Cardiovascular Disease Risk Reduction Research Articles

Increasing the frequency of plant-based food intake in daily diets reduces the risk of cardiovascular disease among elderly Chinese: a cohort study

ObjectiveThere is limited research on the relationship between the frequency of plant-based food intake and the risk of cardiovascular disease (CVD) among elderly Chinese. This study aims to evaluate the association between plant-based dietary index (PDI) and CVD risks, providing evidence for elderly Chinese to reduce CVD risks by increasing the frequency of plant-based food consumption.MethodsThis study analyzed data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2011–2018, employing a multivariate modified Poisson regression model, trend tests, and restricted cubic spline (RCS) analysis to assess the linear and non-linear relationship between the PDI and CVD risks. Subgroup analyses and interaction tests were conducted to evaluate the robustness and population-specificity of the results.ResultsThis study included a total of 1,414 elderly Chinese, and at the end of follow-up, 487 participants had developed CVD. The multivariate modified Poisson regression model revealed a negative association between PDI and CVD risks [RR = 0.983, 95%CI = (0.970, 0.997)]. Similarly, the multivariate trend test (p = 0.031) and RCS analysis (P for nonlinear = 0.600) indicated a linear relationship between PDI and CVD risks. Subgroup analyses showed that the relationship between PDI and CVD risk was not influenced by gender, BMI, smoking, alcohol use, or exercise.ConclusionThe PDI was negatively correlated with CVD risks, indicating that increasing the frequency of plant-based food intake in the diet may reduce CVD risks among elderly Chinese.

Choline consumption reduces CVD risk via body composition modification

Despite extensive research on the relationship between choline and cardiovascular disease (CVD), conflicting findings have been reported. We aim to investigate the relationship between choline and CVD. Our analysis screened a retrospective cohort study of 14,663 participants from the National Health and Nutrition Examination Survey conducted between 2013 and 2018. Propensity score matching and restricted cubic splines was used to access the association between choline intake and the risk of CVD. A two-sample Mendelian randomization (MR) analysis was conducted to examine the potential causality. Additionally, sets of single cell RNA-sequencing data were extracted and analyzed, in order to explore the role of choline metabolism pathway in the progression and severity of the CVD and the underlying potential mechanisms involved. The adjusted odds ratios and 95% confidence intervals for stroke were 0.72 (0.53–0.98; p = 0.035) for quartile 3 and 0.54 (0.39–0.75; p < 0.001) for quartile 4. A stratified analysis revealed that the relationship between choline intake and stroke varied among different body mass index and waist circumference groups. The results of MR analysis showed that choline and phosphatidylcholine had a predominantly negative causal effect on fat percentage, fat mass, and fat-free mass, while glycine had opposite effects. Results from bioinformatics analysis revealed that alterations in the choline metabolism pathway following stroke may be associated with the prognosis. Our study indicated that the consumption of an appropriate quantity of choline in the diet may help to protect against CVD and the effect may be choline-mediated, resulting in a healthier body composition. Furthermore, the regulation of the choline metabolism pathway following stroke may be a promising therapeutic target.

User Acceptability Testing of Mobile Application in Indian Local Languages for Cardiovascular Risk Stratification and Modification among Patients with Type 2 Diabetes

Introduction: Cardiovascular disease is the leading cause of death in patients with type 2 diabetes. Digital health tools like mobile application have fast emerged as a technology capable of closing the gap in cardiovascular disease self- management and revolutionizing the way healthcare is traditionally delivered. One of the causes for low app engagement of Apps in India is perhaps that few of these apps are available in local languages. The goal is to reach as many diabetic patients as possible while avoiding linguistic hurdles.  Methodology: The ‘healthy heart’ mobile app was developed and translated into Hindi and Marathi languages for CVD risk stratification and risk management among Type 2 diabetes mellitus patients. User acceptability testing of the app on its design, presentation, content, and user- friendliness was undertaken. The feedback on utility of the app for CVD risk stratification and modification was assessed. A total 100 multilingual app users profile were noted for CVD Risk Status, Life Style Practices and CVD Risk Factors.  Results: The Healthy Heart multi-lingual app was successfully developed for CVD risk classification and risk management among Type 2 diabetes mellitus patients. The patients had the choice to select the desired language of the app from the versions available in English, Hindi and Marathi. The Mobile App's Home Screen displayed the CVD risk score and category, a health tracker to monitor compliance with WHO recommendations regarding diet, physical activity, addictions, medication adherence, diabetic, and CVD Risk Profile. The majority of respondents rated the App's design, presentation, content, and user- friendliness favorably and emphasized the utility of App for CVD self-management and risk reduction. Characteristics of Type 2 Diabetic patients demonstrated poor compliance for total fruits and vegetable intake, total fat intake and total salt intake, physical activity Guidelines apart from poor control for blood pressure, glycemic control and lipid targets.  Conclusion: The multilingual mobile App for CVD risk stratification, self-management and CVD risk reduction among diabetic patients was successfully developed in Hindi and Marathi language. User acceptability testing results were found to be favorable for the mobile app.

