Progression Of Cardiovascular Risk Factors Research Articles

Biological plausibility and implications of obesity associated valvular heart diseases

Obesity contributes to the development and progression of cardiovascular risk factors and diseases, but so far not much attention has been given to obesity and valvular heart disease. Several observational and mendelian randomization studies have reported an association between body mass index with aortic valve stenosis, but also with secondary functional mitral regurgitation and tricuspid regurgitation in a more indirect manner. Several mechanisms can lead to the link between obesity and valvular heart diseases: left ventricular dilation, as obesity directly contributes to ischemic heart disease and ventricular remodeling, atrial myopathy as well as atrial remodeing and arrhythmias, such as atrial fibrillation, that predispose to valvular regurgitation, but also pulmonary hypertension, which could be the consequence of obesity-related inflammation, insulin resistance, and oxidative stress, valvular calcification which is often associated with adiposity and as a direct effect of increased epicardial adipose tissue and pericardial restraint. Individuals with obesity associated valvular heart disease may experience worse symptoms, quality-of-life, exercise capacity, and risk for adverse outcomes. The effect of and the mechanism for various vavular heart diseases in relation to obesity has not been investigated in depth. Recently, incretin-based drugs and sodium-glucose cotransporter-2 inhibitors have been shown to reduce adiposity, and improve HF outcomes; however, the implications of these drugs on valvular heart diseases have not been evaluated. With innovations in therapies for obesity, several questions merit discussion. Considering the prevalence of obesity and its association with valvular heart diseases, not studying these common comorbid conditions represents a significant missed opportunity.

Effects of melatonin in the prevention of cardiovascular diseases: a systematic review

Introduction: Obesity represents a multifactorial disease that causes major public health problems. There are about 2.0 billion overweight and obese people in the world, represented by 39.6% of adults. Melatonin may provide cardioprotection at low pharmacological doses. Melatonin's ability to improve cardiovascular function and its hypotensive effect because of its direct and receptor-dependent antioxidant actions suggest that melatonin may have some beneficial effects in controlling diabetic vascular complications. Objective: It was to carry out a systematic review of the main effects of melatonin in the treatment of obesity and diabetes mellitus, as well as in the prevention of cardiovascular diseases. Methods: The present study followed a concise systematic review model (PRISMA). The literary search process was carried out from April to May 2023 and was developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, using scientific articles until 2023. The low quality of evidence was attributed to case reports, editorials, and short communications, according to the GRADE instrument. The risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 168 studies were found for eligibility analysis, and so 46 of a total of 68 studies were selected for this systematic review. According to the GRADE instrument, most studies showed homogeneity in their results, with X2 =90.4%>50%. The Funnel Plot showed a symmetrical behavior, not suggesting a significant risk of bias in studies with smaller sample sizes. It was concluded that melatonin can reduce body weight and fat mass and regulate energy expenditure, glucose/lipid metabolism, and insulin secretion; therefore, it can play an effective role in weight management. There is a growing consensus that the antioxidant and anti-inflammatory properties of melatonin are of great importance in preserving the body's function and homeostasis. In adulthood, disturbances in melatonin production negatively impact the progression of cardiovascular risk factors and promote cardiovascular and neurodegenerative diseases. The consumption of melatonin supplements can be effective in controlling blood pressure and anthropometric indices (as predictors of obesity) in patients with T2DM. Furthermore, melatonin has significant effects on ischemia-reperfusion injury, myocardial injury, pulmonary hypertension, hypertension, vascular diseases, valvular heart diseases, and lipid metabolism. As an inexpensive and well-tolerated drug, melatonin could be a new therapeutic option for cardiovascular diseases.

The effects of exercise training on muscle oxygenation of patients with intermittent claudication

Abstract Funding Acknowledgements Type of funding sources: None. Background. Intermittent claudication (IC) is characterized by a cramp-like pain during walking caused by insufficient blood flow to the lower limbs during exercise. The walking impairment caused by IC can lead to a vicious cycle of physical inactivity, decreased quality of life and progression of cardiovascular risk factors. Although current evidence supports the benefits of walking training to increase walking capacity, little is known about its effect on muscle oxygenation in this population. Purpose. The aim of this study was to investigate the effects of a hybrid 12-week walking program (combined center- and home-based walking) on muscle oxygenation of IC patients. Methods. Thirty-seven patients with IC were enrolled of which 33 completed follow-up measurements (age 71 ± 9 yrs, body mass index 26 ± 4 kg/m2, ankle brachial index (ABI) 0.7 ± 0.2) after the 12-week intervention. Outcome measures were pain-free walking capacity (PFWC), maximal walking capacity (MWC) and calf muscle oxygenation, respectively evaluated using a submaximal treadmill test, a Gardner treadmill test and near-infrared spectroscopy (NIRS). Results. After the 12-week intervention, significantly higher values (reported as median and interquartiles) for PFWC (162 m [122, 217] to 272 m [150, 401]; p < 0.001) and MWC (458 m [260, 638] to 611 m [333, 840]; p < 0.001) were observed. As shown in Table 1, NIRS data measured during the submaximal walking test showed an increased availability of oxygenated hemoglobin (p = 0.048) and decreased deoxyhemoglobin (p = 0.013), while total hemoglobin remained unchanged after the 12-week intervention. During the Gardner test, time to reach minimum tissue saturation index (TSI%) increased (p < 0.001), yet no change was noted on minimum TSI during exercise, despite increased MWC. Despite a trend towards faster recovery times, no significant changes were observed after the 12-week intervention. Conclusion. Hybrid walking exercise therapy improves deoxygenation kinetics and walking capacity in IC patients. Increased availability of oxygenated hemoglobin might underly the improvement in walking capacity.

