Cardiac Risk Reduction Research Articles

Progress Toward Cardiac Risk Reduction With the Evolution of Pediatric Hodgkin Lymphoma Therapy

Progress Toward Cardiac Risk Reduction With the Evolution of Pediatric Hodgkin Lymphoma Therapy

Efficacy of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitor Treatment for Repeated In-stent Restenosis in a Coronary Artery.

A 57-year-old woman experienced chest pain. A coronary angiogram revealed middle left anterior descending artery stenosis. Despite receiving adequate anti-hyperlipidemia treatment and undergoing percutaneous coronary intervention (PCI), she experienced angina and required PCI six more times for in-stent restenosis. As she had high lipoprotein (a) (LP-[a]) levels at the seventh PCI procedure, proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) was administered, and a reduction in the LP-(a) and low-density lipoprotein cholesterol (LDL-C) values was observed. She experienced no recurrence of angina for five years with PCSK9i treatment. PCSK9i can reduce not only LDL-C but also LP-(a) levels, resulting in cardiac event risk reduction.

Cardiology co-management of rheumatoid arthritis patients with coronary artery disease as an intervention reduces hospitalization rates and adverse event occurrence.

IntroductionRheumatoid arthritis (RA) is a systemic autoimmune disease with important cardiovascular (CV) implications. CV disease represents over half of RA patient deaths and causes significant morbidity. CV manifestations in RA can be complex, raising concerns for adequate patient management and provider-dependent roles.MethodsThis is a retrospective study of patients diagnosed with RA and coronary artery disease (CAD). Patients were identified and filtered via EPIC Database search engine. Parameters were set from January 1, 2014, to December 31, 2020. Inclusion criteria consisted of patients who met diagnostic criteria for both RA and CAD. A total of 399 patients met criteria.ResultsOf the 399 identified patients, 272 were female (68.2%) and 127 were male (31.8%) with a median age of 73 (range 26–98). The population was further divided into two groups: those with established cardiology care versus those without. Patients without cardiology follow-up experienced significantly more hospitalizations (RR 1.63 95% CI 1.12, 2.38), higher rates of adverse events including myocardial infarction (MI) (RR 4.82 95% CI 1.94, 11.98), heart failure (HF) (OR 15.81 95% CI 3.54, 70.52), and stroke (RR 2.55 95% CI 1.29, 5.03). Patients not followed by cardiology also had numerical increases in CV death (4 deaths compared to none in those with cardiology follow) and all-cause mortality (HR 1.03 95% CI 0.63, 1.67).ConclusionPatients with regular cardiology follow-up demonstrated fewer cardiac-related adverse events. This suggests that co-management may have a role in adverse cardiac event risk reduction and should therefore be an early consideration. Key Points• Rheumatoid arthritis patients demonstrate higher rates of coronary disease compared to the general population. Traditional cardiac risk factors may not be entirely responsible for this phenomenon• Hospitalization rates and adverse event occurrence are significantly higher in patients with single-provider care (rheumatology only) compared to dual provider care (rheumatology and cardiology)• Cardiology co-management should be an early consideration in the management of RA patients• Early screening, risk stratification of coronary disease, and utilization of appropriate treatment algorithms are important to decrease morbidity and mortalitySupplementary InformationThe online version contains supplementary material available at 10.1007/s10067-022-06335-4.

Cardiac Rehabilitation and Mortality Risk Reduction in Peripheral Artery Disease at 6-Month Outcome.