Socioeconomic status as a potential mediator of arterial aging in marginalized ethnic and racial groups: current understandings and future directions.

Cardiovascular diseases (CVDs) are the leading cause of death in the United States. However, disparities in CVD-related morbidity and mortality exist as marginalized racial and ethnic groups are generally at higher risk for CVDs (Black Americans, Indigenous People, South and Southeast Asians, Native Hawaiians, and Pacific Islanders) and/or development of traditional CVD risk factors (groups above plus Hispanics/Latinos) relative to non-Hispanic Whites (NHW). In this comprehensive review, we outline emerging evidence suggesting these groups experience accelerated arterial dysfunction, including vascular endothelial dysfunction and large elastic artery stiffening, a nontraditional CVD risk factor that may predict risk of CVDs in these groups with advancing age. Adverse exposures to social determinants of health (SDOH), specifically lower socioeconomic status (SES), are exacerbated in most of these groups (except South Asians-higher SES) and may be a potential mediator of accelerated arterial aging. SES negatively influences the ability of marginalized racial and ethnic groups to meet aerobic exercise guidelines, the first-line strategy to improve arterial function, due to increased barriers, such as time and financial constraints, lack of motivation, facility access, and health education, to performing conventional aerobic exercise. Thus, identifying alternative interventions to conventional aerobic exercise that 1) overcome these common barriers and 2) target the biological mechanisms of aging to improve arterial function may be an effective, alternative method to aerobic exercise to ameliorate accelerated arterial aging and reduce CVD risk. Importantly, dedicated efforts are needed to assess these strategies in randomized-controlled clinical trials in these marginalized racial and ethnic groups.

Obstructive Sleep Apnea and Its Cardiac Implications in the United States: An Age-Stratified Analysis Between Young andOlder Adults.

Obstructive sleep apnea (OSA) is a common sleep disorder associated with cardiovascular risks. This study aimed to assess the prevalence of probable OSA and its relationship with cardiovascular risks and diseases focusing on age-stratified young adults (20-40 years) and older (>40 years). The study used a cross-sectional design, analyzing data from the National Health and Nutrition Examination Survey conducted between 2013 and 2018, comprising 9887 community-dwelling adults aged ≥20 years. Probable OSA was determined on the basis of self-report of OSA-related symptoms (eg, snoring, gasping/breath cessation while sleeping). Cardiovascular risk factors, including hypertension, diabetes, hyperlipidemia, and metabolic syndrome, were evaluated according to established guidelines. Cardiovascular diseases (CVDs) included self-reported heart conditions, including congestive heart failure, coronary heart disease, angina, heart attacks, and strokes. Individuals with probable OSA showed a significantly higher prevalence of health conditions, including hypertension (adjusted prevalence ratio [aPR], 1.19; P<0.001), diabetes (aPR, 1.17; P: 0.01), metabolic syndrome (aPR, 1.14; P<0.001), heart attack (aPR, 1.63; P<0.01), stroke (aPR, 1.41; P: 0.03), and any CVD event (aPR, 1.36; P: 0.01) after adjusting for relevant factors. Young adults with probable OSA showed higher prevalence rates of any CVD events (aPR, 3.44; P<0.001), hypertension (aPR, 1.45; P<0.001), metabolic syndrome (aPR, 1.25; P<0.001), and angina (aPR, 10.39; P<0.001). The study suggests early identification and management of OSA in individuals at risk for CVD. While cross-sectional, it emphasizes that health care providers should recognize OSA as significantly associated with CVDs and its precursor risks in young adults, stressing proactive care and screening to reduce CVD risk in this population.

Methodological quality and clinical recommendations of guidelines on the management of dyslipidaemias for cardiovascular disease risk reduction: a systematic review and an appraisal through AGREE II and AGREE REX tools.

Clinical practice guidelines (CPGs) are statements to assist practitioners and stakeholders in decisions about healthcare. Low methodological quality guidelines may prejudice decision-making and negatively affect clinical outcomes in non-communicable diseases, such as cardiovascular diseases worsted by poor lipid management. We appraised the quality of CPGs on dyslipidemia management and synthesized the most updated pharmacological recommendations. A systematic review following international recommendations was performed. Searches to retrieve CPG on pharmacological treatments in adults with dyslipidaemia were conducted in PubMed, Scopus, and Trip databases. Eligible articles were assessed using AGREE II (methodological quality) and AGREE-REX (recommendation excellence) tools. Descriptive statistics were used to summarize data. The most updated guidelines (published after 2019) had their recommendations qualitatively synthesized in an exploratory analysis. Overall, 66 guidelines authored by professional societies (75%) and targeting clinicians as primary users were selected. The AGREE II domains Scope and Purpose (89%) and Clarity of Presentation (97%), and the AGREE-REX item Clinical Applicability (77.0%) obtained the highest values. Conversely, guidelines were methodologically poorly performed/documented (46%) and scarcely provided data on the implementability of practical recommendations (38%). Recommendations on pharmacological treatments are overall similar, with slight differences concerning the use of supplements and the availability of drugs. High-quality dyslipidaemia CPG, especially outside North America and Europe, and strictly addressing evidence synthesis, appraisal, and recommendations are needed, especially to guide primary care decisions. CPG developers should consider stakeholders' values and preferences and adapt existing statements to individual populations and healthcare systems to ensure successful implementation interventions.

