Aspects Of Cardiovascular Disease Research Articles

Hypertensive patients\u2019 knowledge of cardiovascular disease in Calabar, Nigeria

BackgroundThis study aimed at assessing knowledge of cardiovascular disease risk factors and prevention, among hypertensive patients in a developing country setting with high cardiometabolic disease morbidity and mortality.MethodsUsing descriptive cross-sectional study design and random sampling method, a 30-item questionnaire was used to obtain quantitative data on knowledge of key aspects of cardiovascular disease and practice of preventive measures among hypertensive patients in Calabar.ResultTwo hundred and twelve (212) respondents were surveyed with mean age of 45.5 ± 10.8 years. Approximately two-thirds of respondents (67.9%) had unsatisfactory level of knowledge of CVD. Most respondents had unsatisfactory level of knowledge of appropriate diet (77.4%), basic epidemiology (80.2%), risk factors (63.2%), and symptoms of CVD (74.5%). The mean score for knowledge of risk factors was significantly higher among females compared with males (p < 0.05). Consumers compared with non-consumers of alcohol had significantly lower mean scores for knowledge of appropriate diet and symptoms of CVD (p < 0.05). Except for medical knowledge where mean score of knowledge was significantly higher among respondents occasionally exercised or consumed fresh fruits compared with other groups, there was no significant difference in mean score of knowledge for other components comparing the various categories of active exercise and consumption of fresh fruits (p > 0.05).ConclusionUnsatisfactory level of knowledge of cardiovascular disease among hypertensive patients in the study setting was high. There is urgent need to improve efforts and strategies for health education and counseling of patients toward sustainable adoption of preventive behaviors.

Place des produits laitiers fermentés dans le traitement des maladies cardio-vasculaires

Fermented milk products have nutritional qualities that could preserve cardiovascular health. While the benefits of yoghurt are highlighted by epidemiological and clinical studies, there is a lack of evidence for other fermented dairy products. In order to better identify their effects, work targeting specific aspects of cardiovascular disease is needed.

Cardiovascular Diseases (CVDs) in COVID-19 Pandemic Era.

Introduction:COVID-19 is the disease caused by an infection of the SARS-CoV-2 virus, previously known as 2019 Novel Coronavirus (2019-nCoV) respiratory disease. World Health Organization (WHO) declared the official name as COVID-19 in February 2020 and in 11th March 2020 declared COVID-19 as Global Pandemic. In June 6th 2020, over 7 million cases registered in the world, recovered 3.4 million and death over 402.000.Aim:The aim of this study is to retreive published papers about COVID-19 infection deposited in PubMed data base and analyzed current results of investigations regarding morbidity and mortality rates as consequences of COVID-19 infection and opinions of experts about treatment of afected patients with COVID-19 who have Cardiovascular diseases (CVDs).Methods:It’s used method of descriptive analysis of the published papers with described studies about Corona virus connected with CVDs.Results:After searching current scientific literature (on PubMed till today is deposited more than 1.000 papers about COVID-19 with consequences in almost every medical disciplines), we have acknowledged that till today not any Evidence Based Medicine (EBM) study in the world. Also, there are no unique proposed ways of treatments and drugs to protect patients, especially people over 65 years old, who are very risk group to be affected with COVID-19, including patients with CVDs. Vaccine against COVID-19 is already produced and being in phases of testing in praxis in treatment of COVID-19 at affected patients, but the opinions of experts and common people whole over the world about vaccination are full of controversis.Conclusion:Frequent hand washing, avoiding crowds and contact with sick people, and cleaning and disinfecting frequently touched surfaces can help prevent coronavirus infections are the main proposal of WHO experts in current Guidelines, artefacts stored on a web site. Those preventive measures at least can help to everybody, including also the patients who have evidenced CVDs in their histories of illness. Authors analyzed most important dilemmas about all aspects of CVDs, including etipathogenesis, treatment with current drugs and use of potential discovered vaccines against COVID-19 infection, described in scientific papers deposited in PubMed data base.