The management of patients with peripheral artery disease (PAD) is integrative and multidisciplinary, in which cardiac rehabilitation (CR) plays a prognostic role in terms of functional status, quality of life, and long-term impact on morbidity and mortality. We conducted a prospective cohort study on 97 patients with PAD admitted to a single tertiary referral center. Based on a prognostic index developed to stratify long-term mortality risk in PAD patients, we divided the cohort into two groups: low and low-intermediate risk group (45 cases) and high-intermediate and high risk group (52 cases). We analyzed demographics, clinical parameters, and paraclinical parameters in the two groups, as well as factors associated with cardiological reassessment prior to the established deadline of 6 months. Obesity (p = 0.048), renal dysfunction (p < 0.001), dyslipidemia (p < 0.001), tobacco use (p = 0.048), and diabetes mellitus (p < 0.001) are comorbidities with long-term prognostic value. Low-density lipoprotein cholesterol (p = 0.002), triglycerides (p = 0.032), fasting glucose (p = 0.011), peak oxygen uptake (p = 0.005), pain-free walking distance (p = 0.011), maximum walking time (p < 0.001), and maximum walking distance (p = 0.002) influence the outcome of PAD patients by being factors associated with clinical improvement at the 6-month follow-up. PAD patients benefit from enrollment in CR programs, improvement of clinical signs, lipid and carbohydrate profile, and weight loss and maintenance of blood pressure profile within normal limits, as well as increased exercise capacity being therapeutic targets.

Lessons from effect of etelcalcetide on left ventricular hypertrophy in patients with end-stage kidney disease.

Purpose of reviewPatients with end-stage kidney disease (ESKD) frequently develop left ventricular hypertrophy (LVH), which is associated with an exceptionally high risk of cardiovascular events and mortality. This review focuses on interventional studies that modify levels of fibroblast growth factor 23 (FGF23) and examine effects on myocardial hypertrophy, cardiovascular events and mortality.Recent findingsQuantitative evaluations of trials of calcimimetics found no effects on cardiovascular events and cardiovascular and all-cause mortality when compared with placebo. However, a recent randomized, controlled trial of etelcalcetide versus alfacalcidol showed that etelcalcetide effectively inhibited the progression of LVH in comparison to vitamin D in patients on haemodialysis after 1 year of treatment. Prior to that, oral calcimimetic treatment has already been shown to reduce left ventricular mass in patients on haemodialysis, whereas treatment with active vitamin D or mineralocorticoids was ineffective in patients with ESKD.SummaryData from a recent trial of etelcalcetide on LVH suggest that FGF23 may be a possible therapeutic target for cardiac risk reduction in patients on haemodialysis. If these findings are confirmed by further research, it might be speculated that a treatment shift from active vitamin D towards FGF23-lowering therapy may occur in patients on haemodialysis.

Cultural context in New Zealand: incorporating kaupapa Māori values in clinical research and practice.

We examined the importance of understanding and incorporating cultural context within Aotearoa/New Zealand when engaging in clinical research and practice. This paper reports on the qualitative findings of a mixed methods study aimed at determining what effect a cardiac risk reduction exercise and lifestyle management programme, embedded within a kaupapa Māori methodological approach, had on Māori participants. This methodology saw participants able to redevelop a western model cardiac risk reduction programme by introducing a Māori worldview. Our study revealed how the kaupapa Māori approach empowered participants to examine and evaluate not only their own health and lifestyle choices, but those of family and the wider community. Combining biomedical and kaupapa Māori components into the programme was found to benefit participants' mental, physical, spiritual and family well-being.

Using pharmacy technicians and electronic health record capabilities to improve outcomes for patients with cardiovascular disease

ObjectiveThis study aimed to compare lipid and blood pressure (BP) control before and after implementing a certified pharmacy technician (CPhT) protocol that optimized electronic health record (EHR) capabilities and shifted work from clinical pharmacy specialists (CPSs) to CPhT. SettingKaiser Permanente Colorado’s pharmacist-managed cardiac risk reduction service (which manages dyslipidemia, hypertension, and diabetes for all patients with atherosclerotic cardiovascular disease). Practice descriptionIn 2019, a protocol that optimized EHR capabilities and allowed work to be offloaded from CPS to CPhT was implemented. Filtered views within the EHR were created that bucketed patients with specific lipid results criteria. The CPhT protocol provided guidance to CPhT on determining whether patients were at low-density lipoprotein cholesterol (LDL-C) and non–high-density lipoprotein (non-HDL) goals, on appropriate statin intensity, adherent to medications, and whether the most recent BP was controlled. The CPhT notified CPS of uncontrolled patients who would assess and manage these patients, as necessary. The CPhT notified controlled patients of their results. Practice innovationData on the outcomes of incorporating pharmacy technicians to support CPS clinical activities in ambulatory clinical pharmacy are limited. Evaluation dethodsThis retrospective study compared a “Pharmacist-Driven” (index date: January 1, 2016) with a “Tech-Enhanced” (index date: January 1, 2019) group. The primary outcome was the proportion of patients at all goals defined as LDL-C < 70 mg/dL, non-HDL < 100 mg/dL, and BP < 140/90 mm Hg at 1 year after the index dates. ResultsThere were 6813 patients included (mean age: 70.2 ± 11.1 years, 71.4% male): 3130 and 3683 in the “Pharmacist-Driven” and “Tech-Enhanced” groups, respectively. The proportion of patients who attained LDL-C, non-HDL, and BP goals was higher in the “Tech-Enhanced” group (51.1% vs. 39.7%, P < 0.001) than the “Pharmacist-Driven” group. ConclusionA protocol integrating EHR decision support and CPhTs enabled work to shift to from CPS to CPhT and improved clinical outcomes.

