Pre-existing Cardiovascular Conditions Research Articles

The Prevalence of Obesity and Metabolic Syndrome among Polish Women without Pre-Existing Cardiovascular Conditions and Diabetes: A Multicenter Study in Poland.

Background: A very prevalent problem worldwide is not only the high prevalence of chronic conditions but also the high frequency of their underdiagnosis and unhealthy lifestyles, both resulting in the development and inadequate treatment of civilization diseases. Therefore, the aim of this study was to assess the prevalence of abnormal metabolic parameters among Polish women aged >35 years who have not yet been diagnosed with cardiovascular diseases, diabetes or chronic kidney disease, as well as evaluate their lifestyles and look for relationships between individual lifestyle parameters and metabolic abnormalities. Methods: This was a multicenter, cross-sectional, observational study conducted on a group of women aged ≥ 35 years without previous cardiovascular disease, diabetes or chronic kidney disease. As part of the study, patients had anthropometric measurements and laboratory tests performed (serum glucose, total cholesterol, LDL, HDL, non-HDL cholesterol and triglycerides) and completed the HLPCQ (the Healthy Lifestyle and Personal Control Questionnaire). Obesity was defined as BMI ≥ 30 kg/m2. Abdominal obesity was defined as a waist circumference ≥ 88 cm. Results: The study included 672 women considered healthy. In the analyzed group of women, 20.6% met the criteria for a diagnosis of obesity based on BMI, and 36.8% were diagnosed with abdominal obesity. In addition, 16.8% of the women had an abnormal fasting blood glucose result. Moreover, 46.4% of the women's blood pressure measurements were above the normal range, and as many as 57.7% of the women had abnormal non-HDL levels. In addition, 150 women met the criteria for a diagnosis of metabolic syndrome. These conditions were far more common in women diagnosed with obesity. Physical activity was associated with a reduced risk of developing obesity and metabolic syndrome. Conclusions: The underdiagnosis of chronic conditions in the study population is high. More than 20% of women met the criteria for a diagnosis of metabolic syndrome, the prevalence of which was significantly higher in patients with obesity. A healthy lifestyle was associated with a reduced risk of developing metabolic syndrome and its individual components. It is necessary to actively search for chronic conditions in patients, which requires the involvement of not only healthcare system employees but also government representatives.

The Long-Term Cardiovascular Impact of COVID-19: Pathophysiology, Clinical Manifestations, and Management.

The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has resulted in a substantial global health crisis, with effects extending far beyond the acute phase of infection. This review aims to provide a comprehensive overview of the long-term cardiovascular impact of COVID-19, focusing on the pathophysiology, clinical manifestations, diagnostic approaches, management strategies, and future research directions. SARS-CoV-2 induces cardiovascular complications through mechanisms such as inflammation, endothelial dysfunction, and direct myocardial injury, leading to conditions like myocarditis, heart failure, arrhythmias, and thromboembolic events. These long-term effects, collectively called "long COVID" or post-acute sequelae of SARS-CoV-2 infection (PASC), present significant challenges for healthcare systems and patient management. Diagnostic approaches include imaging techniques and laboratory tests to identify and monitor cardiovascular complications. Management strategies emphasize a holistic approach, incorporating pharmacological treatments and lifestyle modifications. Special attention is required for vulnerable populations, including those with pre-existing cardiovascular conditions. Ongoing research is essential to understand the full spectrum of long-term cardiovascular impacts and to develop effective treatments. This review highlights the critical need for continued vigilance, multidisciplinary care, and research to address the cardiovascular sequelae of COVID-19 and improve long-term health outcomes for survivors.

Cerebral hypoperfusion exacerbates traumatic brain injury in male but not female mice.

Mild-moderate traumatic brain injuries (TBIs) are prevalent, and while many individuals recover, there is evidence that a significant number experience long-term health impacts, including increased vulnerability to neurodegenerative diseases. These effects are influenced by other risk factors, such as cardiovascular disease. Our study tested the hypothesis that a pre-injury reduction in cerebral blood flow (CBF), mimicking cardiovascular disease, worsens TBI recovery. We induced bilateral carotid artery stenosis (BCAS) and a mild-moderate closed-head TBI in male and female mice, either alone or in combination, and analyzed CBF, spatial learning, memory, axonal damage, and gene expression. Findings showed that BCAS and TBI independently caused a ~10% decrease in CBF. Mice subjected to both BCAS and TBI experienced more significant CBF reductions, notably affecting spatial learning and memory, particularly in males. Additionally, male mice showed increased axonal damage with both BCAS and TBI compared to either condition alone. Females exhibited spatial memory deficits due to BCAS, but these were not worsened by subsequent TBI. Gene expression analysis in male mice highlighted that TBI and BCAS individually altered neuronal and glial profiles. However, the combination of BCAS and TBI resulted in markedly different transcriptional patterns. Our results suggest that mild cerebrovascular impairments, serving as a stand-in for preexisting cardiovascular conditions, can significantly worsen TBI outcomes in males. This highlights the potential for mild comorbidities to modify TBI outcomes and increase the risk of secondary diseases.

