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Fulltext Cardiovascular risk and events in 17 low-, middle-, and high-income countries

Yusuf S, Rangarajan S, Teo K, Islam S, Li W, Liu L, et al.

N Engl J Med, 2014 08 28;371(9):818-27.
PMID: 25162888 DOI: 10.1056/NEJMoa1311890

BACKGROUND: More than 80% of deaths from cardiovascular disease are estimated to occur in low-income and middle-income countries, but the reasons are unknown.
METHODS: We enrolled 156,424 persons from 628 urban and rural communities in 17 countries (3 high-income, 10 middle-income, and 4 low-income countries) and assessed their cardiovascular risk using the INTERHEART Risk Score, a validated score for quantifying risk-factor burden without the use of laboratory testing (with higher scores indicating greater risk-factor burden). Participants were followed for incident cardiovascular disease and death for a mean of 4.1 years.
RESULTS: The mean INTERHEART Risk Score was highest in high-income countries, intermediate in middle-income countries, and lowest in low-income countries (P<0.001). However, the rates of major cardiovascular events (death from cardiovascular causes, myocardial infarction, stroke, or heart failure) were lower in high-income countries than in middle- and low-income countries (3.99 events per 1000 person-years vs. 5.38 and 6.43 events per 1000 person-years, respectively; P<0.001). Case fatality rates were also lowest in high-income countries (6.5%, 15.9%, and 17.3% in high-, middle-, and low-income countries, respectively; P=0.01). Urban communities had a higher risk-factor burden than rural communities but lower rates of cardiovascular events (4.83 vs. 6.25 events per 1000 person-years, P<0.001) and case fatality rates (13.52% vs. 17.25%, P<0.001). The use of preventive medications and revascularization procedures was significantly more common in high-income countries than in middle- or low-income countries (P<0.001).
CONCLUSIONS: Although the risk-factor burden was lowest in low-income countries, the rates of major cardiovascular disease and death were substantially higher in low-income countries than in high-income countries. The high burden of risk factors in high-income countries may have been mitigated by better control of risk factors and more frequent use of proven pharmacologic therapies and revascularization. (Funded by the Population Health Research Institute and others.).
Note: Malaysia is a study site (Author: Yusoff K)

Matched MeSH terms: Cardiovascular Diseases/mortality*; Cardiovascular Diseases/epidemiology
Nanomaterial Based Approaches for the Diagnosis and Therapy of Cardiovascular Diseases

Sharma PA, Maheshwari R, Tekade M, Tekade RK

Curr Pharm Des, 2015;21(30):4465-78.
PMID: 26354926

The increasing prevalence and complexity of cardiovascular diseases demand innovative strategies for diagnostic and therapeutic applications to improve patient care/prognoses. Additionally, various factors constrain present cardiovascular therapies, including low aqueous drug solubility, early metabolism, short half-life and drug delivery limitations. The efficient treatment of cardiovascular diseases requires improvement of traditional drug delivery systems. This can be accomplished by using novel nanomaterial that can incorporate diverse bio-actives along with diagnostic agents in a single carrier, referred to as theranostics. This review discusses the state of the art in the applications to diagnosis and therapy of innovative, nanomaterial- based strategies such as lipid based carriers, nanocapsules, magnetic nanoparticles, gold nanoparticles, protein conjugated nanoparticles, dendrimers and carbon-based nanoformulations with a special emphasis on how they can contribute to improving the management of cardiovascular disease.

Matched MeSH terms: Cardiovascular Diseases/diagnosis*; Cardiovascular Diseases/drug therapy*
MicroRNA-based Biosensors for Early Detection of Cancers

Rezayi M, Farjami Z, Hosseini ZS, Ebrahimi N, Abouzari-Lotf E

Curr Pharm Des, 2018;24(39):4675-4680.
PMID: 30636591 DOI: 10.2174/1381612825666190111144525

Small noncoding microRNAs (miRNAs) are known as noninvasive biomarkers for early detection in various cancers. In fact, miRNAs have key roles in carcinogenicity process such as proliferation, apoptosis and metastasis. After cardiovascular disease, cancer is the second cause of death in the world with an estimated 9.6 million deaths in 2018. So, early diagnosis of cancer is critical for successful treatment. To date, several selective and sensitive laboratory-based methods have been applied for the detection of circulating miRNA, but a simple, short assay time and low-cost method such as a biosensor method as an alternative approach to monitor cancer biomarker is required. In this review, we have highlighted recent advances in biosensors for circulating miRNA detection.

