Cardiovascular Health Outcomes Research Articles

Women and Cardiovascular Health: Unraveling Gender-Specific Factors, Risks, and Therapeutic Approaches in Contemporary Medicine.

Background and objective Cardiovascular diseases (CVDs) constitute a significant global health challenge,causing millions of deaths annually and straining healthcare systems worldwide. This study aimed to investigate and elucidate gender-specific factors, risks, and therapeutic approaches related to cardiovascular health in women within the context of contemporary medicine. Methodology We conducted a prospective observational study spanning one year (November 2022 to October 2023)at the Peshawar Medical Complex Hospital, to meticulously explore the field of women's cardiovascular health. With a diverse cohort of 435 women (age range: 18-55 years), representing various socioeconomic backgrounds and geographic locations, our study aimed to elicit comprehensive insights. Through structured interviews covering reproductive history, lifestyle, and psychosocial aspects, coupled with clinical assessments, we gathered multifaceted data. Statistical analysis was done using SPSS Statisticsversion 23.0 (IBM Corp., Armonk, NY). By employing descriptive and t-tests for quantitative analysisand by thematically analyzing qualitative insights, our approach ultimately sought to provide a nuanced understanding of gender-specific factors impacting women's cardiovascular health. Results The study, involving 435 women, revealed various prevalent cardiovascular risk factors. Notable findings include a high incidence of a family history of CVD (n=213, 48.96%, p=0.013), hypertension (n=207, 47.58%), hypercholesterolemia (n=114, 26.21%), elevated triglycerides (n=162, 37.24%), and diabetes (n=64, 14.71%). Physical inactivity was also significantly more common (53.56%, p=0.004) compared to those engaging in regular activity. Women-specific risk factors comprised miscarriage (n=191, 43.91%). Therapeutic preferences varied, with a majority opting for lifestyle modifications (n=263, 60.39%) and pharmacological interventions (n=331, 76.33%). Conclusions This study provides a comprehensive understanding of prevalent cardiovascular risk factors, distinctive women-specific contributors, and diverse therapeutic preferences, highlighting the importance of personalized and targeted interventions to optimize women's cardiovascular health outcomes in contemporary medicine.

Abstract P294: Age-Sex Differences in the Global Burden of Deaths and Disability Due to Cardiovascular Disease Attributable to Environmental Risk Factors and Its Trend From 1990-2019 in G20 Countries: A Benchmarking Analysis

Background: Cardiovascular Disease (CVDs) is the leading cause of deaths amongst G20 countries accounting for 35.44% deaths in the G20 Countries. The G20 countries, being major economies, have a significant impact on global environmental conditions. Method: Using Global Burden of Disease tool, we estimated the deaths and Disability adjusted life years (DALYs) stratified by age, sex, year, and location due to CVD attributable to environmental risk factors across the G20 Countries from 1990-2019. Results: From 1990-2019, the annual percentage change showed a 37% rise in deaths, rising from 2,608,027-3,571,390. During the same period, DALYs surged by 25%, going from 63,297,319-78,964,495. However, when evaluating the age-standardized rates, both deaths and DALYs displayed a decrease from 1990 to 2019. In 2019, Saudi Arabia recorded the highest ASMR rate at 114 (with a range of 92-137) per 100,000. Bulgaria closely followed with a rate of 113 (87-141). In terms of age-standardized DALYs rates, Saudi Arabia again stood out, registering the highest in 1990 with a value of 2573 ( 2069-3145). Evaluating by age groups, 80-84 year old witnessed the most significant death count in 2019 (527,371). Meanwhile, the age group of 65-69 years saw the highest DALYs count in 2019, (10.4 million). Over the last three decades, males consistently experienced higher counts of both deaths and DALYs compared to females. Conclusion: Environmental risk factors contributed to 26.78% of CVD-related deaths and 29% of DALYs, underscoring the critical role of environment in cardiovascular health outcomes in G20 Countries. it's essential to integrate environmental risk assessments into routine check-ups and tailor treatment plans that address specific environmental exposures linked to CVD. There's an urgent need for policy reforms promoting environmental health, coupled with widespread community education about the environmental determinants of cardiovascular diseases.

