Improve Cardiovascular Health Research Articles

Key Risk-Factors Contributing to Cardiovascular Disease: Lifestyle Modifications to Improve Cardiovascular Health

Cardiovascular disease is a preventable public health issue. The aim of this review is to identify modifiable risk-factors for cardiovascular disease and recommend lifestyle modification to prevent cardiovascular disease. PubMed, ScienceDirect, SAGE, Google Scholar, World Health Organisation websites, as well as public and community health textbooks, were hand searched and academic resources which are relevant for this review were selected for inclusion. Cardiovascular disease is leading cause of deaths in all continents of the world. While deaths from cardiovascular disease is increasing in Africa and Asia, it is decreasing in Australia and fluctuating in the USA. Premature deaths from cardiovascular disease are preeminent across middle income countries in Europe compared with high income countries. Cardiovascular disease is higher in rural areas of South America compared with urban areas. Trends in lifestyle patterns, including physical inactivity, smoking behaviour, and diets contribute to cardiovascular disease-prone conditions. Prevention includes health promotion activities that facilitate healthy living across life course and limit the initial onset of cardiovascular disease. Investment in prevention is the critical sustainable solution for the cardiovascular disease epidemic. Adopting WHO existing policies within individual countries in Africa, Asia, and middle-income countries in Europe, and ensuring robust implementation of such policies across life course and from different layers of sectors such as education and workplaces would have wider impacts in reducing risk and cardiovascular disease burden in the respective continents. Government of countries with worsening cardiovascular events should also increase health financing and focus on strengthening primary health care services for prevention and treatment of cardiovascular disease.

Advancing Heart Disease Prediction through Machine Learning: Techniques and Insights for Improved Cardiovascular Health

Advancing Heart Disease Prediction through Machine Learning: Techniques and Insights for Improved Cardiovascular Health

Using Behavioral Science to Improve Cardiovascular Health.

Using Behavioral Science to Improve Cardiovascular Health.

Intermittent Fasting Regulates Metabolic Homeostasis and Improves Cardiovascular Health.

Obesity is a leading cause of morbidity and mortality globally. While the prevalence of obesity has been increasing, the incidence of its related complications including dyslipidemia and cardiovascular disease (CVD) has also been rising. Recent research has focused on modalities aimed at reducing obesity. Several modalities have been suggested including behavioral and dietary changes, medications, and bariatric surgery. These modalities differ in their effectiveness and invasiveness, with dietary changes gaining more interest due to their minimal risks compared to other modalities. Specifically, intermittent fasting (IF) has been gaining interest in the past decade. IF is characterized by cycles of alternating fasting and eating windows, with several different forms practiced. IF has been shown to reduce weight and alleviate obesity-related complications. Our review of clinical and experimental studies explores the effects of IF on the lipid profile, white adipose tissue (WAT) dynamics, and the gut microbiome. Notably, IF corrects dyslipidemia, reduces WAT accumulation, and decreases inflammation, which reduces CVD and obesity. This comprehensive analysis details the protective metabolic role of IF, advocating for its integration into public health practices.

Abstract P489: Intake of Fiber-Rich Foods is Favorably Associated With Cardiac Structure and Function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Background: Abnormal cardiac phenotypes, including left ventricular (LV) structure and function, are subclinical characteristics, detectable before experiencing heart failure (HF) symptoms. Identifying lifestyle risk factors of abnormal cardiac phenotypes can help to prevent or slow down the progression to HF and ultimately reduce the burden of the aging heart. Therefore, we aimed to identify the associations of carbohydrate (CHO) quality and fiber-rich foods with LV structure and function. Methods: We studied 3,171 Black and White adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Dietary intake was assessed via Diet History and averaged across years 0 (1985-86), 7, and 20. CHO:fiber ratio was created to define CHO quality (greater CHO:fiber ratio representing lower CHO quality). The fiber-rich food score was created based on the servings of whole grains, fruits, vegetables, nuts, and legumes. LV structure and function measures were assessed via echocardiography at years 25 and 30 and were the dependent variables in linear repeated measures models, including random intercepts for individuals. CHO:fiber ratio was treated as a fixed effect. Results: Study participants were 25.1 (range: 18-30, SD: 3.61) years old on average at baseline, 57% (1,807 of 3,171) female, and 53% (1,678 of 3,171) White. Higher CHO quality ratio was favorably associated with global longitudinal strain (GLS); while the fiber-rich food score was favorably associated with LV mass index, GLS, and E/e’ ratio after adjusting for demographic and lifestyle characteristics (see table). Conclusions: Our study finding suggests that higher CHO quality is associated with better systolic function and greater intake of fiber-rich foods is associated with better LV structure and function, which support the Dietary Guidelines for Americans and the Dietary Guidance to Improve Cardiovascular Health by the AHA that recommend intakes of high-quality CHO foods such as whole grains, fruit, and vegetables.

