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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, Tota-Maharaj, R, Cainzos-Achirica, M, Blaha, MJ
Progress in cardiovascular diseases. 2019;(5):423-430
Abstract
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.
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2.
Prospects for the Primary Prevention of Myocardial Infarction and Stroke.
Caldwell, M, Martinez, L, Foster, JG, Sherling, D, Hennekens, CH
Journal of cardiovascular pharmacology and therapeutics. 2019;(3):207-214
Abstract
Cardiovascular disease (CVD), principally myocardial infarction (MI) and stroke, is the leading clinical and public health problem in the United States and is rapidly becoming so worldwide. Their primary prevention is promising, in theory, but difficult to achieve in practice. The principal modalities that have demonstrated efficacy include therapeutic lifestyle changes (TLCs) and adjunctive drug therapies under the guidance of the health-care provider and tailored to the individual patient. The prevention and treatment of the pandemic of overweight and obesity and lack of regular physical activity, both of which are alarmingly common in the United States, prevention and treatment of hypertension, avoidance and cessation of cigarette smoking, adoption and maintenance of a healthy diet, and avoidance of heavy alcohol consumption all have proven benefits in decreasing the risks of a first MI and stroke as well as other clinical manifestations of CVD. Although adoption of TLCs would avoid the need for adjunctive drug therapies in many primary prevention subjects, this strategy is difficult to achieve or maintain for most and may be insufficient for many, especially those at high risk with metabolic syndrome. The criteria for metabolic syndrome, affecting over 40% of the adult population older than 40 in the United States, include overweight or obesity, dyslipidemia, hypertension, and insulin resistance, a precursor of diabetes. The adjunctive therapies of proven benefit in the primary prevention of MI and stroke include statins, blood pressure medications, aspirin, and drugs to treat insulin resistance and hyperglycemia. Fortunately, even for patients who prefer prescription of pills to proscription of harmful lifestyles, these drug therapies still have net benefits. The adoption and maintenance of TLCs and adjunctive drug therapies into clinical practice will reduce both the incidence of and mortality from a first MI and stroke as well as other major clinical manifestations of CVD.
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3.
Fasting or Nonfasting Lipid Measurements: It Depends on the Question.
Driver, SL, Martin, SS, Gluckman, TJ, Clary, JM, Blumenthal, RS, Stone, NJ
Journal of the American College of Cardiology. 2016;(10):1227-1234
Abstract
In the 2013 American College of Cardiology (ACC)/American Heart Association Guideline (AHA) on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, low-density lipoprotein cholesterol treatment thresholds have been replaced with a focus on global risk. In this context, we re-examine the need for fasting lipid measurements in various clinical scenarios including estimating initial risk for atherosclerotic cardiovascular disease in a primary prevention patient; screening for familial lipid disorders in a patient with a strong family history of premature atherosclerotic cardiovascular disease or genetic dyslipidemia; clarifying a diagnosis of metabolic syndrome so it can be used to make lifestyle counseling more effective; assessing residual risk in a treated patient; diagnosing and treating patients with suspected hypertriglyceridemic pancreatitis; or diagnosing hypertriglyceridemia in patients who require therapy for other conditions that may further elevate triglycerides. Posing a specific question can aid the clinician in understanding when fasting lipids are needed and when nonfasting lipids are adequate.
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Impact of a community based health-promotion programme in 2- to 9-year-old children in Europe on markers of the metabolic syndrome, the IDEFICS study.
Mårild, S, Russo, P, Veidebaum, T, Tornaritis, M, De Henauw, S, De Bourdeaudhuij, I, Molnár, D, Moreno, LA, Bramsved, R, Peplies, J, et al
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2015;:41-56
Abstract
INTRODUCTION One objective of 'Identification and prevention of Dietary-and lifestyle-induced health EFfects In Children and infantS', the IDEFICS study, was to implement a community-oriented childhood obesity prevention intervention in eight European countries. OBJECTIVE To assess the effect of an obesity primary prevention programme on metabolic markers. METHODS The study had a non-randomized cluster-experimental design. In each country, children were recruited from distinct communities serving as intervention and control regions. Health examinations were done during 2007-2008 before the intervention (T0 ) and during 2009-2010 (T1 ). Children with results available from T0 and T1 on blood pressure, waist circumference and at least one blood-marker (fasting glucose, insulin, HOMA-IR, HbA1c, HDL- and LDL-cholesterol, triglycerides, C-reactive protein) were included. A metabolic syndrome (MetS) score was calculated. RESULTS A total of 7,406 children (age 2-9.9 years) of the 16,228 participating at T0 provided the necessary data. No effect of the intervention was seen on insulin, HOMA-IR, CRP or the MetS score. Overall fasting glucose increased less in the intervention than in the control region, a pattern driven by three of the eight countries and more pronounced in children of parents with low education. Overall, HbA1c and waist circumference increased more and blood pressure less in the intervention regions. CONCLUSION We observed no convincing effect of the intervention on markers of the metabolic syndrome. We identified diverse patterns of change for several markers of uncertain relation to the intervention.
