scholarly journals Achieving Optimal Population Cardiovascular Health Requires an Interdisciplinary Team and a Learning Healthcare System: A Scientific Statement From the American Heart Association

Circulation ◽  
2020 ◽  
Author(s):  
Randi E. Foraker ◽  
Catherine P. Benziger ◽  
Bailey M. DeBarmore ◽  
Crystal W. Cené ◽  
Fleetwood Loustalot ◽  
...  
Keyword(s):  
Healthcare System ◽  
Cardiovascular Health ◽  
Interdisciplinary Team ◽  
Heart Association ◽  
Evidence Base ◽  
Current Evidence ◽  
Team Approach ◽  
Learning Healthcare System ◽  
Scientific Statement ◽  
The Impact

Population cardiovascular health, or improving cardiovascular health among patients and the population at large, requires a redoubling of primordial and primary prevention efforts as declines in cardiovascular disease mortality have decelerated over the past decade. Great potential exists for healthcare systems–based approaches to aid in reversing these trends. A learning healthcare system, in which population cardiovascular health metrics are measured, evaluated, intervened on, and re-evaluated, can serve as a model for developing the evidence base for developing, deploying, and disseminating interventions. This scientific statement on optimizing population cardiovascular health summarizes the current evidence for such an approach; reviews contemporary sources for relevant performance and clinical metrics; highlights the role of implementation science strategies; and advocates for an interdisciplinary team approach to enhance the impact of this work.

scholarly journals The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association

Circulation ◽  
2017 ◽  
Vol 135 (14) ◽  
Author(s):  
Thomas M. Maddox ◽  
Nancy M. Albert ◽  
William B. Borden ◽  
Lesley H. Curtis ◽  
T. Bruce Ferguson ◽  
...  
Keyword(s):  
Healthcare System ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Learning Healthcare System ◽  
Scientific Statement ◽  
Cardiovascular Care

scholarly journals Polyphenols and Cognition In Humans: An Overview of Current Evidence from Recent Systematic Reviews and Meta-Analyses

2020 ◽  
pp. 1-15
Author(s):  
Daniel Joseph Lamport ◽  
Claire Michelle Williams
Keyword(s):  
Systematic Reviews ◽  
Evidence Base ◽  
Epidemiological Studies ◽  
Cognitive Outcome ◽  
Current Evidence ◽  
Duration Of Treatment ◽  
Current Evidence Base ◽  
Cognitive Benefits ◽  
Meta Analyses ◽  
The Impact

There is increasing interest in the impact of dietary influences on the brain throughout the lifespan, ranging from improving cognitive development in children through to attenuating ageing related cognitive decline and reducing risk of neurodegenerative diseases. Polyphenols, phytochemicals naturally present in a host of fruits, vegetables, tea, cocoa and other foods, have received particular attention in this regard, and there is now a substantial body of evidence from experimental and epidemiological studies examining whether their consumption is associated with cognitive benefits. The purpose of this overview is to synthesise and evaluate the best available evidence from two sources, namely meta-analyses and systematic reviews, in order to give an accurate reflection of the current evidence base for an association between polyphenols and cognitive benefits. Four meta-analyses and thirteen systematic reviews published between 2017–2020 were included, and were categorised according to whether they reviewed specific polyphenol-rich foods and classes or all polyphenols. A requirement for inclusion was assessment of a behavioural cognitive outcome in humans. A clear and consistent theme emerged that whilst there is support for an association between polyphenol consumption and cognitive benefits, this conclusion is tentative, and by no means definitive. Considerable methodological heterogeneity was repeatedly highlighted as problematic such that the current evidence base does not support reliable conclusions relating to efficacy of specific doses, duration of treatment, or sensitivity in specific populations or certain cognitive domains. The complexity of multiple interactions between a range of direct and indirect mechanisms of action is discussed. Further research is required to strengthen the reliability of the evidence base.

scholarly journals Opportunities and Challenges for Interpreting Rare Variation in Clinically Important Genes

2020 ◽  
Author(s):  
Gregory McInnes ◽  
Andrew G. Sharo ◽  
Megan L. Koleske ◽  
Julie E. H. Brown ◽  
Matthew Norstad ◽  
...  
Keyword(s):  
Healthcare System ◽  
Protein Function ◽  
Rare Variants ◽  
Clinical Importance ◽  
Computational Prediction ◽  
Ethical Challenges ◽  
Inborn Errors ◽  
Rare Variation ◽  
Learning Healthcare System ◽  
The Impact