Abstract P463: The Role of Information and Communication Technology in Cardiovascular Health: A Global Perspective

Introduction: Information and Communication Technology (ICT) has emerged as a potent tool in shaping modern healthcare systems. Its ease of availability and function for patients, providers, and administrators has led to its integration at many levels. Because of its multidimensional use, we aimed to investigate the relationship between ICT usage and cardiovascular outcomes at a global scale. This study aims to find the relationship between ICT usage and cardiovascular mortality in countries in the Organisation for Economic Co-operation and Development (OECD). Methods: OECD Statistics, a freely available online database published by the Organisation for Economic Co-operation and Development, was accessed for data retrieval. ICT use, and cardiovascular death rates (per 100,000) in all 38 OECD countries were acquired. Microsoft Excel was used to store data and perform statistical analysis. A linear regression model was used to find the relationship between ICT use and cardiovascular mortality. Significance was assessed using the p-value, with a threshold set at 0.05. Results: A significant relationship between ICT use and cardiovascular mortality was observed (p = 0.02). Notably, Colombia and Japan were excluded from this analysis as they lacked ICT use data. Figure 1 demonstrates the linear relationship. Discussion: With a significant, negative relationship between ICT use and cardiovascular outcomes at a global scale, it can be inferred that elevating cardiovascular health outcomes can be significantly advanced through strategic investment in health technology. It should be considered that greater ICT use can be a proxy for other social and technological infrastructure available in the country leading to better cardiovascular health outcomes. Nonetheless, the integration of innovative health technologies, such as telemedicine, wearable devices, and data analytics, offers the potential to enhance early disease detection, promote health literacy, and optimize resource allocation. These advancements enable timely interventions, informed decision-making, and precise allocation of healthcare resources.

Abstract P466: A Culturally Tailored mHealth Lifestyle Intervention Improves Diet and Physical Activity Self-Regulation Among African Americans

Background: Physical inactivity and poor adherence to healthy eating guidelines impact cardiovascular health (CVH) outcomes in African American (AAs). Our randomized controlled trial (RCT) testing the FAITH! App, an mHealth lifestyle intervention, showed efficacy in promoting ideal CVH, particularly diet and physical activity (PA) among AAs, warranting exploration of underlying factors. Psychosocial factors (e.g., self-regulation, self-efficacy, social support) are key to healthy behavior adoption. Hypothesis: The intervention group would have greater improvements in diet and PA-related psychosocial factors than the control group after using the FAITH! App. Methods: A 2-arm cluster RCT was conducted among AAs from 16 churches in Minnesota comparing the FAITH! App intervention to a delayed intervention control group. The FAITH! App included culturally relevant, CVH-focused education modules, diet/PA self-monitoring and a sharing board. The outcomes were change in diet and PA self-regulation and self-efficacy (primary) and social support and barriers (secondary) at 6 months post-intervention. The intervention effect was assessed using linear regression. Results: Sixty-eight participants were included (71% female; mean age [SD]: 54.7 [12.6] years) ( Table 1 ). The intervention group showed a significantly greater increase in diet self-regulation [planning/tracking nutrition] (+0.66, p<.03) and PA self-regulation [step count strategies] (+0.47, p=.003) than the control group. Within groups, the intervention group demonstrated significant improvements across diet and PA self-regulation measures, while the control group showed an improvement only in fruit/vegetable and grain intake. No effect was observed in self-efficacy, social support, or barriers. Conclusions: Our culturally tailored mHealth lifestyle intervention was associated with notable increases in diet and PA self-regulation, suggesting a potential mechanism by which the FAITH! App improves healthy eating and PA among AAs.

