.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:55-59
Hwang CL, Bishop J, Ching J, Elokda A, ... Laddu D, Phillips SA
Prog Cardiovasc Dis: 30 Dec 1999; 62:55-59 | PMID: 30610884
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Impact:
Abstract

Precision Medicine, Healthy Living and the Complex Patient: Managing the Patient With Multimorbidity.

Holland AE, Lee AL

Multimorbidity is the most common chronic health condition in adults and is associated with poor health outcomes. Optimal care for people with multimorbidity requires a person-centred approach that considers goals and preferences, improves quality of life and coordinates care across services. Because care is focused on patient outcomes, rather than disease outcomes, this provides an ideal setting for delivery of the Healthy Living Polypill (HLPP). Precision in delivery of the HLPP for people with multimorbidity involves active participation of patients in goal setting, strategies to address functional limitations and frailty, and support to develop the self-management skills necessary to adopt and sustain healthy behaviours. The multidisciplinary team is a key feature of integrated care for people with multimorbidity and all members should have the necessary skills to deliver the HLPP. Integration and continuity across health and social care sectors enhances outcomes and increases opportunities for personalised delivery of the HLPP.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:29-33
Holland AE, Lee AL
Prog Cardiovasc Dis: 30 Dec 1999; 62:29-33 | PMID: 30610880
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Impact:
Abstract

Is Speckle Tracking Imaging Ready for Prime Time in Current Echo Clinical Practice?

Luis SA, Pellikka PA

Accurate assessment of left and right ventricular systolic function plays a fundamental role in the prognostication and management of patients with known or suspected cardiovascular disease. Traditional echocardiographic parameters, including left ventricular ejection fraction, may lack the sensitivity to detect subclinical left ventricular systolic dysfunction. The advent of speckle tracking echocardiography for left and right ventricular systolic function assessment provides a further tool in this evaluation. Speckle tracking echocardiography has been demonstrated to provide incremental prognostic value beyond traditional echocardiographic parameters. This review discusses the clinical application of speckle tracking echocardiography in the evaluation of cardiovascular disease and its implementation within the clinical echocardiography laboratory.

Copyright © 2018 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 61:437-445
Luis SA, Pellikka PA
Prog Cardiovasc Dis: 30 Dec 1999; 61:437-445 | PMID: 30408468
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Impact:
Abstract

Physical activity, exercise and cardiac troponins: Clinical implications.

Aakre KM, Omland T

Cardiac troponins constitute essential components of the cardiac contractile apparatus and are released into the bloodstream following cardiomyocyte injury. Because of their cardiac specificity, cardiac troponin I or T are the recommended biomarkers for diagnosing acute myocardial infarction. However, cardiac troponin concentrations also frequently increase acutely after strenuous prolonged exercise, making the interpretation of cardiac troponin test results in patients presenting with acute chest pain challenging. This acute troponin response following exercise is commonly considered to be physiological and without adverse long-term consequences, but the possibility of exercise-induced, minor myocardial injury that may become clinically relevant if repeated over decades, has not been ruled out. Attempts to biochemically differentiate between physiological cardiac troponin release versus release after acute ischemic myocardial injury has so far proved largely unsuccessful, but future measurement of specific troponin fragments could be promising. Cardiac troponins also provide strong prognostic information across the spectrum of cardiovascular (CV) disease (CVD). In the chronic setting, low-level elevation of cardiac troponins has been associated with adverse outcome, and concentrations even within the normal range provide independent information concerning risk of developing heart failure (HF) and CVD death. Exercise exerts many beneficial effects on the CV system, and longitudinal observational data from epidemiological studies suggest that higher physical activity (PA) is associated with lower concentrations of cardiac troponins. Conversely, a sedentary life-style has been associated with higher cardiac troponin concentrations and a parallel increase in the risk of HF. Serial measurement of cardiac troponins using high sensitivity assays for monitoring the effect of life-style intervention, including PA appears promising.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:108-115
Aakre KM, Omland T
Prog Cardiovasc Dis: 30 Dec 1999; 62:108-115 | PMID: 30797799
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Abstract

The Role of Government in Precision Medicine, Precision Public Health and the Intersection With Healthy Living.

