The Impact of Cardiac Rehabilitation on CVD Risk Factors in Diabetic Patients

ObjectivesPatients with rheumatoid arthritis (RA) have an excess risk of cardiovascular disease (CVD). We aimed to assess the impact of CVD risk factors, including potential sex differences, and RA-specific variables on CVD outcome in a large, international cohort of patients with RA.MethodsIn 13 rheumatology centres, data on CVD risk factors and RA characteristics were collected at baseline. CVD outcomes (myocardial infarction, angina, revascularisation, stroke, peripheral vascular disease and CVD death) were collected using standardised definitions.Results5638 patients with RA and no prior CVD were included (mean age: 55.3 (SD: 14.0) years, 76% women). During mean follow-up of 5.8 (SD: 4.4) years, 148 men and 241 women developed a CVD event (10-year cumulative incidence 20.9% and 11.1%, respectively). Men had a higher burden of CVD risk factors, including increased blood pressure, higher total cholesterol and smoking prevalence than women (all p<0.001). Among the traditional CVD risk factors, smoking and hypertension had the highest population attributable risk (PAR) overall and among both sexes, followed by total cholesterol. The PAR for Disease Activity Score and for seropositivity were comparable in magnitude to the PAR for lipids. A total of 70% of CVD events were attributable to all CVD risk factors and RA characteristics combined (separately 49% CVD risk factors and 30% RA characteristics).ConclusionsIn a large, international cohort of patients with RA, 30% of CVD events were attributable to RA characteristics. This finding indicates that RA characteristics play an important role in efforts to reduce CVD risk among patients with RA.

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Patterns of Immune Activation in HIV and Non HIV Subjects and Its Relation to Cardiovascular Disease Risk

Frontiers in Immunology ◽

10.3389/fimmu.2021.647805 ◽

2021 ◽

Vol 12 ◽

Author(s):

Alinda G. Vos ◽

Caitlin N. Dodd ◽

Eveline M. Delemarre ◽

Stefan Nierkens ◽

Celicia Serenata ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Immune Activation ◽

Hiv Positive ◽

Inflammation Markers ◽

Cvd Risk Factors ◽

Immune Markers ◽

Cvd Risk ◽

The Impact ◽

Hiv Negative

IntroductionInsight into inflammation patterns is needed to understand the pathophysiology of HIV and related cardiovascular disease (CVD). We assessed patterns of inflammation related to HIV infection and CVD risk assessed with carotid intima media thickness (CIMT).MethodsA cross-sectional study was performed in Johannesburg, South Africa, including participants with HIV who were virally suppressed on anti-retroviral therapy (ART) as well as HIV-negative participants who were family members or friends to the HIV-positive participants. Information was collected on CVD risk factors and CIMT. Inflammation was measured with the Olink panel ‘inflammation’, allowing to simultaneously assess 92 inflammation markers. Differences in inflammation patterns between HIV-positive and HIV-negative participants were explored using a principal component analysis (PCA) and ANCOVA. The impact of differentiating immune markers, as identified by ANCOVA, on CIMT was assessed using linear regression while adjusting for classic CVD risk factors.ResultsIn total, 185 HIV-positive and 104 HIV negative participants, 63% females, median age 40.7 years (IQR 35.4 – 47.7) were included. HIV-positive individuals were older (+6 years, p <0.01) and had a higher CIMT (p <0.01). No clear patterns of inflammation were identified by use of PCA. Following ANCOVA, nine immune markers differed significantly between HIV-positive and HIV-negative participants, including PDL1. PDL1 was independently associated with CIMT, but upon stratification this effect remained for HIV-negative individuals only.ConclusionHIV positive patients on stable ART and HIV negative controls had similar immune activation patterns. CVD risk in HIV-positive participants was mediated by inflammation markers included in this study.