Genome sequencing is enabling precision medicine—tailoring treatment to the unique constellation of variants in an individual’s genome. The impact of recurrent pathogenic variants is often understood, leaving a long tail of rare genetic variants that are uncharacterized. The problem of uncharacterized rare variation is especially acute when it occurs in genes of known clinical importance with functionally consequent frequent variants and associated mechanisms. Variants of unknown significance (VUS) in these genes are discovered at a rate that outpaces current ability to classify them using databases of previous cases, experimental evaluation, and computational predictors. Clinicians are thus left without guidance about the significance of variants that may have actionable consequences. Computational prediction of the impact of rare genetic variation is increasingly becoming an important capability. In this paper, we review the technical and ethical challenges of interpreting the function of rare variants in two settings: inborn errors of metabolism in newborns, and pharmacogenomics. We propose a framework for a genomic learning healthcare system with an initial focus on early-onset treatable disease in newborns and actionable pharmacogenomics. We argue that (1) a genomic learning healthcare system must allow for continuous collection and assessment of rare variants, (2) emerging machine learning methods will enable algorithms to predict the clinical impact of rare variants on protein function, and (3) ethical considerations must inform the construction and deployment of all rare-variation triage strategies, particularly with respect to health disparities arising from unbalanced ancestry representation.

scholarly journals Cardiovascular Considerations in Caring for Pregnant Patients: A Scientific Statement From the American Heart Association

Circulation ◽  
2020 ◽  
Vol 141 (23) ◽  
Author(s):  
Laxmi S. Mehta ◽  
Carole A. Warnes ◽  
Elisa Bradley ◽  
Tina Burton ◽  
Katherine Economy ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Heart Association ◽  
The United States ◽  
Aortic Disease ◽  
Cerebrovascular Diseases ◽  
Team Approach ◽  
Core Knowledge ◽  
Knowledge Area ◽  
Scientific Statement ◽  
Primary Care Clinicians

Cardio-obstetrics has emerged as an important multidisciplinary field that requires a team approach to the management of cardiovascular disease during pregnancy. Cardiac conditions during pregnancy include hypertensive disorders, hypercholesterolemia, myocardial infarction, cardiomyopathies, arrhythmias, valvular disease, thromboembolic disease, aortic disease, and cerebrovascular diseases. Cardiovascular disease is the primary cause of pregnancy-related mortality in the United States. Advancing maternal age and preexisting comorbid conditions have contributed to the increased rates of maternal mortality. Preconception counseling by the multidisciplinary cardio-obstetrics team is essential for women with preexistent cardiac conditions or history of preeclampsia. Early involvement of the cardio-obstetrics team is critical to prevent maternal morbidity and mortality during the length of the pregnancy and 1 year postpartum. A general understanding of cardiovascular disease during pregnancy should be a core knowledge area for all cardiovascular and primary care clinicians. This scientific statement provides an overview of the diagnosis and management of cardiovascular disease during pregnancy.

Abstract 4450: Does the Evidence Support Guideline Recommendations for Clopidogrel Pretreatment?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Shervin Eshaghian ◽  
Stanley Chou ◽  
Jayanta Das ◽  
George A Diamond ◽  
Prediman K Shah ◽  
...  
Keyword(s):  
Major Bleeding ◽  
Time Course ◽  
Meta Analysis ◽  
Bleeding Risk ◽  
Evidence Base ◽  
Current Evidence ◽  
Optimal Timing ◽  
Significant Heterogeneity ◽  
Current Evidence Base ◽  
The Impact

