1.
The role of physical activity in individuals with cardiovascular risk factors: an opinion paper from Italian Society of Cardiology-Emilia Romagna-Marche and SIC-Sport.
Nasi, M, Patrizi, G, Pizzi, C, Landolfo, M, Boriani, G, Dei Cas, A, Cicero, AFG, Fogacci, F, Rapezzi, C, Sisca, G, et al
Journal of cardiovascular medicine (Hagerstown, Md.). 2019;(10):631-639
Abstract
: Regular physical activity is a cornerstone in the prevention and treatment of atherosclerotic cardiovascular disease (CVD) due to its positive effects in reducing several cardiovascular risk factors. Current guidelines on CVD suggest for healthy adults to perform at least 150 min/week of moderate intensity or 75 min/week of vigorous intensity aerobic physical activity. The current review explores the effects of physical activity on some risk factors, specifically: diabetes, dyslipidemia, hypertension and hyperuricemia. Physical activity induces an improvement in insulin sensitivity and in glucose control independently of weight loss, which may further contribute to ameliorate both diabetes-associated defects. The benefits of adherence to physical activity have recently proven to extend beyond surrogate markers of metabolic syndrome and diabetes by reducing hard endpoints such as mortality. In recent years, obesity has greatly increased in all countries. Weight losses in these patients have been associated with improvements in many cardiometabolic risk factors. Strategies against obesity included caloric restriction, however greater results have been obtained with association of diet and physical activity. Similarly, the beneficial effect of training on blood pressure via its action on sympathetic activity and on other factors such as improvement of endothelial function and reduction of oxidative stress can have played a role in preventing hypertension development in active subjects. The main international guidelines on prevention of CVD suggest to encourage and to increase physical activity to improve lipid pattern, hypertension and others cardiovascular risk factor. An active action is required to the National Society of Cardiology together with the Italian Society of Sports Cardiology to improve the prescription of organized physical activity in patients with CVD and/or cardiovascular risk factors.
2.
Antithrombotic therapy management of adult and pediatric cardiac surgery patients.
Baumann Kreuziger, L, Karkouti, K, Tweddell, J, Massicotte, MP
Journal of thrombosis and haemostasis : JTH. 2018;(11):2133-2146
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Abstract
Despite the development of catheter-based interventions for ischemic and valvular heart disease, hundreds of thousands of people undergo open heart surgery annually for coronary artery bypass graft (CABG), valve replacement or cardiac assist device implantation. Cardiac surgery patients are unique because therapeutic anticoagulation is required during cardiopulmonary bypass. Developmental hemostasis and altered drug metabolism affect management in children. This narrative review summarizes the current evidence-based and consensus guidelines regarding perioperative, intraoperative and postoperative antithrombotic therapy in patients undergoing cardiac surgery. Anticoagulation preoperatively is required in the setting of cardiac arrhythmias, prior valve replacement or history of venous thromboembolism. In patients with ischemic heart disease, aspirin is continued in the perioperative period, whereas oral P2Y12 antagonists are withheld for 5-7 days to reduce the risk of perioperative bleeding. Intraoperative management of cardiopulmonary bypass in adults and children includes anticoagulation with unfractionated heparin. Variability in dose-response to heparin and influence of other medical conditions on dosing and reversal of heparin make intraoperative anticoagulation challenging. Vitamin K antagonist therapy is the standard anticoagulant after mechanical heart valve or left ventricular assist device (LVAD) implantation. Longer duration of dual antiplatelet therapy is recommended after CABG if patients undergo surgery because of acute coronary syndrome. Antiplatelet therapy after LVAD implantation includes aspirin, dipyridamole and/or clopidogrel in children and aspirin in adults. A coordinated approach between hematology, cardiology, anesthesiology, critical care and cardiothoracic surgery can assist to balance the risk of thrombosis and bleeding in patients undergoing cardiac surgery.
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[Metabolic syndrome from the point of view of a cardiologist: diagnosis, non drug and drug treatment].
Makolkin, VI, Podzolkov, VI, Napalkov, DA
Kardiologiia. 2002;(12):91-7
Abstract
Timely diagnosis and treatment of metabolic syndrome is important because of high prevalence of this pathology in population. For the elaboration of approaches to complex treatment of this syndrome it is necessary to understand pathogenetic mechanisms of development of hypertension and metabolic changes as well as acquire an array of non drug and drug methods of influence on elevated blood pressure and disordered carbohydrate, lipid and purine metabolism. Phenylalkylamine calcium antagonists should be used as drugs of choice for treatment of hypertension. These agents exert slowing of heart rate, coronarolytic and antiatherogenic effects, the latter being especially important in this group of patients. Resistance of hypertension to treatment developing on the background of insulin resistance of peripheral tissues dictates necessity of the use of combinations of antihypertensive drugs with consideration of their metabolic effects. For correction of metabolic changes metformin is used in addition to non drug methods which include diet and exercise. Treatment with metformin allows to decrease insulin resistance and thus severity of derangements of metabolism.