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Risk Factors for Cardiovascular Disease (CVD) in Adults with Type 1 Diabetes: Findings from Prospective Real-life T1D Exchange Registry

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa015 ◽

2020 ◽

Vol 105 (5) ◽

pp. e2032-e2038 ◽

Cited By ~ 4

Author(s):

Viral N Shah ◽

Ryan Bailey ◽

Mengdi Wu ◽

Nicole C Foster ◽

Rodica Pop-Busui ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Type 1 Diabetes ◽

Diabetic Nephropathy ◽

The United States ◽

Cvd Risk Factors ◽

Cvd Risk ◽

The Impact

Abstract Context Cardiovascular disease (CVD) is a major cause of mortality in adults with type 1 diabetes. Objective We prospectively evaluated CVD risk factors in a large, contemporary cohort of adults with type 1 diabetes living in the United States. Design Observational study of CVD and CVD risk factors over a median of 5.3 years. Setting The T1D Exchange clinic network. Patients Adults (age ≥ 18 years) with type 1 diabetes and without known CVD diagnosed before or at enrollment. Main Outcome Measure Associations between CVD risk factors and incident CVD were assessed by multivariable logistic regression. Results The study included 8,727 participants (53% female, 88% non-Hispanic white, median age 33 years [interquartile ratio {IQR} = 21, 48], type 1 diabetes duration 16 years [IQR = 9, 26]). At enrollment, median HbA1c was 7.6% (66 mmol/mol) (IQR = 6.9 [52], 8.6 [70]), 33% used a statin, and 37% used blood pressure medication. Over a mean follow-up of 4.6 years, 325 (3.7%) participants developed incident CVD. Ischemic heart disease was the most common CVD event. Increasing age, body mass index, HbA1c, presence of hypertension and dyslipidemia, increasing duration of diabetes, and diabetic nephropathy were associated with increased risk for CVD. There were no significant gender differences in CVD risk. Conclusion HbA1c, hypertension, dyslipidemia and diabetic nephropathy are important risk factors for CVD in adults with type 1 diabetes. A longer follow-up is likely required to assess the impact of other traditional CVD risk factors on incident CVD in the current era.

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Early manifestation of macrovasculopathy in newly diagnosed never treated type II diabetic patients with no traditional CVD risk factors

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2007.12.010 ◽

2008 ◽

Vol 80 (2) ◽

pp. 253-258 ◽

Cited By ~ 23

Author(s):

Sayeeda Rahman ◽

Aziz Al-Safi Ismail ◽

Shaiful Bahari Ismail ◽

Nyi Nyi Naing ◽

Abdul Rashid Abdul Rahman

Keyword(s):

Risk Factors ◽

Diabetic Patients ◽

Type Ii ◽

Newly Diagnosed ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Early Manifestation

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A Cardiac Rehabilitation Program for Breast Cancer Survivors: A Feasibility Study

Journal of Oncology ◽

10.1155/2021/9965583 ◽

2021 ◽

Vol 2021 ◽

pp. 1-11

Author(s):

Filadelfiya Zvinovski ◽

Julie A. Stephens ◽

Bhuvaneswari Ramaswamy ◽

Raquel E. Reinbolt ◽

Anne M. Noonan ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Cardiac Rehabilitation ◽

Cancer Survivors ◽

Feasibility Study ◽

Study Protocol ◽

Breast Cancer Survivors ◽

Cvd Risk Factors ◽

Vo2 Max ◽

Cvd Risk

Purpose. The purpose of this study was to determine the feasibility and preliminary efficacy of a cardiac rehabilitation (CR) intervention in the breast cancer population. Methods. This single-arm feasibility study evaluated a 14-week CR intervention program in breast cancer survivors. Feasibility was defined as completion of at least 30/36 sessions of the program without serious adverse events (SAE) in 80% of patients. Secondary endpoints included the change in VO2 max, cardiovascular disease (CVD) risk factors, Duke Activity Secondary Index (DASI), Brief Fatigue Inventory (BFI), and QLQ-C30. All outcomes were reported as mean change and compared using paired t-tests. Results. A total of 25 patients were enrolled in the study. 18 patients of the 25 enrolled (72%) completed the 14 weeks program without SAE. The overall adherence to the study protocol was 60%. Of the 18 participants who did not withdraw from the program, 15 (83%) adhered to the study protocol and completed 30 or more sessions. There was a nonsignificant improvement in VO2 max (mean Δ0.5, p = 0.6 ). The scores for DASI, BFI, and QLQ-C30 improved from baseline to posttreatment. Conclusion. A CR intervention in breast cancer survivors had high adherence in those who were able to complete the 14-week program. The program significantly improved patient reported physical activity, fatigue, and quality of life (QoL), without significant improvement in CVD risk factors. Implications for cancer patients are that early implementation of a CR program should be considered by practitioners as it improves QoL and exercise tolerance in breast cancer survivors.

