Advances in cardiovascular supplementation: mechanisms, efficacy, and clinical perspectives

Self‐care is defined as a naturalistic decision‐making process addressing both the prevention and management of chronic illness, with core elements of self‐care maintenance, self‐care monitoring, and self‐care management. In this scientific statement, we describe the importance of self‐care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self‐care behaviors such as diet and exercise, barriers to self‐care, and the effectiveness of self‐care in improving outcomes is reviewed, as is the evidence supporting various individual, family‐based, and community‐based approaches to improving self‐care. Although there are many nuances to the relationships between self‐care and outcomes, there is strong evidence that self‐care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self‐care in evidence‐based guidelines.

With free movement of labour in Europe, European guidelines on cardiovascular care and the enlargement of the European Union to include countries with disparate health care systems, it is important to develop common quality standards for cardiovascular prevention and risk management across Europe. Panels from nine European countries (Austria, Belgium, Finland, France, Germany, Netherlands, Slovenia, United Kingdom and Switzerland) developed quality indicators for the prevention and management of cardiovascular disease in primary care. A two-stage modified Delphi process was used to identify indicators that were judged valid for necessary care. Forty-four out of 202 indicators (22%) were rated as valid. These focused predominantly on secondary prevention and management of established cardiovascular disease and diabetes. Less agreement on indicators of preventive care or on indicators for the management of hypertension and hypercholesterolaemia in patients without established disease was observed. Although 85% of the 202 potential indicators assessed were rated valid by at least one panel, lack of consensus among panels meant that the set that could be agreed upon among all panels was much smaller. Indicators for the management of established cardiovascular disease have been developed, which can be used to measure the quality of cardiovascular care across a wide range of countries. Less agreement on how the quality of preventive care should be assessed was observed, probably caused by differences in health systems, culture and attitudes to prevention.

Sodium glucose cotransporter-2 inhibitors (SGLT-2i) are antidiabetic medications with remarkable cardiovascular (CV) benefits proven by multiple randomised controlled trials and real-world data. These drugs are also useful in the prevention of CV disease (CVD) in patients with diabetes mellitus (DM). Although DM as such is a huge risk factor for CVD, the CV benefits of SGLT-2i are not just because of antidiabetic effects. These molecules have proven beneficial roles in prevention and management of nondiabetic CVD and renal disease as well. There are various molecular mechanisms for the organ protective effects of SGLT-2i which are still being elucidated. Proper understanding of the role of SGLT-2i in prevention and management of CVD is important not only for the cardiologists but also for other specialists caring for various illnesses which can directly or indirectly impact care of heart diseases. This clinical review compiles the current evidence on the rational use of SGLT-2i in clinical practice.

Background: Community pharmacists play an intermediary role between prescribing physicians and patients in the United Arab Emirates (UAE) and thus are responsible for ensuring that patients receive optimal cardiovascular disease (CVD) pharmaceutical care.Methods: we used a cross-sectional design to assess the perceptions and practices of community pharmacists concerning pharmaceutical care for patients with CVD. A trained researcher visited randomly selected community pharmacies and used a structured questionnaire to conduct in-person interviews with pharmacists. The questionnaire collected demographic data and information on perceptions and practices regarding CVD pharmaceutical care.Results: Five hundred and fifty-one participants were recruited. The average participant age (mean ± SD) was 35 ± 2.7 years. The average perception score regarding CVD prevention and management was 75.6% (95% confidence interval [CI] 77.1%–74.2%), and the average practice score for CVD prevention and management was 87.1% (95% CI 76.5%–79.6%). Bivariate analysis revealed that gender (p = 0.001), education level (p < 0.001), pharmacy position (p = 0.004), work experience (p < 0.001), number of patients served per day (p < 0.001) and being trained on CVD prevention and management (p < 0.001) were significantly associated with perceptions about the prevention and management of CVD. Better practice scores were seen among older participants (OR 1.01; 95% CI 1–1.019), postgraduates (OR 1.77; 95% CI 1.66–1.89), workers at chain pharmacies (OR 1.24; 95% CI 1.11–1.39), pharmacists in charge (OR 1.22; 95% CI 1.01–1.47), pharmacists with >10 years of experience (OR 11.3; 95% CI 6.01–15.62), pharmacists with 6–10 years of experience (OR 4.42; 95% CI 3.90–5) and pharmacists trained on CVD prevention and management (OR 1.29; 95% CI 1.15–1.46).Conclusion: Pharmacy practitioners working in community pharmacies in the UAE actively engage in delivering pharmaceutical care to patients, playing a role in CVD management and prevention. However, they showed low levels of involvement in other healthcare services, specifically in screening and measuring patients’ weight, glucose levels, and blood pressure, monitoring treatment responses, maintaining medical records, and reviewing medication refill histories. Activities such as educating patients, providing medication counseling, offering support for treatment adherence, and fostering collaborative relationships with other healthcare providers should be encouraged among UAE community pharmacists to ensure the provision of high-quality patient care.