The Impact of an AI-Driven Personal Health Platform on Cardiovascular Disease Risk

Cardiovascular disease (CVD) is a global health concern, particularly among older adults, linked to fat and sugar-rich diet, inactivity, tobacco smoking, as well as genetic factors. Regular exercise and a balanced diet are recommended to reduce CVD risk. Recently, the use of computer of mobile phone application platforms have become promenent tools for personal health interventions and guidance. Although research findings of the efficacy of mobile health apps has had mixed results, improved user health and lowered risk of CVD has been seen with regular engagement. Shae, an AI-driven mobile health platform, offers personalized lifestyle guidance based on an individual's phenotype. The aim of this study is to assess whether engagement with the online platform, Shae, decreases Framingham non-laboratory CVD risk score over time.The study collected data from 1684 participants who engaged with the Shae online platform for at least 3-months between May 2014 and March 2018. After applying exclusion criteria, 5225 complete assessment entries remained for analysis. The Shae platform assessed health, predicted future risks, and recommended personalized interventions. Data included anthropometric measurements and survey responses, converted for standardized analysis. Descriptive statistics were calculated for participants' characteristics and compared across gender and age groups, in alignment with established cardiovascular disease (CVD) risk factors. A linear mixed-effect regression model was employed to assess changes in CVD risk over time. This research aimed to evaluate the impact of personalized health interventions on CVD risk in diverse demographic groups.CVD risk score, when adjusted for age, decreased by 11.2% following 24 months of engagement with the Shae app, with men 45 years and older seeing the largest decrease (16.1%), and the lowest decrease seen in women under 55 years (10%). Use of the Shae app was primarily by women (85%).This study assessed the impact of engagement with the mHealth app, Shae, on reducing CVD risk. Results revealed a significant CVD risk reduction, notably in men over 45. mHealth apps like Shae provide personalized health assessments, activity tracking, nutrition advice, and medication reminders, enabling proactive cardiovascular health management. Increased physical activity and better blood pressure control were key factors in risk reduction. Tailored interventions for high-risk groups align with previous research. Given the importance of preventing CVD, mHealth apps hold promise. This 24-month study offers robust insights, and the focus on individual phenotypes enhances engagement and health outcomes.

Persistence and Adherence to PCSK9 Inhibitor Monoclonal Antibodies Versus Ezetimibe in Real-World Settings.

The cardiovascular disease risk reduction benefits of proprotein convertase subtilisin/kexin type 9 inhibitor monoclonal antibodies (PCSK9i mAb) and ezetimibe are dependent on remaining on treatment and being persistent and adherent. We estimated the percentage of patients on therapy, persistent and adherent at 182 and 365days among US adults with health insurance who initiated a PCSK9i mAb (n = 16,588) or ezetimibe (n = 83,086) between July 2015 and December 2019. Using pharmacy fill claims, being on therapy was defined as having a day of medication supply in the last 60 of 182 and 365days following treatment initiation, being persistent was defined as not having a gap of 60days or more between the last day of supply from one prescription fill and the next fill, and being adherent was defined by having medication available to take on ≥ 80% of the 182 and 365days following treatment initiation. We estimated multivariable-adjusted risk ratios for being persistent and adherent comparing patients initiating PCSK9i mAb versus ezetimibe using Poisson regression. At 182days following initiation, 80% and 68% were on therapy and 76% and 64% were persistent among patients who initiated a PCSK9i mAb and ezetimibe, respectively. Among patients who were on therapy and persistent at 182days following initiation, 88% and 81% of those who initiated a PCSK9i mAb and ezetimibe, respectively, were on therapy at 365days. Among those on therapy and persistent at 182days following initiation, being persistent and being adherent at 365days were each more common among PCSK9i mAb versus ezetimibe initiators (persistent: 82% versus 76%, multivariable-adjusted risk ratio 1.07; 95% confidence interval [CI] 1.06-1.08; adherent: 74% versus 71%, multivariable-adjusted risk ratio 1.02; 95% CI 1.01-1.03). These data suggest approaches to increase persistence and adherence to PCSK9i mAb and ezetimibe should be implemented prior to or within 182days following treatment initiation.

Communicating cardiovascular health information and improving coordination with primary care: A Childhood Cancer Survivor Study randomized trial.

