The Role of Antioxidants Supplementation in Clinical Practice: Focus on Cardiovascular Risk Factors

Oxidative stress may be defined as an imbalance between reactive oxygen species (ROS) and the antioxidant system to counteract or detoxify these potentially damaging molecules. This phenomenon is a common feature of many human disorders, such as cardiovascular disease. Many of the risk factors, including smoking, hypertension, hypercholesterolemia, diabetes, and obesity, are associated with an increased risk of developing cardiovascular disease, involving an elevated oxidative stress burden (either due to enhanced ROS production or decreased antioxidant protection). There are many therapeutic options to treat oxidative stress-associated cardiovascular diseases. Numerous studies have focused on the utility of antioxidant supplementation. However, whether antioxidant supplementation has any preventive and/or therapeutic value in cardiovascular pathology is still a matter of debate. In this review, we provide a detailed description of oxidative stress biomarkers in several cardiovascular risk factors. We also discuss the clinical implications of the supplementation with several classes of antioxidants, and their potential role for protecting against cardiovascular risk factors.

Download Full-text

Influence of methyltestosterone postmenopausal therapy on plasma lipids, inflammatory factors, glucose metabolism and visceral fat: a randomized study

Acta Endocrinologica ◽

10.1530/eje.1.02065 ◽

2006 ◽

Vol 154 (1) ◽

pp. 131-139 ◽

Cited By ~ 18

Author(s):

Lenora M Camarate S M Leão ◽

Mônica Peres C Duarte ◽

Dalva Margareth B Silva ◽

Paulo Roberto V Bahia ◽

Cláudia Medina Coeli ◽

...

Keyword(s):

Risk Factors ◽

Insulin Resistance ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Postmenopausal Women ◽

Fat Mass ◽

Visceral Fat ◽

Increased Risk

Background: There has been a growing interest in treating postmenopausal women with androgens. However, hyperandrogenemia in females has been associated with increased risk of cardiovascular disease. Objective: We aimed to assess the effects of androgen replacement on cardiovascular risk factors. Design: Thirty-seven postmenopausal women aged 42–62 years that had undergone hysterectomy were prospectively enrolled in a double-blind protocol to receive, for 12 months, percutaneous estradiol (E2) (1 mg/day) combined with either methyltestosterone (MT) (1.25 mg/day) or placebo. Methods: Along with treatment, we evaluated serum E2, testosterone, sex hormone-binding globulin (SHBG), free androgen index, lipids, fibrinogen, and C-reactive protein; glucose tolerance; insulin resistance; blood pressure; body-mass index; and visceral and subcutaneous abdominal fat mass as assessed by computed tomography. Results: A significant reduction in SHBG (P < 0.001) and increase in free testosterone index (P < 0.05; Repeated measures analysis of variance) were seen in the MT group. Total cholesterol, triglycerides, fibrinogen, and systolic and diastolic blood pressure were significantly lowered to a similar extent by both regimens, but high-density lipoprotein cholesterol decreased only in the androgen group. MT-treated women showed a modest rise in body weight and gained visceral fat mass relative to the other group (P < 0.05), but there were no significant detrimental effects on fasting insulin levels and insulin resistance. Conclusion: This study suggests that the combination of low-dose oral MT and percutaneous E2, for 1 year, does not result in expressive increase of cardiovascular risk factors. This regimen can be recommended for symptomatic postmenopausal women, although it seems prudent to perform baseline and follow-up lipid profile and assessment of body composition, especially in those at high risk of cardiovascular disease.

Download Full-text

Cardiovascular Disease in Survivors of Childhood Cancer: Insights Into Epidemiology, Pathophysiology, and Prevention

Journal of Clinical Oncology ◽

10.1200/jco.2017.76.3920 ◽

2018 ◽

Vol 36 (21) ◽

pp. 2135-2144 ◽

Cited By ~ 39

Author(s):

Saro H. Armenian ◽

Gregory T. Armstrong ◽

Gregory Aune ◽

Eric J. Chow ◽

Matthew J. Ehrhardt ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Childhood Cancer ◽