Optimizing Cardiovascular Health Worldwide: The Global Cardiovascular Nursing Leadership Forum.

We sought to understand healthcare workers' (HCW) cardiovascular disease (CVD) prevention knowledge, attitudes, and practices to help inform future healthcare policies and optimize preventive cardiology care. Data was collected via an anonymous, online questionnaire which consisted of pre-validated CVD prevention and smoking cessation scales adapted from the Preventive Medicine Attitudes and Activities Questionnaire. Six hundred sixty-eight HCWs (60.5% doctors, 27.8% nurses, 11.7% medical students) from 25 nations responded to the survey. Overall, 74.9% of HCWs routinely assessed patients' cardiovascular risk profiles in clinical practice. About 65.7% of HCWs counselled patients who were asymptomatic for CVD on tangible lifestyle changes to improve their cardiovascular risk profiles, while 68.2% of HCWs did so when patients were overweight. Of note, only 51.3% of HCWs implemented comprehensive smoking cessation interventions for their patients. Practising HCWs demonstrated higher levels of CVD prevention promotion than medical students in all aspects, except for self-reported importance of CVD risk factor counselling (Tukey honestly significant difference diff: 0.31, P-value: .051). Among practising HCWs, there were no significant differences in their CVD prevention practices across varying lengths of clinical practice. HCWs from higher income nations tended to fare worse than their lower income counterparts. A large multi-national survey reveals significant gaps in the promotion of CVD prevention by HCWs. Significant differences between medical students and practising HCWs' CVD prevention behaviours, highlight the role of education for the promotion of long-term positive CVD prevention practices. Further efforts should target the medical education of early-career HCWs, especially in higher income nations. Key message What is already known on this topic: The importance of lifestyle modification for the primordial prevention (risk factor prevention) and primary prevention (risk factor management) of cardiovascular disease (CVD) is indisputable. Studies have shown that physicians and other healthcare workers (HCWs) may be best placed to encourage tangible lifestyle changes and enact meaningful modification in patients' cardiovascular health-related behaviours. What this study adds: However, in practice, the role of HCWs in monitoring and encouraging patients' health behaviours is complicated by the challenges of real-life clinical practice, such as time constraints or lack of manpower. Hence, this large multi-national survey sought to understand HCWs' CVD prevention knowledge, attitudes, and practices to help inform future healthcare policies and optimize preventive cardiology care. How this study might affect research, practice, or policy: This study reveals significant gaps in the promotion of CVD prevention by HCWs, highlighting key differences in CVD prevention practices based on profession, level of training, subspecialty, and national income status. Nurses, cardiology subspecialists, and HCWs from lower middle-income nations were found to be more proficient in promoting CVD prevention compared to their counterparts. Further efforts should target the medical education of undergraduate HCWs, especially in higher income nations, as established clinical practices learned during clinical education typically persist and are resistant to change over time.

It's Not All About that Base Weight: Chipping the Glass Ceiling of Women's Cardiovascular Health.

Objective: This study aims to examine the importance of patient education and awareness and discuss the role of nurses in the prevention and management of cardiovascular diseases, as well as the impact of these activities on improving quality of life and reducing mortality rates. Methodology: A literature review was conducted, analyzing recent studies on cardiovascular disease prevention, patient education, and the role of nurses in disease management. Data from peer-reviewed journals and public health reports were examined to assess the effectiveness of educational interventions and nursing strategies in reducing cardiovascular risk factors. Results: The findings indicate that patient education and awareness significantly contribute to the prevention and management of cardiovascular diseases. Educational programs led by nurses have been shown to improve adherence to treatment, promote healthier lifestyles, and reduce risk factors such as hypertension, high cholesterol, and obesity. Furthermore, active nursing involvement enhances patient self-care capabilities, leading to improved cardiovascular health outcomes and a decrease in hospitalization rates. Conclusions: Strengthening patient education and the role of nurses in cardiovascular disease prevention can lead to better health outcomes and reduced mortality rates. Integrating structured educational programs and nurse-led interventions into healthcare systems is essential for effectively managing cardiovascular diseases and enhancing patients’ quality of life.