10011 Background: Childhood cancer survivors are at risk of early cardiovascular disease (CVD). We conducted a survivorship care plan (SCP)-based counseling intervention to improve CVD risk factor control in adult-aged survivors. Methods: Randomized (1:1) trial of survivors at high CVD risk based on history of anthracycline or chest radiotherapy exposures with undertreated hypertension (≥130/80 mmHg), dyslipidemia (LDL ≥160 mg/dL or triglyceride ≥200 mg/dL), and/or glucose intolerance (threshold varied if history of pre-diabetes or diabetes) based on in-home testing. Approximating a survivorship clinic visit, the intervention consisted of a remotely delivered session with an advanced practice provider to review results, a SCP with personalized CVD risk information, and an action plan to help manage CVD risk factors. A remote booster session was provided 4 months later with the action plan updated. Control participants only received a copy of their in-home results with abnormalities noted and written encouragement to follow-up with their primary care provider (PCP). Blood pressure, lipid profile, and glucose tolerance were retested after 1y. For both groups, all participant materials were sent to PCPs throughout the study, and PCP medical records were abstracted at study completion. Logistic regression assessed the odds ratio (OR) for undertreatment at 1y associated with the intervention, adjusting for pre-specified variables (sex, current age, time since cancer, insurance status, recent history of survivorship clinic visit, and undertreated CVD risk factor). Results: Among 644 survivors who completed in-home testing, 347 met inclusion criteria and were randomized (175 intervention; overall 52% male, mean age 40y, 31y since cancer diagnosis); 264 with 1y follow-up (126 intervention). At baseline, rates of hypertension, dyslipidemia, and glucose intolerance were 53%, 52%, and 49%, respectively; 43% had &gt; 1 undertreated condition. Although the intervention achieved &gt; 95% satisfaction, it was not associated with reduced undertreatment vs control (OR 0.9, 95% CI 0.7-1.3). Notably, 48% of intervention and 44% of control participants had less undertreatment after 1y. In secondary analysis, greater internal locus of control was associated with less undertreatment at 1y (OR 0.7, 95% CI 0.6-0.9). The intervention group was more likely than controls to have CVD risk (+10 vs -1%), SCP (+17 vs -2%), and some late effects surveillance plan (+8 vs +2%) documented within PCP records at 1y vs baseline (p &lt; 0.05 for all). Conclusions: While a remotely delivered counseling intervention did not reduce CVD risk factor undertreatment compared with provision of test results alone, both study arms had &gt; 40% reduction in undertreatment. These results suggest that simply providing a formal CVD risk assessment to high-risk cancer survivors and their PCPs may be effective. Clinical trial information: NCT03104543 .

Impact of integrative care on cardiovascular disease risk in newly diagnosed type 2 diabetes mellitus patients: A BI-VitalLife Cohort study.

Type 2 diabetes mellitus (T2DM), a chronic metabolic disorder, significantly increases cardiovascular disease (CVD) risk. Integrative care (IC) offers a personalized health management approach, utilizing various interventions to mitigate this risk. However, the impact of IC on CVD risk in newly diagnosed T2Dm patients remains unclear. This study aims to assess the differences in CVD risk development within 120 months following a new diagnosis of T2DM, using real-world data from Bumrungrad International Hospital and Vitallife Scientific Wellness Center. This study utilized the BI-VitalLife Cohort dataset that contains de-identified demographics, vitals, diagnoses and clinical information, laboratory and radiological data, medications, and treatments of more than 2.8 million patients who visited Bumrungrad International Hospital and/or VitalLife Scientific Wellness Center from June 1, 1999, to May 31, 2022. This study focused on newly diagnosed T2DM patients, defined according to American Diabetes Association criteria. We compared CVD risk between the IC and conventional care (CC) groups using the Kaplan-Meier curve and Cox proportional hazard model, adjusted for age, sex, and laboratory values. Propensity score matching was employed to enhance comparability. Of the 5,687 patients included, 236 were in the IC group and 5,451 in the CC group. The IC group, characterized by a lower age at T2DM diagnosis, showed favorable hematological and metabolic profiles. The Cox proportional hazard ratios revealed a significantly lower CVD risk in the IC group within 120 months post-T2DM diagnosis compared to the CC group, consistent even after adjusting for confounding factors. Propensity score-matched analysis supported these findings. Personalized integrative care may offer a significant advantage in reducing CVD risk among newly diagnosed T2DM patients compared to conventional care, even when considering various confounding factors. This study sheds light on the potential of integrative care in informing treatment strategies for T2DM patients at risk of developing CVD.

Associations between Vegetable Nitrate Intake and Cardiovascular Disease Risk and Mortality: A Systematic Review.