Expert Opinion: Meditation and Cardiovascular Health: What is the Link?

Meditation as a form of body–mind interaction for primary and secondary prevention in cardiovascular disease has been discussed critically in the past. However, data that aimed to link this intervention to a reduction of various aspects of cardiovascular disease, rendering it a potential part of a cost-effective treatment approach in patients at risk, remain scarce and inconclusive. This article aims to provide an overview of currently available evidence in the literature and the potential impact of meditation on cardiovascular health. However, the data highlighted in this article cannot render with certainty directly reproducible effects of meditation on patients’ cardiovascular disease profiles. Meditation may be suggested only as an additional link in the chain of primary and secondary prevention until future research provides sufficient data on this topic.

Activation of Cannabinoid Receptors Attenuates Endothelin-1-Induced Mitochondrial Dysfunction in Rat Ventricular Myocytes.

Evidence suggests that the activation of the endocannabinoid system offers cardioprotection. Aberrant energy production by impaired mitochondria purportedly contributes to various aspects of cardiovascular disease. We investigated whether cannabinoid (CB) receptor activation would attenuate mitochondrial dysfunction induced by endothelin-1 (ET1). Acute exposure to ET1 (4 hours) in the presence of palmitate as primary energy substrate induced mitochondrial membrane depolarization and decreased mitochondrial bioenergetics and expression of genes related to fatty acid oxidation (ie, peroxisome proliferator-activated receptor-gamma coactivator-1α, a driver of mitochondrial biogenesis, and carnitine palmitoyltransferase-1β, facilitator of fatty acid uptake). A CB1/CB2 dual agonist with limited brain penetration, CB-13, corrected these parameters. AMP-activated protein kinase (AMPK), an important regulator of energy homeostasis, mediated the ability of CB-13 to rescue mitochondrial function. In fact, the ability of CB-13 to rescue fatty acid oxidation-related bioenergetics, as well as expression of proliferator-activated receptor-gamma coactivator-1α and carnitine palmitoyltransferase-1β, was abolished by pharmacological inhibition of AMPK using compound C and shRNA knockdown of AMPKα1/α2, respectively. Interventions that target CB/AMPK signaling might represent a novel therapeutic approach to address the multifactorial problem of cardiovascular disease.

6091Chronic heart failure is associated with inflammatory deterioration of the bone marrow vascular niche

Abstract Introduction Inflammation plays a crucial role in many aspects of cardiovascular disease. Particularly, acquired mutations of hematopoietic stem cells (HSC) leading to clonal expansion of inflammatory cells (CHIP) are increased with age and are associated with an enhanced risk of cardiovascular disease. The bone marrow (BM) vascular niche plays a crucial role in maintenance and regulation of HSC functions. Previous studies in mice showed the reduction of a specific Endomucin-high (H-type) endothelial cells (EC) subpopulation by aging. However, the impact of cardiovascular disease is unclear. Therefore, we aimed to investigate the effects of age and heart failure (HF) on the vascular BM cell composition in mice and humans. Methods and results Aging mice showed an age-dependent decrease of type H (Emcn-high) BM ECs (p=0.004), whereas the BM frequencies of type L (Emcn-low) ECs did not significantly differ (P=0.18). Importantly, we also observed a marked reduction of type H EC in chronic ischemic mice (P=0.016 vs. sham) indicating that chronic ischemic HF induces similar alterations of the vascular stem cell niche. Importantly, type H ECs were also significantly reduced in ischemic HF patients (n=16) compared with control subjects (n=8; P=0.0003). To gain insights into the mechanisms underlying the changes in the vascular niche, we performed single cells RNA sequencing of human BM ECs. These studies confirmed the decrease in Emcn-expressing ECs in ischemic HF patients, which was accompanied by significantly increased expression of inflammatory genes, including IL1b (P&lt;0.0001 vs. control). Inflammatory EC phenotypes and IL1b expression in HF could be further confirmed at protein level using cytospin immunostainings. Finally, we comprehensively evaluated phenotype-associated differences in the bone marrow plasma proteomes of healthy individuals (n=19) and patients with chronic ischemic (n=22) and non-ischemic (n=19) HF, using proximity extension assays. Here, we identified 182 proteins significantly differentially regulated in CHF versus CTRL. Among the top upregulated proteins the BM environment of patients with CHF showed a striking enrichment of inflammatory and ECM remodeling components. Conclusions Our data show for the first time an impact of chronic heart failure on the bone marrow vascular niche in humans. These changes seem to be strongly associated with increased inflammatory response and bone matrix remodeling in CHF. Specifically, the induction of the inflammatory cytokine IL1b may contribute to the disturbed phenotype suggesting that inhibition of IL1b (e.g. by canakinumab) may be used as a novel strategy to prevent or reverse the deterioration of the vascular BM niche.