Matched MeSH terms: Cardiovascular Diseases/blood; Cardiovascular Diseases/diagnosis
Fulltext Hypoxia-inducible factor 1 signalling, metabolism and its therapeutic potential in cardiovascular disease

Sousa Fialho MDL, Abd Jamil AH, Stannard GA, Heather LC

Biochim Biophys Acta Mol Basis Dis, 2019 04 01;1865(4):831-843.
PMID: 30266651 DOI: 10.1016/j.bbadis.2018.09.024

Cardiovascular disease (CVD) accounts for the largest number of deaths worldwide, necessitating the development of novel treatments and prevention strategies. Given the huge energy demands placed on the heart, it is not surprising that changes in energy metabolism play a key role in the development of cardiac dysfunction in CVD. A reduction in oxygen delivery to the heart, hypoxia, is sensed and responded to by the hypoxia-inducible factor (HIF) and its family of proteins, by regulating the oxygen-dependent signalling cascade and subsequent response. Hypoxia is one of the main drivers of metabolic change in ischaemic disease and myocardial infarction, and we therefore suggest that HIF may be an attractive therapeutic target. In this review, we assess cardiac energy metabolism in health and disease, and how these can be regulated by HIF-1α activation. We then present an overview of research in the field of hypoxia-mimetic drugs recently developed in other treatment fields, which provide insight into the potential of systemic HIF-1α activation therapy for treating the heart.

Matched MeSH terms: Cardiovascular Diseases/drug therapy; Cardiovascular Diseases/metabolism*
Prevalence and prevention of cardiovascular disease and diabetes mellitus

Balakumar P, Maung-U K, Jagadeesh G

Pharmacol Res, 2016 11;113(Pt A):600-609.
PMID: 27697647 DOI: 10.1016/j.phrs.2016.09.040

Noncommunicable diseases (NCDs) have become important causes of mortality on a global scale. According to the report of World Health Organization (WHO), NCDs killed 38 million people (out of 56 million deaths that occurred worldwide) during 2012. Cardiovascular diseases accounted for most NCD deaths (17.5 million NCD deaths), followed by cancers (8.2 million NCD deaths), respiratory diseases (4.0 million NCD deaths) and diabetes mellitus (1.5 million NCD deaths). Globally, the leading cause of death is cardiovascular diseases; their prevalence is incessantly progressing in both developed and developing nations. Diabetic patients with insulin resistance are even at a greater risk of cardiovascular disease. Obesity, high cholesterol, hypertriglyceridemia and elevated blood pressure are mainly considered as major risk factors for diabetic patients afflicted with cardiovascular disease. The present review sheds light on the global incidence of cardiovascular disease and diabetes mellitus. Additionally, measures to be taken to reduce the global encumbrance of cardiovascular disease and diabetes mellitus are highlighted.

Matched MeSH terms: Cardiovascular Diseases/epidemiology*; Cardiovascular Diseases/prevention & control*
Fulltext Non-infarcted myocardium bears the weight in CVD

Zhou H, Zainal H, Puntmann VO

Aging (Albany NY), 2019 03 25;11(6):1609-1610.
PMID: 30908271 DOI: 10.18632/aging.101890
Matched MeSH terms: Cardiovascular Diseases/diagnosis*; Cardiovascular Diseases/pathology
Fulltext Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) in patients at high risk of cardiovascular events: a meta-analysis of 10 randomised placebo-controlled trials

