<div><h4>Is exercise a viable therapy for anxiety? Systematic review of recent literature and critical analysis.</h4><i>Stonerock GL, Gupta RP, Blumenthal JA</i><br /><b>Objectives</b><br />Exercise has been promoted as a treatment for a variety of psychiatric conditions. The benefits of exercise for depression are widely recognized, but the benefits of exercise for anxiety are uncertain. Although several reviews promoted exercise as a treatment for anxiety, concerns about the quality of studies prompted us to provide a critical review of the recent literature to re-assess the value of exercise for treating anxiety.<br /><b>Methods and materials</b><br />We conducted a systematic review of all peer-reviewed randomized clinical trials (RCTs) among adults, published between January 2014 and December 2021, with an exercise intervention and anxiety as the a priori primary outcome. Two reviewers independently extracted data from studies meeting inclusion criteria, including sample characteristics, exercise intervention, control conditions, primary anxiety measure, relevant findings, and methodological quality quantified by PEDro scores.<br /><b>Results</b><br />7240 published studies from CINAHL, EMBASE, MEDLINE, and PsycINFO were screened in April 2022, with 1831 participants across 25 eligible RCTs, of which 13 included elevated anxiety at study entry as an eligibility criterion. Only two of these 13 studies, and five of 12 studies of non-anxious individuals, found anxiety to be reduced unequivocally with exercise. Most studies suffered from significant methodological limitations including concurrent therapies and lack of intention-to-treat analyses.<br /><b>Conclusion</b><br />There remains considerable uncertainty about the value of exercise in reducing symptoms of anxiety, particularly among anxious individuals. The paucity of methodologically sound studies of patients with anxiety represents a significant gap in our knowledge and calls for more research in the area. Word count: 249.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 25 May 2023; epub ahead of print</small></div>

<div><h4>Heart failure and obesity: The latest pandemic.</h4><i>Aryee E, Ozkan B, Ndumele CE</i><br /><AbstractText>The marked rise in rates of obesity, which is most prominent among individuals from socio-economically disadvantaged circumstances, has been a powerful contributor to the rising prevalence of heart failure (HF). Obesity has indirect effects on HF through the development of several metabolic risk factors, but also direct adverse effects on the myocardium. Obesity contributes to myocardial dysfunction and HF risk through multiple mechanisms, including hemodynamic changes, neurohormonal activation, endocrine and paracrine effects of adipose tissue, ectopic fat deposition and lipotoxicity. These processes principally result in concentric left ventricular (LV) remodeling and predominant increase in the risk for HF with preserved LV ejection fraction (HFpEF). Despite the excess risk for HF associated with obesity, there is a well described obesity paradox in which individuals with overweight and grade I obesity have better survival than those with normal weight and overweight. Despite the obesity paradox among individuals with prevalent HF, intentional weight loss is associated with improvements in metabolic risk factors, myocardial dysfunction and quality of life, in a dose-response fashion. In matched observational studies of bariatric surgery patients, marked weight loss is associated with decreased risk for developing HF, as well as improved cardiovascular disease (CVD) outcomes in those with existing HF. Ongoing clinical trials using powerful new obesity pharmacotherapies in individuals in with obesity and CVD may provide definitive information regarding the cardiovascular impact of weight loss. Given the powerful contribution of rising obesity prevalence to rates of HF, addressing these intertwined epidemics is a clinical and public health priority.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 24 May 2023; epub ahead of print</small></div>