Cardiovascular Risk Factors ◽

Imaging Biomarkers ◽

Pericardial Disease ◽

Increased Risk ◽

Survivors Of Childhood Cancer

Cardiovascular disease (CVD), which includes cardiomyopathy/heart failure, coronary artery disease, stroke, pericardial disease, arrhythmias, and valvular and vascular dysfunction, is a major concern for long-term survivors of childhood cancer. There is clear evidence of increased risk of CVD largely attributable to treatment exposures at a young age, most notably anthracycline chemotherapy and chest-directed radiation therapy, and compounded by traditional cardiovascular risk factors accrued during decades after treatment exposure. Preclinical studies are limited; thus, it is a high priority to understand the pathophysiology of CVD as a result of anticancer treatments, taking into consideration the growing and developing heart. Recently developed personalized risk prediction models can provide decision support before initiation of anticancer therapy or facilitate implementation of screening strategies in at-risk survivors of cancer. Although consensus-based screening guidelines exist for the application of blood and imaging biomarkers of CVD, the most appropriate timing and frequency of these measures in survivors of childhood cancer are not yet fully elucidated. Longitudinal studies are needed to characterize the prognostic importance of subclinical markers of cardiovascular injury on long-term CVD risk. A number of prevention trials across the survivorship spectrum are under way, which include primary prevention (before or during cancer treatment), secondary prevention (after completion of treatment), and integrated approaches to manage modifiable cardiovascular risk factors. Ongoing multidisciplinary collaborations between the oncology, cardiology, primary care, and other subspecialty communities are essential to reduce therapeutic exposures and improve surveillance, prevention, and treatment of CVD in this high-risk population.

Download Full-text

Future risk of cardiovascular disease risk factors and events in women after a hypertensive disorder of pregnancy

Heart ◽

10.1136/heartjnl-2018-313453 ◽

2019 ◽

Vol 105 (16) ◽

pp. 1273-1278 ◽

Cited By ~ 19

Author(s):

Laura Benschop ◽

Johannes J Duvekot ◽

Jeanine E Roeters van Lennep

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Risk Assessment ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Hypertensive Disorder ◽

Cardiovascular Risk Assessment ◽

Increased Risk

Hypertensive disorders of pregnancy (HDP), such as gestational hypertension and pre-eclampsia, affect up to 10% of all pregnancies. These women have on average a twofold higher risk to develop cardiovascular disease (CVD) later in life as compared with women with normotensive pregnancies. This increased risk might result from an underlying predisposition to CVD, HDP itself or a combination of both. After pregnancy women with HDP show an increased risk of classical cardiovascular risk factors including chronic hypertension, renal dysfunction, dyslipidemia, diabetes and subclinical atherosclerosis. The prevalence and onset of cardiovascular risk factors depends on the severity of the HDP and the coexistence of other pregnancy complications. At present, guidelines addressing postpartum cardiovascular risk assessment for women with HDP show a wide variation in their recommendations. This makes cardiovascular follow-up of women with a previous HDP confusing and non-coherent. Some guidelines advise to initiate cardiovascular follow-up (blood pressure, weight and lifestyle assessment) 6–8 weeks after pregnancy, whereas others recommend to start 6–12 months after pregnancy. Concurrent blood pressure monitoring, lipid and glucose assessment is recommended to be repeated annually to every 5 years until the age of 50 years when women will qualify for cardiovascular risk assessment according to all international cardiovascular prevention guidelines.

Download Full-text

Long-Term All-Cause Mortality and Its Association with Cardiovascular Risk Factors in Thyroid Cancer Survivors: An Israeli Population-Based Study

10.21203/rs.3.rs-39122/v3 ◽

2020 ◽

Author(s):

Elena Izkhakov ◽

Lital Keinan-Boker ◽

Micha Barchana ◽

Yacov Shacham ◽

Iris Yaish ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Thyroid Cancer ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cox Regression ◽