Whitsel LP, Wilbanks J, Huffman MD, Hall JL

This paper focuses on the significant role of government in promoting precision medicine and public health and the potential intersection with healthy living (HL) and population health. Recent research has highlighted the interplay between genes, environments and different exposures individuals and populations experience over a lifetime. These interactions between longitudinal behaviors, epigenetics, and expression of the human genome have the potential to transform health and well-being, even within a single generation. Precision medicine can elucidate these longitudinal interactions with a granularity that has not been previously possible across the exposome. Understanding the interactions between genes, epigenetics, proteins, metabolites, and the exposome may inform more evidence-based, effective policy, system, and environmental change to optimize individual and population health. Government has an important role in helping to fund primary research in precision medicine and precision public health, as well as creating and enforcing standards related to food systems, air quality, and access to health care, defining and optimizing measures of health care quality and safety, and ensuring data privacy standards and protections, interoperability, and integration with surveillance systems. Government partnership and collaboration with the non-profit and private sectors can optimize precision medicine and precision public health for the benefit of the United States and global population.

Copyright © 2018 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:50-54
Whitsel LP, Wilbanks J, Huffman MD, Hall JL
Prog Cardiovasc Dis: 30 Dec 1999; 62:50-54 | PMID: 30529579
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Abstract

Diabetic cardiomyopathy - A comprehensive updated review.

Murtaza G, Virk HUH, Khalid M, Lavie CJ, ... Shanmugasundaram M, Paul TK

Diabetes causes cardiomyopathy and increases the risk of heart failure independent of hypertension and coronary heart disease. This condition called \"Diabetic Cardiomyopathy\" (DCM) is becoming a well- known clinical entity. Recently, there has been substantial research exploring its molecular mechanisms, structural and functional changes, and possible development of therapeutic approaches for the prevention and treatment of DCM. This review summarizes the recent advancements to better understand fundamental molecular abnormalities that promote this cardiomyopathy and novel therapies for future research. Additionally, different diagnostic modalities, up to date screening tests to guide clinicians with early diagnosis and available current treatment options has been outlined.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:315-326
Murtaza G, Virk HUH, Khalid M, Lavie CJ, ... Shanmugasundaram M, Paul TK
Prog Cardiovasc Dis: 30 Dec 1999; 62:315-326 | PMID: 30922976
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Abstract

A role for FNDC5/Irisin in the beneficial effects of exercise on the brain and in neurodegenerative diseases.

Young MF, Valaris S, Wrann CD

The beneficial effects of exercise on the brain are well known. However, the underlying molecular mechanisms are much less well understood. Interestingly, myokines, hormones secreted by muscle in response to exercise, gained attention as such beneficial mediators. In this review, we will focus on FNDC5 and its secreted form, the newly discovered myokine \"irisin\". We will discuss their role in the beneficial effects of exercise and its potential application in neurodegenerative disorders.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:172-178
Young MF, Valaris S, Wrann CD
Prog Cardiovasc Dis: 30 Dec 1999; 62:172-178 | PMID: 30844383
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Abstract

Implementing behaviour change theory and techniques to increase physical activity and prevent functional decline among adults aged 61-70: The PreventIT project.