<div><h4>Cardiopulmonary testing in long COVID-19 versus non-COVID-19 patients with undifferentiated Dyspnea on exertion.</h4><i>Contreras AM, Newman DB, Cappelloni L, Niven AS, ... Bonikowske AR, Allison TG</i><br /><b>Background</b><br />Dyspnea and fatigue are characteristics of long SARS-CoV-2 (COVID)-19. Cardiopulmonary exercise testing (CPET) can be used to better evaluate such patients.<br /><b>Research question</b><br />How significantly and by what mechanisms is exercise capacity impaired in patients with long COVID who are coming to a specialized clinic for evaluation?<br /><b>Study design and methods</b><br />We performed a cohort study using the Mayo Clinic exercise testing database. Subjects included consecutive long COVID patients without prior history of heart or lung disease sent from the Post-COVID Care Clinic for CPET. They were compared to a historical group of non-COVID patients with undifferentiated dyspnea also without known cardiac or pulmonary disease. Statistical comparisons were performed by t-test or Pearson\'s chi<sup>2</sup> test controlling for age, sex, and beta blocker use where appropriate.<br /><b>Results</b><br />We found 77 patients with long COVID and 766 control patients. Long COVID patients were younger (47 ± 15 vs 50 ± 10 years, P < .01) and more likely female (70% vs 58%, P < .01). The most prominent difference on CPETs was lower percent predicted peak V̇O<sub>2</sub> (73 ± 18 vs 85 ± 23%, p < .0001). Autonomic abnormalities (resting tachycardia, CNS changes, low systolic blood pressure) were seen during CPET more commonly in long COVID patients (34 vs 23%, P < .04), while mild pulmonary abnormalities (mild desaturation, limited breathing reserve, elevated V̇<sub>E</sub>/V̇CO<sub>2</sub>) during CPET were similar (19% in both groups) with only 1 long COVID patient showing severe impairment.<br /><b>Interpretation</b><br />We identified severe exercise limitation among long COVID patients. Young women may be at higher risk for these complications. Though mild pulmonary and autonomic impairment were common in long COVID patients, marked limitations were uncommon. We hope our observations help to untangle the physiologic abnormalities responsible for the symptomatology of long COVID.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 19 May 2023; epub ahead of print</small></div>

<div><h4>Exercise recommendations for patients with hypertrophic cardiomyopathy.</h4><i>Bryde R, Martinez MW, Emery MS</i><br /><AbstractText>Individuals with hypertrophic cardiomyopathy (HCM) have historically been advised to limit exercise and sports participation to mild-intensity activities due to concerns for sudden cardiac arrest (SCA). However, more contemporary data have shown SCA is rare in patients with HCM and emerging data is shifting towards support for the safety of exercise in this patient population. Recent guidelines endorse exercise in patients with HCM after a comprehensive evaluation and shared-decision making with an expert provider.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 16 May 2023; epub ahead of print</small></div>

<div><h4>Biomarkers for the diagnosis of heart failure in people with diabetes: A consensus report from diabetes technology society.</h4><i>Yeung AM, Huang J, Pandey A, Hashim IA, ... Wu AHB, Klonoff DC</i><br /><AbstractText>Diabetes Technology Society assembled a panel of clinician experts in diabetes, biomarker screening, and heart failure to review the current evidence on biomarker screening of people with diabetes (PWD) for heart failure (HF), who are, by definition, at risk for HF (Stage A HF). This consensus report reviews features of HF in PWD from the perspectives of 1) epidemiology, 2) classification of stages, 3) pathophysiology, 4) biomarkers for diagnosing, 5) biomarker assays, 6) diagnostic accuracy of biomarkers, 7) benefits of biomarker screening, 8) consensus recommendations for biomarker screening, 9) stratification of Stage B HF, 10) echocardiographic screening, 11) management of Stage A and Stage B HF, and 12) future directions. The Diabetes Technology Society panel recommends 1) biomarker screening with one of two circulating natriuretic peptides (B-type natriuretic peptide or N-terminal prohormone of B-type natriuretic peptide), 2) beginning screening five years following diagnosis of type 1 diabetes (T1D) and at the diagnosis of type 2 diabetes (T2D), 3) beginning routine screening no earlier than at age 30 years for T1D (irrespective of age of diagnosis) and at any age for T2D, 4) screening annually, and 5) testing any time of day. The panel also recommends that an abnormal biomarker test defines asymptomatic preclinical HF (Stage B HF). This diagnosis requires follow-up using transthoracic echocardiography for classification into one of four subcategories of Stage B HF, corresponding to risk of progression to symptomatic clinical HF (Stage C HF). These recommendations will allow identification and management of Stage A and Stage B HF in PWD to prevent progression to Stage C HF or advanced HF (Stage D HF).</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 11 May 2023; epub ahead of print</small></div>