Ong HT, Ong LM, Ho JJ

ISRN Cardiol, 2013;2013:478597.
PMID: 24307952 DOI: 10.1155/2013/478597

Context. Whether angiotensin converting-enzyme inhibitors (ACEI) and angiotensin-receptor blockers (ARB) are useful in high risk patients without heart failure is unclear. We perform a meta-analysis of prospective randomized placebo-controlled ACEI or ARB trials studying patients with a combination of risk factors to assess treatment impact on all cause mortality, cardiovascular mortality, nonfatal myocardial infarction (MI) and stroke. Method. A PubMed search was made for placebo-controlled trials recruiting at least 1,200 high risk patients randomized to either ACEI or ARB, with follow-up of at least 2 years. Meta-analysis was performed using the RevMan 5 program and Mantel-Haenszel analysis was done with a fixed effects model. Results. Ten trials recruiting 77,633 patients were reviewed. All cause mortality was significantly reduced by ACEI (RR 0.89; P = 0.0008), but not by ARB treatment (RR 1.00; P = 0.89). Cardiovascular mortality and nonfatal MI were also reduced in the ACEI trials but not with ARB therapy. Stroke was significantly reduced in the ACEI trials (RR 0.75; P < 0.00001) and more modestly reduced in the ARB trials (RR 0.90; P = 0.01). Conclusion. ACEI treatment reduced stroke, nonfatal MI, cardiovascular and total mortality in high risk patients, while ARB modestly reduced stroke with no effect on nonfatal MI, cardiovascular and total mortality.

Matched MeSH terms: Cardiovascular Diseases*
Fulltext Cardiovascular effects of common analgesics

Ong HT, Ong LM, Tan TE, Chean KY

Med J Malaysia, 2013 Apr;68(2):189-94.
PMID: 23629578 MyJurnal

The clycoxygenase (COX) enzyme forms locally active prostaglandins responsible for producing inflammation and pain. Classical non-steroidal anti-inflammatory drugs (NSAID) inhibit the COX-2 enzyme that produces inflammatory prostaglandins as well as the COX-1 enzyme that produces gastric mucosa protecting prostaglandins. By specifically inhibiting only the COX-2 enzyme, coxibs thus reduce pain but do not damage the gastric mucosa. However, COX-2 at the vascular endothelium produces antithrombotic prostaglandins, and so by inhibiting COX-2 enzyme, the coxibs promote thrombosis. Rofecoxib and valdecoxib have been withdrawn because of the adverse cardiovascular events they induce. Amongst presently available coxibs cardiovascular risk is highest with enterocoxib and lowest with celecoxib. NSAIDS also increase cardiovascular events, the risk is highest with diclofenac and lowest with naproxen. Paracetamol and corticosteroids induce hypertension, while steroids also adversely affect the heart from metabolic change as well as fluid retention. Aspirin is an anti-thrombotic agent because of its ability to inhibit the COX-1 enzyme that produces the pro-aggregatory thromboxane. However, it increases gastrointestinal bleeding, can promote fluid retention and is nephrotoxic, all of which may lead to adverse cardiovascular outcomes. Patients at especially high risk of cardiovascular events from analgesic use include the elderly, and those with heart failure, hypertension, rheumatoid arthritis, chronic renal disease, chronic obstructive airway disease and previous myocardial infarction, cerebrovascular disease or peripheral vascular disease. Adverse cardiovascular events can occur within a week of initiation of analgesic treatment.

Matched MeSH terms: Cardiovascular Diseases*
Fulltext Geographical variation of cardiovascular risk factors in Malaysia

Nuur Amalina AG, Jamaiyah H, Selvarajah S, NHMS Cohort Study Group

Med J Malaysia, 2012 Feb;67(1):31-8.
PMID: 22582546 MyJurnal

The purpose of this study was to describe differences in cardiovascular risk factor prevalences and clustering patterns among the states and federal territories of Malaysia. Risk factors considered were abdominal obesity, diabetes, hypertension, hypercholesterolemia and smoking. Using data from the third National Health and Morbidity Survey (NMHS III) in 2006, we estimated the states and federal territories risk factor prevalences and clustering patterns to map the cardiovascular burden distribution in Malaysia. There was a clear geographical variation in the distribution of the individual risk factors as well as in its clustering with remarkable impact seen in Peninsular Malaysia. Perlis, Kedah and Kelantan were the most affected states overall.
Study name: National Health and Morbidity Survey (NHMS-2006)

Matched MeSH terms: Cardiovascular Diseases/etiology*
Noninvasive assessment of cutaneous vascular function in vivo using capillaroscopy, plethysmography and laser-Doppler instruments: its strengths and weaknesses

Yvonne-Tee GB, Rasool AH, Halim AS, Rahman AR

Clin. Hemorheol. Microcirc., 2006;34(4):457-73.
PMID: 16687786

Given that functional abnormalities of the microcirculation are one of the primary abnormalities in cardiovascular disease pathogenesis, various noninvasive clinical tools have been developed recently to assess the microvascular function, particularly at the skin. The common techniques used to assess cutaneous microvascular function in vivo include capillaroscopy, venous occlusion plethysmography, and laser-Doppler instruments (laser-Doppler fluximetry and laser-Doppler imaging). These noninvasive techniques can be used as an early measure of functional abnormalities within the microvascular tree, predominantly in population at high risk for cardiovascular events. This review discusses some underlying application principle of these techniques, including its clinical significance, method reproducibility and limitations.