Principles of using esmolol in the practice of anesthesiologists and intensive care physicians

Prevention and reduction of cardiac risk remains an important issue in anesthesiology and intensive care. There is a successful clinical experience in the use of esmolol for the correction of hemodynamic and ischemic disorders in acute coronary syndrome, in the perioperative period with excessive activation of the sympathoadrenal system. A large number of works are devoted to the use of esmolol as a drug that prevents hemodynamic changes due to tracheal intubation. The aim of the study was to evaluate the use of esmolol and dexmedetomidine as intravenous adjuvants in general analgesia during thyroidectomy in patients with thyrotoxicosis. The use of esmolol (Biblock) and dexmedetomidine in anesthesia for thyroidectomy, suppresses the hemodynamic response caused by surgical stress. Both adjuvants stabilize oxygen consumption and maintain a stable metabolism. Both drugs are quite effective as intravenous adjuvants in general analgesia for thyroidectomy in patients with thyrotoxicosis. They are the drugs of choice and can be recommended in practical anesthesiology.

Cardiac mortality in patients randomised to elective coronary revascularisation plus medical therapy or medical therapy alone: a systematic review and meta-analysis.

AimsThe value of elective coronary revascularisation plus medical therapy over medical therapy alone in managing stable patients with coronary artery disease is debated. We reviewed all trials comparing the two strategies in this population.Methods and resultsFrom inception through November 2020, MEDLINE, EMBASE, Google Scholar, and other databases were searched for randomised trials comparing revascularisation against medical therapy alone in clinically stable coronary artery disease patients. Treatment effects were measured by rate ratios (RRs) with 95% confidence intervals, using random-effects models. Cardiac mortality was the pre-specified primary endpoint. Spontaneous myocardial infarction (MI) and its association with cardiac mortality were secondary endpoints. Further endpoints included all-cause mortality, any MI, and stroke. Longest follow-up data were abstracted. The study is registered with PROSPERO (CRD42021225598). Twenty-five trials involving 19 806 patients (10 023 randomised to revascularisation plus medical therapy and 9783 to medical therapy alone) were included. Compared with medical therapy alone, revascularisation yielded a lower risk of cardiac death [RR 0.79 (0.67–0.93), P < 0.01] and spontaneous MI [RR 0.74 (0.64–0.86), P < 0.01]. By meta-regression, the cardiac death risk reduction after revascularisation, compared with medical therapy alone, was linearly associated with follow-up duration [RR per 4-year follow-up: 0.81 (0.69–0.96), P = 0.008], spontaneous MI absolute difference (P = 0.01) and percentage of multivessel disease at baseline (P = 0.004). Trial sequential and sensitivity analyses confirmed the reliability of the cardiac mortality findings. All-cause mortality [0.94 (0.87–1.01), P = 0.11], any MI (P = 0.14), and stroke risk (P = 0.30) did not differ significantly between strategies.ConclusionIn stable coronary artery disease patients, randomisation to elective coronary revascularisation plus medical therapy led to reduced cardiac mortality compared with medical therapy alone. The cardiac survival benefit after revascularisation improved with longer follow-up times and was associated with fewer spontaneous MIs.