<div><h4>Social determinants of health, health disparities, and adiposity.</h4><i>Baez AS, Ortiz-Whittingham LR, Tarfa H, Baah FO, ... Baumer Y, Powell-Wiley TM</i><br /><AbstractText>Social determinants of health (SDoH), or the socioeconomic, environmental, and psychosocial conditions in which individuals spend their daily lives, substantially influence obesity as a cardiovascular disease (CVD) risk factor. The coronavirus disease 2019 (COVID-19) pandemic highlighted the converging epidemics of obesity, CVD, and social inequities globally. Obesity and CVD serve as independent risk factors for COVID-19 severity and lower-resourced populations most impacted by adverse SDoH have the highest COVID-19 mortality rates. Better understanding the interplay between social and biologic factors that contribute to obesity-related CVD disparities are important to equitably address obesity across populations. Despite efforts to investigate SDoH and their biologic effects as drivers of health disparities, the connections between SDoH and obesity remain incompletely understood. This review aims to highlight the relationships between socioeconomic, environmental, and psychosocial factors and obesity. We also present potential biologic factors that may play a role in the biology of adversity, or link SDoH to adiposity and poor adipo-cardiology outcomes. Finally, we provide evidence for multi-level obesity interventions targeting multiple aspects of SDoH. Throughout, we emphasize areas for future research to tailor health equity-promoting interventions across populations to reduce obesity and obesity-related CVD disparities.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 11 May 2023; epub ahead of print</small></div>

<div><h4>Evolution of genetic testing and gene therapy in hypertrophic cardiomyopathy.</h4><i>Chiswell K, Zaininger L, Semsarian C</i><br /><AbstractText>Studies over the last 30 years have identified hypertrophic cardiomyopathy (HCM) as predominantly an autosomal dominant disorder caused by disease-causing variants in genes encoding the sarcomere proteins critical for contractile function. The two most common disease genes implicated are the MYBPC3 and MYH7 genes, with disease-causing variants in these two genes accounting for 70-80% of all genotype-positive HCM patients. This increased knowledge of the genetic basis of HCM has heralded the era of precision medicine, with genetic testing leading to more improved and precise diagnosis, effective cascade genetic testing in at-risk family members, assistance with reproductive decisions, targeted therapeutics guided by both phenotype and genotype, and providing important insights into risk stratification and prognosis. Most recently, novel insights into genetic mechanisms have been elucidated, spanning non-Mendelian aetiologies, non-familial forms of HCM, and development of polygenic risk scores. These advances have laid the platform for exciting future endeavours such as newer gene therapy approaches in HCM, including gene replacement studies and genome editing approaches to ultimately cure disease. This brief review summarises the current role of genetic testing in HCM patients and families, and introduces some new mechanistic insights leading to the consideration of gene therapy approaches for HCM.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 01 May 2023; epub ahead of print</small></div>

<div><h4>Obesity and atrial fibrillation: Prevalence, pathogenesis, and prognosis.</h4><i>Middeldorp ME, Kamsani SH, Sanders P</i><br /><AbstractText>The prevalence of atrial fibrillation (AF) and obesity are rising significantly. There is a shared association between these conditions with obesity predisposing individuals to a number of shared risk factors. In addition, obesity in itself has been shown to cause changes to the structure, function and hemodynamics of the heart. There is evidence to show that weight-loss has significant impact on AF symptoms, burden and more recently the potential to reverse the type of AF. Through risk factor management and in the case of morbid obesity, bariatric surgery, there is an improved prognosis for patients with AF and obesity. In this paper we provide a review of the current data on obesity and AF prevalence, pathogenesis and prognosis.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 28 Apr 2023; epub ahead of print</small></div>

<div><h4>Exercise and cardiovascular health: A state-of-the-art review.</h4><i>Isath A, Koziol KJ, Martinez MW, Garber CE, ... Arena R, Krittanawong C</i><br /><AbstractText>Cardiovascular (CV) disease (CVD) is the leading cause of global morbidity and mortality, and low levels of physical activity (PA) is a leading independent predictor of poor CV health and associated with an increased prevalence of risk factors that predispose to CVD development. In this review, we evaluate the benefits of exercise on CV health. We discuss the CV adaptations to exercise, focusing on the physiological changes in the heart and vasculature. We review the impact and benefits of exercise on specific CV prevention, including type II diabetes, hypertension, hyperlipidemia, coronary artery disease, and heart failure, in addition to CVD-related and all-cause mortality. Lastly, we evaluate the current PA guidelines and various modes of exercise, assessing the current literature for the effective regimens of PA that improve CVD outcomes.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Prog Cardiovasc Dis: 27 Apr 2023; epub ahead of print</small></div>

