-
1.
Physical activity and CVD in older adults: an expert's perspective.
Orkaby, AR, Forman, DE
Expert review of cardiovascular therapy. 2018;(1):1-10
Abstract
The benefits of physical activity have long been recognized as powerful preventive opportunities for both prevention of cardiovascular disease and aging-related morbidity. However, physical activity remains under-prescribed and under-utilized. Areas covered: In this narrative review, the authors focus on physical activity as a modifiable lifestyle factor that can modify aging processes as well as cardiovascular pathophysiology that is often exacerbated by aging. Specific recommendations are provided for physical activity over the range of typical older individuals, spanning from those who are sedentary and frail to those who are active and robust. Expert commentary: Physical activity is a critically underused preventive strategy that can prevent cardiovascular disease and mitigate some of the physiological changes that occur with aging. Identifying activities that are accessible and enjoyable, while considering issues of safety, are key to developing an individualized exercise prescription for all older adults.
-
2.
Evaluation of the Pooled Cohort Risk Equations for Cardiovascular Risk Prediction in a Multiethnic Cohort From the Women's Health Initiative.
Mora, S, Wenger, NK, Cook, NR, Liu, J, Howard, BV, Limacher, MC, Liu, S, Margolis, KL, Martin, LW, Paynter, NP, et al
JAMA internal medicine. 2018;(9):1231-1240
-
-
Free full text
-
Abstract
IMPORTANCE Atherosclerotic cardiovascular disease (ASCVD) kills approximately 1 in every 3 US women. Current cholesterol, hypertension, and aspirin guidelines recommend calculating 10-year risk of ASCVD using the 2013 Pooled Cohort Equations (PCE). However, numerous studies have reported apparent overestimation of risk with the PCE, and reasons for overestimation are unclear. OBJECTIVE We evaluated the predictive accuracy of the PCE in the Women's Health Initiative (WHI), a multiethnic cohort of contemporary US postmenopausal women. We evaluated the effects of time-varying treatments such as aspirin and statins, and ascertainment of additional ASCVD events by linkage with the Centers for Medicare and Medicaid Services (CMS) claims. DESIGN, SETTING, AND PARTICIPANTS The WHI recruited the largest number of US women (n = 161 808) with the racial/ethnic, geographic, and age diversity of the general population (1993-1998). For this study, we included women aged 50 to 79 (n = 19 995) participating in the WHI with data on the risk equation variables at baseline and who met the guideline inclusion and exclusion criteria. Median follow-up was 10 years. MAIN OUTCOMES AND MEASURES For this study, ASCVD was defined as myocardial infarction, stroke, or cardiovascular death. RESULTS Among the 19 995 women (mean [SD] age, 64 [7.3] years; 8305 [41.5%] white, 7688 [38.5%] black, 3491 [17.5%] Hispanic, 103 [0.5%] American Indian, 321 [1.6%] Asian/Pacific Islander, and 87 [0.4%] other/unknown), a total of 1236 ASCVD events occurred in 10 years and were adjudicated through medical record review by WHI investigators. The WHI-adjudicated observed risks were lower than predicted. The observed (predicted) risks for baseline 10-year risk categories less than 5%, 5% to less than 7.5%, 7.5% to less than 10%, and 10% or more were 1.7 (2.8), 4.4 (6.2), 5.3 (8.7), and 12.4 (18.2), respectively. Small changes were noted after adjusting for time-dependent changes in statin and aspirin use. Among women 65 years or older enrolled in Medicare, WHI-adjudicated risks were also lower than predicted, but observed (predicted) risks became aligned after including events ascertained by linkage with CMS for additional surveillance for events: 3.8 (4.3), 7.1 (6.4), 8.3 (8.7), and 18.9 (18.7), respectively. Similar results were seen across ethnic/racial groups. Overall, the equations discriminated risk well (C statistic, 0.726; 95% CI, 0.714-0.738). CONCLUSIONS AND RELEVANCE Without including surveillance for ASCVD events using CMS, observed risks in the WHI were lower than predicted by PCE as noted in several other US cohorts, but risks were better aligned after including CMS events. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00000611.
-
3.