Boulton E, Hawley-Hague H, French DP, Mellone S, ... Vereijken B, Todd C

The health and wellbeing benefits of engaging in physical activity (PA), and of improving strength and balance, are well documented. The World Health Organization\'s recommendations of 150 min per week of moderate intensity physical activity have been adopted across the world in policy and practice recommendations. However, the number of older adults engaging in this level of PA remains low. The European Project, PreventIT, has adapted the Lifestyle-integrated Functional Exercise (LiFE) programme, which reduced falls in people 75 years and over, for a younger cohort (aLiFE). aLiFE incorporates challenging strength and balance/agility tasks, as well as specific recommendations for increasing physical activity and reducing sedentary behaviour in young-older adults, aged 60-70 years. Personalised advice is given on how to integrate strength, balance and physical activities into daily life. aLiFE has been further developed to be delivered using smartphones and smartwatches (eLiFE), providing the opportunity to send timely motivational messages and real-time feedback to the user. Both aLiFE and eLiFE are behaviour change interventions, supporting older adults to form long-term physical activity habits. PreventIT has taken the original LiFE concept and further developed the behaviour change elements, explicitly mapping them to Social Cognitive Theory, Habit Formation Theory and 30 Behaviour Change Techniques (BCTs). Goal setting, planning, prompts and real-time feedback are used to deliver a person-centred experience. Over 1300 motivational messages have been written, mapped to psychological theory, BCTs and evidence regarding the importance of strength, balance and PA. A motivational assessment tool has been developed to enable us to investigate stated motivational drivers with actual performed behaviour within the feasibility Randomised Controlled Trial. The PreventIT mHealth intervention focusses on behaviour change from initiation to long-term maintenance, addressing the different phases of adopting a healthier lifestyle. As such, it makes a strong contribution to the developing field of evidence-based mobile health (mHealth).

Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:147-156
Boulton E, Hawley-Hague H, French DP, Mellone S, ... Vereijken B, Todd C
Prog Cardiovasc Dis: 30 Dec 1999; 62:147-156 | PMID: 30685469
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Abstract

Precision in Promoting Physical Activity and Exercise With the Overarching Goal of Moving More.

Ozemek C, Arena R

Physical inactivity is strongly associated with an unfavorable health profile, increasing an individual\'s risk for developing cardiovascular disease. Initiating a regular exercise routine contributes to improvements in cardiorespiratory fitness, body composition, resting blood pressure, blood glucose, and circulating lipoproteins. However, the extent to which positive changes occur come with significant inter-individual variability within intervention groups; non-responders and responders have been commonly identified across populations, highlighting that not all exercise regimens are universally effective in all individuals and should therefore not be treated as a \"one-size fits all\" prescription. Recent studies have therefore emphasized reporting the quantity of participants favorably and meaningfully \"responding\" to varying amounts and intensities of exercise, thereby presenting the opportunity to view exercise prescription in the context of precision medicine. This review will address the impact of varying amounts and intensities of physical activity and exercise, highlighting their impact on key health metrics.

Copyright © 2018 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:3-8
Ozemek C, Arena R
Prog Cardiovasc Dis: 30 Dec 1999; 62:3-8 | PMID: 30529578
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Abstract

Role of Transesophageal Echocardiography in Patients with Ischemic Stroke.

Stewart MH, Gilliland Y

Acute ischemic stroke is a condition with considerable mortality and morbidity. When used appropriately, Transesophageal Echocardiography (TEE) can be an incredibly useful tool to identify potential causes of stroke and guide management. The crucial distinction in this modality lies in separating common incidental findings from those likely to have contributed to ischemic stroke. Furthermore, the management of identified intracardiac causes varies widely from open surgery to antiplatelet therapy. This review seeks to discuss the role of TEE in identifying common etiologies of cardioembolic stroke, review the clinical entities, and the highlight the most recent management recommendations.

Copyright © 2018 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 61:456-467
Stewart MH, Gilliland Y
Prog Cardiovasc Dis: 30 Dec 1999; 61:456-467 | PMID: 30465774
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Abstract

Low-Gradient Aortic Stenosis: Solving the Conundrum Using Multi-Modality Imaging.