Effects and mechanisms of iridoid glycosides from Patrinia scabiosaefolia on improving insulin resistance in 3T3-L1 adipocytes

Insulin resistance causes several adverse effects such as hypertension, diabetes and different aspects of cardiovascular diseases. Patrinia scabiosaefolia Fisch. ex Trev. is a traditional Chinese edible herbal, whose n-BuOH extract significantly increased glucose transportin 3T3-L1 adipocytes at the concentration of 12.5 μM. To determine its active constituent, its chemical components and bioactivities were investigated. Two compounds (1–2) could significantly improve insulin resistance in 3T3-L1 adipocytes at concentrations around 25.0 μM (P < 0.001). Compound 2 was more effective to lower the content of glucose content at 12.5 μM (P < 0.001). Compound 1 was a new compound identified by spectroscopic methods. Western-blot experiment demonstrated an upregulation of p-IRS-1, p-Akt, and GLUT4 induced by compounds 1 and 2. Hence, we speculated that compounds 1 and 2 could activate PI3K and Akt signaling by up-regulating of p-IRS-1 which resulted in the activation of PI3K before phosphorylating Akt, ultimately led to translocation of GLUT4. These events finally improve glucose transport. Our results may provide the scientific basis for the development and effective use of P. scabiosaefolia against type 2 diabetes.

Pre-travel Health Advice for Patients With Cardiovascular Disease

Cardiovascular disease (CVD) is the leading cause of death among international travellers. Practitioner knowledge of the effects of CVD on international travel is imperative in order to promote a healthy travel experience. This review aimed to explore the available literature on this topic. The PubMed database was accessed to source relevant literature using combinations of relevant keywords as search terms. Articles were restricted to those published in the English language through March 2019. Of 1726 article records retrieved, 73 relevant papers were examined carefully. The results of this narrative review are related to multiple aspects of CVD and travel. The pre-travel consultation should address issues regarding vaccinations, travel insurance, anticoagulation, and medical devices. Additional vaccines to be discussed include influenza, pneumococcal, and hepatitis B. Patients with CVD should be advised of the need to carry a copy of their ECG, prescription(s), and pacemaker manufacturer’s card. Knowledge of the location overseas of automated external defibrillators and awareness of health risks associated with strenuous adventure activities are important for CVD travellers. Medical tourism for patients with CVD is briefly considered. Space tourism is an emerging category of extreme international travel that requires specialized pre-travel preparation. This narrative review article highlights the gaps in the travel medicine literature in relation to CVD. A strong evidence base for most recommendations is lacking. Future scholarly efforts are warranted to facilitate more robust travel recommendations for CVD patients. No qualitative studies to date have described the experiences of international travellers with CVD.