#3043 Epidemiology of infective endocarditis in long term hemodialysis patients in France, from 2014 to 2019

Abstract Background and Aims Infective endocarditis (IE) is a frequent pathology among patients treated with long-term hemodialysis (HD). Its epidemiology and risk factors are scarcely reported in this specific population in France. This study aims to describe the frequency and characteristics of IE in long-term hemodialysis patients in mainland France. Method From the national Programme de médicalisation des systèmes d'information (PMSI) data, we selected patients initiating a renal replacement therapy by long-term hemodialysis from 2014 to 2017, with a follow up from 2017 to 2019. Within this population, we defined hospitalizations due to IE by using the CIM-10 coding system. We analyzed various comorbidities such as sociodemographic factors, cardiovascular diseases, cancer, diabetes and vascular access, identified within the PMSI during a minimum duration of 4 years, looking for IE risk factors. As the IE incidence has a low frequency for this follow up length, it was analyzed with a Poisson distribution model. Results We studied 38 569 patients, with a 36 month follow up. Fig. 1 shows IE incidence during the follow up, in which we identified 2492 cases of EI. The incidence rate was 6.69, or 7 out of 100 000 at first month and 1.97 out of 100 000 at twelve months. In multivariate analysis we found the following risk factors associated with EI: having a central vascular catheter (CVC) as initial vascular access while starting renal replacement therapy, compared to an arteriovenous fistula, OR 2.49 [2.29-2.71], diabetes OR 1.25 [1.14-1.35], cardiovascular conditions OR 1.35 [1.23-1.48] and increasing age was associated with a reduction of an IE diagnosis odds. Conclusion Our study highlights a high IE frequency among long-term hemodialysis patients. Its incidence is particularly high during the first year and decreases afterwards. The main risk factors were: CVC, preexisting cardiovascular conditions and diabetes.

Association Between Fluoroquinolones and Major Adverse Cardiovascular Events: A Systematic Review.

Fluoroquinolones (FQs) are routinely administered antibiotics that have demonstrated an increased propensity to cause major adverse cardiovascular events (MACE). We conducted a systematic review aimed to investigate the association between FQ usage and the risk of MACE. A comprehensive literature search was conducted using PubMed, Scopus, and the Cochrane Library from inception to September 2023 to retrieve studies comparing FQ administration with placebo and reporting the occurrence of MACE. Relevant studies that explored the occurrence of MACE, defined as "acute myocardial infarction, stroke, cardiovascular mortality, arrhythmia, or heart failure" with FQ usage were eligible for inclusion. Four studies with a total of 42,808 patients were included. Levofloxacin, moxifloxacin, and gatifloxacin were observed to have an increased propensity to cause MACE, particularly arrhythmias, whereas ciprofloxacin was associated with the lowest risk of causing MACE. Despite the methodological diversity in the included studies, this systematic review uncovered a consistent trend of heightened likelihood of MACE with FQ administration across studies, suggesting that elevated serum concentrations of some FQs may correlate with higher risks of MACE development. This systematic review emphasizes the need for cautious administration of FQs, particularly in patients with a preexisting cardiovascular condition. Routine cardiac monitoring using electrocardiograms is warranted for patients on high doses of FQs to preemptively detect the development of MACE, particularly arrhythmias.

Cause and preventability of in-hospital mortality after PCI: A statewide root-cause analysis of 1,163 deaths.