English

BACKGROUND Obstructive sleep apnoea (OSA) is characterised by recurrent episodes of upper airway obstructions during sleep. Recent studies suggest that OSA is independently associated with hypertension. So, the current study was done to analyse the relationship between OSA and blood pressure changes and to determine as to what extent OSA is independently contributing to those changes. This was to highlight the importance of the need for early diagnosis and prompt treatment of patients with OSA. METHODS 97 patients with symptoms of OSA were selected. Following polysomnography, patients were grouped into two: OSA patients with Apnoea-Hypopnea Index (AHI) ≥ 5 and controls (AHI < 5). Linear regression analysis was done to find out the independent effect of exposure variables (age, body mass index (BMI), AHI etc.) on the outcome the variable (blood pressure) RESULTS Systolic BP was significantly high in OSA patients (154.84 ± 15.89) compared to control group (132.00 ± 11.45). Diastolic BP was significantly high in OSA patients (90.63 ± 7.87) compared to control group (85.13 ± 5.95). Linear regression analysis showed that for each unit change in AHI, systolic blood pressure changed by 0.406 independent of other factors and for each unit change in desaturation index, diastolic blood pressure changed by 0.111 independent of other factors. CONCLUSIONS The blood pressure levels both systolic and diastolic were significantly elevated in patients with OSA. Increase in AHI was independently associated with increase in systolic blood pressure and the increase in desaturation index was independently associated with increase in diastolic blood pressure. Since OSA is a highly prevalent and highly underdiagnosed condition, the current study emphasises the importance of screening for OSA, so that with early diagnosis and prompt treatment the development and progression of cardiovascular risk factors like hypertension can be reduced. KEYWORDS OSA, Sleep Apnoea, Hypertension, Blood Pressure, Sleep Fragmentation

Effect of Empagliflozin and Liraglutide on the Nucleotide-Binding and Oligomerization Domain-Like Receptor Family Pyrin Domain-Containing 3 Inflammasome in a Rodent Model of Type 2 Diabetes Mellitus

ObjectivesChronic inflammation has been identified as an important driver of cardiovascular disease in type 2 diabetes (T2D) and can lead to a higher risk of cardiovascular events and rehospitalization. Empagliflozin or liraglutide represent 2 classes of drugs with proven efficacy in the treatment of T2D to reduce macrovascular complications; however, the exact mechanism behind their cardioprotective properties remains incompletely understood. The nucleotide-binding and oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome is implicated in the progression of cardiovascular disease and linked to the progression of cardiovascular risk factors, such as T2D. MethodsWe set out to determine whether the sodium-glucose cotransporter-2 inhibitor, empagliflozin, or the glucagon-like peptide-1 receptor antagonist, liraglutide, modified components of NLRP3 in a rodent model of T2D, which recapitulates many of the features of humans with T2D. Empagliflozin and liraglutide were used for 8 weeks in a 32-week-old rat model of T2D and compared with an age- and sex-matched control. After treatment, left ventricular tissue samples and blood plasma were obtained for immunoblotting and an interleukin-1β enzyme-linked immunossay. NLRP3, apoptosis-associated speck-like protein, pro-caspase-1 as well as the cleaved caspase-1 subunits p12 and p10 were assessed by Western blot. ResultsGoto-Kakizaki rats demonstrated increased NLRP3 inflammasome activation, but neither empagliflozin nor liraglutide demonstrated any impact across the NLRP3 inflammasome pathways or interleukin-1β levels. ConclusionsThe data suggest that the cardioprotective benefits demonstrated by sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor antagonists occur independently of the NLRP3 inflammasome.

Melatonin's Impact on Antioxidative and Anti-Inflammatory Reprogramming in Homeostasis and Disease.

