Evidence for cardiac rehabilitation in the modern era

2020 ◽  
pp. 1-10
Author(s):  
Constantinos H. Davos ◽  
Bernhard Rauch
Keyword(s):  
Cardiovascular Disease ◽  
Life Expectancy ◽  
Cardiac Rehabilitation ◽  
Meta Analysis ◽  
Coronary Event ◽  
Controlled Trials ◽  
Acute Coronary Event ◽  
Coronary Syndrome ◽  
Modern Era

Management of cardiovascular disease (CVD) has rapidly improved during recent decades and is still changing with the introduction of novel medication and advanced invasive procedures and devices. Notwithstanding these developments, cardiac rehabilitation (CR) is still a cornerstone of secondary prevention. Its effectiveness in improving the physical condition of chronic coronary syndrome (CCS) patients is beyond doubt, but its effectiveness on extending life expectancy is still a matter of debate. This chapter provides insights into the latest evidence (mainly presented in a recent meta-analysis of randomized controlled trials (RCTs) or controlled cohort studies) on the role of CR on morbidity and mortality in patients after an acute coronary event.

Patient with diabetes after acute coronary event. How to improve forecast?

2019 ◽  
Vol 1 (3) ◽  
pp. 6-11
Author(s):  
O. L. Barbarash
Keyword(s):  
Treatment Strategy ◽  
Coronary Event ◽  
High Reactivity ◽  
Acute Coronary Event ◽  
Invasive Treatment ◽  
Coronary Syndrome ◽  
Reduced Dose ◽  
Patients With Diabetes ◽  
History Of

Patients with diabetes mellitus are characterized by a higher risk of developing atherothrombotic events than patients without diabetes. One of the reasons for this is the high reactivity and rate of platelet metabolism. The role of aspirin in the prevention of cardiovascular events in patients with diabetes without a history of atherothrombotic events is unclear. In patients with a history of thromboischemic events, aspirin is useful for cardiovascular prophylaxis. Available data suggest that patients with diabetes and acute coronary syndrome (ACS) will benefit more from using more aggressive antiplatelet drugs than clopidogrel (in addition to aspirin), which will reduce the ischemic risk for patients with diabetes of equal or greater degree compared with patients without diabetes. These drugs include ticagrelor (in patients with ACS, regardless of the initial treatment strategy) and prasugrel (in patients with an invasive treatment strategy). For patients with diabetes, high ischemic and low hemorrhagic risks, prolonging double antiplatelet therapy for more than a year with a reduced dose of ticagrelor (60 mg twice a day) can be accompanied by a decrease in ischemic risk.

scholarly journals Role of the IL-33/ST2 axis in cardiovascular disease: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259026
Author(s):  
Yuan Sun ◽  
Holly Pavey ◽  
Ian Wilkinson ◽  
Marie Fisk
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Random Effects ◽  
Meta Analysis ◽  
Coronary Syndrome ◽  
Hazard Ratios ◽  
All Cause Mortality ◽  
Artery Disease ◽  
Meta Analyses

Interleukin (IL)-33 and its unique receptor, ST2, play a pivotal role in the immune response to infection and stress. However, there have been conflicting reports of the role of IL-33 in cardiovascular disease (CVD) and the potential of this axis in differentiating CVD patients and controls and with CVD disease severity, remains unclear. Aims 1) To quantify differences in circulating IL-33 and/or sST2 levels between CVD patients versus controls. 2) Determine association of these biomarkers with mortality in CVD and community cohorts. Methods and results Using Pubmed/MEDLINE, Web of Science, Prospero and Cochrane databases, systematic review of studies published on IL-33 and/or sST2 levels in patients with CVD (heart failure, acute coronary syndrome, atrial fibrillation, stroke, coronary artery disease and hypertension) vs controls, and in cohorts of each CVD subtype was performed. Pooled standardised mean difference (SMD) of biomarker levels between CVD-cases versus controls and hazard ratios (HRs) for risk of mortality during follow-up in CVD patients, were assessed by random effects meta-analyses. Heterogeneity was evaluated with random-effects meta-regressions. From 1071 studies screened, 77 were meta-analysed. IL-33 levels were lower in HF and CAD patients vs controls, however levels were higher in stroke patients compared controls [Meta-SMD 1.455, 95% CI 0.372–2.537; p = 0.008, I2 = 97.645]. Soluble ST2 had a stronger association with risk of all-cause mortality in ACS (Meta-multivariate HR 2.207, 95% CI 1.160–4.198; p = 0.016, I2 = 95.661) than risk of all-cause mortality in HF (Meta-multivariate HR 1.425, 95% CI 1.268–1.601; p<0.0001, I2 = 92.276). There were insufficient data to examine the association of IL-33 with clinical outcomes in CVD. Conclusions IL-33 and sST2 levels differ between CVD patients and controls. Higher levels of sST2 are associated with increased mortality in individuals with CVD. Further study of IL-33/ST2 in cardiovascular studies is essential to progress diagnostic and therapeutic advances related to IL-33/ST2 signalling.