Although few concrete data exist about the optimal timing and dose of clopidogrel pretreatment, the ACC/AHA & ESC guidelines endorse pretreatment with 300 – 600 mg of clopidogrel at least 2– 6 hours before PCI as Class IA (ACS) and Class IC (elective PCI) recommendation. To evaluate the current evidence base in support for clopidogrel pretreat-ment. Five trials examining the impact of clopidogrel pretreatment in stable and unstable CAD were evaluated: PCI-CURE, PCI-CLARITY, CREDO, PRAGUE-8, ARMYDA-5. Because of substantial clinical heterogeneity in trial design and population, concomitant therapies (glycoprotein 2b/3a inhibitors, thrombolysis, etc), loading dose, pretreatment duration and analysis plan between PCI-CURE, PCI-CLARITY and the rest, a formal meta-analysis was confined only to CREDO, PRAGUE-8, ARMYDA-5. The key data are summarized in the Table . Clopidogrel pretreatment was associated with significant reduction in ischemic outcomes without a significant increase in major bleeding in two out of the 5 trials (PCI-CURE and PCI-CLARITY). Both these trials utilized nonrandomized subgroup comparisons with pretreatment duration longer than that typically encountered in clinical practice (<48h). A meta-analysis of the 3 trials demonstrated a nonsignificant 23% odds reduction in efficacy (P=0.1) and a nonsignificant 29% odds increase in major bleeding (P=0.24). No significant heterogeneity was observed for pooled efficacy (P=0.79) or bleeding (P=0.77) outcomes. Pretreatment hypothesis is currently not validated in rigorous prospective assessments, thereby calling into question the Class I recommendation (benefit >>>risk) endorsed by the guidelines. Clearly, further clinical data regarding dose, time course of pretreatment and associated benefit are warranted to provide unequivocal support. Until then, it is prudent to rule out surgical CAD before pretreatment to avoid bleeding risk. Trials Assessing Clopidogrel Pretreatment

scholarly journals Lifestyle Strategies for Risk Factor Reduction, Prevention, and Treatment of Cardiovascular Disease

2018 ◽  
Vol 13 (2) ◽  
pp. 204-212 ◽  
Author(s):  
James M. Rippe
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Health ◽  
American Heart ◽  
Heart Association ◽  
Lifestyle Factors ◽  
Cvd Risk ◽  
Lifestyle Medicine ◽  
Ideal Cardiovascular Health ◽  
Overwhelming Evidence ◽  
The Impact

Daily habits and actions powerfully affect the risk of cardiovascular disease (CVD), in general, and coronary heart disease, in particular. Regular physical activity, sound nutrition, weight management, and not smoking cigarettes have all been demonstrated to significantly reduce the risk of CVD. In 2 large cohort studies a reduction of risk of CVD of >80% and diabetes >90% were demonstrated in individuals who followed a cluster of these lifestyle practices. The study of the impact of lifestyle factors on CVD risk has coalesced under the framework of “lifestyle medicine.” Despite the overwhelming evidence that lifestyle factors affect CVD, a distinct minority of individuals are following these practices. The American Heart Association estimates that only 5% of individuals follow all of these lifestyle factors as components of a strategy to achieve “ideal” cardiovascular health. The challenge to the medical and health care communities is to more aggressively incorporate this information into the daily practices of medicine.

scholarly journals Cardiovascular disease in transgendered people: A review of the literature and discussion of risk

2019 ◽  
Vol 8 ◽  
pp. 204800401988074 ◽  
Author(s):  
Leighton J Seal
Keyword(s):  
Cardiovascular Disease ◽  
Hormonal Therapy ◽  
Cardiovascular Health ◽  
Current Evidence ◽  
Male Population ◽  
Transgendered People ◽  
Increased Risk ◽  
General Male Population ◽  
The Impact ◽  
Lipid Parameters

This review examines the impact of gender affirming hormone therapy used in the transgendered and non-binary populations on cardiovascular outcomes and surrogate markers of cardiovascular health. Current evidence suggests that hormonal therapy for transgendered women decreases or is neutral regarding myocardial infarction risk. There is an increased incidence of venous thromboembolism (VTE), but newer studies suggest that the risk is significantly lower than previously described. For transgendered men, there appears to be an adverse effect on lipid parameters but this does not translate into an increased risk of cardiovascular disease above that of general male population. In all transgendered people, risk factor interventions such as smoking cessation, weight management and treatment of co-morbid conditions are important in optimising cardiovascular health. The effect of gender affirming hormonal therapy in transgendered people is difficult to interpret due to the variety of hormone regimens used, the relative brevity of the periods of observation and the influence of confounding factors such as the historical use of less physiological, oestrogens such as conjugated equine oestrogen and ethinylestradiol which are more pro-thrombotic than the 17β oestradiol that is used in modern practice.

scholarly journals Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association

Circulation ◽  
2017 ◽  
Vol 136 (21) ◽  
Author(s):  
Mercedes R. Carnethon ◽  
Jia Pu ◽  
George Howard ◽  
Michelle A. Albert ◽  
Cheryl A.M. Anderson ◽  
...  
Keyword(s):  
African Americans ◽  
American Heart Association ◽  
Cardiovascular Health ◽  
American Heart ◽  
Heart Association ◽  
Scientific Statement
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