Peer-led lifestyle interventions for the primary prevention of cardiovascular disease in community: a systematic review of randomised controlled trials

BackgroundPeer-led lifestyle interventions have gained recognition as effective approaches for managing and preventing chronic diseases. However, there remains a critical knowledge gap regarding the impact and effectiveness of peer-led interventions specifically in the primary prevention of cardiovascular disease (CVD). Our systematic review aims to synthesise the available evidence and evaluate the impact of peer-led lifestyle interventions, providing invaluable insights that can guide the development of peer-led strategies for preventing CVD.MethodsSystematic database searches were conducted on Ovid Medline, Embase, Cochrane Centre for Controlled Trials, PubMed and Scopus to source peer-reviewed articles published between 2013 and 2023. Reference lists of the included publications were also manually searched.ResultsFourteen unique randomised controlled trials were identified, of which three were pilot studies. Most of the interventions were conducted among individuals at moderate to high risk of CVD and lasted for a year. There is a variety of components in intervention delivery, including group discussions and individual counselling. Peer leader training mostly covered intervention delivery, communication, and research-specific skills. Systolic blood pressure showed the most promising CVD-related improvement, while mixed results were found for several other dietary and lifestyle behavioural outcomes.ConclusionPeer-led lifestyle interventions have shown varying effectiveness in cardiovascular health outcomes. The competencies and roles of peer leaders were identified to guide future intervention development with a more comprehensive approach to the primary prevention of CVD.

Fibromyalgia and Sedentarism: Which Came First, the Chicken or the Egg?

Fibromyalgia is a chronic disease that causes widespread pain throughout the body, as well as fatigue and a variety of other accompanying symptoms. Physical activity is one of the most useful non-pharmacological treatments for pain and symptom reduction. Therefore, the main objective of this research was to analyse the objective levels of sedentary lifestyle and physical activity, as well as the study of heart rate variability as a predictor of health. A total of 21 women previously diagnosed with fibromyalgia (FM) and 10 healthy women of the same age range participated in the study. Accelerometry was used for the determination of physical activity and sedentary lifestyle as well as the study of heart rate variability (HRV) at rest for the assessment of cardiovascular health. The results show that participants with fibromyalgia have higher levels of sedentary lifestyles and worse cardiovascular health outcomes compared to healthy participants not diagnosed with fibromyalgia. In conclusion, it is observed that the analysis of heart rate variability is a good predictor for the determination of cardiovascular health in patients diagnosed with fibromyalgia. A debate is open to whether sedentary lifestyles and being overweight accentuate the fibromyalgia disease or whether it is the disease itself that favors increased physical inactivity, reflected in inferior cardiovascular health. Future research is needed to deepen this analysis in order to improve the quality of life of these patients.

Cardiorespiratory Performance in Kidney and Liver Transplant Recipients: The Dilemma to Combine Lifestyle and Fitness.

It is widely demonstrated that moderate-intensity exercise is associated with improved fitness in non-communicable chronic diseases. However, there are no specific guidelines available for transplant recipients. Body composition is closely linked to exercise capacity, typically estimated by cardiopulmonary testing, but its potential correlation with cardiovascular health outcomes has not been investigated yet. This study aims to evaluate and compare cardiorespiratory performance and body composition in two groups of liver and kidney transplant recipients. A mixed group of transplant recipients (10 kidney and 15 liver) participating in a lifestyle reconditioning program through unsupervised physical exercise prescription was examined. Both groups were assessed using bioimpedance analysis (BIA), lifestyle, and physical activity levels by IPAQ questionnaire and cardiopulmonary testing (CPET). The two groups differed by IPAQ examination: liver transplant patients practiced more physical activity. Statistically significant differences were found in peak VO2/HR (oxygen pulse), which was higher in the kidney group compared to the liver group (15.63 vs. 12.49 with p < 0.05). Body composition did not show significant differences in BMI and the percentage of FM/FFM (FFM: 78.04 ± 7.7 in Kidney T vs. 77.78 ± 7.2 in Liver T). Systolic pressure measured at the peak was significantly higher in the liver group (162.6 vs. 134 with p < 0.01). The correlation between the CPET and BIA parameters showed a positive VO2 max and FFM mass trend. The results suggest differences in cardiorespiratory fitness between the two populations of solid organ transplant recipients despite not being related to the physical activity level. The data support the importance of body composition analysis in sports medicine and the prescription of physical exercise, especially considering the potential correlation with VO2 max, even though home-based exercise does not seem to alter it substantially. BMI does not appear to be a determinant of cardiovascular performance. Other determinants should be investigated to understand the differences observed.