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Cardiovascular Risk Factors Impact on the Severity of Coronary Artery Disease among Acute ST-Elevation Myocardial Infarction Patients in the United Arab Emirates

Journal of Integrative Cardiology Open Access ◽

10.31487/j.jicoa.2021.01.12 ◽

2021 ◽

pp. 1-9

Author(s):

Vijay Chander Vinod ◽

Zuhair Eltayeb Yousif

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Coronary Artery ◽

Multivessel Disease ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Vessel Disease ◽

St Elevation ◽

Artery Disease ◽

The Impact

Objective: To define the impact of the cardiovascular risk factors on the extent of Coronary Artery Disease in STEMI patients and to identify the common prevalent risk factors that are unrecognized or poorly treated resulting in STEMI among the UAE population. Methods: Retrospective cohort on patients presented to Mediclinic City Hospital from 2011-2016 who underwent Primary Percutaneous Coronary Intervention (PCI) for confirmed ST-Elevation Myocardial Infarction (STEMI). Results: Of the total 104 STEMI patients, 91% were males. Mean (+SD) of 53 (+12.5) years of age. 73% were less than 60 years old. The most prevalent risk factor was hypertension (42%). 38% of diabetics had an HbA1C of >7%. 14% of the dyslipidemic had above target lipid levels in spite of Statin. 100% of the study population had at least 1 risk factor, ≥2 risk factors (97%), ≥3 risk factors (82%). 50% had 1 or more incidental risk factors diagnosed after admission. Dyslipidemia (36%) was the commonest incidental risk factor. The total risk factor counts increased significantly when the incidental or poorly treated risk factors were added to the initial risk factors on admission. Anterior Wall STEMI (38%) was the commonest. Left Anterior Descending Coronary Artery (48%) was the commonest culprit vessel. The majority had Triple Vessel Disease (37%). 37% developed in-hospital complications. Multivessel disease patients had more risk factors than in single-vessel disease but the association between the number of risk factors and disease severity was not statistically significant. The odds of multivessel disease increased with cumulative risk factor categories, but there was no significant trend association. Conclusion: Our study attempted to determine the impact of CVD risk factors on the severity of CAD among STEMI patients who underwent primary PCI. Contrary to other studies, there was no statistical difference noted in the prevalence of CVD risk factors between the single-vessel and multivessel disease. The study did prove that the incidental or under-diagnosed or inadequately treated risk factors had an impact on the severity of CAD. The study stress that every single CVD risk factor should be treated with equal importance. Statistically significant associations need to be confirmed in future studies with a larger number of patients.

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Abstract 16831: Effect of a Virtual Cardiac Rehabilitation Program on Functional Capacity and Risk Factor Modification in Veterans With Ischemic Heart Disease

Circulation ◽

10.1161/circ.142.suppl_3.16831 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Arash Harzand ◽

Alexander A Vakili ◽

Michelle Davis-Watts ◽

Rene Nazar ◽

Phyllis Wright ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Cardiac Rehabilitation ◽