Barriers and Facilitators to Improving Cardiovascular Health in Churches with Predominantly Black Congregations.

Black communities bear a disproportionate burden of cardiovascular disease (CVD). Barriers and facilitators for improving cardiovascular health (CVH) in churches with predominantly black congregations were explored through a qualitative needs assessment. Four focus groups with church members (n=21), 1 with wellness coordinators (n=5), and 1 with primary care providers (n=4) and 7 individual interviews with church leaders were completed in New Orleans and Bogalusa, Louisiana. Virtual, semistructured interviews and focus groups were held between October 2021 and April 2022. The Theorical Domains Framework (TDF) guided a framework analysis of transcribed data based on inductive and deductive coding to identify themes related to determinants of CVH. The following four domains according to the TDF were identified as the most relevant for improving CVH: knowledge, professional role, environmental context, and emotions. Within these domains, barriers expressed by church leadership and members were a lack of knowledge of CVD, provider distrust, and little time and resources for lifestyle changes; facilitators included existing church wellness programs and social support, community resources, and willingness to improve patient-provider relationships. Primary care providers recognized a lack of effective communication and busy schedules as obstacles and the need to strengthen communication through increased patient autonomy and trust. Potential strategies to improve CVH informed by the Expert Recommendation for Implementing Change compilation of implementation strategies include education and training, task shifting, dissemination of information, culturally tailored counselling, and linkage to existing resources. These findings can inform the implementation of interventions for improving cardiovascular health and reducing disparities in black church communities.

Engaging Predominantly Black Churches in an Intervention to Improve Cardiovascular Health and Reduce Racial Inequities.

Cardiovascular disease (CVD) is the leading cause of mortality in the United States and disproportionately impacts Black adults. Effective implementation of interventions to improve cardiovascular health in the Black community is needed to reduce health inequities. The Church-Based Health Intervention to Eliminate Health Inequalities in Cardiovascular Health (CHERISH) study is implementing interventions recommended by the 2019 American College of Cardiology/American Heart Association guideline on the primary prevention of CVD in Black communities to improve cardiovascular health and reduce health disparities. The recently completed 3-year planning phase of CHERISH has focused on engaging with the predominantly Black church community in New Orleans with the goals of informing study protocol development and recruiting churches for study participation. Community engagement approaches include convening a community advisory board (CAB), conducting qualitative and quantitative needs assessments, and hosting and attending church events. These activities have resulted in an engaged CAB that has contributed meaningfully to planning activities and the study protocol. The needs assessment found that while there are substantial barriers to cardiovascular health, such as knowledge, access to healthy foods, and safe spaces for physical activity, people are willing to make lifestyle changes and think that the proposed intervention components are feasible. Community engagement activities have resulted in the recruitment of 50 geographically and denominationally diverse predominantly Black churches willing to participate in the study (exceeding our goal of 42). Overall, a multicomponent approach to extensive community engagement has produced effective church enrollment for study participation and meaningful input on study design and implementation.

Hard Lessons From a School-Based Intervention to Improve Cardiovascular Health in Adolescence

Hard Lessons From a School-Based Intervention to Improve Cardiovascular Health in Adolescence

Physical Exercise as a Physiological Modulator of Improving Cardiovascular Health in Obese Women

The study purpose was to analyze the effective form of physical exercise in improving cardiovascular health in obese individuals. Materials and methods. Twenty-four (24) obese adolescents, aged 20–24 years, who met the criteria were selected as participants. The participants were divided into 3 groups, namely the control, the strength training, and the endurance training, with 8 participants in each group. Strength training was done with Machine Fitness, while endurance training used a Treadmill. Exercise was done with moderate intensity, for 35 minutes, the frequency of exercise was 3x/week, for 1 month. Heart rate and blood pressure, as parameters of heart health, were measured before and after treatment. Data analysis used the One-way ANOVA test with a significance level of 5%. Results. The results showed that there was a significant difference in cardiovascular health between endurance and strength training (p ≤ 0.05). Conclusions. Based on the study results, it was shown that endurance training is a potential physiological modulator to improve cardiovascular health in obese women.