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Nutraceuticals: Definition and Epidemiological Rationale for Their Use in Clinical Practice.
Volpe, R, Sotis, G
High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension. 2015;(3):199-201
Abstract
Cardiometabolic risk factors, such as hypercholesterolemia, hypertriglyceridemia, metabolic syndrome, diabetes, and arterial hypertension, are major predictors of the premature development of cardiovascular diseases (CVD). Since CVD prevention needs a life-course approach, beyond dietary and pharmacological treatment, non-pharmacological treatment should be considered an important alternative for patients in primary prevention with mild-moderate cardiometabolic risk factors at low-moderate global risk of CVD. Several functional foods and nutraceuticals are efficacious, safe and well tolerated. However, only some (monacolins of red yeast rice and omega-3 fatty acids) have showed, in long-term randomized clinical trials, a reduction of cardiovascular events.
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[The beneficial effects of protein and calcium from dairy products of the symptoms of metabolic syndrome].
Giszczak, N, Okręglicka, K
Wiadomosci lekarskie (Warsaw, Poland : 1960). 2014;(1):39-44
Abstract
Metabolic syndrome is the name for a group of risk factors that occur together and increase the risk for atherogenic dyslipidemia, impaired glucose tolerance, central obesity and hypertension. It is the most important cause of the development of cardiovascular diseases and diabetes type II. In the last few years studies have focused on the influence of the nutrient components of the disease, especially calcium and protein intake from dairy products. Studies have shown that varying degrees, and the mechanism may favourably affect the risk factors, but most of them do not take into consideration people with the full symptoms of the metabolic syndrome. Dairy products may play an important role in the prevention and mitigation components of the metabolic syndrome. It is not clear which ingredients of the food groups may be responsible for the positive health effects, and the possible mechanism for their actions.
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7.
Gestational diabetes mellitus and cardiovascular risk after pregnancy.
Harreiter, J, Dovjak, G, Kautzky-Willer, A
Women's health (London, England). 2014;(1):91-108
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Abstract
Gestational diabetes mellitus (GDM) affects many women in pregnancy and is enhanced by epidemic conditions of obesity, increasing age at the time of the first pregnancy, stressful life conditions, a sedentary lifestyle with less physical activity and unhealthy nutrition with highly processed, high-calorie food intake. GDM does not affect the mother and offspring in pregnancy alone, as there is compelling evidence of the long-term effects of the hyperglycemic state in pregnancy postpartum. Type 2 diabetes mellitus, cardiovascular disease and metabolic syndrome are more common in GDM women, and even the offspring of GDM women are reported to have higher obesity rates and a higher risk for noncommunicable diseases. Early prevention of risk factors seems to be key to overcoming the vicious cycle of cardiometabolic disease onset.
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Obesity, metabolic syndrome and diabetes mellitus after renal transplantation: prevention and treatment.