Public knowledge of cardiovascular disease and its risk factors in Tangail, Bangladesh: a cross-sectional survey

Background: Cardiovascular Disease (CVD) is a major public health problem throughout the world. In Bangladesh, the reliable data concerning various aspects of CVD is inadequate at present due to lack of national population-based surveys or central administrative health data. Given the rising incidence of CVDs in Bangladesh, an improved understanding of the CVD, symptoms and risk factors is needed. Hence, this study was performed to assess the level of knowledge towards CVD types, warning symptoms of heart attack or stroke, and CVD risk factors.Methods: A descriptive cross-sectional survey was conducted from May 2018 to June 2018 using standard questionnaire on a sample of 350 randomly selected Bangladeshi individuals. All the data of the study were input in SPSS (Statistical Package for the Social Sciences) version 20.0 software from IBM for windows and the gathered data thus analyzed using SPSS &amp; Microsoft Excel.Results: The respondents’ knowledge about types of CVD, symptom heart attack, symptom of stroke and the risk factors of CVD are 38.9%, 67.7%, 35.7%, and 92.9% respectively. The most common risk factors of CVD found to be known by around than two-third of respondents were unhealthy diet (66.9%), physical inactivity (64.3), obesity (61.4%), and smoking (58.6%).Conclusions: The respondents’ knowledge about types of CVD, symptom heart attack, symptom of stroke and the risk factors of CVD are 38.9%, 67.7%, 35.7%, and 92.9% respectively. The most common risk factors of CVD found to be known by around than two-third of respondents were unhealthy diet (66.9%), physical inactivity (64.3), obesity (61.4%), and smoking (58.6%).

Effect of oral appliance on circulating leukocyte telomere length and SIRT1 in obstructive sleep apnea.

The increased cardiovascular risk seen in patients with obstructive sleep apnea (OSA) may be due to combination of oxidative stress, systemic inflammation and damage to leukocyte telomere length (LTL) seen with aging. Another molecule, Sirtuin 1 (SIRT1), a histone/protein deacetylase, regulates endothelial nitric oxide synthase and is involved in different aspects of cardiovascular disease, aging and stress resistance. The aim of this study was to evaluate the effects of mandibular advancement device (MAD) on the circulating LTL and SIRT1 protein level in peripheral blood mononuclear cells (PBMCs) in patients with OSA. Forty patients with moderately severe to severe OSA who desired MAD and 20 healthy controls were prospectively enrolled. The LTL was measured by quantitative polymerase chain reaction while SIRT1 protein levels in PBMC was assessed using a Sirtuin 1 ELISA Kit. All study subjects underwent baseline sleep study, with OSA patients having repeat testing at 3months after MAD. Compared to healthy subjects, patients with OSA at baseline had lower LTL and SIRT1 protein levels in PBMC. After 3months of MAD, 24 OSA patients, designated as MAD responders, median (range) LTL increased from (0.556 [0.393-0.748]) to (0.708 [0.533-0.893]) and SIRT1 protein levels in PBMC increased from 0.58 ± 0.23pg/μg of total protein to 0.95 ± 0.26pg/μg of total protein. For the 16 MAD unresponsive patients, LTL and SIRT1 protein levels remained low. Successful treatment of OSA with MAD can restore LTL and SIRT1 protein levels in PBMC. LTL and SIRT1 protein levels in PBMC can be improved following effective treatment of OSA using MAD.

Nutraceutical Value of Citrus Flavanones and Their Implications in Cardiovascular Disease.

Background- Cardiovascular diseases, including myocardial infarction, dyslipidaemia and coronary artery pathology, are a major cause of illness and death in Western countries. Therefore, identifying effective therapeutic approaches and their cellular signalling pathways is a challenging goal for medicine. In this regard, several epidemiological studies demonstrate a relationship between the intake of flavonoid-rich foods and the reduction of cardiovascular risk factors and mortality. In particular, flavonoids present in citrus fruits, such as oranges, bergamots, lemons and grapefruit (95% from flavanones), are emerging for their considerable nutraceutical value. Methods- In this review an examination of literature was performed while considering both epidemiological, clinical and pre-clinical evidence supporting the beneficial role of the flavanone class. We evaluated studies in which citrus fruit juices or single flavanone administration and cardiovascular risk factors were analysed; to identify these studies, an electronic search was conducted in PUBMED for papers fulfilling these criteria and written in English. Results- In addition to epidemiological evidence and clinical studies demonstrating that fruits in the Citrus genus significantly reduce the incidence of cardiovascular disease risk, pre-clinical investigations highlight cellular and subcellular targets that are responsible for these beneficial effects. There has been special attention on evaluating intracellular pathways involved in direct cardiovascular and cardiometabolic effects mediated by naringenin, hesperetin and eriodictyol or their glycosylated derivatives. Conclusions- Although some mechanisms of action remain unclear and bioavailability problems remain to be solved, the current evidence supports the use of a nutraceutical approach with citrus fruits to prevent and cure several aspects of cardiovascular disease.