Mortality is the most devastating complication of percutaneous coronary interventions (PCI). Identifying the most common causes and mechanisms of death after PCI in contemporary practice is an important step in further reducing periprocedural mortality. To systematically analyze the cause and circumstances of in-hospital mortality in a large, multi-center, statewide cohort. In-hospital deaths after PCI occurring at 39 hospitals included in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) between 2012 and 2014 were retrospectively reviewed using validated methods. A priori PCI-related mortality risk was estimated using the validated BMC2 model. A total of 1,163 deaths after PCI were included in the study. Mean age was 71±13 years, and 507 (44%) were women. Left ventricular failure was the most common cause of death (52% of cases). The circumstance of death was most commonly related to prior acute cardiovascular condition (61% of cases). Procedural complications were considered contributing to mortality in 235 (20%) cases. Death was rated as not preventable or slightly preventable in 1,045 (89.9%) cases. The majority of the deaths occurred in intermediate or high-risk patients, but 328 (28.2%) deaths occurred in low-risk patients (<5% predicted risk of mortality). PCI was considered rarely appropriate in 30% of preventable deaths. In-hospital mortality after PCI is rare, and primarily related to pre-existing critical acute cardiovascular condition. However, approximately 10% of deaths were preventable. Further research is needed to characterize preventable deaths, in order to develop strategies to improve procedural safety.

Screening for Peripheral Vascular Stiffness in Lipedema Patients by Automatic Electrocardiogram-Based Oscillometric Detection.

Body mass index (BMI) is seen as a predictor of cardiovascular disease (CVD) in lipedema patients. A valid predictor of CVD is increased aortic stiffness (IAS), and previous research described IAS in lipedema. However, it is not known if this applies to all patients. In this cross-sectional single-center cohort study, peripheral pulse wave velocity (PWV) as a non-invasive indicator of aortic stiffness was measured in 41 patients with lipedema, irrespective of stage and without pre-existing cardiovascular conditions or a history of smoking and a maximum body mass index (BMI) of 35 kg/m2. Automatically electrocardiogram-triggered oscillometric sensor technology by the Gesenius-Keller method was used. Regardless of the stage of lipedema disease, there was no significant difference in PWV compared to published standard values adjusted to age and blood pressure. BMI alone is not a predictor of cardiovascular risk in lipedema patients. Measuring other anthropometric factors, such as the waist-hip ratio or waist-height ratio, should be included, and the existing cardiovascular risk factors, comorbidities, and adipose tissue distribution for accurate risk stratification should be taken into account. Automated sensor technology recording the PWV represents a valid and reliable method for health monitoring and early detection of cardiovascular risks.

Acute Cholecystitis Complicating Cardiac Disease: A Cohort Study From a Tertiary Care Center in Mexico City, Mexico.

Background Acute cholecystitis (AC) presents as inflammation of the gallbladder, predominantly attributed to gallstones obstructing the cystic duct. Another notable etiology is ischemic cholecystitis, often stemming from severe illnesses that compromise blood flow to the splanchnic system. Individuals with pre-existing cardiovascular conditions or undergoing cardiopulmonary surgery encounter elevated risks of gastrointestinal pathology, leading to heightened morbidity and mortality rates. In these cases, AC stands out as a significant concern, whether it originates from gallstones or is acalculous (ischemic). Methods We conducted a single-center, retrospective cohort study at the National Medical Center in Mexico City, Mexico. We included demographic, clinical, laboratory, preoperative, intraoperative, and postoperative data. Our main objectives were to describe the characteristics of our population and identify predictors of major complications following surgery for AC in patients with heart disease. Results Our study encompassed 18 patients diagnosed with both AC and cardiac disease, with acute myocardial infarction being the leading cause of admission, constituting 38.9% of cases. The clinical presentation was characterized by right hypochondrial pain, observed in all patients, while Murphy's sign was evident in 44.4% of cases. Additionally, various non-specific symptoms were present in varying percentages across the patient cohort. Concerning imaging studies, 88% of our cohort underwent ultrasound (USG), while computed tomography (CT) was utilized in 55% of patients. Among those who had USG, the most prevalent findings were gallbladder wall thickening in 56% and perivesicular fluid in 37.5%. In patients who underwent CT scans, the predominant observations included perivesicular fluid in 66% and perivesicular fat stranding in 55%. In terms of intraoperative findings, gallbladder empyema and necrosis were the most common findings identified in 55.6% of the cases. After surgery, 61.1% had no complications or developed mild complications, while 11.1% experienced moderate to severe complications without resulting in death; the mortality rate was 27.8% in our cohort. Overall, major complications or death were present in 38.9% of our cohort. In the postoperative data analysis, the use of mechanical ventilation and vasopressors showed a significant correlation with increased morbidity and mortality. Conclusions Our study contributes valuable information to the international literature, providing insights into the complications faced by the Mexican population in the context of heart diseases, particularly among patients suffering from cholecystitis. Within individuals with cardiac disease, the occurrence of AC requiring surgical intervention is associated with heightened morbidity and mortality rates, with our cohort experiencing rates as high as 38.9%. Consistent with findings in the international literature, these results underscore the critical importance of continuing the search for novel clinical or laboratory predictors for this high-risk population. While most parameters assessed in this study did not show any correlation with major complications, exceptions were observed in postoperative vasopressors and mechanical ventilation.