Consumption of nitrate-rich vegetables increases nitric oxide bioavailability, lowers blood pressure, and improves endothelial function. These effects could also translate into reduced cardiovascular disease (CVD) risk and mortality. This systematic review aimed to investigate the associations between habitual vegetable nitrate intake and CVD incidence and mortality. A secondary aim was to identify factors that moderate the relationship between vegetable nitrate intake and CVD incidence/mortality. Seven databases (PubMed, MEDLINE, Embase, Scopus, Web of Science, CINAHL, and APA PsycINFO) were searched from inception to 13 February 2023. Observational studies quantifying vegetable nitrate intake in participants aged 18+ years through self-reported dietary exposure and assessing incidence or mortality from CVD overall, or individual CVD subtypes, were eligible. Five studies including a total of 63,155 participants were included. There was an inverse association between vegetable nitrate intake and most reported CVD outcomes. Reported risk reductions tended to plateau at moderate intake, suggesting a possible ceiling effect. The risk of bias across all studies was low. The results of this systematic review suggest a potential role for vegetable nitrate in reducing CVD risk and mortality. Further randomised controlled trials are now required to corroborate these findings.

Cardiovascular risk among community members in three communities in the Cape Metropole of the Western Cape.

Cardiovascular diseases pose a risk to population health in South Africa and are responsible for almost one in six deaths (17.3%). To determine the cardiovascular risk among community members who attended a community outreach programme. Three communities in the Cape Metropole of the Western Cape. A health survey was conducted with 783 participants, 18 years and older, conveniently sampled. The survey included questions about cardiovascular risk factors, and biometric measurements of blood pressure (BP), height and weight were conducted. A total of 777 participants were included in the study. Most participants were female (529, 68.1%), with an average age of 42.3 years (s.d. 14.2). Risk behaviours reported included smoking (216, 27.8%), consuming more than two drinks of alcohol daily (78, 10%), low physical activity (384, 49.4%), being stressed on most days (436, 56.1%) and unhealthy eating habits (253, 32.6%). More than half of the participants (402, 51.7%) had a body mass index (BMI) ≥ 30, 26.0% (202) had a systolic BP of ≥ 140 mm Hg and 22.4% (174) had a diastolic BP of ≥ 90 mm Hg; 16.6% (130) had a cardiovascular disease (CVD) risk of 10-20 and 19.3% (150) had a CVD risk of 20%. Nearly a fifth of the participants had a significant probability of developing heart disease or experiencing a stroke over the next 10 years.Contribution:There is an urgent need for comprehensive health promotion and behaviour change interventions focused on reducing CVD risk factors at the community level.

Evaluating the Efficacy of Psycho-Behavioral Interventions for Cardiovascular Risk among People Living with HIV: A Systematic Review and Meta-Synthesis of Randomized Controlled Trials

People with HIV (PWH) are disproportionately affected by cardiovascular disease (CVD). Psycho-behavioral therapies are capable of targeting the pathophysiology underlying HIV-CVD comorbidity. This study synthesized findings from randomized controlled trials (RCTs) of psycho-behavioral therapies for reducing CVD risk among PWH following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were: (1) utilized an RCT design, (2) evaluated a cognitive-behavioral or mindfulness-based therapy, (3) sampled adults (age ≥18 years) with HIV, (4) measured a behavioral (e.g., diet) or biological (e.g., immune functioning) CVD risk factor, and (5) published in an English-language peer-reviewed journal. Electronic searches were conducted in six databases (e.g., MEDLINE) using controlled vocabulary and free-text synonyms for HIV, psycho-behavioral therapy, and CVD risk. Data were independently extracted with consensus reached. Outcomes were immune activation, tobacco-smoking, stress, inflammation, and physical activity from 33 studies. There were stronger effects for psycho-behavioral interventions compared to controls on CD4 (Hedge’s g=0.262, 95% Confidence Interval [CI]=0.127, 0.396) and tobacco-smoking abstinence (Hedge’s g=0.537, 95% CI=0.215, 0.86). There were no differences or insufficient data for stress, inflammation, or physical activity. No eligible studies examined psycho-behavioral interventions on blood pressure, lipids, or weight in PWH. There is increasing importance to further invest in broader CVD risk reduction effort for PWH that include psycho-behavioral intervention strategies.

A community health worker led approach to cardiovascular disease prevention in the UK-SPICES-Sussex (scaling-up packages of interventions for cardiovascular disease prevention in selected sites in Europe and Sub-saharan Africa): an implementation research project.

This paper describes a UK-based study, SPICES-Sussex, which aimed to co-produce and implement a community-based cardiovascular disease (CVD) risk assessment and reduction intervention to support under-served populations at moderate risk of CVD. The objectives were to enhance stakeholder engagement; to implement the intervention in four research sites and to evaluate the use of Voluntary and Community and Social Enterprises (VCSE) and Community Health Worker (CHW) partnerships in health interventions. A type three hybrid implementation study design was used with mixed methods data. This paper represents the process evaluation of the implementation of the SPICES-Sussex Project. The evaluation was conducted using the RE-AIM framework. Reach: 381 individuals took part in the risk profiling questionnaire and forty-one women, and five men participated in the coaching intervention. Effectiveness: quantitative results from intervention participants showed significant improvements in CVD behavioural risk factors across several measures. Qualitative data indicated high acceptability, with the holistic, personalised, and person-centred approach being valued by participants. Adoption: 50% of VCSEs approached took part in the SPICES programme, The CHWs felt empowered to deliver high-quality and mutually beneficial coaching within a strong project infrastructure that made use of VCSE partnerships. Implementation: Co-design meetings resulted in local adaptations being made to the intervention. 29 (63%) of participants completed the intervention. Practical issues concerned how to embed CHWs in a health service context, how to keep engaging participants, and tensions between research integrity and the needs and expectations of those in the voluntary sector. Maintenance: Several VCSEs expressed an interest in continuing the intervention after the end of the SPICES programme. Community-engagement approaches have the potential to have positively impact the health and wellbeing of certain groups. Furthermore, VCSEs and CHWs represent a significant untapped resource in the UK. However, more work needs to be done to understand how links between the sectors can be bridged to deliver evidence-based effective alternative preventative healthcare. Reaching vulnerable populations remains a challenge despite partnerships with VCSEs which are embedded in the community. By showing what went well and what did not, this project can guide future work in community engagement for health.

