Reduction In Cardiovascular Disease Research Articles

Effectiveness of Electronic Quality Improvement Activities to Reduce Cardiovascular Disease Risk in People With Chronic Kidney Disease in General Practice: Cluster Randomized Trial With Active Control.

Future Health Today (FHT) is a program integrated with electronic medical record (EMR) systems in general practice and comprises (1) a practice dashboard to identify people at risk of, or with, chronic disease who may benefit from intervention; (2) active clinical decision support (CDS) at the point of care; and (3) quality improvement activities. One module within FHT aims to facilitate cardiovascular disease (CVD) risk reduction in people with chronic kidney disease (CKD) through the recommendation of angiotensin-converting enzyme inhibitor inhibitors (ACEI), angiotensin receptor blockers (ARB), or statins according to Australian guidelines (defined as appropriate pharmacological therapy). This study aimed to determine if the FHT program increases the proportion of general practice patients with CKD receiving appropriate pharmacological therapy (statins alone, ACEI or ARB alone, or both) to reduce CVD risk at 12 months postrandomization compared with active control (primary outcome). General practices recruited through practice-based research networks in Victoria and Tasmania were randomly allocated 1:1 to the FHT CKD module or active control. The intervention was delivered to practices between October 4, 2021, and September 30, 2022. Data extracted from EMRs for eligible patients identified at baseline were used to evaluate the trial outcomes at the completion of the intervention period. The primary analysis used an intention-to-treat approach. The intervention effect for the primary outcome was estimated with a marginal logistic model using generalized estimating equations with robust SE. Overall, of the 734 eligible patients from 19 intervention practices and 715 from 21 control practices, 82 (11.2%) and 70 (9.8%), respectively, had received appropriate pharmacological therapy (statins alone, ACEI or ARB alone, or both) at 12 months postintervention to reduce CVD risk, with an estimated between-trial group difference (Diff) of 2.0% (95% CI -1.6% to 5.7%) and odds ratio of 1.24 (95% CI 0.85 to 1.81; P=.26). Of the 470 intervention patients and 425 control patients that received a recommendation for statins, 61 (13%) and 38 (9%) were prescribed statins at follow-up (Diff 4.3%, 95% CI 0 to 8.6%; odds ratio 1.55, 95% CI 1.02 to 2.35; P=.04). There was no statistical evidence to support between-group differences in other secondary outcomes and general practice health care use. FHT harnesses the data stored within EMRs to translate guidelines into practice through quality improvement activities and active clinical decision support. In this instance, it did not result in a difference in prescribing or clinical outcomes except for small changes in statin prescribing. This may relate to COVID-19-related disruptions, technical implementation challenges, and recruiting higher performing practices to the trial. A separate process evaluation will further explore factors impacting implementation and engagement with FHT. ACTRN12620000993998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380119.

The Acquisition of Cardiovascular Adaptation to Aerobic Exercise: When Does It Begin and How Does It Evolve Depending on Intrinsic and Extrinsic Factors?

The acquisition and evolution of cardiovascular (CV) adaptation to physical activity or exercise training are critical in enhancing cardiorespiratory fitness (CRF) and reducing CV disease (CVD) risk. CV adaptations to exercise occur through structural, functional, and molecular changes that enhance cardiac efficiency. These adaptations, such as increased stroke volume, improved blood pressure regulation, and enhanced endothelial function, collectively reduce CVD morbidity and mortality. This review explores how cardiovascular adaptations vary across different demographics, highlighting the importance of exercise timing, intensity, and recovery periods. It delves into the immediate physiological responses to physical activity, such as increased heart rate and cardiac output, and the longer-term adaptations, including cardiac hypertrophy and improved vascular function. The influence of age, sex, and pre-existing health conditions on cardiovascular responses to exercise is also discussed, emphasizing the need for tailored exercise interventions. Finally, the review highlights the significance of recovery periods in optimizing cardiovascular adaptations and how insufficient recovery may lead to adverse outcomes. Overall, understanding the timing and evolution of cardiovascular adaptations can inform exercise prescriptions to improve cardiovascular health across populations for the primary and secondary prevention of CVD.