Abstract 13886: Colchicine for Secondary Prevention of Adverse Outcomes From Cardiovascular Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ninad Zaman ◽  
Simran Grewal ◽  
Louis Borgatta ◽  
Matthew Nudy ◽  
Brandon Peterson
Keyword(s):  
Cardiovascular Disease ◽  
Adverse Events ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Controlled Trials ◽  
Open Label ◽  
Coronary Syndrome ◽  
Randomized Controlled

Introduction: Recent evidence suggests colchicine may prevent adverse outcomes from cardiovascular disease (CVD). The objective of this study is to perform a meta-analysis of randomized controlled trials (RCTs) testing colchicine’s effect on CVD adverse events and mortality among participants with known CVD. Methods: All RCTs testing colchicine versus control were identified and included in the analysis. The endpoints of interest included CVD adverse events (a composite of acute coronary syndrome, cardiac arrest, acute heart failure and hospitalization, stroke, revascularization, and recurrent myocardial infarction), mortality, and gastrointestinal (GI) adverse events. The primary analysis calculated the summary odds ratio (OR) and 95% confidence intervals (CI) for each endpoint. A secondary analysis tested CVD adverse events for heterogeneity of treatment effect (HTE) using Chi 2 and I 2 tests. Results: 9 RCTs (N = 7,031, mean follow-up 9 months) were identified comparing colchicine to control. Colchicine decreased the risk of CVD adverse events [OR 0.64, 95% CI 0.45-0.91]. Colchicine did not reduce all-cause mortality [OR 0.84, 95% CI 0.61-1.15]. GI adverse events were more likely in the colchicine group [OR 3.03, 95% CI 1.60-5.75, p = 0.0007; I 2 = 83%] but with significant HTE. When performing the test for subgroup differences, there was significant HTE between placebo and open-label trial for CVD events [Chi 2 = 10.55, p = 0.001, I 2 = 90.5%]. After excluding two open-label trials, colchicine reduced the risk of CVD events [OR 0.77, 95% CI 0.63-0.93]. Conclusion: Colchicine was associated with reduced CVD adverse events, but not with reduced mortality, among patients with underlying CVD. Colchicine use was associated with increased GI adverse events. Further studies with longer follow-up times are needed to better understand colchicine’s role in the long-term prevention of CVD adverse events.

scholarly journals 306 - Loneliness and mortality in older adults and the role of depression

2020 ◽  
Vol 32 (S1) ◽  
pp. 64-64
Author(s):  
T.J. Holwerda ◽  
D. Rhebergen ◽  
H.C. Comijs ◽  
J.J.M. Dekker ◽  
M.L. Stek
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Mortality Risk ◽  
Meta Analysis ◽  
Clinical Perspective ◽  
Cross Sectional ◽  
Mediating Role ◽  
Underlying Mechanisms ◽  
Dexamethasone Suppression

Background:The prevalence of loneliness increases with age. The presence of loneliness in older adults has been found to be associated with health problems such as depression, decreased cognitive functioning, increases in systolic blood pressure and increased mortality. The underlying mechanisms of the higher mortality risk are largely unknown.Methods:Meta-analysis to investigate the present evidence for the associations between loneliness and mortality. Cross-sectional studies investigating the associations between loneliness and cardiovascular disease and between loneliness and cortisol in 378 depressed and 132 non-depressed older adults.Results:Loneliness appears to be associated with increased mortality, although when only studies are included that consider depression as a covariate, the association is not significant. Therefore it seems likely that depression plays a mediating role in the higher mortality risk.We did not find a significant association between loneliness and cardiovascular disease. In contrast, loneliness was significantly associated with lower cortisol output and decreased dexamethasone suppression.Discussion:The results and their implications for prevention and treatment will be discussed from a clinical perspective as well as a general health perspective. Is loneliness as potentially dangerous as depression?

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