Red Quinoa Hydrolysates with Antioxidant Properties Improve Cardiovascular Health in Spontaneously Hypertensive Rats.

In recent years, quinoa has been postulated as an emerging crop for the production of functional foods. Quinoa has been used to obtain plant protein hydrolysates with in vitro biological activity. The aim of the present study was to evaluate the beneficial effect of red quinoa hydrolysate (QrH) on oxidative stress and cardiovascular health in an in vivo experimental model of hypertension (HTN) in the spontaneously hypertensive rat (SHR). The oral administration of QrH at 1000 mg/kg/day (QrHH) showed a significant reduction in SBP from baseline (-9.8 ± 4.5 mm Hg; p < 0.05) in SHR. The mechanical stimulation thresholds did not change during the study QrH groups, whereas in the case of SHR control and SHR vitamin C, a significant reduction was observed (p < 0.05). The SHR QrHH exhibited higher antioxidant capacity in the kidney than the other experimental groups (p < 0.05). The SHR QrHH group showed an increase in reduced glutathione levels in the liver compared to the SHR control group (p < 0.05). In relation to lipid peroxidation, SHR QrHH exhibited a significant decrease in plasma, kidney and heart malondialdehyde (MDA) values compared to the SHR control group (p < 0.05). The results obtained revealed the in vivo antioxidant effect of QrH and its ability to ameliorate HTN and its associated complications.

Profiling Cardiometabolic Health in Jordan: A Call to Action to Improve Cardiovascular Health.

Over the past decades, Jordan has witnessed unprecedented growth in the prevalence of cardiometabolic diseases, with a crude prevalence of 48.2% in 2020, up from 38% in 2009. This is slightly higher than the reported prevalence of 40% in the US population. According to the latest World Health Organization report published in 2020, Jordan's leading cause of mortality iscardiovascular diseases with a cause-specific mortality rate of 18.6%. Since the advancement of the healthcare system in Jordan took place in the early 2000s, Jordan has witnessed a major epidemiologic transition where the burden of infectious disease has decreased, but on the other hand, the burden of cardiometabolic disease has increased as well. For such a country with limited resources and healthcare infrastructure where two-thirds of its population is below the age of 30, this is alarming. This growth can be attributed to a complex interplay between genetic and lifestyle factors. Smoking, physical inactivity, obesity, and unhealthy dietare considered major public health problems in Jordan, as reported in 2007 by the Jordanian Behavioral Risk Factor Surveillance.We attempt to raise awareness through this review article, so healthcare providers in Jordan understand the magnitude of the issue, and appropriate steps are taken to reestablish screening and management guidelines pertaining to cardiometabolic diseases in Jordan.

Abstract P396: A Culturally Tailored Mobile Health Lifestyle Intervention Improves Cardiovascular Health Among African Americans With Preexisting Risk Factors

Background: African-American (AA) adults have a higher prevalence of cardiovascular (CV) risk factors, leading to higher CV disease mortality than White adults. Prior findings of our mobile health (mHealth) lifestyle intervention (FAITH! App) demonstrated efficacy in promoting ideal cardiovascular health (CVH) in AAs. Hypothesis: We hypothesized that the intervention group with preexisting CV risk factors would have a greater increase in LS7 scores than the control group with the same risk factors following use of the FAITH! App. Methods: A cluster randomized controlled trial was conducted among AAs from 16 churches in Minnesota. The intervention included culturally relevant, LS7-focused education modules, diet/physical activity self-monitoring and a group sharing board. A subgroup of participants with ≥1 diagnosis of overweight/obesity, hyperlipidemia, hypertension (HTN) or diabetes was examined. The primary outcome was change in LS7 score—a measure of CVH ranging from poor to ideal (range 0-14 points)—at 6 months post-intervention. Results: Forty-nine participants (75.5% female) were included in the intervention (n=20; mean age [SD]: 58.8 [9.5]) or control (n=29, mean age [SD]: 52.5 [10.7]) groups (Table 1). There was no significant difference in the CV risk factor prevalence between the two groups. There was a greater increase in LS7 score in the intervention vs. control group across all CV risk factors, with significant differences among those with overweight/obesity (1.77, p&lt;.0001) and with 2+ or 3+ CV risk factors (1.00, p=.03; 1.09, p=.04). Compared to the control group, the increase in the percentage of participants with ideal LS7 scores in the intervention group was higher among those with overweight/obesity, HTN, diabetes and 3+ CV risk factors. Conclusions: Our culturally tailored mHealth lifestyle intervention was associated with notable increases in LS7 scores among AAs with preexisting CV risk factors, suggesting its efficacy in improving CVH among this population.