<div><h4>A Women\'s health perspective on managing obesity.</h4><i>Johnson VR, Anekwe CV, Washington TB, Chhabria S, Tu L, Stanford FC</i><br /><AbstractText>While the prevalence of obesity in US men and women is nearly equivalent, obesity management in women requires a different approach that considers age and life stage in development including sexual maturation/reproduction, menopause and post-menopause. In this review, the diagnosis and treatment of obesity using lifestyle modification, pharmacotherapy and metabolic and bariatric surgery are discussed from a women\'s health perspective, with emphasis on management during pregnancy and post-partum.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 27 Apr 2023; epub ahead of print</small></div>

<div><h4>Epicardial fat links obesity to cardiovascular diseases.</h4><i>Iacobellis G</i><br /><AbstractText>Patients with obesity have been historically associated with higher risk to develop cardiovascular diseases (CVD). However, regional, visceral, organ specific adiposity seems to play a stronger role in the development of those cardiovascular diseases than obesity by itself. Epicardial adipose tissue is the visceral fat depot of the heart with peculiar anatomy, regional differences, genetic profile and functions. Due to its unobstructed contiguity with heart and intense pro inflammatory and pro arrhythmogenic activities, epicardial fat is directly involved in major obesity-related CVD complications, such as coronary artery disease (CAD), atrial fibrillation (AF) and heart failure (HF). Current and developing imaging techniques can measure epicardial fat thickness, volume, density and inflammatory status for the prediction and stratification of the cardiovascular risk in both symptomatic and asymptomatic obese individuals. Pharmacological modulation of the epicardial fat with glucagon like peptide-1 receptor (GLP1R) analogs, sodium glucose transporter-2 inhibitors, and potentially dual (glucose-dependent insulinotropic polypeptide -GLP1R) agonists, can reduce epicardial fat mass, resume its original cardio-protective functions and therefore reduce the cardiovascular risk. Epicardial fat assessment is poised to change the traditional paradigm that links obesity to the heart.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 25 Apr 2023; epub ahead of print</small></div>

<div><h4>Cardiology and lifestyle medicine.</h4><i>Rozanski A, Blumenthal JA, Hinderliter AL, Cole S, Lavie C</i><br /><AbstractText>Poor lifestyle habits, such as physical inactivity and poor diets, are highly prevalent within society and even more so among patients with chronic disease. The need to stem poor lifestyle habits has led to the development of a new field of Lifestyle Medicine, whose mission is to prevent, treat, and even reverse chronic diseases through lifestyle interventions. Three fields within Cardiology relate to this mission: Cardiac Rehabilitation, Preventive Cardiology, and Behavioral Cardiology. Each of these three fields have contributed substantially to the reduction of cardiovascular disease (CVD) morbidity and mortality. The historic contributions of these three cardiac fields are reviewed as well as the challenges each of these fields has faced in optimizing the application of lifestyle medicine practices. A shared agenda between Cardiology and the American College of Lifestyle Medicine could further the utilization of behavioral interventions. This review suggests seven steps that could be shared by these organizations and other medical societies. First, there is a need to develop and promulgate the assessment of lifestyle factors as \"vital signs\" during patient visits. Second, developing a strong partnership between the fields of Cardiology and Physiatry could improve important aspects of cardiac care, including a potential redesign of cardiac stress testing. Third, behavioral evaluations should be optimized at patients\' entrée points into medical care since these may be considered \"windows of opportunity\". Fourth, there is a need to broaden cardiac rehabilitation into inexpensive programs and make this program eligible for patients with risk factors but no known CVD. Fifth, lifestyle medicine education should be integrated into the core competencies for relevant specialties. Sixth, there is a need for inter-societal advocacy to promote lifestyle medicine practices. Seventh, the well-being effects of healthy lifestyle behaviors, such as their impact on one\'s sense of vitality, should be emphasized.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 12 Apr 2023; epub ahead of print</small></div>

