MATERIALS AND METHODS: Cardiovascular risk factors (CRFs) were estimated using the 30-year Framingham Risk Score in 73 childhood leukemia survivors (median age: 25; median years from diagnosis: 19) and 78 healthy controls (median age: 23). Radial arterial stiffness was measured using pulse wave analyzer, while endothelial activation markers were measured by soluble intercellular adhesion molecule 1 (sICAM-1) and soluble vascular cell adhesion molecule 1 (sVCAM-1). Retinal fundus images were analyzed for central retinal artery/vein equivalents (CRAE/CRVE) and arteriolar-venular ratio (AVR).
RESULTS: cALL survivors had higher CRF (P<0.0001), arterial stiffness (P=0.001), and sVCAM-1 (P=0.007) compared with controls. Survivors also had significantly higher CRVE (P=0.021) while AVR was significantly lower (P=0.026) in survivors compared with controls, compatible with endothelial dysfunction. In cALL survivors with intermediate risk for CVD, CRAE, and AVR are significantly lower, while sVCAM-1 and sICAM-1 are significantly higher when compared with survivors with low CVD risk after adjusting with covariates (age, sex, and smoking status).
CONCLUSIONS: cALL survivors have an increased risk of CVD compared with age-matched peers. The survivors demonstrated microvasculopathy, as measured by retinal vascular analysis, in addition to physical and biochemical evidence of endothelial dysfunction. These changes predate other measures of CVD. Retinal vessel analysis may be utilized as a robust screening tool for identifying survivors at increased risk for developing CVD.
AREAS COVERED: There is no specific contraindication or caution related to COVID-19 on the use of antihypertensives unless patients develop severe hypotension from septic shock where all antihypertensives should be discontinued or severe hyperkalemia in which continuation of renin-angiotensin system inhibitors is not desired. The continuation of antiplatelet or statin is not desired when severe thrombocytopenia or severe transminitis develop, respectively. Patients with atrial fibrillation receiving oral anticoagulants, particularly those who are critically ill, should be considered for substitution to parenteral anticoagulants.
EXPERT OPINION: An individualized approach to medication management among hospitalized COVID-19 patients with concurrent CVDs would seem prudent with attention paid to changes in clinical conditions and medications intended for COVID-19. The decision to modify prescribed long-term CV medications should be entailed by close follow-up to check if a revision on the decision is needed, with resumption of any long-term CV medication before discharge if it is discontinued during hospitalization for COVID-19, to ensure continuity of care.
METHODS: This was a cross sectional survey using mall intercept interviews. It was carried out in a hypermarket surrounded by housing estates with a population of varying socioeconomic backgrounds. Inclusion criteria were Malaysian nationality and age 30 years and older. The validated CVD health check questionnaire was used to assess participants' intention and the determinants that influenced their intention to undergo CVD health checks.
RESULTS: A total of 413 participants were recruited. The median age of the participants was 45 years (IQR 17 years) and 60% of them were female. Participants indicated they were likely (45.0%) or very likely (38.7%) to undergo CVD health checks while 16.2% were not sure, unlikely or very unlikely to undergo health checks. Using ordinal regression analysis, perception of benefits, drawbacks of CVD health checks, perception of external barriers and readiness to handle outcomes following CVD health checks were the significant determinants of individuals' intention to undergo CVD health checks.
CONCLUSIONS: To improve individuals' participation in CVD health checks, we need to develop strategies to address their perception of benefits and drawbacks of CVD health checks, the perceived external barriers and their readiness to handle outcomes following CVD health checks.
METHODS: A cross-sectional observational study was designed. Forty normotensive (median age 47 +/- 6 yrs.) and twenty untreated hypertensive Malay men (median age 50 +/- 7 yrs.) without clinical evidence of cardiovascular complications were selected. Pulse wave velocity measured using the automated Complior machine was used as an index of arterial stiffness. Other measurements obtained were blood pressure, body mass index, fasting insulin, cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, glucose and creatinine level.
RESULTS: The blood pressure and pulse wave velocity (PWV) were significantly higher in the hypertensives compared to the normotensives (blood pressure 169/100 mm Hg +/- 14/7 vs. 120/80 mm Hg +/- 10/4, p < 0.001; PWV 11.69 m/s +/- 1.12 vs. 8.83 m/s +/- 1.35, p < 0.001). Other variables such as body mass index, fasting insulin, cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and haematocrit were comparable among the two groups. Within each group, there was a significant positive correlation between pulse wave velocity and systolic blood pressure (r = 0.76, p < 0.001 in normotensives; r = 0.73, p < 0.001 in hypertensives) and mean arterial pressure (r = 0.74, p < 0.001 in normotensives; r = 0.73, p < 0.001 in hypertensives). No correlation was noted between pulse wave velocity and diastolic blood pressure, age, body mass index, fasting insulin level, cholesterol, HDL-cholesterol, LDL-cholesterol or triglyceride levels.
CONCLUSION: Arterial stiffness as determined by PWV is increased in newly diagnosed untreated hypertensive subjects even before clinically evident cardiovascular disease. However, arterial stiffness is not correlated with the fasting insulin level in normotensives and newly diagnosed hypertensives.
METHOD: A 12-month single blinded multicenter randomized control trial was designed to investigate the measured variables [Glycated Hemoglobin (HbA1c), Renal function, Albumin Creatinine Ratio (ACR) etc.]. The trial was randomized into 2 experimental parallel arms (ascorbic acid vs acetylsalicylic acid) were blinded with study supplements in combination with metformin and findings were compared to control arm with metformin alone and blinded with placebo. Withdrawal criteria was defined to maintain the equity and balance in the participants in the whole trial.
FINDING: Patients with metformin and ascorbic acid (parallel arm I) was twice more likely to reduce HbA1c than metformin alone (control arm) in a year (OR 2.31 (95% CI 1.87-4.42) p
METHODS: The study was conducted in two stages. First, the factors affecting nutritional behaviors associated with cardiovascular disease on 350 women who were referred to Fasa urban health centers were determined based on the TPB. In the second stage, based on the results of a cross-sectional study, quasi-expeimental study was performed on 200 women covered by Fasa health centers. The questionnaire used for the study was a questionnaire based on TPB. The questionnaire was completed by the experimental and control groups before and three months after the intervention. Data were analyzed by SPSS software using logistic regression, paired t-test, independent sample t-test, and chi-square test. The level of significance is considered 0.05.
RESULT: The constructs of attitude, subjective norms, and perceived behavioral control (PBC) were predictors of nutritional behaviors associated with cardiovascular disease in women. The constructs predicted 41.6% of the behavior. The results showed that mean scores of attitude, subjective norms, PBC, intention, nutritional performance related to the cardiovascular disease before intervention were, respectively, 24.32, 14.20, 18.10, 13.37 and 16.28, and after the intervention, were, respectively, 42.32, 25.40, 33.72, 30.13 and 41.38. All the constructs except the attitude in the intervention group were significantly higher (p cardiovascular disease in women. Considering the role of mothers in providing family food baskets and the effect of their nutritional behaviors on family members, the education of this group can promote healthy eating behaviors in the community and family.