Abstract P165: Key Tenets for Lifestyle Programs Aiming to Improve Hypertension Control and Cardiovascular Health

Introduction: Promoting lifestyle changes, such as consuming a healthier diet, engaging in exercise, and quitting smoking can help control hypertension (HTN) and reduce the risk of adverse cardiac outcomes. To support public health practitioners and health care providers, the Centers for Disease Control and Prevention’s (CDC) Division for Heart Disease and Stroke Prevention (DHDSP) sought to develop a set of key tenets of lifestyle programs that support successful implementation and impact on HTN-related outcomes. Hypothesis: No a priori hypotheses. Methods: We conducted rapid evaluations of three lifestyle programs identified first through a broad call for nominations and then a panel of experts for final selections. We also performed a literature review to assess the landscape of lifestyle programs focused on managing HTN. To build upon these findings, a rigorous mixed-methods evaluation of a local YMCA’s (St. Louis Gateway Region) implementation of a Blood Pressure Self-Monitoring (BPSM) program was conducted to describe program characteristics and innovations and assess HTN outcomes. Results: The evaluation of a local YMCA included 333 participants with HTN (2018-2020) and reported a statistically significant average reduction of 2.6 mmHg in SBP from baseline to 16-week follow-up. Based on comprehensive findings from the project, DHDSP identified the following four key tenets for an effective program: 1) Implementing programs in community settings provides an opportunity to offer programming where people are already gathering and can build trust and commitment. Findings from rapid evaluation of a program held at churches and other community locations demonstrated increased BP control rates from 66.2% to 71.5% at 12-week follow-up. 2) A team-based approach with clinical and non-clinical staff allows for more impactful and effective implementation. Evaluation results demonstrated completion of a program with trained lifestyle coaches was associated with a decrease of 7.3 mmHg in SBP and 5.7 mmHg in DBP over a 16-week period. 3) Programs with shorter durations (between 3-24 weeks) allow for those not able to commit to a longer program to still benefit from learning to control BP and reduce other risk factors. Findings from rapid evaluation of a three-week program resulted in increased BP control from 28.4% to 61.3% by end of program period. 4) Targeting multiple lifestyle behaviors provide the opportunity to closely match participant needs with the type of activities that work best for them. Rapid evaluation of a 12-week program focused on exercise, diet, and reducing stress demonstrated an increase in BP control from 76.9% to 82.2%. Conclusion: Findings can be used as a resource to link patients to effective BP control and management programs that have implemented these key tenets. Strategies highlighted may also provide considerations for replication in other communities.

CRT-500.10 Improving Cardiovascular Health and Quality of Life on a Global Perspective

CRT-500.10 Improving Cardiovascular Health and Quality of Life on a Global Perspective

Physical Exercise Promotes DNase Activity Enhancing the Capacity to Degrade Neutrophil Extracellular Traps.

(1) Background: An unhealthy lifestyle is a significant contributor to the development of chronic diseases. Physical activity can benefit primary and secondary prevention. Higher DNase activity is associated with favourable outcomes after cardiovascular (CV) events. In this study, we aimed to investigate the influence of consequent endurance exercise on DNase activity. (2) Methods: 98 subjects with at least one CV risk factor but the physical ability to perform endurance training were included. Individuals performed a bicycle stress test at the beginning and after 8 months to assess physical performance. In between, all participants were instructed to engage in guideline-directed physical activity. Blood samples were drawn in two-month intervals to assess routine laboratory parameters, cell-free DNA (cfDNA), and DNase activity. (3) Results: Prevailing CV risk factors were overweight (65.9%), a positive family history (44.9%), hypertension (32.7%) and smoking (20.4%). Performance changed by 7.8 ± 9.1% after 8 months. Comparison of baseline to 8 months revealed a decrease in cfDNA and an increase in DNase activity. This effect was driven by participants who achieved a performance gain. (4) Conclusions: Regular physical activity might improve CV health by increasing DNase activity and thereby, the capacity to lower pro-inflammatory signalling, complementing measures of primary and secondary prevention.