Toward a Better Understanding of Cardiovascular Risk in the Transgender and Gender-Diverse Community: A Global Call to Action.

On World Heart Day 2022, the Mexican Society of Cardiology, the Inter-American Society of Cardiology, and the World Heart Federation collaborated on a public call to action regarding the increased risk of adverse cardiovascular health outcomes in transgender and gender diverse (TGD) individuals. The aim of this article is to unpack the numerous factors that contribute to this, such as the social stigma faced by members of the TGD community, their reduced access to clinical care, and the scarcity of research regarding the unique needs of their community, which makes it difficult for clinicians to provide individualized medical care. Decreasing the incidence of adverse cardiovascular events among TGD individuals requires interventions such as educational reform in the medical community, an increase in inclusive research studies, and broader social initiatives intended to reduce the stigma faced by TGD individuals.

Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

ObjectiveTo evaluate the existing meta-analytic evidence of associations between exposure to ultra-processed foods, as defined by the Nova food classification system, and adverse health outcomes.DesignSystematic umbrella review of existing meta-analyses.Data...

Choosing the Right Angiotensin Converting Enzyme Inhibitors; Gender –Specific Approach

Abstract This review article explores the importance of a masculinity- and feminine-specific approach in choosing the appropriate angiotensin-converting enzyme (ACE) inhibitors for patients with cardiovascular diseases. This review highlights the historical underrepresentation of women in clinical trials for cardiovascular medications, leading to a knowledge gap regarding the effectiveness and safety of these drugs in female patients. The article discusses the potential differences in treatment outcomes between men and women when it comes to ACE inhibitors and the gender-specific factors that can impact drug responses. The integration of bigender-specific data into clinical guidelines and decision-making processes can contribute to a more equitable and evidence-based approach to cardiovascular care. The article also references a report by the American College of Obstetricians and Gynecologists Force on Hypertension in Pregnancy, which emphasizes the importance of managing hypertension in pregnant women. By embracing a personalized medicine framework that accounts for gender-related differences, health-care professionals can optimize therapeutic interventions, minimize treatment disparities, and strive for improved cardiovascular health outcomes for all individuals. Overall, this review article provides insights into the potential mechanisms underlying sexuality-related differences in ACE inhibitor efficacy, safety, and adverse effects and discusses the implications of these findings in advancing personalized cardiovascular medicine.

Satisfaction and effectiveness of a digital health tool to improve health behavior counseling among adolescent and young adult cancer survivors: a randomized controlled pilot trial

BackgroundThis pilot study examined the preliminary effectiveness of the PREVENT digital intervention that supports health care teams in delivering health behavior counseling on cancer survivors’ motivation to change behavior, their physical activity and food intake behaviors, and cardiovascular health (CVH).MethodsClinicians (physicians, nurse practitioners) at three urban cancer survivorship clinics were trained to use PREVENT. Patients were randomized to the PREVENT intervention or a wait-list routine care control group. Eligibility criteria for patients included: between ages 12–39, overweight or obese, were at least 6-months post-active cancer treatment, and had sufficient English proficiency.ResultsFifty-five participants were enrolled; 27 were randomized to the PREVENT intervention and 28 to wait-list routine care control. The majority of the participants (82%) identified as non-Hispanic white, with an average age of 19.8 (SD ± 5.2) years. Patients that received the PREVENT intervention had greater increases in their self-efficacy, vigorous activity and number of food recommendations met than those who received routine clinical care. Changes in willingness, knowledge, and CVH outcomes were not significant.ConclusionsThe PREVENT digital intervention may provide improvements in preventive behaviors among AYA cancer survivors by supporting care teams with delivering evidence-based, tailored behavior change recommendations and resources to support patient health.Trial registrationThis trial (NCT04623190) was registered on 11/02/2022.

Severe mental illness: cardiovascular risk assessment and management.