Role of PCSK9 inhibition during the inflammatory stage of SARS-COV-2: an updated review

The potential role of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition in the management of COVID-19 and other medical conditions has emerged as an intriguing area of research. PCSK9 is primarily known for its impact on cholesterol metabolism, but recent studies have unveiled its involvement in various physiological processes, including inflammation, immune regulation, and thrombosis. In this abstract, the authors review the rationale and potential implications of PCSK9 inhibition during the inflammatory stage of SARS-CoV-2 infection. Severe cases of COVID-19 are characterized by an uncontrolled inflammatory response, often referred to as the cytokine storm, which can lead to widespread tissue damage and organ failure. Preclinical studies suggest that PCSK9 inhibition could dampen this inflammatory cascade by reducing the production of pro-inflammatory cytokines. Additionally, PCSK9 inhibition may protect against acute respiratory distress syndrome (ARDS) through its effects on lung injury and inflammation. COVID-19 has been linked to an increased risk of cardiovascular complications, especially in patients with pre-existing cardiovascular conditions or dyslipidemia. PCSK9 inhibitors are known for their ability to lower low-density lipoprotein (LDL) cholesterol levels by enhancing the recycling of LDL receptors in the liver. By reducing LDL cholesterol, PCSK9 inhibition might protect blood vessels from further damage and lower the risk of atherosclerotic plaque formation. Moreover, PCSK9 inhibitors have shown potential antithrombotic effects in preclinical studies, making them a potential avenue to mitigate the increased risk of coagulation disorders and thrombotic events observed in COVID-19. While the potential implications of PCSK9 inhibition are promising, safety considerations and possible risks need careful evaluation. Hypocholesterolemia, drug interactions, and long-term safety are some of the key concerns that should be addressed. Clinical trials are needed to establish the efficacy and safety of PCSK9 inhibitors in COVID-19 patients and to determine the optimal timing and dosing for treatment. Future research opportunities encompass investigating the immune response, evaluating long-term safety, exploring combination therapy possibilities, and advancing personalized medicine approaches. Collaborative efforts from researchers, clinicians, and policymakers are essential to fully harness the therapeutic potential of PCSK9 inhibition and translate these findings into meaningful clinical outcomes.

The effect of a single closed-circuit rebreather decompression dive in extremely cold water to cardiac function.

Dive-induced cardiac and hemodynamic changes are caused by various mechanisms, and they are aggravated by cold water. Therefore, aging divers with pre-existing cardiovascular conditions may be at risk of acute myocardial infarction, heart failure, or arrhythmias while diving. The aim of this study was to assess the effect of a single decompression CCR dive in arctic cold water on cardiac function in Finnish technical divers. Thirty-nine divers performed one identical 45 mfw CCR dive in 2-4°C water. Hydration and cardiac functions were assessed before and after the dive. Detection of venous gas embolization was performed within 120min after the dive. The divers were affected by both cold-water-induced hemodynamic changes and immersion-related fluid loss. Both systolic and diastolic functions were impaired after the dive although the changes in cardiac functions were subtle. Venous inert gas bubbles were detected in all divers except for one. Venous gas embolism did not affect systolic or diastolic function. A single trimix CCR dive in arctic cold water seemed to debilitate both systolic and diastolic function. Although the changes were subtle, they appeared parallel over several parameters. This indicates a real post-dive deterioration in cardiac function instead of only volume-dependent changes. These changes are without a clinical significance in healthy divers. However, in a population with pre-existing or underlying heart problems, such changes may provoke symptomatic problems during or after the dive.