Increased Risk ◽

All Cause Mortality

Abstract Background: The global incidence of thyroid cancer (TC) has risen considerably during the last three decades, while prognosis is generally favorable. We assessed the long-term all-cause mortality in TC survivors compared to the general population, and its association with cardiovascular risk factors. Methods: Individuals diagnosed with TC during 2001-2014 (TC group) and age- and sex-matched individuals from the same Israeli healthcare system without thyroid disease or a cancer history (non-TC group) were compared. Cox regression hazard ratios (HRs) and 95% confidence intervals (95%CIs) for all-cause mortality were calculated by exposure status. Results: During a 15-year follow-up (median 8 years), 577 TC survivors out of 5,677 (10.2%) TC patients and 1,235 individuals out of 23,962 (5.2%) non-TC patients died. The TC survivors had an increased risk of all-cause mortality (HR=1.89, 95%CI 1.71-2.10), after adjusting for cardiovascular risk factors already present at follow-up initiation. This increased risk was most pronounced in the 55- to 64-year-old age group (HR=1.49, 95%CI 1.33-1.67). The TC survivors who died by study closure had more hypertension (14.6% vs. 10.3%, P = 0.002), more dyslipidemia (11.4% vs. 7.2%, P < 0.001), and more cardiovascular disease (33.6% vs. 22.3%, P = 0.05) compared to those who died in the non-TC group. Conclusions: This large cohort study showed higher all-cause mortality with a higher prevalence of hypertension, dyslipidemia, and cardiovascular disease among TC survivors compared to matched non-TC individuals. Primary and secondary prevention of cardiovascular risk factors in TC survivors is mandatory.

Download Full-text

Association between Cardiovascular Risk Factors and Long-Term All-Cause Mortality in Thyroid Cancer Survivors: An Israeli Population-Based Study

10.21203/rs.3.rs-39122/v1 ◽

2020 ◽

Author(s):

Elena Izkhakov ◽

Lital Keinan-Boker ◽

Micha Barchana ◽

Yacov Shacham ◽

Iris Yaish ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Thyroid Cancer ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cox Regression ◽

Increased Risk ◽

All Cause Mortality

Abstract Background: The global incidence of thyroid cancer (TC) has risen considerably during the last three decades, while prognosis is generally favorable. We assessed the association between long-term all-cause mortality and cardiovascular risk factors in TC survivors compared to the general population. Methods: Individuals diagnosed with TC during 2001-2014 (TC group) and age- and sex-matched individuals from the same Israeli healthcare system without thyroid disease or a cancer history (non-TC group) were compared. Cox regression hazard ratios (HRs) and 95% confidence intervals (95%CIs) for all-cause mortality were calculated by exposure status. Results: During a 15-year follow-up (median 8 years), 577 TC survivors out of 5,677 (10.2%) TC patients and 1,235 individuals out of 23,962 (5.2%) non-TC patients died. The TC survivors had an increased risk of all-cause mortality (HR=1.89, 95%CI 1.71-2.10), after adjusting for cardiovascular risk factors already present at follow-up initiation. This increased risk was most pronounced in the 55- to 64-year-old age group (HR=1.49, 95%CI 1.33-1.67). The TC survivors who died by study closure had more hypertension (14.6% vs. 10.3%, P = 0.002), more dyslipidemia (11.4% vs. 7.2%, P < 0.001), and more cardiovascular disease (33.6% vs. 22.3%, P = 0.05) compared to those who died in the non-TC group. Conclusions: This large cohort study showed higher all-cause mortality with a higher prevalence of hypertension, dyslipidemia, and cardiovascular disease among TC survivors compared to matched non-TC individuals. Primary and secondary prevention of cardiovascular risk factors in TC survivors is mandatory.

Download Full-text

Family history and polygenic risk of cardiovascular disease: independent factors associated with secondary cardiovascular events in patients undergoing carotid endarterectomy

10.1101/19006718 ◽

2019 ◽

Author(s):

Nathalie Timmerman ◽

Dominique P.V. de Kleijn ◽

Gert J. de Borst ◽

Hester M. den Ruijter ◽

Folkert W. Asselbergs ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Family History ◽