Patients with severe mental illness (SMI) including schizophrenia and bipolar disorder die on average 15-20 years earlier than the general population often due to sudden death that, in most cases, is caused by cardiovascular disease. This state-of-the-art review aims to address the complex association between SMI and cardiovascular risk, explore disparities in cardiovascular care pathways, describe how to adequately predict cardiovascular outcomes, and propose targeted interventions to improve cardiovascular health in patients with SMI. These patients have an adverse cardiovascular risk factor profile due to an interplay between biological factors such as chronic inflammation, patient factors such as excessive smoking, and healthcare system factors such as stigma and discrimination. Several disparities in cardiovascular care pathways have been demonstrated in patients with SMI, resulting in a 47% lower likelihood of undergoing invasive coronary procedures and substantially lower rates of prescribed standard secondary prevention medications compared with the general population. Although early cardiovascular risk prediction is important, conventional risk prediction models do not accurately predict long-term cardiovascular outcomes as cardiovascular disease and mortality are only partly driven by traditional risk factors in this patient group. As such, SMI-specific risk prediction models and clinical tools such as the electrocardiogram and echocardiogram are necessary when assessing and managing cardiovascular risk associated with SMI. In conclusion, there is a necessity for differentiated cardiovascular care in patients with SMI. By addressing factors involved in the excess cardiovascular risk, reconsidering risk stratification approaches, and implementing multidisciplinary care models, clinicians can take steps towards improving cardiovascular health and long-term outcomes in patients with SMI.

Cardiovascular Disease and the Mediterranean Diet: Insights into Sex-Specific Responses.

Cardiovascular disease (CVD) is a leading cause of mortality and disease burden in women globally. A healthy diet is important for the prevention of CVD. Research has consistently favoured the Mediterranean diet as a cardio-protective diet. Several studies have evaluated associations between the Mediterranean diet and cardiovascular outcomes, including traditional risk factors like hypertension, type 2 diabetes mellitus, and obesity. In addition, consistent evidence suggests that the components of the Mediterranean diet have a synergistic effect on cardiovascular risk due to its anti-inflammatory profile and microbiome effects. While the benefits of the Mediterranean diet are well-established, health advice and dietary guidelines have been built on largely male-dominant studies. Few studies have investigated the beneficial associations of the Mediterranean diet in sex-specific populations, including those with non-traditional risk factors that are specific to women, for instance polycystic ovarian syndrome and high-risk pregnancies, or more prevalent in women, such as chronic inflammatory diseases. Therefore, this review aims to provide a comprehensive overview of the current evidence regarding the Mediterranean diet in women in relation to cardiovascular health outcomes.

Ambient temperature and risk of cardiovascular and respiratory adverse health outcomes: a nationwide cross-sectional study from Spain.

We assessed the association of temperature and temperature variability with cause-specific emergency hospitalizations and mortality from cardiovascular and respiratory diseases in Spain, as well as the effect modification of this association by individual and contextual factors. We collected data on health (hospital admissions and mortality), weather (temperature and relative humidity), and relevant contextual indicators for 48 Spanish provinces during 2004-2019. The statistical analysis was separately performed for the summer (June-September) and winter (December-March) seasons. We first applied a generalized linear regression model with quasi-Poisson distribution to estimate daily province-specific temperature-health associations, and then we fitted multilevel multivariate meta-regression models to the evaluate effect modification of the contextual characteristics on heat- and cold-related risks. High temperature increased the risk of mortality across all cardiovascular and respiratory diseases, with the strongest effect for hypertension (relative risk (RR) at 99th temperature percentile vs. optimum temperature: 1.510 [95% empirical confidence interval {eCI} 1.251 to 1.821]), heart failure (1.528 [1.353 to 1.725]), and pneumonia (2.224 [1.685 to 2.936]). Heat also had an impact on all respiratory hospitalization causes (except asthma), with similar risks between pneumonia (1.288 [1.240 to 1.339]), acute bronchitis and bronchiolitis (1.307 [1.219 to 1.402]), and chronic obstructive pulmonary disease (1.260 [1.158 to 1.372]). We generally found significant risks related to low temperature for all cardiovascular and respiratory causes, with heart failure (RR at 1st temperature percentile vs. optimum temperature: 1.537 [1.329 to 1.779]) and chronic obstructive pulmonary disease (1.885 [1.646 to 2.159]) exhibiting the greatest risk for hospitalization, and acute myocardial infarction (1.860 [1.546 to 2.238]) and pneumonia (1.734 [1.219 to 2.468]) for mortality. Women and the elderly were more vulnerable to heat, while people with secondary education were less susceptible to cold compared to those not achieving this educational stage. Results from meta-regression showed that increasing heating access to the highest current provincial value (i.e. 95.6%) could reduce deaths due to cold by 59.5% (57.2 to 63.5). Exposure to low and high temperatures was associated with a greater risk of morbidity and mortality from multiple cardiovascular and respiratory conditions, and heating was the most effective societal adaptive measure to reduce cold-related mortality.