Effectiveness of treat-to-target cholesterol-lowering interventions on cardiovascular disease and all-cause mortality risk in the community-dwelling population: a target trial emulation

Little is known about the long-term effectiveness of risk-based treat-to-target cholesterol-lowering interventions on cardiovascular risk. Here, we show the emulated effectiveness of guideline-recommended low-density and non-high-density lipoprotein cholesterol-lowering interventions using the absolute risk reduction (ARR) and the restricted mean event-free time-based number needed to treat (NNT). With 5,375 participants, the 29-year risks for cardiovascular disease (CVD), all-cause mortality, and atherosclerotic CVD were 18.6%, 25.6%, and 17.7%, respectively. Long-term treat-to-target interventions showed significant reductions in CVD (ARR −2.3%, 95%CI −3.4% to −0.8%; NNT 115), all-cause mortality (−3.0%, −4.3% to −1.8%; 95), and atherosclerotic CVD (−2.6%, −3.5% to −1.2%; 104). Such effects appear more pronounced in women, smokers, and those with body mass index < 24 kg/m² or higher adherence rates.

Clinical Acceptability of a Quality Improvement Program for Reducing Cardiovascular Disease Risk in People With Chronic Kidney Disease in Australian General Practice: Qualitative Study.

Future Health Today (FHT) is a technology program that integrates with general practice clinical software to provide point of care (PoC) clinical decision support and a quality improvement dashboard. This qualitative study looks at the use of FHT in the context of cardiovascular disease risk in chronic kidney disease (CKD). This study aims to explore factors influencing clinical implementation of the FHT module focusing on cardiovascular risk in CKD, from the perspectives of participating general practitioner staff. Practices in Victoria were recruited to participate in a pragmatic cluster randomized controlled trial using FHT, of which 19 practices were randomly assigned to use FHT's cardiovascular risk in CKD program. A total of 13 semistructured interviews were undertaken with a nominated general practitioner (n=7) or practice nurse (n=6) from 10 participating practices. Interview questions focused on the clinical usefulness of the tool and its place in clinical workflows. Qualitative data were coded by 2 researchers and analyzed using framework analysis and Clinical Performance Feedback Intervention Theory. All 13 interviewees had used the FHT PoC tool, and feedback was largely positive. Overall, clinicians described engaging with the tool as a "prompt" or "reminder" system. Themes reflected that the tool's goals and clinical content were aligned with clinician's existing priorities and knowledge, and the tool's design facilitated easy integration into existing workflows. The main barrier to implementation identified by 2 clinicians was notification fatigue. A total of 7 interviewees had used the FHT dashboard tool. The main barriers to use were its limited integration into clinical workflows, such that some participants did not know of its existence; clinicians' competing clinical priorities; and limited time to learn and use the tool. This study identified many facilitators for the successful use of the FHT PoC program, in the context of cardiovascular risk in CKD, and barriers to the use of the dashboard program. This work will be used to inform the wider implementation of FHT, as well as the development of future modules of FHT for other risk or disease states.

Reply: Deep Inspiration Breath Hold to Reduce Cardiovascular Disease Risk for Breast Radiotherapy: Challenges and Opportunities.

Reply: Deep Inspiration Breath Hold to Reduce Cardiovascular Disease Risk for Breast Radiotherapy: Challenges and Opportunities.

Implementation and Reach of Health Coaching Using Motivational Interviewing to Reduce Cardiovascular Disease Risk in Uninsured Illinois Women.