<div><h4>The pursuit of health: A vitality based perspective.</h4><i>Rozanski A</i><br /><AbstractText>The larger number of adults who enter their senior years with a high burden of chronic diseases has led to new metrics designed to promote health pro-activity, such as the calculation of one\'s \"healthspan\". These efforts call for re-evaluation as to what is meant by \"health\". A large body of epidemiologic and clinical investigation identifies that good health is shaped by specific health behaviors (aerobic exercise, resistance training, sleep, and good diet quality) and four psychological determinants (positive emotions, positive mindsets, purposeful living, and social connectivity). In common, each of these determinants produce \"vitality\", which can be defined as having the pleasing sensation of feeling energetic. Having a strong sense of vitality produces a sense of agency, provides resilience, and serves as a leading indicator of good health. Importantly, vitality can be assessed as a single item \"vital sign\" in clinical practice and can be promoted by recommending simple steps to patients, such as suggesting that they initiate walking or other aerobic activities. Because health habits and psychological determinants of health are inter-related, such simple steps can initiate a \"virtuous cycle\" of health improvement. An emphasis on vitality can also encourage patients to become more cognizant of their level of energy and manage it through health-promoting behaviors rather than quick fix behaviors. Finally, vitality assessment and prescription can promote more successful aging. In sum, an updated and more clinically useful definition of health recognizes that it is a dynamic entity that is influenced at any time by one\'s engagement in physical and psychological practices that promote health. Accordingly, an updated definition of health is proposed: good health is characterized by physical and psychological well-being and is associated with vitality.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 08 Apr 2023; epub ahead of print</small></div>

<div><h4>New principles, the benefits, and practices for fostering a physically active lifestyle.</h4><i>Rozanski A</i><br /><AbstractText>The modern environment has led to an increased risk and incidence of sedentary lifestyles. When physical activity (PA) becomes insufficient, pathophysiological pathways are invoked and the future risk for chronic diseases and premature mortality increases. As a consequence, since the 1970s governmental agencies and medical societies have published guidelines to promote PA. The 2018 Guidelines for Physical Activity for Americans contain important updated guidelines, but many of these guidelines are not yet sufficiently known by the public or health providers. In addition, to make use of these guidelines, they need to be integrated with optimal behavioral interventions. Accordingly, this narrative review critically assesses five tenets that stem from the 2018 Guidelines and illustrates how these tenets can be integrated with tools and techniques for motivating individuals to initiate and maintain a more physically active lifestyle. The first tenet indicates that there is no lower threshold of PA that must be obtained before health benefits begin to accrue. Second, it is no longer required that PA be obtained in bouts of 10 min or more to \"count\". Bouts of lesser duration also count. Pending further study, new accelerometry data suggest that vigorous intermittent PA of just 1-2 min may also benefit health, such as that acquired by stair climbing or carrying heavy groceries. This has led to a new concept of promoting \"lifestyle physical activity\". Third, excessive sitting is health damaging if it is not accompanied by sufficient daily life PA or accrues over long uninterrupted bouts. Fourth, it is essential to incorporate resistance exercises for optimal health and to promote successful aging. Fifth, a wealth of new evidence indicates that PA strongly protects and promotes all aspects of brain health and may improve cognition even after a single bout of exercise.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 06 Apr 2023; epub ahead of print</small></div>

<div><h4>The polypill strategy in cardiovascular disease prevention: It\'s time for its implementation.</h4><i>Di Fusco SA, Aquilani S, Spinelli A, Alonzo A, ... Imperoli G, Colivicchi F</i><br /><AbstractText>A polypill strategy has been demonstrated to improve treatment adherence in several cardiovascular disease (CVD) settings. However, data on the prognostic impact in the secondary prevention setting have been scarce. The Secondary Prevention of Cardiovascular Disease in the Elderly trial, the results of which have been recently published, has demonstrated a benefit in terms of major adverse CVD event reduction. This finding, in addition to previous evidence, should lead to a broader polypill implementation in CVD prevention.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 15 Mar 2023; epub ahead of print</small></div>

<div><h4>Assessment of lifestyle-related risk factors enhances the effectiveness of cardiac stress testing.</h4><i>Rozanski A, Sakul S, Narula J, Uretsky S, Lavie CJ, Berman D</i><br /><AbstractText>Cardiac stress tests have been widely utilized since the 1960s for the diagnostic and prognostic assessment of patients with suspected coronary artery disease (CAD). Clinical risk is primarily based on assessing the presence and magnitude of inducible myocardial ischemia. However, the primary factors driving mortality risk have changed over recent decades. Factors such as typical angina and inducible ischemia have decreased, whereas the percentage of patients with diabetes, obesity and hypertension have increased. There has also been a marked temporal increase in the percentage of patients who require pharmacologic testing due to inability to perform treadmill exercise at the time of cardiac stress testing and this need has emerged as the most potent predictor of mortality risk in contemporary stress test populations. However, the long-term clinical risk posed by the inability to perform exercise and concomitant CAD risk factors are rarely reflected in the assessment of patients\' prognostic risk in cardiac stress test reports. In this review, we suggest that the clinical utility of present-day cardiac stress testing can be improved by developing a more comprehensive assessment that integrates and reports all factors which modulate patients\' long-term clinical risk following stress testing. This should include assessment of patients\' CAD risk factors, physical activity habits and mobility risks, identification of the reasons why patients could not exercise at the time of cardiac stress testing. In addition, the assessment of four core non-aerobic functional parameters should be considered among patients who cannot exercise: assessment of gait speed, handgrip strength, lower extremity strength, and standing balance.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 15 Mar 2023; epub ahead of print</small></div>