Functional Capacity ◽

Ischemic Heart ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Home Based

Background: Cardiac rehabilitation (CR) is a comprehensive lifestyle change program proven to reduce cardiovascular disease (CVD) risk and improve quality of life in patients with ischemic heart disease but remains highly underutilized (<20% of eligible patients) due to the inconvenience and cost of attending a facility-based program. We evaluated the efficacy of a home-based, virtual CR program using mobile health (mHealth) in veterans with coronary artery disease (CAD) on improving functional capacity, CVD risk factors, and depressive symptoms. Methods: We enrolled 196 Veterans with a qualifying CR diagnosis between May 2016 and April 2020. All participants underwent baseline functional evaluation with a 6-minute walk test (6MWT), followed by a 12-week home-based, virtual CR program delivered via the Movn smartphone app (Movn by Moving Analytics). The Movn app featured daily alerts to exercise, a digital diary to record activity and vital signs, and connectivity with a health coach who remotely monitored participants through an integrated dashboard and scheduled weekly phone visits. We compared the risk factor profile pre-intervention versus post-intervention with paired t-tests. Results: Among enrolled Veterans, the mean (SD) age was 61 (9) years, 95% were male, and 50% were black. A majority (63%) completed the full 12-week virtual CR program including an exit visit. Participants completed an average of 10.4 ± 1.9 (range 3–13) phone visits with the coach. There were concurrent improvements in 6MWT distance (443.9 vs. 481.9 meters; mean difference [MD], 38 meters; 95% CI, 26.6 – 50.8, P<0.001), low-density lipoprotein cholesterol (80 vs. 69 mg/dL, MD, -10.9; 95% CI, -17.9 to -3.9, P=0.003), body mass index (31.1 vs 30.8; MD, -0.33; 95% CI, -0.60 to -0.06; P=0.001), and PHQ-9 depression scores (7.4 vs. 6; MD, -1.4, 95% CI, -2.4 to -0.44; P=0.005) among program completers. Conclusions: Among veterans with ischemic heart disease, a virtual CR program results in moderate improvements in functional capacity, CVD risk factors, and mood. The durability of these effects and whether virtual CR improves longer-term outcomes such as readmissions, survival, and cost remain to be determined.

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Interaction between CETP polymorphism and dietary insulin index and load in relation to cardiovascular risk factors in diabetic adults

Scientific Reports ◽

10.1038/s41598-021-95359-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Faezeh Abaj ◽

Masoumeh Rafiee ◽

Fariba Koohdani

Keyword(s):

Risk Factors ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Cross Sectional Study ◽

Diabetic Patients ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Type 2 Diabetic Patients ◽

Cross Sectional

AbstractGene–diet interactions may play an important role in the inter individual diversity observed in on cardiovascular disease (CVD) risk factors. Therefore, in the current study, we examined the interaction of CETP TaqB1 polymorphism with dietary insulin index and load (DII and DIL), in altering on CVD risk factors among type 2 diabetes mellitus (T2DM). In this cross-sectional study, blood samples were collected from 220 type 2 diabetic patients (134 females and 86 male) with a mean age of 52.24 years in Tehran, Iran. DIL and DII were obtained via validated food-frequency questionnaire (FFQ). Taq1B polymorphism was genotyped by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Biochemical markers including total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), superoxide dismutase (SOD), C-reactive protein (CRP), total antioxidant capacity (TAC), pentraxin-3 (PTX3), isoprostaneF2α (PGF2α). interleukin 18 (IL18), leptin and ghrelin were measured by standard protocol. Patients with B1B1 genotype had lower lipid profiles include LDL/HDL (P < 0.001) and TG (P = 0.04) when they consumed diets higher on the DIL and DII index. Moreover, carriers of B2B2 genotype who were in the last tertile of DIL had higher antioxidant and inflammatory markers include SOD (P = 0.01), PGF2α (P = 0.04) and CRP (P = 0.02). Further, a significant interaction between CETP TaqB1 and DII was shown in terms of WC (P = 0.01), where the highest WC were observed in B2B2 genotype carriers following a DII score. However, the highest inflammatory and antioxidant markers include CRP (P = 0.04), TAC (P = 0.01), SOD (P = 0.02), and PGF2α (P = 0.02) were observed in B2B2 genotype carriers when they consumed diets higher on the DII index. Based on the current study, it could be proposed that CETP polymorphism may be associated with CVD risk factors in T2DM patients with high following insulin indices, including DII and DIL. It seems that CETP Taq1B polymorphism can invert the result produced by insulin. This conclusion illustrates that the CETP Taq1B B1 allele could counteract the CVD risk induced by high DII and DIL.