Matched MeSH terms: Cardiovascular Diseases/physiopathology
Association of bedtime with mortality and major cardiovascular events: an analysis of 112,198 individuals from 21 countries in the PURE study

Wang C, Hu B, Rangarajan S, Bangdiwala SI, Lear SA, Mohan V, et al.

Sleep Med, 2021 04;80:265-272.
PMID: 33610073 DOI: 10.1016/j.sleep.2021.01.057

OBJECTIVES: This study aimed to examine the association of bedtime with mortality and major cardiovascular events.
METHODS: Bedtime was recorded based on self-reported habitual time of going to bed in 112,198 participants from 21 countries in the Prospective Urban Rural Epidemiology (PURE) study. Participants were prospectively followed for 9.2 years. We examined the association between bedtime and the composite outcome of all-cause mortality, non-fatal myocardial infarction, stroke and heart failure. Participants with a usual bedtime earlier than 10PM were categorized as 'earlier' sleepers and those who reported a bedtime after midnight as 'later' sleepers. Cox frailty models were applied with random intercepts to account for the clustering within centers.
RESULTS: A total of 5633 deaths and 5346 major cardiovascular events were reported. A U-shaped association was observed between bedtime and the composite outcome. Using those going to bed between 10PM and midnight as the reference group, after adjustment for age and sex, both earlier and later sleepers had a higher risk of the composite outcome (HR of 1.29 [1.22, 1.35] and 1.11 [1.03, 1.20], respectively). In the fully adjusted model where demographic factors, lifestyle behaviors (including total sleep duration) and history of diseases were included, results were greatly attenuated, but the estimates indicated modestly higher risks in both earlier (HR of 1.09 [1.03-1.16]) and later sleepers (HR of 1.10 [1.02-1.20]).
CONCLUSION: Early (10 PM or earlier) or late (Midnight or later) bedtimes may be an indicator or risk factor of adverse health outcomes.

Matched MeSH terms: Cardiovascular Diseases*
From basic mechanisms to clinical applications in heart protection, new players in cardiovascular diseases and cardiac theranostics: meeting report from the third international symposium on "New frontiers in cardiovascular research"

Cabrera-Fuentes HA, Aragones J, Bernhagen J, Boening A, Boisvert WA, Bøtker HE, et al.

Basic Res Cardiol, 2016 11;111(6):69.
PMID: 27743118

In this meeting report, particularly addressing the topic of protection of the cardiovascular system from ischemia/reperfusion injury, highlights are presented that relate to conditioning strategies of the heart with respect to molecular mechanisms and outcome in patients' cohorts, the influence of co-morbidities and medications, as well as the contribution of innate immune reactions in cardioprotection. Moreover, developmental or systems biology approaches bear great potential in systematically uncovering unexpected components involved in ischemia-reperfusion injury or heart regeneration. Based on the characterization of particular platelet integrins, mitochondrial redox-linked proteins, or lipid-diol compounds in cardiovascular diseases, their targeting by newly developed theranostics and technologies opens new avenues for diagnosis and therapy of myocardial infarction to improve the patients' outcome.

Matched MeSH terms: Cardiovascular Diseases*
A comparison of low and high dose of moderate intensity aerobic exercise on heart rate recovery of the sedentary adults: a pragmatic randomized controlled trial

Jaafar Z, Lim YZ

J Sports Med Phys Fitness, 2023 Feb;63(2):310-318.
PMID: 35620954 DOI: 10.23736/S0022-4707.22.13958-7