<div><h4>Coronary artery calcium, hepatic steatosis, and atherosclerotic cardiovascular disease risk in patients with type 2 diabetes mellitus: Results from the Dallas heart study.</h4><i>Khawaja T, Linge J, Leinhard OD, Al-Kindi SG, ... Joshi P, Neeland IJ</i><br /><b>Introduction</b><br />Cardiovascular disease (CVD) risk amongst those with type 2 diabetes (T2D) is heterogenous. The role of imaging-based cardiometabolic biomarkers (e.g., coronary artery calcium [CAC] score, and hepatic triglyceride content [HTC]) in CVD risk stratification in T2D is unclear. To better understand this, we sought to evaluate the individual and joint associations between CAC and hepatic steatosis (HS) with clinical atherosclerotic CVD (ASCVD) in Dallas Heart Study (DHS) participants with and without T2D.<br /><b>Methods</b><br />We examined participants in the DHS, multi-ethnic cohort study, without self-reported ASCVD. CAC scoring was performed via computed tomography with the mean of two consecutive scores used. HTC was measured using magnetic resonance spectroscopy, and HS was defined as HTC >5.5% The primary outcome was incident ASCVD, defined as coronary heart disease (CHD; myocardial infarction, percutaneous coronary intervention, or coronary artery bypass graft surgery), ischemic stroke, transient ischemic attack, or CVD death. Cox regression analyses, and interaction testing was performed to evaluate the individual and joint associations between CAC and HS with ASCVD. The association between HS and coronary heart disease was validated in the UK Biobank (UKB).<br /><b>Results</b><br />A total of 1252 DHS participants were included with mean age 44.8 ± 9.3 years, mean body mass index 28.7 ± 5.9 kg/m<sup>2</sup>, 55% female, and 59% black with an overall prevalence of T2D of 9.7%. CAC scores were significantly higher (p < 0.01) and HS was significantly more prevalent in those with T2D (p < 0.01). Over a median of 12.3 years, 8.3% of participants experienced ASCVD events. The ASCVD event rate was significantly higher in participants with T2D (20.5% vs 7.0%, p < 0.01). Continuous CAC was associated with ASCVD events in the overall cohort regardless of T2D status with a significant interaction present between CAC and T2D status on ASCVD, P<sub>interaction</sub> = 0.02. HTC was not associated with ASCVD risk in participants without T2D but was inversely associated with risk in participants with T2D (HR 0.91, 95% CI 0.83-0.99 per 1% increase in HTC, p = 0.02), P<sub>interaction</sub> = 0.02. Amongst 37,266 UKB participants, 4.5% had T2D. CHD events occurred in 2.2% of participants, with 10.2% of events occurring amongst those with T2D. An inverse relationship between HTC and CHD was also found amongst those with T2D in UKB with a significant interaction between T2D status and HTC on CHD (HR per 1% increase in HTC 0.95, 95% CI 0.91-0.99, p = 0.01, P<sub>interaction</sub> = 0.02).<br /><b>Conclusions</b><br />In the DHS, we found that CAC was associated with ASCVD risk independent of T2D status. We did not observe an association between HTC and ASCVD in participants without T2D, but there was an inverse association between HTC and ASCVD in those with T2D that was replicated in the UKB cohort. Further investigation is warranted to understand the possible protective association of HS in participants with T2D.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 15 Mar 2023; epub ahead of print</small></div>