Coenzyme Q10 (CoQ10) is a naturally occurring vitamin-like substance that plays a key role in the normal functioning of the cardiovascular system. Recent randomised controlled clinical studies (Q-SYMBIO and KISEL-10) comprising more than 400 patients have demonstrated significant benefits of long-term CoQ10 supplementation for the treatment or prevention of cardiovascular disease respectively. In the Q-SYMBIO study, CoQ10 supplementation (3 x 100 mg/day) over a 2-year period in patients with chronic heart failure reduced cardiovascular mortality risk by 43%. In the KISEL-10 study, supplementation with a combination of CoQ10 (200 mg/day) and selenium (200 mcg/day) over a 5-year period in the normal elderly population reduced cardiovascular mortality risk by 53%. No significant adverse effects were reported in either the Q-SYMBIO or KISEL-10 studies. The specific form of CoQ10 used in the Q-SYMBIO and KISEL-10 studies addresses previous concerns regarding issues of product quality, safety and variable efficacy in the management of cardiovascular disease.

To update the 2015 clinical practice guideline and provide a simplified approach to lipid management in the prevention of cardiovascular disease (CVD) for primary care. Following the Institute of Medicine's Clinical Practice Guidelines We Can Trust, a multidisciplinary, pan-Canadian guideline panel was formed. This panel was represented by primary care providers, free from conflicts of interest with industry, and included the patient perspective. A separate scientific evidence team performed evidence reviews on statins, ezetimibe, proprotein convertase subtilisin-kexin type 9 inhibitors, fibrates, bile acid sequestrants, niacin, and omega-3 supplements (docosahexaenoic acid with eicosapentaenoic acid [EPA] or EPA ethyl ester alone [icosapent]), as well as on 11 supplemental questions. Recommendations were finalized by the guideline panel through use of the Grading of Recommendations Assessment, Development and Evaluation methodology. All recommendations are presented in a patient-centred manner designed with the needs of family physicians and other primary care providers in mind. Many recommendations are similar to those published in 2015. Statins remain first-line therapy for both primary and secondary CVD prevention, and the Mediterranean diet and physical activity are recommended to reduce cardiovascular risk (primary and secondary prevention). The guideline panel recommended against using lipoprotein a, apolipoprotein B, or coronary artery calcium levels when assessing cardiovascular risk, and recommended against targeting specific lipid levels. The team also reviewed new evidence pertaining to omega-3 fatty acids (including EPA ethyl ester [icosapent]) and proprotein convertase subtilisin-kexin type 9 inhibitors, and outlined when to engage in informed shared decision making with patients on interventions to lower cardiovascular risk. These updated evidence-based guidelines provide a simplified approach to lipid management for the prevention and management of CVD. These guidelines were created by and for primary health care professionals and their patients.

Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide, with nearly 18–20 million deaths annually. Conventional pharmacological and surgical therapies have improved survival but are often associated with side effects, high costs, and limited long-term efficacy. Nutraceuticals—bioactive compounds derived from dietary sources such as omega-3 fatty acids, phytosterols, polyphenols, vitamins, probiotics, and herbal bioactives—have emerged as promising adjuncts for the prevention and management of CVD. These agents exert cardioprotective effects through diverse mechanisms, including lipid-lowering, antioxidant, anti-inflammatory, anti-thrombotic, and endothelial-protective pathways. Clinical trials such as GISSI-Prevenzione, REDUCE-IT, PREDIMED, and Q-SYMBIO provide strong evidence supporting the efficacy of specific nutraceuticals, particularly omega-3 fatty acids, plant sterols, Coenzyme Q10, and polyphenols, in reducing cardiovascular risk and improving outcomes in patients with heart disease. Furthermore, plant-based diets rich in fruits, vegetables, legumes, and whole grains—naturally enriched with nutraceuticals—demonstrate significant protective benefits against CVD progression. However, challenges remain regarding variability in supplement quality, bioavailability, and the need for standardized dosing. Future directions include integration of nutraceuticals into precision nutrition, exploration of gut microbiota interactions, and development of novel delivery systems to enhance clinical effectiveness. Overall, nutraceuticals represent a cost-effective, multi-targeted, and accessible strategy that complements conventional therapies, offering a promising era in the prevention and treatment of cardiovascular disease. Keywords: Nutraceuticals; Cardiovascular disease; Omega-3 fatty acids; Polyphenols; Probiotics; Functional foods; Antioxidants; Precision nutrition.