African Immigrants' perceptions and attitudes toward cardiovascular health.

To explore perceptions and attitudes of African immigrants (Ghanaians, Nigerians, Liberians, and Sierra Leoneans) in the Baltimore-Washington, DC, metropolitan area toward cardiovascular health. This was a qualitative study among African immigrants recruited from religious and community-based organizations in the Baltimore-Washington metro area. A purposive sample of 66 African immigrants originally from Ghana, Nigeria, Liberia, and Sierra Leone completed a sociodemographic survey and participated in focus group discussions. Focus group data were analysed using qualitative description to develop emergent themes. A total of 66 African immigrants with a mean (±standard deviation) age of 51 (±11.8) years participated in the focus group discussions. Fifty percent were women, 91% had at least a bachelor's degree, 84% were employed, 80% had health insurance, and 75% were married/cohabitating. The majority of the participants (74%) had lived in the US for 10 years or more, 44% of them had hypertension, and 12% had diabetes. Findings from the focus group discussions revealed: gender differences in descriptions of cardiovascular health and healthiness, an emotional response associated with cardiovascular disease (evoking fear and anxiety and associated with family secrecy), positive and negative lifestyle changes after migration, cardiovascular screening behaviours, and facilitators and barriers to cardiovascular disease prevention practices and heart-healthy lifestyle. Participants understood health to be a holistic state of well-being. Secrecy in disclosing their cardiovascular disease diagnoses informed by historical socio-cultural belief systems, perceived racial discrimination by healthcare providers, communication and health literacy barriers, economic barriers of holding multiple jobs and the exorbitant cost of heart-healthy foods were identified as some barriers to achieving optimal cardiovascular health in this immigrant population. Our study expanded on the body of knowledge on African immigrants' perceptions and attitudes toward cardiovascular health. Addressing this knowledge gap will provide important intervention opportunities targeted at improving cardiovascular health outcomes in this population. No patient or public contribution.

The effects of daily dose of intense exercise on cardiac responses and atrial fibrillation.