Messika-Zeitoun D, Oh JK, Topilsky Y, Burwash IG, Michelena HI, Enriquez-Sarano M

Up to 1/3 of patients with both reduced or preserved left ventricular ejection fraction (LVEF), harbor a mean pressure gradient (MPG) < 40 mm Hg (peak velocity (PV) < 4 m/s), suggesting moderate aortic stenosis (AS) and an aortic valve area (AVA) < 1 cm suggesting severe AS raising uncertainties regarding AS severity and appropriate management. In patients with reduced LVEF, increased transvalvular flow and stroke volume ≥ 20% (i.e. contractile reserve) during low-dose dobutamine echocardiography enables distinguishing patients with \"true-severe AS\" (severe AS with secondary LV dysfunction, PV ≥ 4 m/s or MPG > 30-40 mm Hg at peak while AVA remains <1 cm) from patients with \"pseudo-severe AS\" (moderate AS with associated LV dysfunction due to ischemic or dilated cardiomyopathy, AVA at peak ≥1 cm with a MPG < 30-40 mm Hg). However, interpretation of dobutamine stress echocardiography is often challenging, and absence of contractile reserve is observed in 20 to 30% of patients. Measurement of the degree of calcification (AVC) using computed tomography is an accurate and flow-independent method for the assessment of AS severity. A score > 1250 AU in women and >2000 UA in men strongly suggest severe AS. Combination of dobutamine echocardiography and AVC scoring enables assessment of AS severity with high confidence. The subset of patients with discordant grading and preserved LVEF is heterogenous and encompasses various conditions. A minority harbor a low flow state related to a reduced myocardial performance, an increased arterial afterload or combination of both. A low flow state is an important prognostic factor but does not provide any information regarding AS severity. Similarly to patients with reduced LVEF, assessment of the degree of AVC seems the best method to differentiate patients with pseudo-severe AS from patients with true severe AS. The latter should be referred for an intervention if symptomatic whereas the optimal management of the former subset remains uncertain.

Copyright © 2018 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 61:416-422
Messika-Zeitoun D, Oh JK, Topilsky Y, Burwash IG, Michelena HI, Enriquez-Sarano M
Prog Cardiovasc Dis: 30 Dec 1999; 61:416-422 | PMID: 30445161
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Abstract

Meta-analysis of Exercise Training on Left Ventricular Ejection Fraction in Heart Failure with Reduced Ejection Fraction: A 10-year Update.

Tucker WJ, Beaudry RI, Liang Y, Clark AM, ... Ellingsen O, Haykowsky MJ
Background
The role of exercise training modality to attenuate left ventricular (LV) remodeling in heart failure patients with reduced ejection fraction (HFrEF) remains uncertain. The authors performed a systematic review and meta-analysis of published reports on exercise training (moderate-intensity continuous aerobic, high-intensity interval aerobic, and resistance exercise) and LV remodeling in clinically stable HFrEF patients.
Methods
We searched MEDLINE, Cochrane Central Registry of Controlled Trials, CINAHL, and PubMed (2007 to 2017) for randomized controlled trials of exercise training on resting LV ejection fraction (EF) and end-diastolic and end-systolic volumes in HFrEF patients.
Results
18 trials reported LV ejection fraction (LVEF) data, while 8 and 7 trials reported LV end-diastolic and LV end-systolic volumes, respectively. Overall, moderate-intensity continuous training (MICT) significantly increased LVEF (weighted mean difference, WMD = 3.79%; 95% confidence interval, CI, 2.08 to 5.50%) with no change in LV volumes versus control. In trials ≥6 months duration, MICT significantly improved LVEF (WMD = 6.26%; 95% CI 4.39 to 8.13%) while shorter duration (<6 months) trials modestly increased LVEF (WMD = 2.33%; 95% CI 0.84 to 3.82%). High-intensity interval training (HIIT) significantly increased LVEF compared to control (WMD = 3.70%; 95% CI 1.63 to 5.77%) but was not different than MICT (WMD = 3.17%; 95% CI -0.87 to 7.22%). Resistance training performed alone or combined with aerobic training (MICT or HIIT) did not significantly change LVEF.
Conclusions
In clinically stable HFrEF patients, MICT is an effective therapy to attenuate LV remodeling with the greatest benefits occurring with long-term (≥6 months) training. HIIT performed for 2 to 3 months is superior to control, but not MICT, for improvement of LVEF.