Cardiovascular disease (CVD) is the leading cause of mortality for US women; lack of health insurance contributes to poor control of risk factors and increased mortality. Health coaching including motivational interviewing can support primary and secondary CVD prevention, but among uninsured women, improving health outcomes is dependent on successfully reaching priority populations. We evaluated the implementation and reach of health coaching with motivational interviewing among clients in the Illinois WISEWOMAN Program (IWP), a CVD screening and risk-reduction program for uninsured women aged 40 to 64. Following CVD screening, motivational interviewing is offered to all IWP clients via four 30-min one-on-one health coaching sessions to offer personalized guidance on setting and achieving health behavior goals. Our analysis included clients from the eight community-based Illinois agencies that implemented IWP from 2019 to 2023. We assessed client demographic and baseline health characteristics among all IWP clients, those who participated in health coaching by attending at least one session, and those who completed health coaching by attending at least three of four sessions. We also assessed health coaching participation and completion by agency and examined agency-specific associations between client characteristics and health coaching participation and completion. Among IWP enrollees (n =3094), 89.7% participated in at least one health coaching session but only 31.4% completed health coaching by attending at least three sessions. Over 90% of IWP clients participated in at least one health coaching session at 4 IWP agencies. Further, over 85% of health coaching participants completed health coaching at four agencies. Across agencies, no client-level characteristics were consistently associated with health coaching participation or completion. High motivational interviewing participation rates support its acceptability among uninsured women, but agency-level community-level barriers likely prevent client engagement in multiple sessions. Reducing CVD risk requires working with partner agencies to address barriers to reaching the priority population.

The co-benefits of climate change mitigation strategies on cardiovascular health: a systematic review

Climate change is a significant threat to global human health and a leading cause of premature death. Global warming, leading to more extreme weather (in particular extreme heat events), and air pollution has been associated with increased cardiovascular disease (CVD) morbidity and mortality. According to the Global Burden of Disease Study 2019, 62% of the deaths attributable to climate change were from CVD. Climate change mitigation is a slow, steady process, and the concept of co-benefits has arisen to promote climate action. This systematic review examines how numerous mitigation strategies, such as plant-based diets, increasing green spaces, increasing active transport, using renewable energy sources, and smoking cessation, may have the co-benefit of reducing CVD. A mixed methods systematic review with narrative synthesis was conducted on four databases, according to the PRISMA guidelines. The articles retrieved (published between 2012 and 2022) had a mitigation strategy as the exposure, and CVD related morbidity or mortality reduction as an outcome. The review found that renewable energy has a stronger association with cardiovascular co-benefits compared to emission reduction targets. Multimodal transport is more beneficial for both the climate and cardiac health than zero emission vehicles. Diet modification, such as Mediterranean and plant-based-diets, is positively associated with CVD reduction. Proximity to green spaces and reducing urbanisation may also improve cardiac health. This systematic review demonstrates that implementing four mitigation strategies - increasing renewable energy use, active transport, green spaces, and plant-based diets; could lead to the co-benefit of reducing CVD morbidity and mortality. Furthermore, it illustrates the importance of plant-based diets and active transport to improve cardiovascular health. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Indoxyl Sulfate-Induced Macrophage Toxicity and Therapeutic Strategies in Uremic Atherosclerosis.

Cardiovascular disease (CVD) frequently occurs in patients with chronic kidney disease (CKD), particularly those undergoing dialysis. The mechanisms behind this may be related to traditional risk factors and CKD-specific factors that accelerate atherosclerosis and vascular calcification in CKD patients. The accumulation of uremic toxins is a significant factor in CKD-related systemic disorders. Basic research suggests that indoxyl sulfate (IS), a small protein-bound uremic toxin, is associated with macrophage dysfunctions, including increased oxidative stress, exacerbation of chronic inflammation, and abnormalities in lipid metabolism. Strategies to mitigate the toxicity of IS include optimizing gut microbiota, intervening against the abnormality of intracellular signal transduction, and using blood purification therapy with higher efficiency. Further research is needed to examine whether lowering protein-bound uremic toxins through intervention leads to a reduction in CVD in patients with CKD.

WhatsApp-based intervention to promote tea consumption and healthy lifestyle in Indonesian’s adult