Possible Reduction of Cardiac Risk after Supplementation with Epigallocatechin Gallate and Increase of Ketone Bodies in the Blood in Patients with Multiple Sclerosis. A Pilot Study.

Multiple sclerosis (MS) is a neurodegenerative disease that causes anthropometric changes characterised by functional disability, increase in fat mass, and decrease in lean mass. All these variables are related to a greater cardiac risk. The polyphenol epigallocatechin gallate (EGCG) and an increase in ketone bodies in the blood have been shown to have beneficial effects on anthropometric and biochemical variables related to cardiovascular activity. The aim of this study was to analyse the impact of the intervention with EGCG and ketone bodies on cardiac risk in MS patients. A population of 51 MS patients were randomly assigned to a control group and an intervention group (daily dose of 800 mg of EGCG and 60 mL of coconut oil). Both groups followed an isocaloric diet for 4 months. Levels of beta-hydroxybutyrate (BHB), albumin, paraoxonase 1 (PON1) and C-reactive protein (CRP) were measured in serum before and after the intervention, as well as determining functional ability, waist circumference, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), fat percentage and muscle percentage. After 4 months, in the intervention group there was a significant increase in BHB, PON1 and albumin, while CRP did not vary; a significant decrease in cardiac risk associated with a significant decline in WHR; as well as a significant increase in muscle percentage. By contrast, these changes were not observed in the control group. Finally, results from analysis of variance (ANOVA) revealed a significant time–condition interaction effect, observing that WHtR and fat mass decreased in the intervention group, while they increased in the control group.

Statin Use and Major Adverse Cardiac Events among High Cardiac Risk Patients with Lung Cancer Receiving Radiotherapy

Statin use is recommended in patients with high Framingham risk or established coronary heart disease (CHD). Patients with lung cancer have a high prevalence of pre-existing CHD and face excess cardiac risk following thoracic radiotherapy (RT). We sought to characterize statin use by cardiac risk in a large cohort of patients with locally advanced non-small cell lung cancer (NSCLC) treated with RT. Retrospective analysis of 748 locally advanced NSCLC patients treated with thoracic RT. Patients were stratified by 10-year Framingham risk. High cardiac risk was defined as either high (≥20%) Framingham risk or pre-existing CHD or CHD risk equivalent. The cumulative incidence of major adverse cardiac events (MACE; unstable angina, heart failure, myocardial infarction [MI], coronary revascularization, and cardiac death) was estimated and Fine and Gray regressions were performed (non-cardiac death as a competing risk). The median follow-up was 20 months overall and 48 months in patients alive. Among CHD-negative patients (64.2%), 27.9% were low Framingham risk, 25.0% moderate and 47.1% high risk. At the time of RT, statin use by Framingham risk group (low, moderate, or high) or known CHD was 15.7%, 25.8%, 37.2%, and 63.1%, respectively. Among all high cardiac risk patients (66%, n = 496), only 51.2% were on a statin at the time of RT. High cardiac risk patients on statins (compared to no statin) were more likely to have a history of hypertension (73.3% vs. 51.4%, P<.001), hyperlipidemia (83.4% vs. 29.2%, P<.001), diabetes (28.1% vs. 11.5%, P<.001), former smoking (62.1% vs. 49.4%, P = .017), peripheral vascular disease (17.1 vs. 7.4%, P = .001), stroke (4.4% vs. 1.2%, P = .032), coronary artery disease (52.2% vs. 32.5%, P<.001), MI (49.6% vs. 26.0%, P = .001), and congestive heart failure (17.8% vs. 6.6%, P<.001), with no significant difference in age, sex, performance status, cancer stage, chemotherapy use, RT prescription dose, or cardiac or coronary RT dose exposure (P>.05). Statin use was associated with increased risk of MACE in high cardiac risk patients on univariable analysis (hazard ratio [HR] 1.76; 95% CI: 1.06-2.90; P = .027) with 2-year MACE estimates of 10.9% vs. 4.5%, but not when adjusted for known cardiac prognostic factors (P = 0.4). Only half of statin-eligible high cardiac risk patients with locally advanced NSCLC are on a statin at the time of RT. Even among high cardiac risk patients, those on statins harbored significantly more cardiac risk factors than those not on statins, suggesting only those of highest cardiac risk are on anti-lipid therapy at the time of RT. These results highlight that NSCLC patients represent a distinctly high cardiac risk population due to elevated baseline risk factors and cardiac radiation exposure with an unmet need for improved cardiac risk reduction, including optimization of medical therapy.