Effect of statins and non-statin LDL-lowering medications on cardiovascular outcomes in secondary prevention: a meta-analysis of randomized trials.
Koskinas, KC, Siontis, GCM, Piccolo, R, Mavridis, D, Räber, L, Mach, F, Windecker, S
European heart journal. 2018;(14):1172-1180
-
-
Free full text
-
Abstract
AIMS: Current evidence on dyslipidaemia management has expanded to novel treatments and very low achieved levels of low-density lipoprotein cholesterol (LDL-C). We sought to compare the clinical impact of more-intensive vs. less-intensive LDL-C lowering by means of statins and currently recommended non-statin medications in secondary prevention. METHODS AND RESULTS We searched Medline, EMBASE, and Cochrane databases for randomized controlled trials of statins, ezetimibe, proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors, or bile acid sequestrants with >500 patients followed for ≥1 year. We employed random-effects models using risk ratios (RRs) with 95% confidence intervals (CIs) to compare outcomes. We included 19 trials (15 of statins, 3 of PCSK9 inhibitors, and 1 of ezetimibe) with 152 507 patients randomly assigned to more-intensive (n = 76 678) or less-intensive treatment (n = 75 829). More-intensive treatment was associated with 19% relative risk reduction for the primary outcome, major vascular events (MVEs; RR 0.81, 95% CI 0.77-0.86). Risk reduction was greater across higher baseline levels and greater achieved reductions of LDL-C. The clinical benefit was significant across varying types of more-intensive treatment and was consistent for statins (RR 0.81, 95% CI 0.76-0.86) and non-statin agents (PCSK9 inhibitors and ezetimibe; RR 0.85, 95% CI 0.77-0.94) as active (more-intensive) intervention (P-interaction = 0.38). Each 1.0 mmol/L reduction in LDL-C was associated with 19% relative decrease in MVE. Death, cardiovascular death, myocardial infarction, stroke, and coronary revascularization also favoured more-intensive treatment. CONCLUSION Reduction of MVE is proportional to the magnitude of LDL-C lowering across a broad spectrum of on-treatment levels in secondary prevention. Statin intensification and add-on treatment with PCSK9 inhibitors or ezetimibe are associated with significant reduction of cardiovascular morbidity in this very high-risk population.
-
4.
PCSK9 inhibitors: a non-statin cholesterol-lowering treatment option.
Pokrywka, GS
Postgraduate medicine. 2018;(3):287-298
Abstract
Elevated low-density lipoprotein cholesterol (LDL-C) plays a major role in the development of atherosclerotic cardiovascular disease. Statins are the first-line treatment to lower LDL-C in patients with hypercholesterolemia; however, some high cardiovascular risk patients may have inadequate responses to statin therapy or are intolerant to statins, and may need additional and/or alternative non-statin therapies to further reduce their LDL-C levels. Monoclonal antibodies that inhibit proprotein convertase subtilisin/kexin type 9 (PCSK9), a key regulator of circulating LDL-C levels, have received considerable attention as promising non-statin therapeutic options for the management of hypercholesterolemia. This review provides a brief overview of the history and science of PCSK9 inhibitors, focusing on two PCSK9 monoclonal antibodies that have been approved by the US Food and Drug Administration: alirocumab and evolocumab. Recently released and forthcoming clinical trial data will be discussed, as well as the practical application of patient populations that may benefit from PCSK9 inhibitors. Finally, the recent expert recommendations regarding the use of PCSK9 inhibitors and other non-statin therapies to treat patients with inadequate LDL-C-lowering on statin therapy will be summarized.
-
5.
Rosuvastatin: Role in Secondary Prevention of Cardiovascular Disease.