&lt;p&gt;&lt;em&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Background: &lt;/span&gt;&lt;/strong&gt;&lt;/em&gt;&lt;em&gt;&lt;span lang="EN-US"&gt;Tea flavonoids have been shown to reduce Cardiovascular Disease (CVD) risks, and tea consumption might help reduce the problem in the community. Meanwhile, tea consumption among Indonesian people is still rare and in small quantities.&lt;/span&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Objectives: &lt;/span&gt;&lt;/strong&gt;&lt;/em&gt;&lt;em&gt;&lt;span lang="EN-US"&gt;This research aimed to evaluate the effect of a WhatsApp-based education intervention, "HaH (Heart at Home)," a program that aims to increase KAP (Knowledge, Attitude, Practice) to prevent CVD by practicing a healthy lifestyle and encouraging tea consumption.&lt;/span&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Methods: &lt;/span&gt;&lt;/strong&gt;&lt;/em&gt;&lt;em&gt;&lt;span lang="EN-US"&gt;Subjects were women/men who are married, members of IHF (Indonesia Heart Foundation), aged 25-50 years old, own and used a smartphone in their daily life. A total of 80 adults was participated in this study. The study design was pre-post intervention conducted online using WhatsApp for 21 days. The intervention included videos/ picture posts and online discussion through WhatsApp. Wilcoxon and McNemmar tests were used to examine the differences in subjects' KAP before and after the intervention.&lt;/span&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Results: &lt;/span&gt;&lt;/strong&gt;&lt;/em&gt;&lt;em&gt;&lt;span lang="EN-US"&gt;Most subjects were women (96.3%) aged 25-40 years (78.8%) and housewives (67.5%). The knowledge score increased by about 17.5% (p&amp;lt;0.05). More than 10% of subjects increased their knowledge of CVD risk. Almost all subjects already had a positive attitude at baseline (94%) and was slightly increased to 97.0% (p&amp;lt;0.05). After the intervention, positive health practices such as exercise, consuming vegetables, relaxation, and sleep were increased. In contrast, harmful practices such as smoking, stress symptoms, and consuming high-cholesterol food were decreased.&lt;/span&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Conclusions: &lt;/span&gt;&lt;/strong&gt;&lt;/em&gt;&lt;em&gt;&lt;span lang="EN-US"&gt;The present study showed that an online program effectively increases the KAP of subjects, although this can be maximized by having more interaction with subjects.&lt;/span&gt;&lt;/em&gt;&lt;/p&gt;

Effects of statins beyond lipid-lowering agents in ART-treated HIV infection.

Antiretroviral therapies (ART) have reduced human immunodeficiency virus (HIV) infection-associated morbidity and mortality improving the life of people with HIV (PWH). However, ART lead to residual HIV production, which in conjunction with microbial translocation and immune dysfunction contributes to chronic inflammation and immune activation. PWH on ART remain at an increased risk for cardiovascular diseases (CVDs) including myocardial infarction and stroke; which in part is explained by chronic inflammation and immune activation. Lifestyle factors and certain ART are associated with dyslipidemia characterized by an increase of low-density lipoprotein (LDL), which further contributes in the increased risk for CVDs. Lipid-lowering agents like statins are emerging as immune modulators in decreasing inflammation in a variety of conditions including HIV. The international randomized clinical trial REPRIEVE has shed light on the reduction of CVDs with statin therapy among PWH. Such reports indicate a more than expected benefit of statins beyond their lipid-lowering effects. Bempedoic acid, a first-in-class non-statin LDL-lowering drug with immune modulatory effects, may further aid PWH in combination with statins. Herein, we critically reviewed studies aimed at lipid-lowering and immune-modulating roles of statins that may benefit aging PWH.

Opportunities in the Postpartum Period to Reduce Cardiovascular Disease Risk After Adverse Pregnancy Outcomes: A Scientific Statement From the American Heart Association.

Adverse pregnancy outcomes are common among pregnant individuals and are associated with long-term risk of cardiovascular disease. Individuals with adverse pregnancy outcomes also have an increased incidence of cardiovascular disease risk factors after delivery. Despite this, evidence-based approaches to managing these patients after pregnancy to reduce cardiovascular disease risk are lacking. In this scientific statement, we review the current evidence on interpregnancy and postpartum preventive strategies, blood pressure management, and lifestyle interventions for optimizing cardiovascular disease using the American Heart Association Life's Essential 8 framework. Clinical, health system, and community-level interventions can be used to engage postpartum individuals and to reach populations who experience the highest burden of adverse pregnancy outcomes and cardiovascular disease. Future trials are needed to improve screening of subclinical cardiovascular disease in individuals with a history of adverse pregnancy outcomes, before the onset of symptomatic disease. Interventions in the fourth trimester, defined as the 12 weeks after delivery, have great potential to improve cardiovascular health across the life course.