Wissing, KM, Pipeleers, L
Transplantation reviews (Orlando, Fla.). 2014;(2):37-46
Abstract
The prevalence of the metabolic syndrome in dialysis patients is high and further increases after transplantation due to weight gain and the detrimental metabolic effects of immunosuppressive drugs. Corticosteroids cause insulin resistance, hyperlipidemia, abnormal glucose metabolism and arterial hypertension. The calcineurin inhibitor tacrolimus is diabetogenic by inhibiting insulin secretion, whereas cyclosporine causes hypertension and increases cholesterol levels. Mtor antagonists are responsible for hyperlipidemia and abnormal glucose metabolism by mechanisms that also implicate insulin resistance. The metabolic syndrome in transplant recipients has numerous detrimental effects such as increasing the risk of new onset diabetes, cardiovascular disease events and patient death. In addition, it has also been linked with accelerated loss of graft function, proteinuria and ultimately graft loss. Prevention and management of the metabolic syndrome are based on increasing physical activity, promotion of weight loss and control of cardiovascular risk factors. Bariatric surgery before or after renal transplantation in patients with body mass index >35 kg/m(2) is an option but its long term effects on graft and patient survival have not been investigated. Steroid withdrawal and replacement of tacrolimus with cyclosporine facilitate control of diabetes, whereas replacement of cyclosporine and mtor antagonists can improve hyperlipidemia. The new costimulation inhibitor belatacept has potent immunosuppressive properties without metabolic adverse effects and will be an important component of immunosuppressive regimens with better metabolic risk profile. Medical treatment of cardiovascular risk factors has to take potential drug interactions with immunosuppressive medication and drug accumulation due to renal insufficiency into account.
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Atrial fibrillation in the 21st century: a current understanding of risk factors and primary prevention strategies.
Menezes, AR, Lavie, CJ, DiNicolantonio, JJ, O'Keefe, J, Morin, DP, Khatib, S, Milani, RV
Mayo Clinic proceedings. 2013;(4):394-409
Abstract
Atrial fibrillation (AF) is the most common arrhythmia worldwide, and it has a significant effect on morbidity and mortality. It is a significant risk factor for stroke and peripheral embolization, and it has an effect on cardiac function. Despite widespread interest and extensive research on this topic, our understanding of the etiology and pathogenesis of this disease process is still incomplete. As a result, there are no set primary preventive strategies in place apart from general cardiology risk factor prevention goals. It seems intuitive that a better understanding of the risk factors for AF would better prepare medical professionals to initially prevent or subsequently treat these patients. In this article, we discuss widely established risk factors for AF and explore newer risk factors currently being investigated that may have implications in the primary prevention of AF. For this review, we conducted a search of PubMed and used the following search terms (or a combination of terms): atrial fibrillation, metabolic syndrome, obesity, dyslipidemia, hypertension, type 2 diabetes mellitus, omega-3 fatty acids, vitamin D, exercise toxicity, alcohol abuse, and treatment. We also used additional articles that were identified from the bibliographies of the retrieved articles to examine the published evidence for the risk factors of AF.
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A novel approach to cardiovascular health by optimizing risk management (ANCHOR): behavioural modification in primary care effectively reduces global risk.
Cox, JL, Vallis, TM, Pfammatter, A, Szpilfogel, C, Carr, B, O'Neill, BJ
The Canadian journal of cardiology. 2013;(11):1400-7
Abstract
BACKGROUND Primary care is well positioned to facilitate cardiovascular risk improvement and reduce future cardiovascular disease (CVD) burden. METHODS The efficacy of risk factor screening, behavioural counselling, and pharmacological treatment to lower CVD risk was assessed via a prospective pre- and postintervention health risk assessment, individualized intervention with behaviour modification, risk factor treatment, and linkage to community programs, with 1-year follow-up and final health risk assessment. Primary outcome was the proportion of subjects with moderate and high baseline Framingham Risk Score (FRS) reducing their risk by 10% and 25%, respectively; the secondary end point was the proportion dropping ≥ 1 risk category. RESULTS Patients were enrolled (N = 1509) from March 2006 through October 2008 and 72% completed the study. This analysis focuses on 563 subjects with moderate or high baseline FRS, and excluded 325 low-risk patients and 205 with established CVD or diabetes mellitus. Median age was 56 years, 57.7% were female. The primary outcome was achieved in 31.8% (N = 112; 95% confidence interval [CI], 26.9%-36.6%) of moderate risk FRS participants and 47.9% (N = 101; 95% CI, 41.2%-54.6%) of high-risk participants. The secondary outcome was achieved by 37.2% (N = 210; 95% CI, 33.2%-41.2%). Prevalence of metabolic syndrome fell from 79.2% (N = 446; 95% CI, 75.9%-82.6%) at entry to 52.8% (N = 303; 95% CI, 48.7%-56.9%) at study end. Significant improvements in all modifiable risk factors occurred through lifestyle modification. CONCLUSIONS Global cardiovascular risk can be effectively decreased via lifestyle changes informed by readiness to change assessment and individualized counselling targeting specific behaviours. TRIAL REGISTRATION ClinicalTrials.gov number NCT01620996.