Carotid Endarterectomy ◽

Cardiovascular Risk Factors ◽

Cardiovascular Events ◽

Polygenic Risk ◽

Increased Risk ◽

The Impact

AbstractBackgroundFamily history (FHx) of cardiovascular disease (CVD) is a risk factor for CVD and a proxy for cardiovascular heritability. Polygenic risk scores (PRS) summarizing >1 million variants for coronary artery disease (CAD) are associated with incident and recurrent CAD events. However, little is known about the influence of FHx or PRS on secondary cardiovascular events (sCVE) in patients undergoing carotid endarterectomy (CEA).MethodsWe included 1,788 CEA patients from the Athero-Express Biobank. A weighted PRS for CAD including 1.7 million variants was calculated (MetaGRS). The composite endpoint of sCVE during three years follow-up included coronary, cerebrovascular and peripheral events and cardiovascular death. We assessed the impact of FHx and MetaGRS on sCVE and carotid plaque composition.ResultsPositive FHx was associated with a higher 3-year risk of sCVE independent of cardiovascular risk factors and MetaGRS (adjusted HR 1.40, 95%CI 1.07-1.82, p=0.013). Patients in the highest MetaGRS quintile had a higher 3-year risk of sCVE compared to the rest of the cohort independent of cardiovascular risk factors including FHx (adjusted HR 1.35, 95%CI 1.01-1.79, p=0.043), and their atherosclerotic plaques contained more fat (adjusted OR 1.59, 95%CI, 1.11-2.29, p=0.013) and more macrophages (OR 1.49, 95%CI 1.12-1.99, p=0.006).ConclusionIn CEA patients, both positive FHx and higher MetaGRS were independently associated with increased risk of sCVE. Moreover, higher MetaGRS was associated with vulnerable plaque characteristics. Future studies should unravel underlying mechanisms and focus on the added value of PRS and FHx in individual risk prediction for sCVE.

Download Full-text

Effect of daily consumption of cranberry beverage on insulin sensitivity and modification of cardiovascular risk factors in adults with obesity: a pilot, randomised, placebo-controlled study

British Journal Of Nutrition ◽

10.1017/s0007114520001336 ◽

2020 ◽

Vol 124 (6) ◽

pp. 577-585 ◽

Cited By ~ 1

Author(s):

Daniel S. Hsia ◽

Derek J. Zhang ◽

Robbie S. Beyl ◽

Frank L. Greenway ◽

Christina Khoo

Keyword(s):

Oxidative Stress ◽

Risk Factors ◽

Cardiovascular Risk ◽

Insulin Sensitivity ◽

Glucose Tolerance ◽

Cardiovascular Risk Factors ◽

Controlled Study ◽

Oxidative Stress Biomarkers ◽

Beverage Consumption ◽

Stress Biomarkers

AbstractCranberries are high in polyphenols, and epidemiological studies have shown that a high-polyphenol diet may reduce risk factors for diabetes and CVD. The present study aimed to determine if short-term cranberry beverage consumption would improve insulin sensitivity and other cardiovascular risk factors. Thirty-five individuals with obesity and with elevated fasting glucose or impaired glucose tolerance participated in a randomised, double-blind, placebo-controlled, parallel-designed pilot trial. Participants consumed 450 ml of low-energy cranberry beverage or placebo daily for 8 weeks. Changes in insulin sensitivity and cardiovascular risk factors including vascular reactivity, blood pressure, RMR, glucose tolerance, lipid profiles and oxidative stress biomarkers were evaluated. Change in insulin sensitivity via hyperinsulinaemic–euglycaemic clamp was not different between the two groups. Levels of 8-isoprostane (biomarker of lipid peroxidation) decreased in the cranberry group but increased in the placebo group (–2·18 v. +20·81 pg/ml; P = 0·02). When stratified by baseline C-reactive protein (CRP) levels, participants with high CRP levels (>4 mg/l) benefited more from cranberry consumption. In this group, significant differences in the mean change from baseline between the cranberry (n 10) and the placebo groups (n 7) in levels of TAG (–13·75 v. +10·32 %; P = 0·04), nitrate (+3·26 v. −6·28 µmol/l; P = 0·02) and 8-isoprostane (+0·32 v. +30·8 pg/ml; P = 0·05) were observed. These findings indicate that 8 weeks of daily cranberry beverage consumption may not impact insulin sensitivity but may be helpful in lowering TAG and changing certain oxidative stress biomarkers in individuals with obesity and a proinflammatory state.