Copyright © 2018 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:163-171
Tucker WJ, Beaudry RI, Liang Y, Clark AM, ... Ellingsen O, Haykowsky MJ
Prog Cardiovasc Dis: 30 Dec 1999; 62:163-171 | PMID: 30227187
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Abstract

Outcomes of Healthy Eating Ad Campaigns: A Systematic Review.

Abril EP, Dempsey PR

Social marketing campaigns seeking to promote healthy eating hold promise in precision messaging and behavior change related to a key component of healthy living medicine. A systematic review that examines the behaviors promoted against their success is lacking. Of interest is the consideration of stop or go behaviors, such as not eating fast food or increasing the consumption of fruits and vegetables, respectively. We systematically searched five databases for peer-reviewed quantitative articles examining healthy eating campaigns that included at least one ad. We found evidence that campaigns with both stop and go outcomes (such as swapping) and outcomes that were not clarifying whether they were stop or go (such as calling a coach) tended to be more successful than campaigns with simple stop or go outcomes. Further, campaigns that were longer than six months seemed consistently successful. However, with 14 included studies, it is clear that further research is needed.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:39-43
Abril EP, Dempsey PR
Prog Cardiovasc Dis: 30 Dec 1999; 62:39-43 | PMID: 30610882
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Abstract

Advances in Health Technology Use and Implementation in the Era of Healthy Living: Implications for Precision Medicine.

Phillips SA, Ali M, Modrich C, Oke S, ... Laddu D, Bond S

Much of the focus of precision medicine has been directed toward genomics, despite the fact that \"lifestyle and behavioral factors\" are included in the description of precision medicine. Numerous structured diet and PA interventions have demonstrated success in preventing and/or reducing chronic-disease risk. The use of personal health technologies has expanded exponentially in the health care arena; there are a number of consumer-based technologies yielding health information to individual users. The explosion in technology use provides an opportunity for broader dissemination of health care services and products. In addition, tracking cardiovascular disease risk and lifestyle and behavioral aspects of healthy living (HL) profiles in those products may be an important leveraging interface for precision medicine. This review will discuss and present an overview of current health technologies, their use in promotion of HL metrics and how this data may be integrated into venues that support HL and precision medicine.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 30 Dec 1999; 62:44-49
Phillips SA, Ali M, Modrich C, Oke S, ... Laddu D, Bond S
Prog Cardiovasc Dis: 30 Dec 1999; 62:44-49 | PMID: 30597149
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Abstract

The Bicuspid Aortic Valve Condition: The Critical Role of Echocardiography and the Case for a Standard Nomenclature Consensus.

Michelena HI, Chandrasekaran K, Topilsky Y, Messika-Zeitoun D, ... Enriquez-Sarano M,

The bicuspid aortic valve (BAV) condition is characterized by prominent heterogeneity of its valvular phenotypic expression, of its associated disorders, its complications and its prognosis. Echocardiography serves as the first-line imaging modality in 5 major capacities: (1) BAV diagnosis, (2) valvular phenotyping, (3) assessment of valvular function, (4) measurement of the thoracic aorta and exclusion of aortic coarctation, and (5) assessment of uncommon but serious complications such as infective endocarditis and aortic dissection. This article presents a nosological perspective on the BAV condition, discusses the critical role of echocardiography as it relates to these 5 aforementioned capacities; and makes the case for a unified standard nomenclature for the BAV condition.

Copyright © 2018 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 61:404-415
Michelena HI, Chandrasekaran K, Topilsky Y, Messika-Zeitoun D, ... Enriquez-Sarano M,
Prog Cardiovasc Dis: 30 Dec 1999; 61:404-415 | PMID: 30408467
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Abstract

Neurocognitive Impairment and Its Long-term Impact on Adults With Congenital Heart Disease.