There is a growing consensus that the antioxidant and anti-inflammatory properties of melatonin are of great importance in preserving the body functions and homeostasis, with great impact in the peripartum period and adult life. Melatonin promotes adaptation through allostasis and stands out as an endogenous, dietary, and therapeutic molecule with important health benefits. The anti-inflammatory and antioxidant effects of melatonin are intertwined and are exerted throughout pregnancy and later during development and aging. Melatonin supplementation during pregnancy can reduce ischemia-induced oxidative damage in the fetal brain, increase offspring survival in inflammatory states, and reduce blood pressure in the adult offspring. In adulthood, disturbances in melatonin production negatively impact the progression of cardiovascular risk factors and promote cardiovascular and neurodegenerative diseases. The most studied cardiovascular effects of melatonin are linked to hypertension and myocardial ischemia/reperfusion injury, while the most promising ones are linked to regaining control of metabolic syndrome components. In addition, there might be an emerging role for melatonin as an adjuvant in treating coronavirus disease 2019 (COVID 19). The present review summarizes and comments on important data regarding the roles exerted by melatonin in homeostasis and oxidative stress and inflammation related pathologies.

The Emerging Role of Gut Dysbiosis in Cardio-metabolic Risk Factors for Heart Failure.

To summarize the recent evidence that supports a role for the gut microbiota, microbiota-derived metabolites, and dysbiosis on cardiovascular risk factors, and to discuss the neuro-cardio-metabolic mechanisms that link gut microbiota and heart failure. There is growing evidence that the gut microbiota communicates with and impacts the cardiovascular system, contributing to the development of heart failure once it becomes out of balance (i.e. gut dysbiosis). The exact mechanisms of how the gut microbiota influences cardiovascular outcomes are not fully understood, but immune dysregulation and disturbance of neuro-enteroendocrine hormones seem to be involved. The disturbances in the gut microbiota influence the progression of several risk factors for heart failure, including atherosclerosis, obesity, diabetes, kidney disease and hypertension. In turn, these conditions also act to regulate the gut microbiota through the deterioration of the integrity of the intestinal barrier and the release of neurotransmitters and gastrointestinal hormones. In normal and healthy physiological conditions, these interactions are homeostatic and tightly controlled. However, a combination of environmental exposures (e.g. antibiotics use and Western diet) and the host's intrinsic conditions (e.g. genetics and fluid status) can result in the breakdown of intestinal homeostasis and further progression of cardiovascular risk factors, which lead to the development of heart failure. Manipulation of the gut microbiota may have the potential to improve cardiovascular outcomes by ameliorating immune system dysregulation, enteroendocrine disruptions, and neurohormonal activation in patients with cardiovascular risk factors for heart failure.

Increasing liver fat is associated with progression of cardiovascular risk factors.

Nonalcoholic fatty liver disease is associated with cardiovascular risk factors in cross-sectional analyses. However, less is known about how changes in liver fat associate with the progression of cardiovascular risk factors. A substudy (n=808) drawn from the Framingham Heart Study underwent serial computed tomography scans 6years apart. We performed multivariable-adjusted regression to determine the association between changes in liver fat and progression of cardiovascular risk factors. Each standard deviation increase in liver fat was associated with adverse progression of systolic blood pressure, diastolic blood pressure, fasting glucose, high-density lipoprotein and log triglycerides. After adjusting for baseline cardiovascular risk, baselinebody mass index (BMI),and change in BMI, increasing liver fat was significantly associated with adverse changes in fasting glucose and triglycerides. In a longitudinal cohort, increasing liver fat over 6years was associated with progression of cardiovascular risk factors, even after accounting for BMI changes.

Obesity in Adolescents and Youth: The Case for and against Bariatric Surgery

Obesity in Adolescents and Youth: The Case for and against Bariatric Surgery

Quasi Prospective Comparative Study on Effect of Yoga among Prediabetics on Progression of Cardiovascular Risk Factors.

Introduction:Prediabetic patients have higher risk for cardiovascular diseases, which further increases the rate of mortality. Reason for the rate of increase may be lack of observation, follow-up programs, and self-awareness about the conditions of disease. Lifestyle interventions such as yoga can prove to be a beneficial nonpharmacologic intervention in preventing progression of prediabetes to type 2 diabetes. This study highlights importance of short-term intervention, i.e., yoga in prediabetic patients and use it as a tool for primary prevention of diabetes.Methods:This was an interventional study among adults aged 30–50 years in RUHS college of Medical Sciences and Associated Rukmani Devi Beni Prasad Jaipuria Hospital in Jaipur city. The design of study was quasi prospective comparative study. A total of 102 prediabetic patients of age group 30–50 years were recruited from Jaipuria Hospital. These were divided into two groups: study group (Group A, n = 51) were engaged in yoga session and control group (B, n = 51) not performed any yoga session.Results:Yoga intervention resulted in a significant decline in blood glucose (P < 0.001), glycated hemoglobin (P < 0.01), lipid profile cholesterol (P < 0.01), triglyceride (P < 0.01), and low-density lipoprotein (P < 0.01), but high-density lipoprotein (P < 0.02) and very low-density lipoprotein increase (P < 0.03) but not statistically significant relative to the control group.Conclusion:Short-term yoga intervention is helpful in the control of glycemic parameters like blood glucose, glycated hemoglobin and lipid profile in prediabetic patients. This preliminary study indicates that a yoga program would be a possible risk reduction option for adults at high risk for type 2 diabetes. In addition, yoga holds promise as an approach to reducing cardiometabolic risk factors and increasing exercise self-efficacy for prediabetics performing yoga.