Atrial fibrillation (AF) is a supraventricular tachyarrhythmia that is strongly associated with cardiovascular (CV) disease and sedentary lifestyles. Despite the benefits of exercise on overall health, AF incidence in high-level endurance athletes rivals that of CV disease patients, suggesting a J-shaped relationship with AF. To investigate the dependence of AF vulnerability on exercise, we varied daily swim durations (120, 180 or 240minday-1 ) in 7-week-old male CD1mice. We assessed mice after performing equivalent amounts of cumulative work during swimming (i.e. ∼700L O2 kg-1 ), as determined from O2 consumption rates ( ). The mean during exercise increased progressively throughout the training period and was indistinguishable between the swim groups. Consistent with similar improvements in aerobic conditioning induced by swimming, skeletal muscle mitochondria content increased (P=0.027) indistinguishably between exercise groups. Physiological ventricular remodelling, characterized by mild hypertrophy and left ventricular dilatation, was also similar between exercised mice without evidence of ventricular arrhythmia inducibility. By contrast, prolongation of daily swim durations caused progressive and vagal-dependent heart rate reductions (P=0.008), as well as increased (P=0.005) AF vulnerability. As expected, vagal inhibition prolonged (P=0.013) atrial refractoriness, leading to reduced AF vulnerability, although still inducible in the 180 and 240min swim groups. Accordingly, daily swim dose progressively increased atrial hypertrophy (P=0.003), fibrosis (P<0.001) and macrophage accumulation (P=0.006) without differentially affecting the ventricular tissue properties. Thus, increasing daily exercise duration drives progressively adverse atrial-specific remodelling and vagal-dependent AF vulnerability despite robust and beneficial aerobic conditioning and physiological remodelling of ventricles and skeletal muscle. KEY POINTS: Previous studies have suggested that a J-shaped dose-response relationship exists between physical activity and cardiovascular health outcomes, with moderate exercise providing protection against many cardiovascular disease conditions, whereas chronic endurance exercise can promote atrial fibrillation (AF). We found that AF vulnerability increased alongside elevated atrial hypertrophy, fibrosis and inflammation as daily swim exercise durations in mice were prolonged (i.e. ≥180minday-1 for 6weeks). The MET-hweek-1 (based on O2 measurements during swimming) needed to induce increased AF vulnerability mirrored the levels linked to AF in athletes. These adverse atria effects associated with excessive daily exercise occurred despite improved aerobic conditioning, skeletal muscle adaptation and physiological ventricular remodelling. We suggest that atrial-specific changes observed with exercise arise from excessive elevations in venous filling pressures during prolonged exercise bouts, which we argue has implications for all AF patients because elevated atrial pressures occur in most cardiovascular disease conditions as well as ageing which are linked to AF.

Time-series analysis of temperature variability and cardiovascular emergency department visits in Atlanta over a 27-year period.

Short-term temperature variability, defined as the temperature range occurring within a short time span at a given location, appears to be increasing with climate change. Such variation in temperature may influence acute health outcomes, especially cardiovascular diseases (CVD). Most research on temperature variability has focused on the impact of within-day diurnal temperature range, but temperature variability over a period of a few days may also be health-relevant through its impact on thermoregulation and autonomic cardiac functioning. To address this research gap, this study utilized a database of emergency department (ED) visits for a variety of cardiovascular health outcomes over a 27-year period to investigate the influence of three-day temperature variability on CVD. For the period of 1993-2019, we analyzed over 12million CVD ED visits in Atlanta using a Poisson log-linear model with overdispersion. Temperature variability was defined as the standard deviation of the minimum and maximum temperatures during the current day and the previous two days. We controlled for mean temperature, dew point temperature, long-term time trends, federal holidays, and day of week. We stratified the analysis by age group, season, and decade. All cardiovascular outcomes assessed, except for hypertension, were positively associated with increasing temperature variability, with the strongest effects observed for stroke and peripheral vascular disease. In stratified analyses, adverse associations with temperature variability were consistently highest in the moderate-temperature season (October and March-May) and in the 65 + age group for all outcomes. Our results suggest that CVD morbidity is impacted by short-term temperature variability, and that patients aged 65 and older are at increased risk. These effects were more pronounced in the moderate-temperature season and are likely driven by the Spring season in Atlanta. Public health practitioners and patient care providers can use this knowledge to better prepare patients during seasons with high temperature variability or ahead of large shifts in temperature.

Life-course trajectories of body mass index and cardiovascular disease risks and health outcomes in adulthood: Systematic review and meta-analysis.

This systematic review aimed to assess the effect of life course body mass index (BMI) trajectories (childhood to adulthood) on cardiovascular disease (CVD) risk factors and outcomes. Prospective or retrospective cohort studies were identified that assessed the association of BMI trajectories with CVD risks and outcomes from databases published in English. The pooled effect sizes were estimated using a random-effects model. Seventeen eligible studies were included in this systematic review. The results revealed that a persistently overweight trajectory from childhood to adulthood was associated with a higher risk of hypertension (RR: 2.49; 95% CI: 1.9, 3.28) and type 2 diabetes (RR: 4.62; 95% CI: 2.36, 9.04) compared with a trajectory characterized by a normal BMI throughout both childhood and adulthood. Similarly, the risk of hypertension (RR: 2.38; 95% CI: 1.70, 3.33) and type 2 diabetes (RR: 3.66; 95% CI: 2.57, 5.19) was higher in those with normal-to-overweight trajectory compared with participants with a stable normal weight trajectory. The findings suggest that lifetime BMI trajectories may be influential on health outcomes, and preventive strategies should be designed accordingly. Implementing appropriate preventive strategies at all life stages may reduce CVD risks and adverse outcomes later in life.