Wander, GS, Hukkeri, MYK, Yalagudri, S, Mahajan, B, Panda, AT
The Journal of the Association of Physicians of India. 2018;(3):70-4
Abstract
Cardiovascular (CV) diseases are a major cause of premature death and disability. Non-communicable diseases (NCD) are responsible for 52% of mortality amongst Indians, of these CV diseases are responsible for 66% of NCD mortality in India. We not only need widespread primary preventive strategy but also need effective secondary prevention protocols to reduce this. Secondary prevention in patients who already had myocardial infarction (MI) or revascularization is of utmost importance to reduce mortality, cardiac events and improve quality of life. Lifestyle changes and medical therapy have a very important role in secondary prevention of CVD. Optimal control of hypertension, diabetes mellitus and dyslipidemia plays a critical role in secondary prevention. Statins are one of the most commonly used drugs in secondary prevention as a part of medical therapy. Effective LDL reduction, more patients achieving LDL goals, reduction in intima thickness, improvement in endothelial dysfunction, reduction in inflammatory markers are considered to be surrogate markers of reduced risk with statins. Rosuvastatin is one of the two most commonly used statins. It is a potent, effective and safe HMG-COA reductase inhibitor. Data related to secondary prevention is limited with rosuvastatin. Most of the clinical evidences with rosuvastatin have shown more effective LDL reduction than other statins. More number of patients achieve LDL goals and reduction in intima thickness. This article attempts to explore data on role of rosuvastatin for secondary prevention.
-
6.
The toxicology of air pollution predicts its epidemiology.
Ghio, AJ, Soukup, JM, Madden, MC
Inhalation toxicology. 2018;(9-10):327-334
-
-
Free full text
-
Abstract
The epidemiologic investigation has successively delineated associations of air pollution exposure with non-malignant and malignant lung disease, cardiovascular disease, cerebrovascular disease, pregnancy outcomes, perinatal effects and other extra-pulmonary disease including diabetes. Defining these relationships between air pollution exposure and human health closely parallels results of an earlier epidemiologic investigation into cigarette smoking and environmental tobacco smoke (ETS), two other particle-related exposures. Humic-like substances (HULIS) have been identified as a chemical component common to cigarette smoke and air pollution particles. Toxicology studies provide evidence that a disruption of iron homeostasis with sequestration of host metal by HULIS is a fundamental mechanistic pathway through which biological effects are initiated by cigarette smoke and air pollution particles. As a result of a common chemical component and a shared mechanistic pathway, it should be possible to extrapolate from the epidemiology of cigarette smoking and ETS to predict associations of air pollution exposure with human disease, which are currently unrecognized. Accordingly, it is anticipated that the forthcoming epidemiologic investigation will demonstrate relationships of air pollution with COPD causation, peripheral vascular disease, hypertension, renal disease, digestive disease, loss of bone mass/risk of fractures, dental disease, eye disease, fertility problems, and extrapulmonary malignancies.
-
7.
Assessing the awareness of Czechs, age 40+, on the link between lifestyle choices and risk factors for cardiovascular diseases.
Tóthová, V, Bártlová, S, Chloubová, I, Michálková, H, Olišarová, V, Prokešová, R, Šedová, L, Treslova, M, Adámkova, V
Neuro endocrinology letters. 2018;(5):401-408
Abstract
OBJECTIVES Cardiovascular diseases constitute the main cause of disability and premature death worldwide. Those diseases will continue to endanger health unless the public understands clearly and completely which risk factors contribute to the development of these diseases and what they can do to avoid these risks. This article assesses the understanding of risk factors that can lead to the development of heart and vessel diseases. METHODS A non-standardized questionnaire was used for data collection. The respondents expressed their opinions on influenceable factors using a five-degree Likert scale. The research set included 1,992 respondents. Data were statistically analyzed using the SASD program, version 1.4.12. To calculate the level of dependence of the selected characteristics, the Wallis, and Spearman correlation coefficients were calculated. The goodness-of-fit χ2 was applied as well. RESULTS The results show that 66.8% of respondents go walking for at least 30 minutes on 5 or more days per week. Respondents from lower age groups reported significantly more (p < 0.001) walking. The comparison of mean values showed that Czech citizens aged 40 or more years express the highest agreement with the statement that they could prevent heart and vessel diseases by modifying their eating habits. The results further showed that 25.8% of Czech citizens smoked and that men smoked significantly more (29.6%) than women (22.5%). More than one-half (60.1%) reported drinking alcohol occasionally; the remaining respondents reported drinking alcohol 3-4 times a month or more often. Men reported drinking beer significantly more often (p < 0.001) than women, while women reported drinking wine significantly more often (p < 0.001) than men. CONCLUSIONS Respondents aged 40 or more years were aware of some, but not all, of the risk factors that can influence the development of cardiovascular diseases. They accepted that they could prevent heart and vessel diseases by modifying their eating habits, however, their opinions regarding exercise differed from professional recommendations. Two-thirds of the respondents stated that smoking could also influence heart and vessel diseases. The study suggests that primary care providers need to put more effort into educating their patients regarding steps that can be to influence their own health.