Prevalence of abnormalities in electrocardiogram conduction in dialysis patients: a comparative study.

The electrocardiogram (ECG) can aid in identification of chronic kidney disease (CKD) patients at high risk for cardiovascular diseases. Cohort studies describe ECG abnormalities in patients on hemodialysis (HD), but we did not find data comparing ECG abnormalities among patients with normal kidney function or peritoneal dialysis (PD) to those on hemodialysis. We hypothesized that ECG conduction abnormalities would be more common, and cardiac conduction interval times longer, among patients on hemodialysis vs. those on peritoneal dialysis and CKD 1 or 2. Retrospective review of adult inpatients' charts, comparing those with billing codes for "Hemodialysis" vs. inpatients without those charges, and an outpatient peritoneal dialysis cohort. Patients with CKD 3 or 4 were excluded. One hundred and sixty-seven charts were reviewed. ECG conduction intervals were consistently and statistically longer among hemodialysis patients (n=88) vs. peritoneal dialysis (n=22) and CKD stage 1 and 2 (n=57): PR (175±35 vs 160±44 vs 157±22 msec) (p=0.009), QRS (115±32 vs. 111±31 vs 91±18 msec) (p=0.001), QT (411±71 vs. 403±46 vs 374±55 msec) (p=0.006), QTc (487±49 vs. 464±38 vs 452±52 msec) (p=0.0001). The only significantly different conduction abnormality was prevalence of left bundle branch block: 13.6% among HD patients, 5% in PD, and 2% in CKD 1 and 2 (p=0.03). To our knowledge, this is the first study to report that ECG conduction intervals are significantly longer as one progresses from CKD Stage 1 and 2, to PD, to HD. These and other data support the need for future research to utilize ECG conduction times to identify dialysis patients who could potentially benefit from proactive cardiac evaluations and risk reduction.

Prevalence of abnormalities in electrocardiogram conduction in dialysis patients: a comparative study

ABSTRACTBackground: The electrocardiogram (ECG) can aid in identification of chronic kidney disease (CKD) patients at high risk for cardiovascular diseases. Cohort studies describe ECG abnormalities in patients on hemodialysis (HD), but we did not find data comparing ECG abnormalities among patients with normal kidney function or peritoneal dialysis (PD) to those on hemodialysis. We hypothesized that ECG conduction abnormalities would be more common, and cardiac conduction interval times longer, among patients on hemodialysis vs. those on peritoneal dialysis and CKD 1 or 2.Methods: Retrospective review of adult inpatients’ charts, comparing those with billing codes for “Hemodialysis” vs. inpatients without those charges, and an outpatient peritoneal dialysis cohort. Patients with CKD 3 or 4 were excluded.Results: One hundred and sixty-seven charts were reviewed. ECG conduction intervals were consistently and statistically longer among hemodialysis patients (n=88) vs. peritoneal dialysis (n=22) and CKD stage 1 and 2 (n=57): PR (175±35 vs 160±44 vs 157±22 msec) (p=0.009), QRS (115±32 vs. 111±31 vs 91±18 msec) (p=0.001), QT (411±71 vs. 403±46 vs 374±55 msec) (p=0.006), QTc (487±49 vs. 464±38 vs 452±52 msec) (p=0.0001). The only significantly different conduction abnormality was prevalence of left bundle branch block: 13.6% among HD patients, 5% in PD, and 2% in CKD 1 and 2 (p=0.03). Conclusion: To our knowledge, this is the first study to report that ECG conduction intervals are significantly longer as one progresses from CKD Stage 1 and 2, to PD, to HD. These and other data support the need for future research to utilize ECG conduction times to identify dialysis patients who could potentially benefit from proactive cardiac evaluations and risk reduction.

Cardiovascular Complications Associated with Mediastinal Radiation.