Ibrutinib Dose Adjustment Does Not Impact Time to Next Treatment in First-Line Patients with Chronic Lymphocytic Leukemia: A Real-World Analysis of Electronic Medical Records from Academic and Non-Teaching Hospitals Using Target Trial Emulation

Introduction: Ibrutinib, a once-daily Bruton's tyrosine kinase inhibitor (BTKi), is recommended as first-line (1L) treatment for patients with chronic lymphocytic leukemia (CLL). Dosing flexibility with ibrutinib allows patients to adjust their daily dose to help prevent recurrence or worsening of adverse events, while maintaining efficacy by allowing patients to stay on treatment and benefit from long-term treatment outcomes. The current study aimed to compare time to next treatment (TTNT) in CLL patients initiating 1L single-agent ibrutinib at 420mg/day and staying on this dose versus those having a dose adjustment (DA) within 3-12 months. Methods: Specialty pharmacy electronic medical records from the Acentrus database, comprised primarily of academic and non-teaching hospital systems in the United States (1/1/2016-4/30/2022), were used to identify adults with CLL who initiated 1L single-agent ibrutinib at a starting dose of 420mg/day (index date) (N = 1,171). A washout period of ≥12 months pre-index (also used to evaluate baseline characteristics) was required to confirm use as 1L therapy. The following treatment strategies were compared: treatment for 3 months post-index at 420mg/day followed by DA to a dose below 420mg/day between 3-12 months post-index versus sustained treatment for ≥12 months post-index at 420mg/day. The first 3 months were required to be at 420mg/day for both strategies, as most DAs occur after this period. TTNT was defined as the time from the index date to the initiation of a next treatment. Administrative censoring included treatment discontinuation (based on treatment gap of ≥365 days), death, participation in a clinical trial, end of data availability, within-class BTKi switch (i.e., switching to another covalent BTKi), anti-CD20 antibody (i.e., obinutuzumab or rituximab), or venetoclax add-on within 180 days post-index. To account for immortal time bias (i.e., patients with DA are required to survive on 1L therapy until DA), as well as overlap between follow-up time and definition of treatment strategies, a target trial emulation approach was used, where all patients were cloned at index date and contributed follow-up to both treatment strategy arms. Hazard ratios (HRs) were approximated from odds ratios obtained from multivariate pooled logistic regression models comparing TTNT between the two treatment strategies. Sensitivity analyses using different time periods to capture DA (3-6, 3-9, and 3-18 months) were also conducted. Results were replicated in the subgroup of patients at high risk for a cardiovascular (CV) event (based on pre-existing CV conditions or a high CV risk score). Results: Among the 1,171 patients who initiated 1L single-agent ibrutinib at a starting dose of 420mg/day, the mean age was 70.4 years, with 34.6% being female. The mean Quan-Charlson Comorbidity Index score was 3.0, and 61.8% were classified as high risk for a CV event. The mean (median) follow-up was 29.8 (30.9) months. Overall, 229 (19.6%) patients had a DA at any time (178 [77.7%] adjusted their dose to 280mg/day), with a mean (median) time to DA of 9.0 (5.5) months. Of these patients, 111 (48.5%) had a DA between 3-12 months post-index date (3-6 months: 66 [28.8%] patients, 3-9 months: 87 [38.0%] patients, 3-18 months: 126 [55.0%] patients). A total of 90 (7.7%) patients initiated a next treatment, out of which 59 (65.6%) patients initiated a venetoclax-based regimen (beyond the first 180 days) as their subsequent therapy. After adjustment in a pooled logistic regression model, DA was not associated with an increased risk of having a next treatment (HR: 1.14, p-value: 0.469) ( Figure 1). In sensitivity analyses evaluating DA over periods of 3-6, 3-9, and 3-18 months, results remained non-significant, with HRs ranging from 1.13 to 1.30 (all p-values &amp;gt;0.05) ( Figure 2). Results were also consistent in the subgroup with high risk for a CV event. Conclusions: This large real-world analysis of CLL patients from academic and non-teaching hospital systems showed that undergoing DA of 1L ibrutinib yielded similar clinical outcomes compared to having no DA, with similar findings for the high CV risk subgroup. These findings, along with those from clinical trials and real-world community oncology practices, suggest that a flexible dosing approach with ibrutinib may be an effective approach in allowing patients to achieve optimal outcomes while remaining on long-term continuous 1L treatment.