BACKGROUND: Heart rate recovery (HRR) has been used as a prognostication marker of health. A slower drop in HRR is linked to a higher risk of cardiovascular diseases and all-cause mortality. Since aerobic exercise has been shown to have favorable effects on HRR, we aimed to compare the effects of two different aerobic exercise doses on HRR among a sedentary adult population.
METHODS: A pragmatic randomised controlled trial was conducted on 29 healthy sedentary adults (seven males and 22 females) in a 12-week exercise program. They were randomly assigned to group A (75 min/week, N.=15) or group B (150 min/week, N.=14) of moderate intensity aerobic exercise groups. HRR at 1-minute (HRR1), HRR at 2-minute (HRR2), and peak oxygen uptake (VO2peak) were measured pre- and post-intervention.
RESULTS: The improvements of HRR1 and HRR2 were seen in both groups but was only significant (P<0.05) for group A with HRR1, -4.07 bpm (post 24.47±6.42 - pre 20.40±5.51, P=0.018) and HHR2, -3.93 bpm (post 43.40±13.61 - pre 39.47±10.68, P=0.046). Group B showed increment of HRR1, -1.14 bpm (post 21.14±5.35 - pre 20.00±6.30, P=0.286) and HRR2, -2.5 bpm, (post 39.36±8.01 - pre 36.86±9.57, P=0.221). Improvement of the VO2peak was only significant in group B with an increment of 1.52±2.61 (P=0.049).
CONCLUSIONS: In conclusion, our study suggests that improvements in heart rate recovery (HRR1 and HRR2) among sedentary healthy adults can be achieved by engaging in moderate intensity exercise at a dose lower than the current recommended guidelines. The lower dose seems to be more attainable and may encourage exercise compliance. Future studies should further explore the effects of different exercise volumes on HRR in a larger sample size and also by controlling for BMI or gender.

Matched MeSH terms: Cardiovascular Diseases*
Fulltext The Mentakab Hypertension Study project. Part I--Complicated hypertensives in hospital: who are they?

Lim TO, Ngah BA, Suppiah A, Ismail F, Abdul Rahman R

Singapore Med J, 1991 Aug;32(4):245-8.
PMID: 1776003

Consecutive hypertensives admitted with cardiovascular complications were studied. One hundred and eight complicated hypertensives (10%) out of 1,066 medical admissions were seen in the three month study. Thirty three per cent had cerebrovascular disease, 30% ischaemic heart disease, 2% had malignant hypertension and 85% had hypertensive heart disease. All patients had uncontrolled hypertension at admission (mean blood pressure 184/115 mmHg). Twenty-four patients (22%) were newly diagnosed; of the rest of previously diagnosed hypertensives (78%), 3% had never been on treatment and 56% had dropped out of treatment, which explained their ineffective blood pressure control. However, 18% of patients had apparently been on regular follow up and treatment, and yet their blood pressure control was poor. Many patients had evidence of renal disease. The prevalence of cardiovascular risk factors was also high; 56% had hypercholesterolaemia; 46% had hypertriglyceridaemia; 44% smoked, 38% were overweight or obese, and 18% were diabetic. This indicates that hypertension is best regarded as an ingredient of a cardiovascular risk profile and its management requires multifactorial correction of all risk factors identified.

Matched MeSH terms: Cardiovascular Diseases/complications*
Higher risk of adverse cardiovascular outcomes in females with type 2 diabetes Mellitus: an Umbrella review of systematic reviews

Yaow CYL, Chong B, Chin YH, Kueh MTW, Ng CH, Chan KE, et al.

Eur J Prev Cardiol, 2023 Sep 06;30(12):1227-1235.
PMID: 37185913 DOI: 10.1093/eurjpc/zwad133

BACKGROUND: Previous studies have shown that females with type 2 diabetes mellitus (T2DM) may have excess mortality risk compared to their male counterparts. An important next step to address the high global burden of T2DM and cardiovascular disease (CVD) is an umbrella review to summarize data on sex differences in cardiovascular outcomes for patients with T2DM and assess the strength of the evidence observed.
METHODS AND RESULTS: Medline and Embase were searched from inception till 7 August 2022 for systematic reviews and meta-analyses studying the effects of sex on cardiovascular outcomes in T2DM patients. Results from reviews were synthesized with a narrative synthesis, with a tabular presentation of findings and forest plots for reviews that performed a meta-analysis. 27 review articles evaluating sex differences in cardiovascular outcomes were included. Females with T2DM had a higher risk of developing coronary heart disease (CHD; RRR: 1.52, 95%CI: 1.32-1.76, P < 0.001), acute coronary syndrome (ACS; RRR: 1.38, 95%CI: 1.25-1.52, P < 0.001), heart failure (RRR: 1.09, 95%CI: 1.05-1.13, P < 0.001) than males. Females had a higher risk of all-cause mortality (RRR: 1.13, 95%CI: 1.07-1.19, P < 0.001), cardiac mortality (RRR: 1.49, 95%CI: 1.11-2.00, P = 0.009) and CHD mortality (RRR: 1.44, 95%CI: 1.20-1.73, P < 0.001) as compared to males.
CONCLUSIONS: This umbrella review demonstrates that females with T2DM have a higher risk of cardiovascular outcomes than their male counterparts. Future research should address the basis of this heterogeneity and epidemiological factors for better quality of evidence, and identify actionable interventions that will narrow these sex disparities.