A Systematic Review of Herbal Interventions for the Management of Cardiovascular Diseases.

Cardiovascular diseases represent a significant global health burden, necessitating diverse approaches for effective management. Herbal interventions have gained attention as potential adjuncts or alternatives to conventional therapies due to their perceived safety and therapeutic potential. This structured abstract provides a comprehensive review of herbal interventions for the management of CVDs, summarising key findings, mechanisms of action, and clinical implications. This systematic review aims to evaluate the impact of various herbal interventions employed for managing cardiovascular diseases. We conducted an extensive literature search across electronic databases, including PubMed, Scopus, and Web of Science, from inception to 2022. Studies were included if they investigated the use of herbal remedies for preventing or treating CVDs. Data extraction and synthesis focused on botanical sources, active compounds, mechanisms of action, and clinical outcomes. Numerous herbal interventions have demonstrated promising cardiovascular benefits. A number of medicinal herbs well identified to treat CVD are Moringaoleifera, Ginseng, Ginkgo biloba, Celosia argentea, Gongronematrifolium, Gynostemmapentaphyllum, Bombaxceiba, Gentianalutea, Allium sativum, Crataegusspp, Curcuma longa, Camellia sinensis, and Zingiberofficinale. Mechanistic insights reveal that herbal interventions often target multiple pathways involved in CVD pathogenesis. These mechanisms encompass anti-inflammatory, antioxidant, anti-thrombotic, anti-hypertensive, and lipid-lowering effects. Additionally, some herbs enhance endothelial function, promote nitric oxide production, and exert vasodilatory effects, contributing to improved cardiovascular health. Clinical studies have provided evidence of the efficacy of certain herbal interventions in reducing CVD risk factors and improving patient outcomes. However, more rigorous, large-scale clinical trials are needed to establish their long-term safety and effectiveness. It is crucial to consider potential herb-drug interactions and standardise dosages for reliable therapeutic outcomes. This comprehensive review highlights the potential of herbal interventions as valuable adjuncts or alternatives for managing cardiovascular diseases. Herbal remedies offer diverse mechanisms of action, targeting key CVD risk factors and pathways. While promising, their clinical utility warrants further investigation through well-designed trials to establish their safety and efficacy, paving the way for integrated approaches to cardiovascular disease management. Healthcare providers and patients should engage in informed discussions about the use of herbal interventions alongside conventional therapies in the context of CVD prevention and treatment.

Feasibility of remotely supervised home-based high intensity interval training and effects on aerobic fitness and body composition in healthy older adults

Aging is associated with declines in aerobic fitness and increases in adiposity, both of which increase the risk of cardiovascular disease in older adults. High intensity interval training is an effective strategy for cardiovascular disease risk reduction; however, this promising exercise regimen may be inaccessible to older adults due to weight-bearing limitations or inability to travel to a fitness center. To address these barriers, we have developed a remotely supervised, home-based exercise intervention using high intensity interval training on an all-extremity non-weight-bearing ergometer (HIIT-ANE). The purpose of this study was to investigate the hypotheses that remotely supervised home-based HIIT-ANE would be feasible and lead to improvements in aerobic fitness and body composition in healthy older adults. Twenty sedentary older adults free of major clinical disease (66±1 yrs, mean ± SE) participated in this study. HIIT-ANE was remotely delivered at home under supervision via video conferencing (Zoom) and live heart rate monitoring (Zephyr OmniSense, Medtronic). HIIT-ANE consisted of a 10-min warm-up, 4 × 4-min intervals at 90% HRmax interspersed by 3 × 3-min bouts of active recovery at 70% HRmax, and a 5-min cool down and was performed on 4 days/week. Feasibility was assessed throughout the 8 weeks of HIIT-ANE. Aerobic fitness (maximal oxygen consumption) and body composition (dual-energy x-ray absorptiometry) were assessed at baseline and following an 8-week control period of normal lifestyle and an 8-week HIIT-ANE period. We found that exercise compliance to HIIT-ANE — the number of completed sessions relative to the number of scheduled sessions — was 96±1% and there were no adverse events related to the exercise intervention. Aerobic fitness increased in response to HIIT-ANE (baseline vs. post-HIIT-ANE: 23.7±1.2 vs. 27.0±1.1 ml/kg/min, P=0.001; pre- and post-HIIT-ANE: 22.5±1.2 vs. 27.0±1.1 ml/kg/min, P&lt;0.001), but decreased following the control period (23.7±1.2 vs. 22.5±1.2 ml/kg/min, P=0.04). Body fat % (36±2 vs. 35±2%, P=0.001) and fat mass (28.4±2.0 vs. 27.0±2.0 kg, P=0.003) decreased following HIIT-ANE, but fat free mass did not significantly change ( P=0.05 for time effect; 48.5±1.7 vs. 49.3±1.7 kg). Body weight and body mass index did not change throughout the study duration ( P≥0.8 for time effect). In conclusion, remotely supervised home-based HIIT-ANE was feasible and safe and was associated with improved aerobic fitness and body composition in healthy older adults. This work was supported by the National Institute of Aging grant AG063143. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Nitrate-rich beetroot juice supplementation in midlife and older adults with renal dysfunction increases vascular endothelial function and changes the circulating milieu to improve endothelial cell nitric oxide production and oxidative stress