LONG-TERM CARDIOVASCULAR EFFECTS OF COVID-19: A COMPARATIVE STUDY

The COVID-19 pandemic has left a lasting impact on global health, with increasing evidence of long-term cardiovascular consequences in affected individuals. This study aims to comprehensively investigate and compare the persistent cardiovascular effects of COVID-19 across a diverse population, shedding light on the implications for long-term public health management. The primary objective of this comparative study is to assess and compare the long-term cardiovascular sequelae in COVID-19 survivors across various demographics and disease severities. We seek to understand the extent of cardiovascular involvement, associated risk factors, and outcome variations to inform clinical strategies and public health interventions. We conducted a multi-center retrospective analysis of electronic health records and patient data from diverse geographical regions and demographic groups. Our study involved a large cohort of COVID-19 survivors, categorizing them based on age, sex, comorbidities, and disease severity. We utilized comprehensive cardiovascular assessments, including echocardiography, electrocardiography, and biomarker analysis, to evaluate the cardiovascular status of participants. Our findings revealed long-term cardiovascular effects in COVID-19 survivors, including myocardial injury, arrhythmias, vascular abnormalities, and thrombotic events. These effects varied significantly among different demographic groups and were strongly associated with disease severity and pre-existing comorbidities. Older individuals and those with pre-existing cardiovascular conditions exhibited a higher risk of developing severe cardiovascular complications post-COVID-19. This comparative study underscores the substantial burden of long-term cardiovascular effects in COVID-19 survivors and the need for tailored healthcare interventions. The results emphasize the importance of continuous monitoring and risk assessment, particularly among older adults and individuals with pre-existing cardiovascular conditions. These findings have critical implications for long-term public health management strategies, including vaccination campaigns, prevention programs, and post-COVID-19 care pathways.

Cardiovascular Outcomes in COVID-19 Patients: A Retrospective Analysis of Intensive Care Unit Data from Saudi Arabia

Abstract Background: The COVID-19 pandemic has brought to the fore significant challenges in understanding the disease’s impact on cardiovascular health. Emerging evidence suggests that COVID-19 patients, especially those with severe symptoms, face considerable cardiovascular complications. Objectives: This study aims to investigate the extent and nature of cardiovascular complications in COVID-19 patients admitted to intensive care units (ICUs) in Saudi Arabia, thereby contributing to the broader understanding of the disease’s cardiovascular impact. Methods: This study was conducted at Almoosa Hospital; this cohort study involved adult patients (aged 18 and above) hospitalized with confirmed COVID-19 and admitted to the ICU. Patients with preexisting cardiovascular conditions or incomplete medical records were excluded. The study focused on outcomes such as myocardial injury and arrhythmias, utilizing SPSS version 26 for logistic regression and survival analysis in data analysis. Results: Our research revealed a high incidence of myocardial injury and arrhythmias among severely ill COVID-19 patients. These findings highlight the significant cardiovascular impact of COVID-19, particularly in severe cases, extending beyond the common respiratory complications. Conclusion: The study underscores the critical need for vigilant cardiovascular care in managing severe COVID-19 cases. It suggests the potential need for revising medical protocols and emphasizes the importance of ongoing research, especially in understanding long-term cardiovascular outcomes in COVID-19 survivors. This research contributes valuable insights to the evolving landscape of COVID-19-related cardiovascular health implications.

Short- and long-term effects of the COVID-19 pandemic on patients with cardiovascular diseases: A mini-review

The COVID-19 pandemic had profound implications for patients with cardiovascular diseases (CVDs), both in the short- and long-term. In this article, we provide an overview of the effects of the pandemic on individuals with preexisting cardiovascular conditions. In the short term, the severe acute respiratory syndrome coronavirus 2 infection increased the risk of many cardiovascular events. Furthermore, the pandemic has disrupted health-care systems worldwide, leading to constraints in routine care, and limited access to specialized cardiovascular services and procedure. This has resulted in increased morbidity and mortality rates among patients with CVD (coronary artery disease, hypertrophic cardiomyopathy, heart failure (HF), heart transplant recipients, atrial fibrillation, atrial flutter, previous stroke, or previous peripheral artery disease). In the long term, the COVID-19 impact on patients with CVD extends beyond the acute phase of the disease. Studies have highlighted the development of long-term cardiovascular complications in COVID-19 survivors, such as acute coronary syndrome myocarditis, HF, stroke, venous thromboembolism, and arrhythmias, which may lead to a surge of new cases associated with CVD in the postpandemic era. Health-care systems must prioritize cardiovascular care, developing strategies to identify the patients at higher risk and provide the care to minimize the impact of the pandemic on patients with CVD.

Therapeutic Aspects of Prunus cerasus Extract in a Rabbit Model of Atherosclerosis-Associated Diastolic Dysfunction.