A Novel Blending Approach for Smoking Status Prediction in Hidden Smokers to Reduce Cardiovascular Disease Risk

A Novel Blending Approach for Smoking Status Prediction in Hidden Smokers to Reduce Cardiovascular Disease Risk

Prioritizing the Exposome to Reduce Cardiovascular Disease Burden

Prioritizing the Exposome to Reduce Cardiovascular Disease Burden

Polycystic Ovary Syndrome Fuels Cardiovascular Inflammation and Aggravates Ischemic Cardiac Injury.

Reducing cardiovascular disease burden among women remains challenging. Epidemiologic studies have indicated that polycystic ovary syndrome (PCOS), the most common endocrine disease in women of reproductive age, is associated with an increased prevalence and extent of coronary artery disease. However, the mechanism through which PCOS affects cardiac health in women remains unclear. Prenatal anti-Müllerian hormone treatment or peripubertal letrozole infusion was used to establish mouse models of PCOS. RNA sequencing was performed to determine global transcriptomic changes in the hearts of PCOS mice. Flow cytometry and immunofluorescence staining were performed to detect myocardial macrophage accumulation in multiple PCOS models. Parabiosis models, cell-tracking experiments, and in vivo gene silencing approaches were used to explore the mechanisms underlying increased macrophage infiltration in PCOS mouse hearts. Permanent coronary ligation was performed to establish myocardial infarction (MI). Histologic analysis and small-animal imaging modalities (eg, magnetic resonance imaging and echocardiography) were performed to evaluate the effects of PCOS on injury after MI. Women with PCOS and control participants (n=200) were recruited to confirm findings observed in animal models. Transcriptomic profiling and immunostaining revealed that hearts from PCOS mice were characterized by increased macrophage accumulation. Parabiosis studies revealed that monocyte-derived macrophages were significantly increased in the hearts of PCOS mice because of enhanced circulating Ly6C+ monocyte supply. Compared with control mice, PCOS mice showed a significant increase in splenic Ly6C+ monocyte output, associated with elevated hematopoietic progenitors in the spleen and sympathetic tone. Plasma norepinephrine (a sympathetic neurotransmitter) levels and spleen size were consistently increased in women with PCOS when compared with those in control participants, and norepinephrine levels were significantly correlated with circulating CD14++CD16- monocyte counts. Compared with animals without PCOS, PCOS animals showed significantly exacerbated atherosclerotic plaque development and post-MI cardiac remodeling. Conditional Vcam1 silencing in PCOS mice significantly suppressed cardiac inflammation and improved cardiac injury after MI. Our data documented previously unrecognized mechanisms through which PCOS could affect cardiovascular health in women. PCOS may promote myocardial macrophage accumulation and post-MI cardiac remodeling because of augmented splenic myelopoiesis.

Abstract 13763: Reducing Cardiovascular Disease Risk by Estrogen Treatment After Surgical Menopause in Combination With the Suppression of Interferon Gamma Pathway in Ldlr Null Mice

Atherosclerotic cardiovascular disease (ASCVD) risk is increased in women after menopause, which has not been shown to be reversed by postmenopausal hormone therapy. To understand the underlying mechanism for the lack of improvement in ASCVD with hormone therapy, Ldlr -/- mice with established atherosclerosis were subjected to procedures of surgical menopause (ovariectomy, ovx), 17β-estradiol (E 2 ) treatment after ovariectomy (ovx+E 2 ), or sham. In all groups, hyperlipidemia was normalized with a chow diet. Ten weeks later, atherosclerosis burden and ASCVD risk were evaluated. Atherosclerosis was reversed by the resolution of hyperlipidemia in sham but not ovx nor ovx+E 2 mice. While E 2 treatment improved lipid management in ovx mice, we observed persistent inflammation, which presented as high levels of IFNγ, IL-6, and C-PEP2 as well as impaired HDL anti-atherogenic functions and unresolved inflammation in the atherosclerosis lesion. To further investigate the role of inflammation in persistent ASCVD during hormone therapy, the interferon gamma (IFNγ) pathway was suppressed in a second cohort of Ldlr -/- mice that were constituted with bone marrow from Ifn γ -/- mice following lethal irradiation. Similar to the 1 st cohort of mice, E 2 treatment improved ASCVD risk factors including hyperlipidemia and insulin actions. In mice carrying IFNγ -/- bone marrow, atherosclerosis lesion size was reversed with E 2 treatment, which was associated with decreased IFNγ and IL-6 in the blood. We are further investigating the HDL functions and lesion inflammation in this cohort. Our studies indicate that limiting inflammation may be needed in order to restore the cardiovascular benefits of menopause E 2 treatment.