Radiation-induced heart disease (RIHD) encompasses a broad range of pathologies and is a significant source of morbidity and mortality among cancer survivors. Increased awareness of the early and late consequences of mediastinal radiation has led to the development of strategies for cardiac risk reduction to improve outcomes through active surveillance and early detection of RIHD. This review aims to discuss the current knowledge on the presentation, diagnosis, and management of RIHD. Decades' worth of cohort data demonstrates an increased risk of RIHD as cancer survivors age. Additionally, interventional/surgical management of irradiated patients poses unique considerations and can be technically challenging. Used in conjunction with echocardiography, multimodality imaging for morphologic and functional assessment adds complementary value in screening, surveillance, and targeted symptom investigation in patients at risk for RIHD. Furthermore, sensitive imaging parameters and biomarkers have shown potential in detecting subclinical RIHD. Despite the development of techniques which minimize cardiac exposure to ionizing radiation, their effects on the long-term development of RIHD remain to be seen. Due to the morbidity and mortality associated with RIHD, both patients and clinicians should be aware of the lifelong cardiovascular risks of mediastinal radiation exposure. RIHD surveillance should be a consideration throughout the survivorship period. Studies to evaluate the clinical consequences of contemporary radiation therapy strategies aimed at minimizing cardiac doses and the value of novel, more sensitive metrics for the early detection or prognostication of RIHD are ongoing.

Cardiovascular Parameters of People with Diabetes Mellitus: An Intervention Study

Cardiovascular diseases are the main chronic complication of diabetes mellitus. The literature shows that educational interventions can promote, among other benefits, the reduction of cardiac risk, especially when they include, in practice, lifestyle changes. The present study aimed to evaluate the effects of an educational program, centered on self-care and concurrent physical training, on the cardiovascular parameters of 15 people with type 2 diabetes mellitus. There was a higher frequency of elderly, female, low educational level, a diagnosis time less than 10 years and the use of oral antidiabetics.

In Vitro Cardiac Risk Reduction Bioactive Substance from the Seedlings of Echinochloa frumentacea and Panicum sumantrance

In Vitro Cardiac Risk Reduction Bioactive Substance from the Seedlings of Echinochloa frumentacea and Panicum sumantrance

Trends in high-intensity statin use and low-density lipoprotein cholesterol control among patients enrolled in a clinical pharmacy cardiac risk service

Although high-intensity statin therapy (HIST) is recommended for most patients between 21 and 75years of age with atherosclerotic cardiovascular disease (ASCVD), several recent analyses examining contemporary statin use trends have identified a clinical care gap in the utilization of HIST. The objective of this study was to assess secular trends in lipid management for patients with ASCVD enrolled in a clinical pharmacy program within an integrated health care delivery system. We performed serial cross-sectional studies over time, comprising 18,006 adults with both acute and chronic ASCVD, to assess trends in statin use and low-density lipoprotein cholesterol (LDL-C) levels from 2007 to2016. Although the use of statin therapy (any intensity) remained relatively consistent throughout the 10-year study period (89% in 2007, 87% in 2016), the proportion of patients receiving HIST increased over time (44% in 2007, 67% in 2016; P<.001 for trend). Population mean LDL-C levels ranged from 73 to 83mg/dL with a downward trend over the 10-year study period (P<.001 for trend). By 2016, the proportion of patients attaining an LDL-C <100mg/dL and <70mg/dL was 85% and 54%, respectively. Nonstatin lipid-lowering therapy use decreased over the study period, which was primarily driven by decreased use of ezetimibe (24% in 2007, 2% in 2016; P<.001 for trend). Among adults with ASCVD enrolled in a clinical pharmacy cardiac risk reduction service, guideline-directed use of HIST significantly increased over the past 10years and coincided with decreased population LDL-C levels.

Biomarkers of cardio-renal syndrome in uremic myocardiopathy animal model.