Forming Cardi-OH: A Statewide Collaborative to Improve Cardiovascular Health in Ohio.

BackgroundCardiovascular risk factor control is challenging, especially in disadvantaged populations. However, few statewide efforts exist to tackle this challenge. Therefore, our objective is to describe the formation of a unique statewide cardiovascular health collaborative so others may learn from this approach.MethodologyWith funding from the Ohio Department of Medicaid’s Ohio Medicaid Technical Assistance and Policy Program, we used a collective impact model to link the seven medical schools in Ohio, primary care clinics across the state, the Ohio Department of Medicaid, and Ohio’s Medicaid Managed Care Plans in a statewide health improvement collaborative for expanding primary care capacity to improve cardiovascular health in Ohio.ResultsInitial dissemination activities for primary care teams included a virtual case-based learning series focused on hypertension and social determinants of health, website resources, a monthly newsletter with clinical tips, webinars, and in-person conferences. The collaborative is aligned with a separately funded hypertension quality improvement project for paired implementation.ConclusionsThe collective impact model is a useful framework for developing a statewide collaborative focused on the dissemination and implementation of evidence-based best practices for cardiovascular health improvement and disparity reduction. Statewide collaboratives bringing payers, clinicians, and academic partners together have the potential to substantially impact cardiovascular health.

“Quick and to the point”: Participant Input for the Development of an Online Gardening Intervention to Improve Cardiovascular Health

ObjectivesGardening is associated with cardiovascular health promoting behaviors such fruit and vegetable (F&V) intake and physical activity. The majority of published gardening interventions are based on labor intensive, in-person models and there is little published data on optimal delivery modes or topics needed to develop a scalable, online intervention. The purpose of this study was to solicit input from a pool of potential online learners to inform the development of an online gardening intervention. MethodsA survey was delivered to an Amazon Mechanical Turk (mTurk) panel including quantitative and open-ended questions. Participants were asked about socio-demographic and health information, their experiences with gardening, preferences for intervention delivery (e.g., in person or online), and topics needed to teach new gardeners. Quantitative data were summarized with chi-squared tests or t-tests and comparisons were made between participants with 0 years (Never gardeners, NG) and 1+ years (Experienced Gardeners, EG). Qualitative data were coded and organized into intervention functions based on the Behavior Change Wheel from Michie et al. ResultsOverall, 465 participants were included (45.6% NG and 54.4% EG). Participants had a mean age of 40.2 years, were majority white (79.8%), lived in non-urban areas (56.8%) and had at least one risk factor for cardiovascular disease (73.6%). Gardening program interest was high for both NG and EG (67.0% v. 84.2% respectively, p < 0.001). Both groups preferred “quick and to the point” delivery methods including <5 minute videos (64.2% NG, 57.7% EG, p = 0.191). Key intervention functions identified were education and training (fundamentals of gardening maintenance at each step for planting, harvesting, and cooking), environmental restructuring (social support), persuasion (the benefits of gardening), modeling (seeing others who were successful), and enablement (the provision of supplies and tools). ConclusionsParticipants in this sample were interested in learning gardening skills, preferred “quick” online intervention delivery methods, and were interested in a multi-component intervention including how to garden from planting to harvesting and cooking. Funding SourcesThis study was funded by the Penn State Department of Professional Development (PI: Veldheer).

THE NEED FOR OPTIMUM NUTRITIONAL STRATEGIES FOR CARDIOVASCULAR HEALTH IN PAKISTANI POPULATION

THE NEED FOR OPTIMUM NUTRITIONAL STRATEGIES FOR CARDIOVASCULAR HEALTH IN PAKISTANI POPULATION

Effect of Clinical Decision Support on Cardiovascular Risk Among Adults With Bipolar Disorder, Schizoaffective Disorder, or Schizophrenia