<div><h4>Bempedoic acid in the management of lipid disorders and cardiovascular risk. 2023 position paper of the international lipid expert panel (ILEP).</h4><i>Banach M, Penson PE, Farnier M, Fras Z, ... Vrablik M, Escobar C</i><br /><AbstractText>Cardiovascular disease (CVD) is a chronic non-communicable disease (NCD) and the predominant cause of morbidity and mortality worldwide. Substantial reductions in the CVD prevalence have been achieved in recent years by the attenuation of risk factors (particularly hypertension and dyslipidaemias) in primary and secondary prevention. Despite the remarkable success of lipid lowering treatments, and of statins in particular, in reducing the risk of CVD, there is still an unmet clinical need for the attainment of guideline lipid-targets in even 2/3 of patients. Bempedoic acid, the first in-class inhibitor of ATP-citrate lyase presents a new approach to lipid-lowering therapy. By reducing the endogenous production of cholesterol, upstream of the rate-limiting enzyme HMG-CoA-reductase, i.e., the target of statins, bempedoic acid reduces circulating plasma concentrations of low-density lipoprotein cholesterol (LDL-C), and major adverse CVD events (MACE). Bempedoic acid has the potential to contribute to the reduction of CVD risk not only as monotherapy, but even further as part of a lipid-lowering combination therapy with ezetimibe, reducing LDL-C cholesterol up to 40%. This position paper of the International Lipid Expert Panel (ILEP) summarises the recent evidence around the efficacy and safety of bempedoic acid and presents practical recommendations for its use, which complement the \'lower-is-better-for-longer\' approach to lipid management, which is applied across international guidelines for the management of CVD risk. Practical evidence-based guidance is provided relating to the use of bempedoic acid in atherosclerotic CVD, familial hypercholesterolaemia, and statin intolerance. Although there are currently no data available for the role of bempedoic acid in the primary prevention of CVD, its favourable effects on plasma glucose and inflammatory markers makes this drug a rational choice in the patient-centred care of specific groups of primary prevention.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 06 Mar 2023; epub ahead of print</small></div>

<div><h4>PCSK9 inhibitor, ezetimibe, and bempedoic acid: Evidence-based therapies for statin-intolerant patients.</h4><i>Gunta SP, O\'Keefe JH, O\'Keefe EL, Lavie CJ</i><br /><AbstractText>Statins are first-line therapy for treating dyslipidemia because of their low-density lipoprotein cholesterol (LDL-C) lowering efficacy, superior event-reduction data and unrivaled cost-effectiveness. Yet, many people are intolerant of statins, whether due to true adverse events or the nocebo effect, so within one year about two-thirds of primary prevention patients and one-third of secondary prevention patients are no longer taking their prescription. Statins still dominate this landscape, but other agents, often used in combination, potently reduce LDL-C levels, regress atherosclerosis and lower risk of major adverse cardiovascular events (MACE). Ezetimibe lowers LDL-C by reducing intestinal absorption of cholesterol. Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) lower LDL-C by increasing the number and durability of hepatic LDL receptors. Bempedoic acid reduces hepatic cholesterol synthesis. Ezetimibe, PCSK9i and bempedoic are evidence-based, non-statin therapies that synergistically lower LDL-C and reduce risk of MACE; they also have benign side-effect profiles and are generally well tolerated.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 03 Mar 2023; epub ahead of print</small></div>

<div><h4>Popular fad diets: An evidence-based perspective.</h4><i>Anderson K</i><br /><AbstractText>Despite the emergence of stronger nutritional science over the past two decades, fad diets remain highly popular. However, growing medical evidence has led to the endorsement of healthy eating patterns by medical societies. This thus allows fad diets to be compared to the emerging scientific evidence as to which diets promote or damage health. In this narrative review, the most popular current fad diets are critically analyzed, including low-fat diets, vegan and vegetarian diets, low-carbohydrate diets, ketogenic diets, Paleolithic diets, and intermittent fasting. Each of these diets has some scientific merit, but each has potential deficiencies relative to the findings of nutritional science. This article also presents the common themes that emerge among the dietary guidance of leading health organizations, such as the American Heart Association and the American College of Lifestyle Medicine. While there are important distinctions between dietary recommendations emanating from various medical societies, each recommends eating more unrefined, plant-based foods, while eating fewer highly processed foods and added sugars, and avoiding excessive calorie consumption as an important nutritional strategy for the prevention and management of chronic conditions and promotion of overall health.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>Prog Cardiovasc Dis: 03 Mar 2023; epub ahead of print</small></div>