ABSTRACTIntroduction:Cardio-renal syndrome subtype 4 (CRS4) is a condition of primary chronic kidney disease that leads to reduction of cardiac function, ventricular hypertrophy, and risk of cardiovascular events. Objective: Our aim was to understand the mechanisms involved on the onset of CRS4.Methods:We used the nephrectomy 5/6 (CKD) animal model and compared to control (SHAM). Serum biomarkers were analyzed at baseline, 4, and 8 weeks. After euthanasia, histology and immunohistochemistry were performed in the myocardium.Results:Troponin I (TnI) was increased at 4 weeks (W) and 8W, but nt-proBNP showed no difference. The greater diameter of cardiomyocytes indicated left ventricular hypertrophy and the highest levels of TNF-α were found at 4W declining in 8W while fibrosis was more intense in 8W. Angiotensin expression showed an increase at 8W.Conclusions:TnI seems to reflect cardiac injury as a consequence of the CKD however nt-proBNP did not change because it reflects stretching. TNF-α characterized an inflammatory peak and fibrosis increased over time in a process connecting heart and kidneys. The angiotensin showed increased activity of the renin-angiotensin axis and corroborates the hypothesis that the inflammatory process and its involvement with CRS4. Therefore, this animal study reinforces the need for renin-angiotensin blockade strategies and the control of CKD to avoid the development of CRS4.

The Yale Fitness Intervention Trial in female cancer survivors: Cardiovascular and physiological outcomes

BackgroundInduced premature menopause and cardio-toxic therapy increase cardiovascular disease risk in female cancer survivors. ObjectiveTo compare the effects of a 12 month aerobic-resistance fitness center intervention to home based physical activity on cardiovascular function and metabolic risk factors. MethodsSubjects (N = 154) who had completed primary and/or adjuvant chemotherapy (past 3 years) were randomized to a fitness center intervention or a home based group. The fitness center intervention was a structured thrice weekly aerobic (30 min brisk walking treadmill in target heart range) combined with resistance (30 min of lower body strength training) exercise program, supervised for the first 6 months. The home based group received national guidelines for 30 min moderate intensity exercise most days of the week. Fasting serum samples were collected at baseline, 6 and 12 months for insulin, glucose, lipids and hemoglobin A-1C. A graded exercise stress test was also performed at baseline and 6 months. ResultsThe majority of subjects were white (85.7%), had breast cancer (83.1%) and the average age was 51.9 years. Subjects in the fitness center intervention had significantly improved time on treadmill (p = .039), improved heart rate recovery at 1 min (p = .028), greater MET minutes/week (p ≤ .0001), a trend for improved insulin resistance (p = .067) and stable insulin levels (p = .045) compared to the home based physical activity group. ConclusionsExercise represents a potential cardiac risk reduction intervention for cancer survivors. Clinical Trials.govNCT01102985.

The effect of a 12-week exercise and lifestyle management programme on cardiac risk reduction: A pilot using a kaupapa Māori philosophy

Introduction: Cardiovascular disease remains the leading cause of premature death and disability for all New Zealanders. Māori, the Indigenous people of New Zealand, are disproportionately affected. The New Zealand Māori Health Strategy recognises that “health and wellbeing are influenced and affected by the ‘collective’ … and the importance of working with people in their social contexts, not just with their physical symptoms” (Ministry of Health, 2002, p. 1). In a Māori worldview, a holistic approach to health is innate. Objectives: This project piloted a kaupapa Māori approach within an existing 12-week clinical exercise and lifestyle management programme. The aims of the study were to determine the effectiveness of a kaupapa Māori 12-week exercise and lifestyle management programme on parameters of cardiac risk and quality of life. Methods: 12 Māori participants attended, 3 times per week over a 12-week period, for monitored, supervised, and individualised exercise. Participants performed a progressive aerobic-only programme for 6 weeks and then a combined aerobic and resistance training programme from weeks 7 through 12. Education sessions were chosen by participants. Results: There was a statistically significant improvement in waist circumference (–3.7 cm; p = .05), hip circumference (–4.6 cm; p = .03), systolic blood pressure (–22 mm Hg; p = .01), and HDL cholesterol (0.22 mmol/L; p = .01). In addition, physical (p = .05) and overall (p = .03) quality of life improved. Conclusion: A kaupapa Māori approach within a structured lifestyle management programme modifies cardiac risk parameters in Māori.