Adults with schizophrenia, schizoaffective disorder, or bipolar disorder, collectively termed serious mental illness (SMI), have shortened life spans compared with people without SMI. The leading cause of death is cardiovascular (CV) disease. To assess whether a clinical decision support (CDS) system aimed at primary care clinicians improves CV health for adult primary care patients with SMI. In this cluster randomized clinical trial conducted from March 2, 2016, to September 19, 2018, restricted randomization assigned 76 primary care clinics in 3 Midwestern health care systems to receive or not receive a CDS system aimed at improving CV health among patients with SMI. Eligible clinics had at least 20 patients with SMI; clinicians and their adult patients with SMI with at least 1 modifiable CV risk factor not at the goal set by the American College of Cardiology/American Heart Association guidelines were included. Statistical analysis was conducted on an intention-to-treat basis from January 10, 2019, to December 29, 2021. The CDS system assessed modifiable CV risk factors and provided personalized treatment recommendations to clinicians and patients. Patient-level change in total modifiable CV risk over 12 months, summed from individual modifiable risk factors (smoking, body mass index, low-density lipoprotein cholesterol level, systolic blood pressure, and hemoglobin A1c level). A total of 80 clinics were randomized; 4 clinics were excluded for having fewer than 20 eligible patients, leaving 42 intervention clinics and 34 control clinics. A total of 8937 patients with SMI (4922 women [55.1%]; mean [SD] age, 48.4 [13.5] years) were enrolled. There was a 4% lower rate of increase in total modifiable CV risk among intervention patients relative to control patients (relative rate ratio [RR], 0.96; 95% CI, 0.94-0.98). The intervention favored patients who were 18 to 29 years of age (RR, 0.89; 95% CI, 0.81-0.98) or 50 to 59 years of age (RR, 0.93; 95% CI, 0.90-0.96), Black (RR, 0.93; 95% CI, 0.88-0.98), or White (RR, 0.96; 95% CI, 0.94-0.98). Men (RR, 0.96; 95% CI, 0.94-0.99) and women (RR, 0.95; 95% CI, 0.92-0.97), as well as patients with any SMI subtype (bipolar disorder: RR, 0.96; 95% CI, 0.94-0.99; schizoaffective disorder: RR, 0.94; 95% CI, 0.90-0.98; schizophrenia: RR, 0.92; 95% CI, 0.85-0.99) also benefited from the intervention. Despite treatment effects favoring the intervention, there were no significant differences in individual modifiable risk factors. This CDS intervention resulted in a rate of change in total modifiable CV risk that was 4% lower among intervention patients compared with control patients. Results were driven by the cumulative effects of incremental and mostly nonsignificant changes in individual modifiable risk factors. These findings emphasize the value of using CDS to prompt early primary care intervention for adults with SMI. ClinicalTrials.gov Identifier: NCT02451670.

Greenspace, Inflammation, Cardiovascular Health, and Cancer: A Review and Conceptual Framework for Greenspace in Cardio-Oncology Research.

Cardiovascular disease (CVD) is a leading cause of global morbidity and mortality. Cancer survivors have significantly elevated risk of poor cardiovascular (CV) health outcomes due to close co-morbid linkages and shared risk factors between CVD and cancer, as well as adverse effects of cancer treatment-related cardiotoxicity. CVD and cancer-related outcomes are exacerbated by increased risk of inflammation. Results from different pharmacological interventions aimed at reducing inflammation and risk of major adverse cardiovascular events (MACEs) have been largely mixed to date. Greenspaces have been shown to reduce inflammation and have been associated with CV health benefits, including reduced CVD behavioral risk factors and overall improvement in CV outcomes. Greenspace may, thus, serve to alleviate the CVD burden among cancer survivors. To understand pathways through which greenspace can prevent or reduce adverse CV outcomes among cancer survivors, we review the state of knowledge on associations among inflammation, CVD, cancer, and existing pharmacological interventions. We then discuss greenspace benefits for CV health from ecological to multilevel studies and a few existing experimental studies. Furthermore, we review the relationship between greenspace and inflammation, and we highlight forest bathing in Asian-based studies while presenting existing research gaps in the US literature. Then, we use the socioecological model of health to present an expanded conceptual framework to help fill this US literature gap. Lastly, we present a way forward, including implications for translational science and a brief discussion on necessities for virtual nature and/or exposure to nature images due to the increasing human–nature disconnect; we also offer guidance for greenspace research in cardio-oncology to improve CV health outcomes among cancer survivors.