The Role of Pigmented Rice in Reducing Cardiovascular Disease Risk: A Mini-Review of Animal and Human Studies

Higher dietary intake of polyphenols is associated with a reduced risk of cardiovascular disease (CVD) events and mortality. However, these phytochemicals are predominantly present in fruits and vegetables, which are inadequately consumed by some populations, including Filipinos. This narrative mini-review explores the potential role of polyphenol-containing pigmented rice consumption in modulating risk through a range of mechanisms identified in animal studies. Further, human studies have demonstrated promising but inconsistent effects on risk factors associated with the development of CVD, such as dyslipidemia, hyperglycemia, overweight and obesity. Therefore, this review identifies the need for more clinical trials to examine the effect of pigmented rice on CVD risk factors. Keywords: pigmented rice, cholesterol, glucose, weight, polyphenols

O042 Healthy lifestyle is Associated with Reduced Cardiovascular Disease, Depression and Mortality in People at Elevated risk of Sleep Apnea

Abstract Background We evaluated 1) the independent and combined influence of obstructive sleep apnea (OSA) risk and a healthy lifestyle on typical OSA outcomes [excessive daytime sleepiness (EDS), depression, cardiovascular disease (CVD), and stroke]; and 2) the impact of a healthy lifestyle on survival in individuals presenting a heightened risk of OSA. Method We utilized data from 13,694 adults (median age 46 years; 50% men) for both cross-sectional and longitudinal analyses (15 years). A healthy lifestyle score ranging from 0 (most unhealthy) to 5 (most healthy) was computed based on diet, alcohol consumption, physical activity levels, smoking habits, and body mass index. Results A dose-response relationship was found between OSA risk and all examined chronic conditions and EDS (p for trend &amp;lt; 0.001). A healthy lifestyle was found to be inversely related to all chronic conditions (p for trend &amp;lt; 0.001), except EDS (p for trend = 0.379). A higher healthy lifestyle score correlated with lower odds of depression and CVD. An inverse relationship was found between healthy lifestyle score and depression (P for trend &amp;lt; 0.001), CVD (P for trend = 0.003), and stroke (P for trend = 0.025) in those with high OSA risk. An inverse relationship was observed between a healthy lifestyle and all-cause mortality in general, and in the moderate/high and high OSA risk groups (p for trend &amp;lt; 0.001). Discussion This study highlights the role of a healthy lifestyle in reducing chronic conditions and in enhancing survival rates in individuals with a heightened risk of OSA.

Comparing dietary strategies to manage cardiovascular risk in primary care: a narrative review of systematic reviews.