Abstract 17840: Progression of Cardiovascular Risk Factors Across the Menopausal Transition - Results from Study of Women’s Health Across the Nation

Objectives: To correlate arterial compliance and measures of subclinical atherosclerosis with menopausal status during menopausal transition. Background: Cardiovascular risk increases in women after the menopausal transition. To assess factors that might explain this increased risk, we used radial tonometry to measure arterial compliance in SWAN (Study of Women’s Health Across the Nation), a longitudinal study of women in the menopausal transition. Methods: Raw waveforms were digitized and a generalized transfer function was utilized to calculate central Augmentation Pressure (cAP) &amp; aortic Augmentation index (AIx) adjusted for heart rate of 75bpm. Carotid intima-media thickness (cIMT) was calculated using B-mode ultrasound. Coronary artery calcium (CAC) and thoracic aortic calcium (TAC) scores were obtained by computed tomography. Pulse wave velocity (PWV) was recorded as time taken for the arterial pulse to propagate from the carotid to the femoral artery. Results: Mean age was 52±9, BMI 28±6; 7% of women were premenopausal, 48% perimenopausal, and 45% were postmenopausal. PWV, cAP, cIMT, CAC and TAC were higher in post-menopause than peri-menopause and lowest in the premenopausal group with a similar trend for AIx (see Table). Higher PWV correlated significantly with higher cIMT (r=0.32), cAP (r=0.34), AIx (0.17), CAC (r=0.13) &amp; TAC (r=0.19). Conclusion: Physiologic measures of arterial stiffness were higher through the menopausal transition along with morphologic measures of subclinical atherosclerosis, with a correlation between the two. Such changes may help to explain the increased risk of cardiovascular disease in women after menopause and may be assessed using a combination of physiologic and morphologic parameters. Supported by NIH/DHHS (grants U01AG012505, U01AG012546, R01HL065581, R01HL065591, R01HL089862).

Progression of cardiovascular risk factors in black Africans: 3 year follow up of the SABPA cohort study

Recent work identified a high prevalence of modifiable risk factors for cardiovascular disease (CVD) among urban black South Africans. The aim was to track the progression of CVD risk factors in a multi-ethnic sample of South Africans. Participants were 173 black (aged 47.5 ± 7.8 yrs) and 186 white teachers (aged 49.6 ± 9.9 yrs) that were examined at baseline and 3 years follow-up. Blacks demonstrated a substantially higher prevalence of composite CVD burden (defined as history of physician diagnosed heart disease, use of anti-hypertensives, anti-diabetic, or statin medications at either time point) compared to whites (49.1 vs. 32.0%, p = 0.012) respectively. After controlling for baseline, the black participants demonstrated greater increases in 24 h systolic and diastolic blood pressure, total cholesterol, fasting glucose, fibrinogen, D-dimer, and waist circumference in comparison with whites. In summary, an adverse progression of CVD risk factors was observed in the whole sample, although to a larger degree in black participants. Aggressive treatment strategies for controlling risk factors in black Africans are needed to reduce the increasing burden of CVD in South Africa.

Conceptual framework for research and clinical practice concerning cardiovascular health-related behaviors

OBJECTIVE: To present a conceptual framework based on the PRECEDE model conceived to guide research and the clinical practice of nurses in the clinical follow-up of patients with cardiovascular diseases. METHOD: The conceptual bases as well as the study designs used in the framework are discussed. The contextualization of the proposed structure is presented in the clinical follow-up of hypertensive patients. Examples of the intervention planning steps according to the intervention mapping protocol are provided. RESULTS: This conceptual framework coherently and rationally guided the diagnostic steps related to excessive salt intake among hypertensive individuals, as well as the development and assessment of specific interventions designed to change this eating behavior. CONCLUSION: The use of this conceptual framework enables a greater understanding of health-related behaviors implied in the development and progression of cardiovascular risk factors and is useful in proposing nursing interventions with a greater chance of success. This model is a feasible strategy to improve the cardiovascular health of patients cared for by the Brazilian Unified Health System.