Thoughts on Future Trends in Cardiology

BackgroundIn Kenya, cardiovascular diseases (CVDs) accounted for more than 10% of total deaths and 4% of total Disability-Adjusted Life Years (DALYs) in 2015 with a steady increase over the past decade. The main objective of this paper was to review the existing policies and their content in relation to prevention, control and management of CVDs at primary health care (PHC) level in Kenya.MethodsA targeted document search in Google engine using keywords “Kenya national policy on cardiovascular diseases” and “Kenya national policy on non-communicable diseases (NCDs)” was conducted in addition to key informant interviews with Kenyan policy makers. Relevant regional and international policy documents were also included. The contents of documents identified were reviewed to assess how well they aligned with global health policies on CVD prevention, control and management. Thematic content analysis of the key informant interviews was also conducted to supplement the document reviews.ResultsA total of 17 documents were reviewed and three key informants interviewed. Besides the Tobacco Control Act (2007), all policy documents for CVD prevention, control and management were developed after 2013. The national policies were preceded by global initiatives and guidelines and were similar in content with the global policies. The Kenya health policy (2014–2030), The Kenya Health Sector Strategic and Investment Plan (2014–2018) and the Kenya National Strategy for the Prevention and Control of Non-communicable diseases (2015–2020) had strategies on NCDs including CVDs. Other policy documents for behavioral risk factors (The Tobacco Control Act 2007, Alcoholic Drinks Control (Licensing) Regulations (2010)) were available. The National Nutrition Action Plan (2012–2017) was available as a draft. Although Kenya has a tiered health care system comprising primary healthcare, integration of CVD prevention and control at PHC level was not explicitly mentioned in the policy documents.ConclusionThis review revealed important gaps in the policy environment for prevention, control and management of CVDs in PHC settings in Kenya. There is need to continuously engage the ministry of health and other sectors to prioritize inclusion of CVD services in PHC.

Dear Sir, We read with interest the article by Heidbuchel and colleagues in this journal, presenting a comprehensive curriculum in sports cardiology, which may be suitable for physicians seeking higher specialist training in this evolving subspecialty. We would like to relate our experiences in providing educational programmes in the prevention and management of cardiovascular disease, together with the development of a core undergraduate curriculum in preventive cardiology. The newly established National Institute for Preventive Cardiology has as a central mission the generation of scholars and leaders in cardiovascular disease prevention. Our multidisciplinary clinical team has reported findings from a community-based, lifestylecentred cardiovascular disease prevention programme, demonstrating that managing cardiovascular diseases as a single family of diseases with common antecedents represents a new paradigm for cardiovascular disease prevention. Our postgraduate taught programmes in preventive cardiology, delivered in partnership with our university, introduce graduates from diverse professional backgrounds to the practical clinical application of evidence-based prevention guidelines. Healthcare team members, who are honorary clinical fellows of the university, also deliver a range of student selected components to undergraduate medical students, including modules in sports cardiology, cardiovascular nutrition, stroke prevention and preventive cardiology. Healthcare graduates should serve as positive role models for health promoting lifestyles, and undergraduate exposure to preventive cardiology has been demonstrated favourably to affect knowledge, attitudes and dietary behaviour of medical students. Furthermore, with a shift in healthcare policy towards disease prevention, there is a pressing need to ensure that all graduates of healthcare courses are equipped with the core knowledge, skills and attitudes to enable them to effect meaningful changes in patients’ lifestyles that modify their cardiovascular disease risk. We propose that a standardised inter-professional undergraduate curriculum in preventive cardiology be developed on an e-learning platform, which could ensure consistency of teaching across Europe. A precedent exists with the development of the European Society of Cardiology e-learning platform for cardiology education. Table 1 outlines the modular structure of such a programme, which may be delivered to medical, nursing and other healthcare students as an online certified, interactive study programme, comprising narrated lecture slides, core reading material, video consultations and self-assessment activities. Previous research supports the potential for e-learning and blended learning approaches in the development of inter-professional team knowledge, attitudes and skills. Our proposed syllabus emphasises cardiovascular disease risk estimation using the SCORE tool, and the integration of health behaviour change, lifestyle and pharmacological approaches to cardiovascular disease risk modification. We believe that, if implemented on a Europe-wide level, a standardised core undergraduate healthcare curriculum in preventive cardiology has the potential to support the translation of evidence-based prevention guidelines to clinical practice, address health inequalities, improve quality of life and reduce premature mortality from cardiovascular disease.

Cardiology Patient Page. C-reactive protein: a simple test to help predict risk of heart attack and stroke.