Predicting physical activity and quality of life in coronary heart disease patients: An 18-month path analysis of motivational and emotional factors.

Investigating factors that promote cardiovascular health outcomes is essential for secondary prevention. In a sample of coronary heart disease patients, we examined the direct and indirect effects of selected psychological factors on physical activity behavior and health-related quality of life (HRQoL) over 18 months. Patient-reported data were collected over three time points. Through structured equation modeling, a longitudinal path analysis was conducted to estimate the indirect effects of baseline HRQoL and cardiac self-efficacy on reported physical activity behavior and HRQoL (evaluated at 18 months) through the mediation of anxiety and depression symptoms, patients' reported intention to change the behavior, and emotions regulation strategies (evaluated at 9 months). A total of 410 patients were included. Significant indirect effects of baseline HRQoL (β = .05, 95% CI [-0.001, 0.111]) and cardiac self-efficacy (β = .105, 95% CI [0.06, 0.16]) on physical activity behavior were found, with anxiety symptoms and emotions regulation strategies as significant mediators. Additionally, the mediation of reported intention in the association between cardiac self-efficacy and physical activity levels was estimated. At the final follow-up, we also found a significant direct association between physical activity behavior and HRQoL (β = .12, p < .01), which was indirectly impacted by baseline HRQoL (β = .006, 95% CI [0.000, 0.017]) and cardiac self-efficacy (β = .012, 95% CI [0.003, 0.027]). This study underlines the significance of addressing stress management, anxiety symptoms reduction, and cardiac self-efficacy enhancement when targeting better cardiovascular health outcomes. Identifying cardiovascular risk profiles based on these findings may benefit future clinical practice and further inform secondary prevention policy guidelines. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Chronic pain-mental health comorbidity and excess prevalence of health risk behaviours: a cross-sectional study.

Chronic musculoskeletal pain and anxiety/depression are significant public health problems. We hypothesised that adults with both conditions constitute a group at especially high risk of future cardiovascular health outcomes. To determine whether having comorbid chronic musculoskeletal pain and anxiety/depression is associated with the excess prevalence of selected known cardiovascular health risk behaviours. A cross-sectional survey of adults aged 35+ years randomly sampled from 26 GP practice registers in West Midlands, England. Respondents were classified into four groups based on self-reported presence/absence of chronic musculoskeletal pain (pain present on most days for six months) and anxiety or depression (Hospital Anxiety and Depression Score 11+). Standardised binomial models were used to estimate standardised prevalence ratios and prevalence differences between the four groups in self-reported obesity, tobacco smoking, physical inactivity, and unhealthy alcohol consumption after controlling for age, sex, ethnicity, deprivation, employment status and educational attainment. The excess prevalence of each risk factor in the group with chronic musculoskeletal pain-anxiety/depression comorbidity was estimated. Totally, 14519 respondents were included, of whom 1329 (9%) reported comorbid chronic musculoskeletal pain-anxiety/depression, 3612 (25%) chronic musculoskeletal pain only, 964 (7%) anxiety or depression only, and 8614 (59%) neither. Those with comorbid chronic musculoskeletal pain-anxiety/depression had the highest crude prevalence of obesity (41%), smoking (16%) and physical inactivity (83%) but the lowest for unhealthy alcohol consumption (18%). After controlling for covariates, the standardised prevalence ratios and differences for the comorbid group compared with those with neither chronic musculoskeletal pain nor anxiety/depression were as follows: current smoking [1.86 (95% CI 1.58, 2.18); 6.8%], obesity [1.93 (1.76, 2.10); 18.9%], physical inactivity [1.21 (1.17, 1.24); 14.3%] and unhealthy alcohol consumption [0.81 (0.71, 0.92); -5.0%]. The standardised prevalences of smoking and obesity in the comorbid group exceeded those expected from simple additive interaction.