This study evaluates the potential therapeutic effects of anthocyanin-rich Prunus cerasus (sour cherry) extract (PCE) on atherosclerosis-associated cardiac dysfunction, described by the impairment of the NO-PKG (nitric oxide-protein kinase G) pathway and the antioxidant capacity. Initially, a rabbit model of atherosclerotic cardiovascular disease was established by administering a cholesterol-rich diet, enabling the examination of the impact of 9 g/kg PCE on the pre-existing compromised cardiovascular condition. After that, the animals were divided into four groups for 12 weeks: the (1) untreated control group; (2) PCE-administered healthy rabbits; (3) hypercholesterolemic (HC) group kept on an atherogenic diet; and (4) PCE-treated HC group. Dyslipidemia, impaired endothelial function, and signs of diastolic dysfunction were evident in hypercholesterolemic rabbits, accompanied by a reduced cardiac expression of eNOS (endothelial nitric oxide synthase), PKG, and SERCA2a (sarco/endoplasmic reticulum calcium ATPase 2a). Subsequent PCE treatment improved the lipid profile and the cardiac function. Additionally, PCE administration was associated with elevated myocardial levels of eNOS, PKG, and SERCA2a, while no significant changes in the vascular status were observed. Western blot analysis further revealed hypercholesterolemia-induced increase and PCE-associated reduction in heme oxygenase-1 expression. The observed effects of anthocyanins indicate their potential as a valuable addition to the treatment regimen for atherosclerosis-associated cardiac dysfunction.

Increasing patient advocacy: The development of patient guidelines for cardio-oncology

Abstract Funding Acknowledgements Type of funding sources: None. Background As people live longer, many are living with two conditions- cardiovascular disease and cancer. With advancements in treatment in cancer including surgery and immunotherapy and, a relatively new specialty- cardio-oncology- has evolved. As patients can either have a pre-existing cardiovascular condition or present with a cardiac complication such as Acute Coronary Syndrome or Atrial Fibrillation during cancer treatment, there is a need for cardiovascular assessment prior to, during and after cancer treatment. The first cardio-oncology guidelines were released in 2022 for use in clinical practice that is aimed at clinicians. Despite increased involvement of patients in the research process, the evidenced-based results are not always written in ‘patient’ friendly language. Often lay summaries and thus the practical aspects of the condition or treatment are not available to patients and their families. Purpose Given the need to be more inclusive and make research findings and guidelines more patient friendly, the aim was to develop patient guidelines for Methods The ESC clinical practice guidelines on cardio-oncology for patients were written by a multidisciplinary team of healthcare professionals, including doctors, nurses, scientists and patients, and are intended mainly for use in clinics and hospitals with the aim of ensuring the language was inclusive and non-technical. Results Guidelines are useful in making diagnoses and deciding on treatment using the most up-to-date medical and scientific evidence to ensure that patients receive the most appropriate care. The guidelines outline recommendations on (i) Being treated by a multidisciplinary cardio-oncology team, (ii) Looking after your heart health, during and after cancer treatment, (iii) Paying particular attention to your heart health if you have previously had a heart attack, a stroke, an arrhythmia (irregular heartbeat) or you have high blood pressure, diabetes or high cholesterol and (iv) Making appropriate healthy lifestyle choices. A final version was published in late 2022 and the plan is to translate thee guidelines into several languages so they can be widely used and disseminated. Conclusion These guidelines demonstrate how clinicians and patients can work collaboratively to develop patient-friendly guidelines that can be used in practice and potentially optimise the shared-decision making process between patients and their healthcare team.

Heat and the Heart.

Globally, more people die from cardiovascular disease than any other cause. Extreme heat can have serious implications for heart health, especially in people with pre-existing cardiovascular conditions. In this review, we examined the relationship between heat and the leading causes of cardiovascular diseases as well as the proposed physiological mechanisms for the deleterious effect of heat on the heart. The body's response to high temperatures, including dehydration, increased metabolic demand, hypercoagulability, electrolyte imbalances, and systemic inflammatory response, can place a significant strain on the heart. Epidemiological studies showed that heat can result in ischemic heart disease, stroke, heart failure, and arrhythmia. However, targeted research is needed to understand the underlying mechanisms of hot temperatures on these main causes of cardiovascular disease. Meanwhile, the absence of clinical guidance on how to manage heart diseases during heat events highlights the need for cardiologists and other health professionals to lead the charge in addressing the critical relationship between a warming climate and health.