Cardiovascular Disease in Bangladesh: A Review

Like elsewhere, cardiovascular disease (CVD) is an increasingly important cause of morbidity and mortality in Bangladesh. Over the past few decades, because of epidemiological transition, the prevailing disease pattern in this country changed from predominantly communicable to predominantly non- communicable disease, CVD contributes to the latter a lot. Actually, CVD particularly coronary artery disease (CAD) is getting epidemic proportion day by day. Hypertension and heart failure are on the rise, whereas the prevalence of acute rheumatic fever is declining. However, despite some efforts, reliable data concerning various aspects of CVD is inadequate at present. The current prevalence of hypertension, CAD, rheumatic fever and rheumatic heart disease and stroke may be 20-25%, 4-6%, &lt;1/1000, 0.3- 1.0% respectively. Besides conventional risk factors for different CVD, genetic predisposition and some novel issues like high salt intake, arsenicosis, hypovitaminosis D and air pollution may play important role in the aetiopathogenesis of CVD in this population. Formulation of appropriate policy and more emphasis on preventive strategy may help combat CVD in Bangladesh.Bangladesh Heart Journal 2016; 31(2) : 80-99

The Role of Nrf2 in Cardiovascular Function and Disease.

Free radicals, reactive oxygen/nitrogen species (ROS/RNS), hydrogen sulphide, and hydrogen peroxide play an important role in both intracellular and intercellular signaling; however, their production and quenching need to be closely regulated to prevent cellular damage. An imbalance, due to exogenous sources of free radicals and chronic upregulation of endogenous production, contributes to many pathological conditions including cardiovascular disease and also more general processes involved in aging. Nuclear factor erythroid 2-like 2 (NFE2L2; commonly known as Nrf2) is a transcription factor that plays a major role in the dynamic regulation of a network of antioxidant and cytoprotective genes, through binding to and activating expression of promoters containing the antioxidant response element (ARE). Nrf2 activity is regulated by many mechanisms, suggesting that tight control is necessary for normal cell function and both hypoactivation and hyperactivation of Nrf2 are indicated in playing a role in different aspects of cardiovascular disease. Targeted activation of Nrf2 or downstream genes may prove to be a useful avenue in developing therapeutics to reduce the impact of cardiovascular disease. We will review the current status of Nrf2 and related signaling in cardiovascular disease and its relevance to current and potential treatment strategies.

Use of a proximity extension assay proteomics chip to discover new biomarkers associated with albuminuria.

Background The underlying mechanisms for the development of albuminuria and the increased cardiovascular risk in patients with elevated albuminuria levels are incompletely understood. We therefore investigated the associations between 80 cardiovascular proteins and the urinary albumin to creatinine ratio (ACR). Methods We used a discovery/replication approach in two independent community-based cohorts of elderly patients: the Uppsala Longitudinal Study of Adult Men ( n = 662; mean age 78 years) and the Prospective Investigation of the Vasculature in Uppsala Seniors ( n = 757; mean age 75 years; 51% women). A proteomic chip with a panel of 80 plasma proteins associated with different aspects of cardiovascular disease was analysed. In the discovery cohort, we used a false discovery rate of 5% to take into account the multiple statistical testing. Nominal p values were used in the replication. Results Higher levels of T-cell immunoglobulin mucin-1, placenta growth factor, growth/differentiation factor-15, urokinase plasminogen activator surface receptor and kallikrein-11 were robustly associated with a higher ACR in both cohorts in multivariable linear regression models adjusted for sex, established cardiovascular risk factors, antihypertensive treatment, prevalent cardiovascular disease and glomerular filtration rate ( p < 0.02 for all). All associations were also significant in separate analyses of patients without diabetes. Conclusions We discovered and replicated associations between ACR and five cardiovascular proteins involved in tubular injury, atherosclerosis, endothelial function, heart failure, inflammation, glomerulosclerosis and podocyte injury. Our findings put forward multiplex proteomics as a promising approach to explore novel aspects of the complex detrimental interplay between kidney function and the cardiovascular system.