Cohen S, Earing MG

It is well-recognized now that adult survivors with congenital heart disease (ACHD) are at risk for non-cardiac co-morbidities and complications that can impact symptoms and clinical outcomes. Cognitive dysfunction, in particular, is common in this population, but likely an under-recognized and undertreated cause for long-term morbidity. Abnormal cognitive function has a major impact on all aspects of quality of life, including employment opportunities, educational attainment, and the ability to maintain meaningful social relationships, such as marriage. The association and impact of cognitive dysfunction in ACHD is not fully understood and continues to be understudied. Nevertheless, cognitive dysfunction may be a potentially modifiable risk factor in this population that is amenable to intervention, which may in-turn translate to improved outcomes. This review summarizes our current understanding of the prevalence, impact, and management of cognitive dysfunction in ACHD.

Copyright © 2018 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 61:287-293
Cohen S, Earing MG
Prog Cardiovasc Dis: 30 Dec 1999; 61:287-293 | PMID: 30118722
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Abstract

Imaging for sudden cardiac death risk stratification: Current perspective and future directions.

van der Bijl P, Delgado V, Bax JJ

Sudden cardiac death (SCD) accounts for one fifth of global deaths, and occurs when a trigger (e.g. myocardial ischemia, premature ventricular contraction) interacts with an arrhythmic substrate (e.g. myocardial scar, dilated cardiomyopathy). Multimodality imaging (echocardiographic, cardiac magnetic resonance and nuclear techniques) can potentially visualize many predisposing substrates and triggers. Implantable cardioverter-defibrillator (ICD) is the most effective approach to primary prevention of SCD, and current guidelines regarding ICD implantation are based on a left ventricular ejection fraction (LVEF) ≤35%. This practice is limited by a low sensitivity and specificity, and has limited value when applied to different etiologies. In this review, the role of multimodality imaging in SCD risk-stratification and the limitations of an LVEF-based approach, are discussed. Additional randomized, prospective data are eagerly awaited to inform on the role of imaging in SCD risk-stratification, and ongoing/ planned trials are subsequently discussed.

Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:205-211
van der Bijl P, Delgado V, Bax JJ
Prog Cardiovasc Dis: 30 Dec 1999; 62:205-211 | PMID: 31054859
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Abstract

Mechanistic insights regarding the role of SGLT2 inhibitors and GLP1 agonist drugs on cardiovascular disease in diabetes.

Garg V, Verma S, Connelly K

The treatment landscape for patients with established or at high risk for cardiovascular disease and type 2 diabetes mellitus has entirely changed over the past decade, with the introduction of several anti-hyperglycemic agents. Sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) agonists are two anti-hyperglycemic classes which have been of special interest after multiple large cardiovascular disease (CVD) outcomes studies have demonstrated superiority of these agents compared to placebo for major adverse CVD events and in some cases, hospitalization for heart failure. Despite the dramatic results of these trials, only recently have we began to understand the mechanisms underlying these CVD benefits. Here we review the underlying mechanisms which have the greatest plausibility for both of these agents including the impact of ventricular loading conditions, direct effects on cardiac structure and function, myocardial energetics and sodium/hydrogen exchange for SGLT2 inhibitors, and the anti-atherosclerotic, anti-inflammatory, and modulation of endothelial function for GLP-1 agonists.

Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:349-357
Garg V, Verma S, Connelly K
Prog Cardiovasc Dis: 30 Dec 1999; 62:349-357 | PMID: 31381891
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Abstract

Curing breast cancer and killing the heart: A novel model to explain elevated cardiovascular disease and mortality risk among women with early stage breast cancer.