Matched MeSH terms: Cardiovascular Diseases*
Fulltext The burden of premature mortality from cardiovascular diseases: A systematic review of years of life lost

Rodzlan Hasani WS, Muhamad NA, Hanis TM, Maamor NH, Wee CX, Omar MA, et al.

PLoS One, 2023;18(4):e0283879.
PMID: 37083866 DOI: 10.1371/journal.pone.0283879

INTRODUCTION: Premature mortality refers to deaths that occur before the expected age of death in a given population. Years of life lost (YLL) is a standard parameter that is frequently used to quantify some component of an "avoidable" mortality burden.
OBJECTIVE: To identify the studies on premature cardiovascular disease (CVD) mortality and synthesise their findings on YLL based on the regional area, main CVD types, sex, and study time.
METHOD: We conducted a systematic review of published CVD mortality studies that reported YLL as an indicator for premature mortality measurement. A literature search for eligible studies was conducted in five electronic databases: PubMed, Scopus, Web of Science (WoS), and the Cochrane Central Register of Controlled Trials (CENTRAL). The Newcastle-Ottawa Scale was used to assess the quality of the included studies. The synthesis of YLL was grouped into years of potential life lost (YPLL) and standard expected years of life lost (SEYLL) using descriptive analysis. These subgroups were further divided into WHO (World Health Organization) regions, study time, CVD type, and sex to reduce the effect of heterogeneity between studies.
RESULTS: Forty studies met the inclusion criteria for this review. Of these, 17 studies reported premature CVD mortality using YPLL, and the remaining 23 studies calculated SEYLL. The selected studies represent all WHO regions except for the Eastern Mediterranean. The overall median YPLL and SEYLL rates per 100,000 population were 594.2 and 1357.0, respectively. The YPLL rate and SEYLL rate demonstrated low levels in high-income countries, including Switzerland, Belgium, Spain, Slovenia, the USA, and South Korea, and a high rate in middle-income countries (including Brazil, India, South Africa, and Serbia). Over the past three decades (1990-2022), there has been a slight increase in the YPLL rate and the SEYLL rate for overall CVD and ischemic heart disease but a slight decrease in the SEYLL rate for cerebrovascular disease. The SEYLL rate for overall CVD demonstrated a notable increase in the Western Pacific region, while the European region has experienced a decline and the American region has nearly reached a plateau. In regard to sex, the male showed a higher median YPLL rate and median SEYLL rate than the female, where the rate in males substantially increased after three decades.
CONCLUSION: Estimates from both the YPLL and SEYLL indicators indicate that premature CVD mortality continues to be a major burden for middle-income countries. The pattern of the YLL rate does not appear to have lessened over the past three decades, particularly for men. It is vitally necessary to develop and execute strategies and activities to lessen this mortality gap.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021288415.

Matched MeSH terms: Cardiovascular Diseases*
Effect of Different Types of Aerobic Exercise on Individuals With and Without Hypertension: An Updated Systematic Review

Esmailiyan M, Amerizadeh A, Vahdat S, Ghodsi M, Doewes RI, Sundram Y

Curr Probl Cardiol, 2023 Mar;48(3):101034.
PMID: 34718034 DOI: 10.1016/j.cpcardiol.2021.101034