Circulation : The Beat Goes On

The American Heart Association (AHA) was founded in 1924 to promote the research and education of physicians in the emerging specialty of cardiology. Within months of its founding, the AHA took its first major step to support this core mission by publishing the first American journal in the field, the American Heart Journal . The editor-in-chief, Lewis B. Conner, was a founder and the first president of the AHA. The editorial board included such historic figures as Paul D. White, James B. Herrick, Henry A. Christian, and Carl J. Wiggers. In his opening editorial, Conner wrote of “the truly revolutionary advances made in our knowledge of the normal and pathological physiology of the heart and its beat, along with the advances in understanding of its diseases and their management” and of “the conviction on the part of the AHA that such a journal might be a potent factor in the furtherance of its purposes - the better education of the medical profession in matters relating to the diagnosis, treatment and prevention of heart diseases.”1 In 1948, the AHA was transformed from what then-president of the association H.M. Marvin described as a relatively “small organization of doctors interested in the purely scientific aspects of cardiovascular disease into a large, national voluntary health agency with wide interests and broad responsibilities.”2 This “new” AHA needed a new journal, and in 1950, Circulation was born. Marvin went on to write: > This first issue of Circulation, the official journal of the AHA, represents a major step toward the realization of an ambition long cherished by the Editorial Board and by many of our members; namely, the creation of a scientific journal that shall be acknowledged as foremost in the world among those devoted to a special field of medicine….It is the firm purpose …

Levels of Circulating Progenitor Cells, Cardiovascular Outcomes and Death: A Meta-Analysis of Prospective Observational Studies.

Circulating progenitor cells (CPCs), including endothelial progenitor cells (EPCs) are biologically related to many aspects of cardiovascular disease, as they promote angiogenesis and vascular repair. We herein aimed to meta-analyze studies reporting the prognostic role of the CPC/EPC measure on cardiovascular outcomes and death. We screened the English-language literature for longitudinal studies reporting the association between baseline CPC/EPC levels, future cardiovascular events, and death. We retrieved 28 studies, 21 of which contained poolable data and entered the meta-analysis, for a total of 4155 patients, mostly with a high baseline cardiovascular risk. Sixty percent of the studies met at least 11 of 16 items of quality assessment. Overall, reduced CPC/EPC levels were associated with a ≈2-fold increased risk of future cardiovascular events and cardiovascular death. The most predictive phenotype was CD34(+)CD133(+): low versus high levels predicted cardiovascular events, restenosis after endovascular intervention, cardiovascular death, and all-cause mortality. Heterogeneity among studies and according to the CPC/EPC phenotype was generally high. Excluding studies for which the risk estimate had to be extrapolated or limiting the analyses to higher quality studies still indicated a significant risk for future cardiovascular events and death in patients with low versus high progenitor cell counts. This meta-analysis shows that a reduction in the levels of circulating cells putatively provided with vasculoregenerative properties represents a risk factor for adverse cardiovascular outcomes and death.

Macrophage migration inhibitory factor promotes cardiac stem cell proliferation and endothelial differentiation through the activation of the PI3K/Akt/mTOR and AMPK pathways.