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Abstract 17276: Impact of Cardiovascular Comorbidities on COVID-19 Infection Risk

Circulation ◽

10.1161/circ.142.suppl_3.17276 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

David Tofovic ◽

Minji Seok ◽

Logan S Schwarzman ◽

Sreenivas Konda ◽

Noreen T Nazir

Keyword(s):

Risk Factors ◽

Cohort Analysis ◽

Age Groups ◽

Significant Risk ◽

Significant Risk Factor ◽

Age Group ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Patient Demographics ◽

The Impact

Introduction: A disproportionate amount of COVID-19 infections has occurred in minority populations and in individuals with comorbid disease. We sought to evaluate the impact of patient demographics, cardiovascular disease (CVD), and known CVD risk factors on the incidence of COVID-19 infection. Methods: Between April 1st to May 1st, 2020, 844 adult patients (mean age 51.4±17.7 years, mean BMI 29.6±8.3, 50% male) admitted for any reason and tested for COVID-19 based on CDC criteria were studied in this large, metropolitan, single-center retrospective cohort analysis. Bivariate and multivariate analysis between patient demographics, CVD, and CVD risk factors with COVID-19 were evaluated. The nonlinear effects of age on COVID-19 test results were further analyzed. Results: Prevalence of COVID-19 was 21.7%. African Americans, Latinos, and Caucasian were 463(55%), 216(25%), 165(20%) respectively. Unadjusted, diabetes mellitus (DM) was significantly related with the COVID-19 positivity (OR 1.83, 95% CI 1.30-2.58, P=0.0005), but age adjusted DM was insignificant (OR 1.35, 95% CI 0.93-1.97, P=0.12). Similar results were found with other CVD risk factors (see Tables 1,2). Stratified analysis by age groups (18-40 years, ≥40 years), DM in the younger age group was the most significant risk factor for the COVID-19 positivity (OR 4.52, 95% CI 1.95-10.52, P=0.0002) but not in older inpatients (OR 1.23, 95% CI 0.85-1.81, P=0.2763). In the older age group, Latinos were significantly higher risk for COVID-19 compared to Caucasian (OR 2.27, 95% CI 1.26-4.07, P=0.005). Conclusions: Increased resources for testing in younger individuals with DM and the Hispanic population may be merited.

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Intersection between gonadal function and vascular aging in women

Journal of Applied Physiology ◽

10.1152/japplphysiol.00117.2018 ◽

2018 ◽

Vol 125 (6) ◽

pp. 1881-1887 ◽

Cited By ~ 10

Author(s):

Kerrie L. Moreau

Keyword(s):

Risk Factors ◽

Sleep Disturbances ◽

Hot Flashes ◽

Vascular Wall ◽

Menopausal Transition ◽

Vascular Aging ◽

Gonadal Function ◽

Cvd Risk Factors ◽

Cvd Risk ◽

The Impact

Vascular aging, characterized by endothelial dysfunction and large elastic arterial stiffening, is a major risk factor for age-associated cardiovascular disease (CVD). Although women have a lower prevalence of CVD until midlife, prevalence rates increase rapidly coincident with the menopausal transition to match those observed in men. The menopausal transition, or perimenopause, is a chaotic period that is associated with increased symptoms (e.g., hot flashes, depressed mood, anxiety, sleep disturbances) and CVD risk factors due to changes in the hormonal environment. Because these quality of life factors and CVD risk factors also change with aging, the arteries of women appear to endure a double insult. Our laboratory has been investigating how changes in gonadal function and hormone levels with the menopause transition impacts the vascular aging process in healthy women. Our work has shown that vascular endothelial function progressively declines, and large elastic arterial stiffness is greater across the stages of the menopausal transition. This acceleration in vascular aging may be due to the loss of vasodilatory, antioxidant, anti-inflammatory, and antiproliferative effects of estradiol on the vascular wall. This minireview discusses the impact of changes in gonadal function and hormones with the menopausal transition on vascular aging in women and areas for investigations to further our understanding of the intersection between gonadal function and vascular aging.

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