BACKGROUND: Midlife and older (ML/O) adults with mild-to-moderate renal dysfunction (MRD) are at increased risk for cardiovascular disease (CVD). A key antecedent to CVD in ML/O adults with MRD is vascular endothelial dysfunction, mediated by declines in nitric oxide (NO) bioavailability due to excess reactive oxygen species (ROS)-related oxidative stress. We have shown that targeting the nitrate-nitrite-NO pathway with sodium nitrite in heathy ML/O adults improves endothelial function and changes the circulating milieu to lower endothelial cell (EC) ROS bioactivity. However, if nitrate-rich beetroot juice (N-BRJ) is effective for improving endothelial function in ML/O men and women with MRD is unknown. HYPOTHESES: We tested the hypotheses that chronic N-BRJ in ML/O men and women with MRD would: 1) improve endothelial function and 2) induce changes to the circulating milieu to increase EC NO production and lower EC ROS bioactivity. We also assessed possible sex differences in the effcacy of N-BRJ for improving endothelial function. METHODS: Twenty-six ML/O men and women with MRD (estimated glomerular filtration rate [eGFR; CKD-EPI]: 40-89 mL/min/1.73m2) underwent three months of supplementation with N-BRJ (70 mL with 6.45 mmol nitrate/day) (n=13, 7 women; age: 65±2 years; eGFR: 69.2±3.3 mL/min/1.73m2) or nitrate-depleted BRJ (placebo, PBO) (n=13, 7 women; age: 68±2 years; eGFR: 79.8±3.1 mL/min/1.73m2) in a randomized, placebo-controlled, parallel-group design clinical trial. Endothelial function was assessed by brachial artery flow-mediated dilation (FMDBA). Smooth muscle sensitivity to NO was assessed by brachial artery dilation to sublingual nitroglycerin. Human aortic ECs (HAECs) in culture were exposed to 10% subject serum (n=10[6-7 women]/group) collected before and after N-BRJ and PBO supplementation. Acetylcholine-stimulated NO production (DAR-4M-AM) and whole-cell ROS bioactivity (CellROX) were assessed in HAECs using immunofluorescence. Results: N-BRJ supplementation increased FMDBA by 28% (pre: 4.6±0.7%, post: 5.9±0.8%; p=0.03). FMDBA did not change with PBO (pre: 4.6±0.9%, post: 4.7±0.8%; p&gt;0.05). Traditional CVD risk factors (i.e., blood pressure, cholesterol) and smooth muscle sensitivity to NO were unchanged in both groups (p&gt;0.05). Preliminary assessments suggest greater improvements in endothelial function with N-BRJ in women (Δ=post-pre intervention; ΔFMDBA=1.6±0.4) compared to men (ΔFMDBA=0.9±1.0). Compared to pre-intervention, NO production was (trending) 7% higher (p=0.05) and ROS bioactivity was 25% lower (p=0.02) in HAECs exposed to serum collected post N-BRJ. Serum from PBO had no effects (p&gt;0.05). CONCLUSION: N-BRJ supplementation in ML/O adults with MRD holds promise for improving endothelial function, in part by inducing changes to the circulating milieu that increase NO production and decrease oxidative stress in ECs. The effects on endothelial function may be greater in women compared to men. Targeting the nitrate-nitrite-NO pathway with N-BRJ may be an effective strategy for improving endothelial function in ML/O adults with renal dysfunction to possibly reduce CVD risk. K01DK115524 (MJR); R01AG013038 (DRS); F32HL167552 (KOM); NIH/NCATS CTSA UL1TR002535. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Sleep Patterns and Traditional Cardiovascular Health Metrics: Joint Impact on Major Adverse Cardiovascular Events in a Prospective Cohort Study.