Macrophage migration inhibitory factor (MIF) has pleiotropic immune functions in a number of inflammatory diseases. Recent evidence from expression and functional studies has indicated that MIF is involved in various aspects of cardiovascular disease. In this study, we aimed to determine whether MIF supports in vitro c-kit+CD45− cardiac stem cell (CSC) survival, proliferation and differentiation into endothelial cells, as well as the possible mechanisms involved. We observed MIF receptor (CD74) expression in mouse CSCs (mCSCs) using PCR and immunofluorescence staining, and MIF secretion by mCSCs using PCR and ELISA in vitro. Increasing amounts of exogenous MIF did not affect CD74 expression, but promoted mCSC survival, proliferation and endothelial differentiation. By contrast, treatment with an MIF inhibitor (ISO-1) or siRNA targeting CD74 (CD74-siRNA) suppressed the biological changes induced by MIF in the mCSCs. Increasing amounts of MIF increased the phosphorylation of Akt and mammalian target of rapamycin (mTOR), which are known to support cell survival, proliferation and differentiation. These effects of MIF on the mCSCs were abolished by LY294002 [a phosphoinositide 3-kinase (PI3K) inhibitor] and MK-2206 (an Akt inhibitor). Moreover, adenosine monophosphate-activated protein kinase (AMPK) phosphorylation increased following treatment with MIF. The AMPK inhibitor, compound C, partly blocked the pro-proliferative effects of MIF on the mCSCs. In conclusion, our results suggest that MIF promotes mCSC survival, proliferation and endothelial differentiation through the activation of the PI3K/Akt/mTOR and AMPK signaling pathways. Thus, MIF may prove to be a potential therapeutic factor in the treatment of heart failure and myocardial infarction by activating CSCs.

Medico-Social and Psychological Aspects of Cardiovascular Diseases

The article analyzes the research of foreign and domestic researchers in the field of psychological measures of prevention, treatment, and rehabilitation of patients with heart disease. We considered psychosocial risk factors and protective factors in patients with cardiovascular disease and present the results of our analysis of the personal characteristics of patients with arterial hypertension and ischemic heart disease, dedicated targets for the development of methods of psychological correction of patients with these diseases as well as recommendations for psychological assistance in cardiorehabilitation, which will give an opportunity to increase the effectiveness of preventive and therapeutic interventions.

Circulating microRNAs as Biomarkers in Cardiovascular Diseases.

MicroRNAs, key regulators of biological processes, are involved in the pathophysiological mechanisms underlying human diseases, including cardiovascular diseases. Their recent discovery revealed a previously unknown layer of pathophysiologic regulators, which also play a key role in the regulation of several aspects of cardiovascular diseases. More recently, it was demonstrated that circulating microRNAs can be measured in the blood. Hence, the potential use of microRNAs as disease biomarkers attracted many research groups. Indeed, their unusual stability in the bloodstream and during prolonged storage make circulating miRs very interesting as potential biomarkers. Circulating microRNAs are emerging as the next generation "smart" biomarkers and could be helpful in further improving the diagnostic and therapeutic processes of cardiovascular diseases. The present chapter summarizes the most relevant experimental evidence on circulating microRNAs in cardiovascular diseases, including arterial remodeling, restenosis, coronary artery disease, acute coronary syndromes, hypertension, heart failure, and ischemic stroke, highlighting potential pathophysiological correlations to the mechanisms underlying cardiovascular diseases.

Vitamin D and Aspects of Cardiovascular Disease

Vitamin D deficiency is widely prevalent worldwide and is primarily caused by lack of ultraviolet B (UVB) radiation from reduced sun exposure and the consequent limiting of vitamin D production in the skin. Epidemiological studies support the concept that vitamin D is involved in the pathogenesis of cardiovascular disease (CVD). There are several lines of evidence for a number of potential mechanisms whereby vitamin D status may influence CVD risk. Vitamin D receptors (VDR) are known to be expressed in cells throughout the cardiovascular system. In addition, 1α-hydroxylase which converts 25-hydroxyvitamin D to calcitriol is produced in many cell types including vascular, smooth muscle cells, endothelial cells and cardiomyocytes. However, as reported in this review previous observational and vitamin D supplemental studies have shown conflicting results regarding vitamin D and CVD.