The role of the formation of neutrophil extracellular traps (NETosis) in the pathophysiology and the complications of COVID-19

Coronavirus disease 2019 (COVID-19) pandemic which caused a significant disaster globally, has long term health implication known as long COVID. Long COVID refers to a wide range of symptoms that persist or develop after the acute phase of COVID-19 infection, which can last for weeks or months. Some of the symptoms associated with long COVID include fatigue, shortness of breath, chest pain, joint pain, cognitive impairment, and depression. Recent studies have also shown that long COVID can lead to various cardiovascular complications, including myocarditis, pericarditis, heart failure, and arrhythmias. These can significantly increase morbidity and mortality rates in COVID-19 patients, particularly those with preexisting cardiovascular conditions. The exact mechanisms underlying the cardiovascular complications associated with long COVID are not yet fully understood. However, it is believed that the persistent inflammation and immune dysregulation associated with COVID-19 may contribute to endothelial dysfunction, oxidative stress, and fibrosis in the cardiovascular system, leading to long-term cardiovascular complications. Neutrophils play a crucial role in immune system's response to infection. Upon encountering pathogens, neutrophils release neutrophil extracellular traps (NETs) to trap and kill microbes. The severity of COVID-19 has been linked to various factors, including the role of neutrophils and NETs. These extracellular webs, composed of chromatin, microbicidal proteins, and oxidant enzymes, are released by neutrophils to fight infections. However, excessive or dysregulated NET formation can lead to damage to surrounding tissues and organs, contributing to the development of inflammatory and thrombotic complications in various diseases, including COVID-19. COVID-19 patients with severe disease have increased levels of NETs in their blood, suggesting that NETs contribute to the disease's pathogenesis. NETs have been implicated in COVID-19-associated coagulopathy, acute respiratory distress syndrome, and multi-organ failure. Moreover, the presence of autoantibodies that target NET components has been reported in COVID-19 patients with severe disease, indicating that these autoantibodies may contribute to the development of hyperinflammation and thrombosis. Several potential therapeutic interventions targeting NETs have been proposed for COVID-19 patients, including the use of agents that inhibit NET formation or degradation. The role of NETs in the pathogenesis of COVID-19 and its associated complications is an active area of research. Further studies are needed to elucidate the mechanisms underlying NET dysregulation in COVID-19 and to evaluate the potential of NET-targeting therapies as a treatment strategy for COVID-19 patients. The purpose of this review is to analyze the potential contribution of NETosis in the pathophysiology of COVID-19 and its subsequent complications apart from its beneficial effect. This may provide insight into potential therapeutic interventions for COVID-19 patients.

The Critical Role of the Adipocytokine NOV in Obstructive Sleep Apnea Induced Cardiometabolic Dysfunction: A Review.

Obstructive sleep apnea (OSA) is highly prevalent and associated with oxidative stress, chronic inflammation, and adverse cardiovascular consequences. The comorbid condition of obesity remains epidemic. Both obesity and OSA are highly comorbid in patients with cardiovascular disease including atrial fibrillation, resistant hypertension, congestive heart failure, and coronary artery disease. Patients with these preexisting cardiovascular conditions should be screened for OSA with a low threshold to treat, even if OSA severity is mild. Nephroblastoma overexpressed (NOV/CCN3) protein has been identified in multiple chronic inflammatory states, most notably in obesity and more recently in OSA, even in the absence of obesity. As such, NOV may represent an important biomarker for oxidative stress in OSA and may lead to a deeper understanding of the relationship between OSA and its clinical sequelae.

Cardiovascular Complications in Patients with Prostate Cancer: Potential Molecular Connections.

Cardiovascular diseases (CVDs) and complications are often seen in patients with prostate cancer (PCa) and affect their clinical management. Despite acceptable safety profiles and patient compliance, androgen deprivation therapy (ADT), the mainstay of PCa treatment and chemotherapy, has increased cardiovascular risks and metabolic syndromes in patients. A growing body of evidence also suggests that patients with pre-existing cardiovascular conditions show an increased incidence of PCa and present with fatal forms of the disease. Therefore, it is possible that a molecular link exists between the two diseases, which has not yet been unraveled. This article provides insight into the connection between PCa and CVDs. In this context, we present our findings linking PCa progression with patients' cardiovascular health by performing a comprehensive gene expression study, gene set enrichment (GSEA) and biological pathway analysis using publicly available data extracted from patients with advanced metastatic PCa. We also discuss the common androgen deprivation strategies and CVDs most frequently reported in PCa patients and present evidence from various clinical trials that suggest that therapy induces CVD in PCa patients.