High blood pressure (BP) is one of the main modifiable risk factors for cardiovascular disease (CVD) and preventing it greatly reduces the vascular consequences of aging and, along with intensive treatment of hypertension, eliminates a large portion of the burden of CVD-related mortality. Many meta-analyses and studies proved that regular aerobic exercise (AE) reduces BP but most of these studies consider only hypertensive populations or only AE but not resistant exercise or their combination. In this review, we aimed to study the effect of different types of physical activity (PA)/AE on various populations including normotensive, prehypertensive, primary hypertensive, and resistant hypertensive with different comorbidities. We searched PubMed, Web of Science, and Google Scholar for English articles with keywords for physical activity, aerobic exercise, and blood pressure from January 2010 until September 2021. Finally, 24 studies were included. Results showed that chronic or acute AE (long-term or short-term), either alone or as combined with different sessions and programs can reduce systolic and diastolic BP in every group including normotensive, prehypertensive, primary hypertensive, resistant hypertensive individuals and diabetic patients and those with kidney problems but not in people with chronic heart failure. Isometric exercise training showed to be useful in reducing BP in all groups either as low intensity or as high intensity but the rate of reduction was different in terms of gender. AE showed to be effective in terms of BP reduction in a different age range. It can be seen that different types and duration of AE independent of the modality and programs and independent of the BP medical situation of individuals have been successful in terms of BP reduction. For those with chronic heart failure, more concern and help might be needed to decrease BP via exercise.

Matched MeSH terms: Cardiovascular Diseases*
The need for population-specific cardiovascular risk prediction models for guiding risk stratification and treatment approaches in type 2 diabetes

Lim QH, Lau ESH, Lim LL

Eur J Prev Cardiol, 2023 Sep 06;30(12):1291-1292.
PMID: 37439153 DOI: 10.1093/eurjpc/zwad230
Matched MeSH terms: Cardiovascular Diseases*
Physical Inactivity as an Early Sign of Frailty in Young Adult Survivors of Childhood Acute Lymphoblastic Leukemia

Chua LL, Azanan MS, Oh L, Ariffin H

J Pediatr Hematol Oncol, 2023 Jul 01;45(5):e560-e566.
PMID: 36730635 DOI: 10.1097/MPH.0000000000002586

Young adult survivors of childhood leukemia have been reported with increased likelihood of age-related comorbidities compared with the general population. We compared the prevalence of frailty in young adult survivors of childhood acute lymphoblastic leukemia (n=58, median age=23 y, median survival time=18 y) with age-matched and sex-matched controls without history of cancer. Frailty phenotypes were determined using Fried frailty model. Association between frailty status and cardiometabolic conditions, systemic inflammation, and T-cell immunophenotype changes were also examined. Frailty and prefrailty were more common among survivors compared with controls (58.6% vs. 34.5%, P =0.019). Physical inactivity (39.7%) was the most frequently observed frailty criterion among the survivors. Prevalence of cardiometabolic conditions was comparable between the robust and frail/prefrail survivors. Robust survivors had a higher level of T-cell activation than the prefrail/frail survivors ( P <0.05), but no significant difference was observed for systemic inflammatory markers (IL-6 and C-reactive protein) and percentage of terminally differentiated T cells. Signs of frailty, especially physical inactivity, was detected in childhood acute lymphoblastic leukemia survivors early in their third decade of life. Survivors who were prefrail/frail also had altered T-cell activation; however, the role of such changes in T-cell phenotype in the etiology of frailty warrant further investigation.

Matched MeSH terms: Cardiovascular Diseases*
Comparison of Cell-based and Nanoparticle-based Therapeutics in Treating Atherosclerosis

Goh WX, Kok YY, Wong CY

Curr Pharm Des, 2023;29(35):2827-2840.
PMID: 37936453 DOI: 10.2174/0113816128272185231024115046

Today, cardiovascular diseases are among the biggest public health threats worldwide. Atherosclerosis, a chronic inflammatory disease with complex aetiology and pathogenesis, predispose many of these conditions, including the high mortality rate-causing ischaemic heart disease and stroke. Nevertheless, despite the alarming prevalence and absolute death rate, established treatments for atherosclerosis are unsatisfactory in terms of efficacy, safety, and patient acceptance. The rapid advancement of technologies in healthcare research has paved new treatment approaches, namely cell-based and nanoparticle-based therapies, to overcome the limitations of conventional therapeutics. This paper examines the different facets of each approach, discusses their principles, strengths, and weaknesses, analyses the main targeted pathways and their contradictions, provides insights on current trends as well as highlights any unique mechanisms taken in recent years to combat the progression of atherosclerosis.

Matched MeSH terms: Cardiovascular Diseases*

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