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Lipoprotein(a): An independent, genetic, and causal factor for cardiovascular disease and acute myocardial infarction.
Enas, EA, Varkey, B, Dharmarajan, TS, Pare, G, Bahl, VK
Indian heart journal. 2019;(2):99-112
Abstract
Lipoprotein(a) [Lp(a)] is a circulating lipoprotein, and its level is largely determined by variation in the Lp(a) gene (LPA) locus encoding apo(a). Genetic variation in the LPA gene that increases Lp(a) level also increases coronary artery disease (CAD) risk, suggesting that Lp(a) is a causal factor for CAD risk. Lp(a) is the preferential lipoprotein carrier for oxidized phospholipids (OxPL), a proatherogenic and proinflammatory biomarker. Lp(a) adversely affects endothelial function, inflammation, oxidative stress, fibrinolysis, and plaque stability, leading to accelerated atherothrombosis and premature CAD. The INTER-HEART Study has established the usefulness of Lp(a) in assessing the risk of acute myocardial infarction in ethnically diverse populations with South Asians having the highest risk and population attributable risk. The 2018 Cholesterol Clinical Practice Guideline have recognized elevated Lp(a) as an atherosclerotic cardiovascular disease risk enhancer for initiating or intensifying statin therapy.
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2.
Pregnancy As a Predictor of Maternal Cardiovascular Disease: The Era of CardioObstetrics.
Wu, P, Mamas, MA, Gulati, M
Journal of women's health (2002). 2019;(8):1037-1050
Abstract
Globally, cardiovascular disease (CVD) is the most common cause of mortality in women accounting for one in three deaths. There remains an under recognition of CVD as well as a lack of awareness of risk in women. Promotion of CVD prevention is essential, but the current risk assessment tools do not incorporate any sex-specific cardiovascular risk factors. There is increasing recognition of sex-specific risk factors that appear during pregnancy that are associated with CVD. These adverse pregnancy outcomes (APOs) include preeclampsia, gestational hypertension, preterm birth, gestational diabetes, delivery of a small-for-gestational-age infant, miscarriage, and high parity number. Although the underlying biological mechanism for these association remains to be elucidated, current international guidelines are beginning to recommend the inclusion of APOs in the assessment of CVD risk in women. This review summarizes the evidence for the association between APOs and future CVD. It also highlights the importance of considering APOs in the cardiovascular risk assessment, specifically in young women, allowing for targeted lifestyle-modifying interventions with the potential to alter their risk trajectory and improve their long-term cardiovascular health.
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3.
Implications of Cardio-Respiratory Fitness on the Performance of Exercise Tests.
Jelinek, M, Hossack, K
Heart, lung & circulation. 2019;(4):e64-e66
Abstract
In 2016, the American Heart Association (AHA) produced a position paper on cardiorespiratory fitness (CRF) which defined CRF as the most important cardiac risk factor in the assessment of prognosis in a wide variety of clinical states [1]. The aim of the paper was to improve patient management and to encourage life-style based strategies designed to improve cardiovascular risk. The authors showed that: In this Brief Communication, we expand on how CRF can be assessed and reported in exercise testing.
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4.
Lipid Management for the Prevention of Atherosclerotic Cardiovascular Disease.
Michos, ED, McEvoy, JW, Blumenthal, RS
The New England journal of medicine. 2019;(16):1557-1567
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5.
The Impact of Obesity on the Association between Vitamin D Deficiency and Cardiovascular Disease.