This study examines the association between traditional cardiovascular health (CVH) metrics and major adverse cardiovascular events (MACE) incidence in individuals with diverse sleep patterns. We analyzed data from 208 621 participants initially free of cardiovascular disease (CVD) in the UK Biobank study. Sleep patterns were assessed using scores for chronotype, duration, insomnia, snoring, and daytime dozing. Traditional CVH scores were derived from the Life's Simple 7 metrics. Cox proportional hazards multivariate regression assessed associations between distinct combinations of CVH and sleep scores and MACE, including nonfatal myocardial infarction, nonfatal stroke, and CVD mortality. Over a mean follow-up of 12.73 years, 9253 participants experienced incident MACE. Individuals with both a healthy sleep pattern and ideal CVH levels had the lowest MACE risk compared with those with a poor sleep pattern and poor CVH levels (hazard ratio, 0.306 [95% CI, 0.257-0.365]; P<0.001). Elevated CVH scores were associated with a reduced risk of MACE across different sleep patterns. Similar trends were observed for individual MACE components, heart failure, and all-cause mortality. These findings remained robust in sensitivity analyses and across various subgroups. In individuals without known CVD, maintaining a favorable sleep pattern and achieving optimal CVH levels, as measured by traditional metrics, were associated with the lowest MACE risk. Enhanced CVH significantly reduced CVD risk, even in individuals with a poor sleep pattern. These results emphasize the importance of considering multiple dimensions of sleep health alongside CVH to mitigate CVD risk. URL: https://www.ukbiobank.ac.uk; Unique identifier: 91090.

Association of gestational diabetes with long-term risk of premature mortality, and cardiovascular outcomes and risk factors: A retrospective cohort analysis in the UK Biobank.

To investigate the association of gestational diabetes mellitus (GDM) with premature mortality and cardiovascular (CVD) outcomes and risk factors. Parous women recruited to the UK Biobank cohort during 2006-2010 were followed up from their first delivery until 31 October 2021. The data were linked to Hospital Episode Statistics and mortality registries. Multivariate Cox proportional hazard models investigated associations of GDM with all-cause mortality, CVD, diabetes, hypertension and dyslipidaemia. The maximum total analysis time at risk and under observation was 9 694 090 person-years. Among 220 726 women, 1225 self-reported or had a recorded diagnosis of GDM. After adjusting for confounders and behavioural factors, GDM was associated with increased risk for premature mortality [hazard ratio (HR): 1.44, 95% confidence interval (CI): 1.12-1.86], particularly CVD-related death (HR: 2.38, 95% CI: 1.63-3.48), as well as incident total CVD (HR: 1.50, 95% CI: 1.30-1.74), non-fatal CVD (HR: 1.41, 95% CI: 1.20-1.65), diabetes (HR: 14.37, 95% CI: 13.51-15.27), hypertension (HR: 1.49, 95% CI: 1.38-1.60), and dyslipidaemia (HR: 1.30, 95% CI: 1.22-1.39). The total CVD risk was greater in women with GDM who did not later develop diabetes than in those with GDM and diabetes. Women with GDM are at increased risk of premature death and have increased CV risk, emphasizing the importance of interventions to prevent GDM. If GDM develops, the diagnosis represents an opportunity for future surveillance and intervention to reduce CVD risk factors, prevent CVD and improve long-term health.

The dynamic risk factors of cardiovascular disease among people living with HIV: a real-world data study

BackgroundThis study aims to investigate the incidence and dynamic risk factors for cardiovascular diseases (CVD) among people living with HIV (PLWH).MethodsIn this population-based statewide cohort study, we utilized integrated electronic health records data to identify adult (age ≥ 18) who were diagnosed with HIV between 2006 and 2019 and were CVD event-free at the HIV diagnosis in South Carolina. The associations of HIV-related factors and traditional risk factors with the CVD incidence were investigated during the overall study period, and by different follow-up periods (i.e., 0-5yrs, 6-10yrs 11-15yrs) using multivariable logistic regression models.ResultsAmong 9,082 eligible participants, the incidence of CVD was 18.64 cases per 1000 person-years. Overall, conventional risk factors, such as tobacco use, hypertension, obesity, chronic kidney disease (CKD), were persistently associated with the outcome across all three groups. While HIV-related factors, such as recent CD4 count (e.g., > 350 vs. <200 cells/mm3: adjusted odds ratio [aOR] range: 0.18–0.25), and percent of years in retention (e.g., 31–75% vs. 0–30%: aOR range: 0.24–0.57) were associated with lower odds of CVD incidence regardless of different follow up periods. The impact of the percent of days with viral suppression gradually diminished as the follow-up period increased.ConclusionsMaintaining an optimal viral suppression might prevent CVD incidence in the short term, whereas restoring immune recovery may be beneficial for reducing CVD risk regardless of the duration of HIV diagnosis. Our findings suggest the necessity of conducting more targeted interventions during different periods of HIV infection.