Kirkham AA, Beaudry RI, Paterson DI, Mackey JR, Haykowsky MJ

Due to advances in prevention, early detection and treatment, early breast cancer mortality has decreased by nearly 40% during the last four decades. Yet, the risk of cardiovascular disease (CVD) mortality is significantly elevated following a breast cancer diagnosis, and it is a leading cause of death in this population. This review will discuss the most recent evidence for risks, pathology, mechanisms, and prevention of CVD morbidity and mortality in women with breast cancer. This evidence will be synthesized into a new model \'the compounding risk and protection model.\' This model proposes that the balance between risk factors (i.e., older age, pre-existing traditional CVD risk factors and shared biologic pathways for CVD and cancer such as inflammation, as well as treatment-related and lifestyle toxicity) and potential protection factors (i.e., lifelong non-smoking, regular physical activity, a healthy diet rich in fruits and vegetables, and management of body weight and stress, heart failure therapy) determine the individual risk of CVD morbidity and mortality after diagnosis of early breast cancer.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:116-126
Kirkham AA, Beaudry RI, Paterson DI, Mackey JR, Haykowsky MJ
Prog Cardiovasc Dis: 30 Dec 1999; 62:116-126 | PMID: 30797800
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Abstract

Cardiorespiratory fitness and cardiovascular disease - The past, present, and future.

Kaminsky LA, Arena R, Ellingsen Ø, Harber MP, ... Ozemek C, Ross R

The importance of cardiorespiratory fitness (CRF) is now well established and it is increasingly being recognized as an essential variable which should be assessed in health screenings. The key findings that have established the clinical significance of CRF are reviewed in this report, along with an overview of the current relevance of exercise as a form of medicine that can provide a number of positive health outcomes, including increasing CRF. Current assessment options for assessing CRF are also reviewed, including the direct measurement via cardiopulmonary exercise testing which now can be interpreted with age and sex-specific reference values. Future directions for the use of CRF and related measures are presented.

Copyright © 2019 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:86-93
Kaminsky LA, Arena R, Ellingsen Ø, Harber MP, ... Ozemek C, Ross R
Prog Cardiovasc Dis: 30 Dec 1999; 62:86-93 | PMID: 30639135
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Abstract

Addressing the Nutritional Phenotype Through Personalized Nutrition for Chronic Disease Prevention and Management.

Laddu D, Hauser M

The primary focus of public health recommendations related to the prevention of food-related chronic disease has been on the adoption of healthy dietary patterns; however, implementation has been challenging. There has been increasing recognition that an individual\'s diet and environment may impact disease susceptibility by affecting the expression of genes involved in critical metabolic pathways. Precision nutrition (PN) has emerged to translate discoveries about diversity in nutrient metabolism between subgroups and the inter-individual variability in the responses to dietary interventions. The overarching goals of PN are to deliver individualized, actionable dietary therapy based on an individual\'s nutritional phenotype, created from the integration of genetics, metabolic profile, and environmental factors in order to prevent and treat chronic disease. This review addresses the developments of genome- and omic-driven PN and how they have been used to prevent and treat disease, as well as how they might be integrated into broader clinical practice.

Copyright © 2018 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:9-14
Laddu D, Hauser M
Prog Cardiovasc Dis: 30 Dec 1999; 62:9-14 | PMID: 30553801
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Abstract

Doppler-Echocardiographic Assessment of Tricuspid Regurgitation.

Topilsky Y, Michelena HI, Messika-Zeitoun D, Enriquez Sarano M

Compared with the vast literature concerning the echocardiographic assessment of mitral, or aortic disease, the data concerning the evaluation of tricuspid regurgitation (TR) is very limited. In this review we summarized the present data concerning the assessment of TR. We review the present knowledge concerning the pathogenesis of TR showing that it is extremely multi-factorial, thus, when assessing patients with TR by echocardiography it is imperative to focus on four major aspects: evaluation of severity of TR, assessment of the etiology of TR, evaluation of the mechanism of TR and suitability for surgical or per-cutaneous repair.