Paschou, SA, Kosmopoulos, M, Nikas, IP, Spartalis, M, Kassi, E, Goulis, DG, Lambrinoudaki, I, Siasos, G
Nutrients. 2019;(10)
Abstract
The aim of this article is to review the literature regarding the relationship between vitamin D deficiency and cardiovascular disease (CVD) and its modification in the presence of obesity. Despite the strong association between vitamin D status and cardiovascular outcomes, vitamin D supplementation trials in the general population have failed to decrease the incidence of cardiovascular events and mortality. A comprehensive study of the published literature and a comparison with experimental data lead to the conclusion that obesity, due to its high prevalence and strong association with both vitamin D deficiency and CVD, may act as a critical confounder, which is responsible for the different results on this association. Adoption of a vitamin D preventive supplementation strategy for CVD is unlikely to yield any benefit to the general population. However, it might be particularly useful in obese adults with increased risk for CVD.
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6.
Intestinal Microbiota in Cardiovascular Health and Disease: JACC State-of-the-Art Review.
Tang, WHW, Bäckhed, F, Landmesser, U, Hazen, SL
Journal of the American College of Cardiology. 2019;(16):2089-2105
Abstract
Despite major strides in reducing cardiovascular disease (CVD) burden with modification of classic CVD risk factors, significant residual risks remain. Recent discoveries that linked intestinal microbiota and CVD have broadened our understanding of how dietary nutrients may affect cardiovascular health and disease. Although next-generation sequencing techniques can identify gut microbial community participants and provide insights into microbial composition shifts in response to physiological responses and dietary exposures, provisions of prebiotics or probiotics have yet to show therapeutic benefit for CVD. Our evolving understanding of intestinal microbiota-derived physiological modulators (e.g., short-chain fatty acids) and pathogenic mediators (e.g., trimethylamine N-oxide) of host disease susceptibility have created novel potential therapeutic opportunities for improved cardiovascular health. This review discusses the roles of human intestinal microbiota in normal physiology, their associations with CVD susceptibilities, and the potential of modulating intestinal microbiota composition and metabolism as a novel therapeutic target for CVD.
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7.
Diabetes as a cardiovascular risk factor: An overview of global trends of macro and micro vascular complications.
Dal Canto, E, Ceriello, A, Rydén, L, Ferrini, M, Hansen, TB, Schnell, O, Standl, E, Beulens, JW
European journal of preventive cardiology. 2019;(2_suppl):25-32
Abstract
The global prevalence of diabetes is predicted to increase dramatically in the coming decades as the population grows and ages, in parallel with the rising burden of overweight and obesity, in both developed and developing countries. Cardiovascular disease represents the principal cause of death and morbidity among people with diabetes, especially in those with type 2 diabetes mellitus. Adults with diabetes have 2-4 times increased cardiovascular risk compared with adults without diabetes, and the risk rises with worsening glycaemic control. Diabetes has been associated with 75% increase in mortality rate in adults, and cardiovascular disease accounts for a large part of the excess mortality. Diabetes-related macrovascular and microvascular complications, including coronary heart disease, cerebrovascular disease, heart failure, peripheral vascular disease, chronic renal disease, diabetic retinopathy and cardiovascular autonomic neuropathy are responsible for the impaired quality of life, disability and premature death associated with diabetes. Given the substantial clinical impact of diabetes as a cardiovascular risk factor, there has been a growing focus on diabetes-related complications. While some population-based studies suggest that the epidemiology of such complications is changing and that rates of all-cause and cardiovascular mortality among individuals with diabetes are decreasing in high-income countries, the economic and social burden of diabetes is expected to rise due to changing demographics and lifestyle especially in middle- and low-income countries. In this review we outline data from population-based studies on recent and long-term trends in diabetes-related complications.
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8.
[Obstructive sleep apnoea].
Thoonsen, H, van der Zeijden, J, Hoogeboom, PN, Copper, MP, Schure, PJCM, Teunissen, LL
Nederlands tijdschrift voor geneeskunde. 2019
Abstract
Obstructive sleep apnoea Obstructive sleep apnoea (OSA) is a complex condition with many different phenotypes. Historically, OSA has been defined using the apnoea-hypopnoea index (AHI). However, because there is no clear relationship between the AHI and the severity of symptoms and comorbidities the degree of hypoxia is increasingly being used to define OSA severity. To reach a diagnosis of obstructive sleep apnoea syndrome (OSAS), it has to be shown that symptoms improve with therapy. The treatment of first choice for patients with severe OSA is continuous positive airway pressure (CPAP) therapy. The indication for other therapies depends upon the patient's characteristics and preferences. Treatment with a position trainer and implantation of a hypoglossal nerve stimulator are relatively new therapies. OSA is a cardiovascular risk factor, but the effect of OSA treatment on cardiovascular outcome measures and mortality has not been shown in clinical trials.