-
8.
Government continues to have an important role in promoting cardiovascular health.
Tomaselli, G, Roach, WH, Piña, IL, Oster, ME, Dietz, WH, Horton, K, Borden, WB, Brownell, K, Gibbons, RJ, Otten, JJ, et al
American heart journal. 2018;:160-165
-
9.
Assortment of herbal medicines of the treatment of cardiovascular diseases.
Sakhanda, IV, Kosyachenko, KL
Wiadomosci lekarskie (Warsaw, Poland : 1960). 2018;(5):1104-1108
Abstract
OBJECTIVE Introduction: Medicinal plants are an effective means of prevention of many cardiovascular diseases in high-risk groups. Also, they are often used as a means of adjuvant therapy. Centuries of experience in the use of medicinal plants in folk medicine is the result of their relatively high efficiency and their wide distribution in natural ecosystems, and sometimes close to human habitation. The aim of this work is to study the assortment of herbal medicinal products and to consider examples of the basic methods of treatment of cardiovascular diseases with medicinal plants. PATIENTS AND METHODS Materials and methods: In the work the marketing method, monitoring methods, logical generalization, grouping and graphic method of research were used. A comparative analysis of the assortment and economic availability of cardiological drugs of plant origin, presented on the pharmaceutical market of Ukraine. RESULTS Review: As the study showed, in the period under review the total assortment of the Ukrainian phytopreparation market had a pain of two thousand titles, namely: 2280, which was about 17%, that is almost a fifth of the officially published figure for all drugs registered for period 2001-2016 years (13,5 thousand). This is a rather high indicator, indicating the importance of drugs with medicinal plant raw materials (MP RM) for the treatment and prevention of various diseases. Among the medicinal forms of plant almost half (41,8%) falls on the share of liquid forms: solutions for internal or external use, for injections, drops, syrups, etc., 31,6% are solid dosage forms: capsules, powders, etc. More than 13% of the assortment for soft forms: ointments, liniments, suppositories, etc. Among medicines there are also medicinal herbal remedies in the form of collections, briquettes, tea, whose specific gravity is 9,1%. Other dosage forms, which account for only 3,7%, represented by aerosols (15 items), concentrates, cubes. CONCLUSION Conclusions: The list of plants that have been shown to reflect the main approaches to the herbal medicine of diseases of the cardiovascular system: it is the use of cardiac glycosides the first high-performance drugs to treat heart failure; the P-active compounds that strengthen blood vessels and regulate the body's metabolism; a variety of alkaloids, including stimulating activity of the organism, which is important, such as hypotension. The analysis of the assortment of phytopreparations on the Ukrainian market showed that the assortment of medicines is characterized as a dynamic system that is constantly updated for a set of domestic drugs or registration for the first time in Ukraine of herbal preparations that have won consumer preferences abroad.
-
10.
Cardiovascular effects of antidiabetic drugs.
Sørensen, AM, Christensen, MB
Drugs of today (Barcelona, Spain : 1998). 2018;(9):547-559
Abstract
Type 2 diabetes mellitus is a common and severe chronic metabolic disease, which confers increased risk of cardiovascular disease and mortality. During the last decade a large number of new drugs within the classes dipeptidyl peptidase 4 (DPP-4) inhibitors (DPP-4Is), glucagon-like peptide 1 (GLP-1) receptor agonists (GLP-1RAs) and sodium/glucose cotransporter 2 (SGLT-2) inhibitors (SGLT-2Is) have been developed and tested in nine large-scale cardiovascular outcome trials (CVOTs). Here we review the evidence behind antihyperglycemic treatment of patients with type 2 diabetes with a particular focus on compiling and summarizing the evidence of hard clinical endpoints stemming from these large CVOTs.