Nutrition care in general practice is crucial for cardiovascular disease (CVD) prevention and management, although comparison between dietary strategies is lacking. To compare the best available (most recent, relevant, and high-quality) evidence for six dietary strategies that are effective for primary prevention/absolute risk reduction of CVD. A pragmatic narrative review of systematic reviews of randomised trials focused on primary prevention of cardiovascular events. Studies about: 1) adults without a history of cardiovascular events; 2) target dietary strategies postulated to reduce CVD risk; and 3) direct cardiovascular or all-cause mortality outcomes were included. Six dietary strategies were examined: energy deficit, Mediterranean-like diet, sodium reduction (salt reduction and substitution), the Dietary Approaches to Stop Hypertension (DASH) diet, alcohol reduction, and fish/fish oil consumption. Reviews were selected based on quality, recency, and relevance. Quality and certainty of evidence was assessed using GRADE. Twenty-five reviews met inclusion criteria; eight were selected as the highest quality, recent, and relevant. Three dietary strategies showed modest, significant reductions in cardiovascular events: energy deficit (relative risk reduction [RRR] 30%, 95% confidence interval [CI] = 13 to 43), Mediterranean-like diet (RRR 40%, 95% CI = 20 to 55), and salt substitution (RRR 30%, 95% CI = 7 to 48). Still, some caveats remain on the effectiveness of these dietary strategies. Salt reduction, DASH diet, and alcohol reduction showed small, significant reductions in blood pressure, but no reduction in cardiovascular events. Fish/fish oil consumption showed little or no effect; supplementation of fish oil alone showed small reductions in CVD events. For primary prevention, energy deficit, Mediterranean-like diets, and sodium substitution have modest evidence for risk reduction of CVD events. Strategies incorporated into clinical nutrition care should ensure guidance is person centred and tailored to clinical circumstances.

Effects of socioeconomic status on physical activity and cardiovascular diseases prior to and during the COVID-19 pandemic in the older adults.

This research seeks to evaluate the repercussions of socioeconomic status (SES) on physical activity (PA) among the older population, both pre and intra-COVID-19 pandemic. The study aims to scrutinize whether alteration in PA behaviors based on SES impacts cardiovascular diseases (CVDs). It is well established that PA has a significant association with CVDs and the pandemic has restricted PA in the older population. We endeavor to discern whether SES modulates PA levels and whether these levels of PA behavior subsequently influence the incidence of CVDs among older adults. The analytical framework of this study relies on the data procured from the Fact-Finding on the Status of Senior Citizens (FSSSC) survey conducted in 2017 and 2020, involving 10,299 (75 ± 6 years) and 10,097 (74 ± 6 years) participants, respectively. We employ Structural Equation Modeling (SEM) to elucidate the ramification of the COVID-19 pandemic on CVDs while accommodating potential mediating and confounding variables, including socioeconomic status, PA levels, body mass index (BMI), and gender, in the context of the pandemic and CVDs. Our empirical models indicated a tendency for older adults of lower socioeconomic status (SES) to exhibit diminished levels of physical activity (PA) compared to their counterparts of higher SES, particularly considering the influence of the COVID-19 pandemic. Furthermore, prolonged engagement in PA is associated with a reduced risk of hypertension (p = 0.010), and congestive heart failure & arrhythmia (p < 0.001), when accounting for confounding factors. The COVID-19 pandemic has generated an SES-based disparity in PA among older adults, despite PA time being greater in older individuals with higher SES. Interestingly, this did not result in a reduction in CVDs. Therefore, the study emphasizes the need for targeted exercise programs may be necessary to mitigate health inequality among the older population.

Cardiovascular Disease Burden Attributable to High Body Mass Index in Taiwan.

Studies on disease burden in Taiwan are lacking. We aimed to quantify the burden of cardiovascular disease (CVD) attributable to high body mass index (BMI) in Taiwan. Using a comparative risk assessment approach from the Global Burden of Disease study, we estimated the population attributable fraction (PAF), attributable CVD burden, and disability-adjusted life years (DALYs) according to sex, age, and area of residence in Taiwan. The BMI distribution for the population was obtained from the National Health Interview Survey in 2013. CVD was defined as an ischemic heart disease or stroke. The attributable PAF for CVD from high BMI was 18.0% (19.6% in men and 15.6% in women), and it was highest (42.7%) in those aged 25-30 years. Adults aged 60-65 years had the highest absolute DALYs (11,546). The average relative age-standardized attributable burden was 314 DALYs per 100,000 person-years, and it was highest in those aged 75-80 years (1,407 DALYs per 100,000 person-years). Those living in Taitung County had the highest PAF of 21.9% and the highest age-standardized attributable burden (412 DALYs). In Taiwan, an 18% reduction in CVDs could be achieved if obesity/overweight was prevented. Prevention was most effective in early adulthood. The absolute CVD burden from obesity/overweight was highest in middle-aged men, and the relative burden was highest in older adults. Resource allocation in targeted populations and specific areas to eliminate CVD and health inequities is urgently required.