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9.
Meta-analysis of the Relation of Television-Viewing Time and Cardiovascular Disease.
Takagi, H, Hari, Y, Nakashima, K, Kuno, T, Ando, T, ,
The American journal of cardiology. 2019;(11):1674-1683
Abstract
To determine whether television (TV) viewing is associated with cardiovascular disease (CVD) risk, we performed a meta-analysis of currently available prospective cohort studies. We systematically searched PubMed and Web of Science through April 2019. Eligible for inclusion in the present meta-analysis was a prospective cohort study investigating the association of TV viewing time with CVD risk (CVD prevalence, CVD incidence, cardiovascular events, and cardiovascular mortality). From each study, adjusted hazard ratios (HRs) of CVD risk were extracted. We separately combined study-specific estimates for dichotomous, tertile, quartile, and continuous values of TV viewing time in the random-effects model. The pooled analysis for dichotomous time demonstrated that CVD risk was significantly higher in the longer than shorter viewing (HR 1.28; p = 0.02). In the meta-analysis for tertile time, CVD risk was significantly higher in the longest than shortest tertile (T1) (HR 1.26; p = 0.0006), but there was no significant difference between the middle tertile and T1 (p = 0.51). The meta-analysis for quartile time indicated that CVD risk was significantly higher in the longest than shortest quartile (Q1) (HR 1.32; p = 0.0007), but there were no significant differences between the second longest quartile and Q1 (p = 0.12) and between the second shortest quartile and Q1 (p = 0.60). In the meta-analysis for continuous time, longer viewing was significantly associated with higher CVD risk (HR per 1-h/day increment; 1.06; p = 0.005). In conclusion, longer TV viewing time is significantly associated with higher CVD risk.
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10.
Cholesterol screening and statin use in children: a literature review.
King, K, Macken, A, Blake, O, O'Gorman, CS
Irish journal of medical science. 2019;(1):179-188
Abstract
Atherosclerosis begins in childhood. Fatty streaks, the earliest precursor of atherosclerotic lesions, have been found in the coronary arteries of children of 2 years of age. Hypercholesterolaemia is a risk factor for coronary artery disease. Hypercholesterolaemia can be either primary, when it is characteristic of the main disease, or secondary when it occurs as a result of either a disease process or drug treatment. Given the risk of vascular disease, including myocardial infarction (MI), cerebrovascular accidents (CVA, also known as strokes), peripheral vascular disease (PVD) and ruptured aortic aneurysm, which may follow atherosclerosis, it is important to prevent or slow the early development of atherosclerotic lesions. This prevention necessitates the control of key risk factors such hypercholesterolaemia, dyslipidaemia, hypertension etc. However, at what point this prevention ought to occur, and in what form, is uncertain. Using pharmacological primary prevention for hypercholesterolaemia in the paediatric population is controversial. In an adult patient, hypercholesterolaemia warrants the initiation of a statin. Statins, also known as hydroxymethylglutaryl co-enzyme A inhibitors (or HMG-CoA inhibitors) act by altering cholesterol metabolism. In the paediatric population, the clinical course of vascular disease and the effect of altering this clinical course are less certain. This article reviews the published literature on hypercholesterolaemia in children and the use of statins as a treatment for dyslipidaemia in children. The US National Cholesterol Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents 2012 guidelines (NCEP guidelines) regarding the recognition and treatment of childhood dyslipidaemia are reviewed.