Copyright © 2018 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 61:397-403
Topilsky Y, Michelena HI, Messika-Zeitoun D, Enriquez Sarano M
Prog Cardiovasc Dis: 30 Dec 1999; 61:397-403 | PMID: 30447222
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Abstract

An Update on the Role of Cardiorespiratory Fitness, Structured Exercise and Lifestyle Physical Activity in Preventing Cardiovascular Disease and Health Risk.

Ozemek C, Laddu DR, Lavie CJ, Claeys H, ... Arena R, Blair SN

The cardiovascular disease (CVD) pandemic has placed considerable strain on healthcare systems, quality of life, and physical function, while remaining the leading cause of death globally. Decades of scientific investigations have fortified the protective effects of cardiorespiratory fitness (CRF), exercise training, and physical activity (PA) against the development of CVD. This review will summarize recent efforts that have made significant strides in; 1) the application of novel analytic techniques to increase the predictive utility of CRF; 2) understanding the protective effects of long-term compliance to PA recommendations through large cohort studies with multiple points of assessment; 3) and understanding the potential harms associated with extreme volumes of PA.

Copyright © 2018 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 61:484-490
Ozemek C, Laddu DR, Lavie CJ, Claeys H, ... Arena R, Blair SN
Prog Cardiovasc Dis: 30 Dec 1999; 61:484-490 | PMID: 30445160
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Abstract

When Should Adult Congenital Heart Disease Patients be Considered for Transplant and Deciding Which Organs to Transplant.

Lewis M, Rosenbaum M

The number of adult congenital heart disease (ACHD) patients continues to increase. Because of multiple related factors such as aging, residual cardiac lesions and prior palliative procedures, advanced heart failure (HF) is increasingly prevalent in this population. Consequently, there is an emerging need to determine which patients are best suited for advanced cardiac therapies, including heart transplantation (HT) and mechanical circulatory support. Unfortunately, optimizing patient selection for these therapies is complicated by patient heterogeneity, variable HF presentation across lesion-type, and a paucity of outcome data. The lack of patient specific data and the increasing number of ACHD patients with end-stage HF identifies a need to more precisely stratify risk and determine appropriate timing for referral. As such, this article will discuss the clinical recognition and classification of advanced HF in the ACHD patient populations and review current data regarding HT outcomes. Following, key considerations regarding the timing of HT in specific forms of ACHD, the role of device therapy, and when dual organ transplantation should be considered will be reviewed. Finally, existing knowledge gaps and key research needs will be highlighted.

Copyright © 2018. Published by Elsevier Inc.

Prog Cardiovasc Dis: 30 Dec 1999; 61:377-381
Lewis M, Rosenbaum M
Prog Cardiovasc Dis: 30 Dec 1999; 61:377-381 | PMID: 30227188
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Impact:
Abstract

Determining Cardiorespiratory Fitness With Precision: Compendium of Findings From the FRIEND Registry.

Kaminsky LA, Myers J, Arena R

Healthy living (HL) behaviors and characteristics are central to both preventing and treating a myriad of chronic diseases; a key HL characteristic is cardiorespiratory fitness (CRF). Knowing an individual\'s CRF provides vital information when assessing health status and formulating a plan of care. Normative reference values as well as thresholds that denote varying degrees of health and future risk exist for measures of CRF. However, improving upon the precision of CRF reference standards according to key factors as well as precision in how CRF assessments can be used to assess health status and prognosis is needed. The current review will: 1) provide an overview of current approaches to CRF assessment and interpretations; 2) describe more recent efforts to improve upon the precision of CRF values; and 3) describe the Fitness Registry and the Importance of Exercise: A National Data Base (FRIEND) for the precision of CRF as a clinical measure.

Copyright © 2018 Elsevier Inc. All rights reserved.

Prog Cardiovasc Dis: 30 Dec 1999; 62:76-82
Kaminsky LA, Myers J, Arena R
Prog Cardiovasc Dis: 30 Dec 1999; 62:76-82 | PMID: 30385268
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Impact:

This program is still in alpha version.