Download Full-text

Cardiovascular disease and COVID-19: les liaisons dangereuses

European Journal of Preventive Cardiology ◽

10.1177/2047487320924501 ◽

2020 ◽

Vol 27 (10) ◽

pp. 1017-1025 ◽

Cited By ~ 1

Author(s):

Andrea Barison ◽

Alberto Aimo ◽

Vincenzo Castiglione ◽

Chiara Arzilli ◽

Josep Lupón ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Effective Action ◽

Current Evidence ◽

Crucial Importance ◽

Increased Risk ◽

Practical Recommendations

Patients with cardiovascular risk factors or established cardiovascular disease have an increased risk of developing coronavirus disease 19 and have a worse outcome when infected, but translating this notion into effective action is challenging. At present it is unclear whether cardiovascular therapies may reduce the likelihood of infection, or improve the survival of infected patients. Given the crucial importance of this issue for clinical cardiologists and all specialists dealing with coronavirus disease 19, we tried to recapitulate the current evidence and provide some practical recommendations.

Download Full-text

Distribution of Cardiovascular Risk Factors in Patients with Psoriasis

Revista de Chimie ◽

10.37358/rc.19.5.7185 ◽

2019 ◽

Vol 70 (5) ◽

pp. 1643-1648

Author(s):

Ana Maria Alexandra Stanescu ◽

Ioana Veronica Grajdeanu ◽

Bogdan Serban ◽

Camelia Cristina Diaconu

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

General Population ◽

Cardiovascular Risk Factors ◽

Family Doctor ◽

Family Doctors ◽

Cardiovascular Comorbidities ◽

Increased Risk ◽

Systemic Disorder

Psoriasis is a chronic inflammatory systemic disorder that associates many cardiovascular comorbidities. The association between psoriasis and cardiovascular disease is a complex one, which implies many risk factors, such as age, gender, heredity, smoking, alcohol and stress. The prognosis of patients with psoriasis may be improved by identifying and reduction of these cardiovascular risk factors. The objective of our study was to determine the prevalence of cardiovascular risk factors among patients with psoriasis from Bucharest and Ilfov county, Romania. 634 individuals from the general population were initially included. From these individuals, 208 patients with psoriasis have been selected for inclusion in our observational study. The patients were selected from Elias Emergency Hospital of Bucharest, Romania, and through the family doctors praxis, between 2010-2017. Of the 634 individuals from the general population, 208 patients (33%) were identified as patients with a diagnosis of vulgar psoriasis, confirmed by the dermatologist, forming the study group. The presence of risk factors is consistent with the presence of cardiovascular disease (23%) in the studied group. Patients with psoriasis, without cardiovascular diseases, have an increased risk of developing them throughout their lives. Patients with psoriasis have a very high risk of developing life-long cardiovascular disease, because of a multitude of risk factors associated with psoriasis. Intervention on modifiable risk factors for cardiovascular disease can be mediated by a family doctor, who can monitor the development over time and may also intervene early when appropriate.

Download Full-text

Vascular disease: coronary, stroke, and peripheral vascular disease

ESC CardioMed ◽

10.1093/med/9780198784906.003.0300 ◽

2018 ◽

pp. 1196-1200

Author(s):

Darrin Ryan Naidoo ◽

Sherlina Kasipersad

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Antiretroviral Therapy ◽

Life Expectancy ◽

Vascular Disease ◽

Cardiovascular Risk Factors ◽

Early Screening ◽

Endothelial Inflammation ◽

Increased Risk

Antiretroviral therapy has resulted in a decrease in AIDS-related deaths. However, the increased life expectancy due to antiretroviral therapies has resulted in an increase in non-infectious diseases, including cardiovascular disease. HIV-infected patients have an increased risk of developing cardiovascular disease due to immune systemic activation that promotes endothelial inflammation and accelerated atherosclerosis. Antiretroviral therapy-related metabolic changes and a higher prevalence of traditional cardiovascular risk factors in HIV-infected patients also results in an increased risk for developing cardiovascular disease. The cornerstone of management includes early initiation of antiretroviral therapy and early screening and management of traditional cardiovascular risk factors.

Download Full-text