The Benefits of Telemedicine in Personalized Prevention of Cardiovascular Diseases (CVD): A Systematic Review

Introduction: Adverse effects on personalized care and outcomes of cardiovascular diseases (CVD) could occur if health systems do not work in an efficient manner. The pandemic caused by COVID-19 has opened new perspectives for the execution and advancement of cardiovascular tests through telemedicine platforms. Objective: This study aimed to analyze the usefulness of telemedical systems for providing personal care in the prevention of CVD. Methods: A systematic review analysis was conducted on the literature available from libraries such as PubMed (Medline), Scopus (Embase), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Data available in the last 10 years (2011–2020) were also examined by PRISMA guidelines. The selected studies were divided into two categories: (1) benefits of telemedicine in CVD prevention, and (2) recent progress in telemedical services for personalized care of CVD. Results: The literature search produced 587 documents, and 19 articles were considered in this review. Results highlighted that the timely delivery of preventive care for CVD which can be implemented virtually can benefit and modify morbidity and mortality. This could also reduce the pressure on hospitals by decreasing acute CVD occurrence among the general population. The use of these technologies can also help to reduce access to hospitals and other medical devices when not necessary. Conclusions: Telemedicine platforms can be used for regular checkups for CVD and contribute to preventing the occurrence of acute events and more in general the progression of CVD.

Cardiovascular benefits of a home-based exercise program in patients with sickle cell disease

Background Physical inactivity is an important risk factor for cardiovascular disease. The benefits of exercise in patients with chronic diseases, including cardiovascular diseases, are well established. For patients with sickle cell disease, medical recommendation was to avoid physical exercise for fear of triggering painful crises or increasing the impairment of the cardiopulmonary function. Only recently, studies have shown safety in exercise programs for this population. Despite that, there is no report that assess the effects of physical exercise on cardiac parameters in patients with sickle cell disease. Objective This study aimed to evaluate the impact of regular physical exercise (a home-based program) on cardiovascular function in patients with sickle cell disease. Design A quasi-randomized prospective controlled trial. Setting During the years 2015 and 2016, we started recruiting among adult patients treated at a Brazilian Center for Patients with Sickle Cell Disease to participate in a study involving a home exercise program. The experimental (exercise) and control groups were submitted to clinical evaluation and cardiovascular tests before and after the intervention. Analysis of variance was applied to compare groups, considering time and group factors. Participants Twenty-seven adult outpatients with a sickle cell disease diagnosis. Interventions Exercise group (N = 14): a regular home-based aerobic exercise program, three to five times per week not exceeding give times per week, for eight weeks; no prescription for the control group (N = 13). Main outcome measures Echocardiographic and treadmill test parameters. Results The exercise group showed significant improvement in cardiovascular tests, demonstrated by increased distance traveled on a treadmill (p<0.01), increased ejection fraction (p < 0.01) and improvement of diastolic function assessed by mitral tissue Doppler E’ wave on echocardiography (p = 0.04). None of the patients presented a sickle cell crisis or worsening of symptoms during the exercise program. Conclusion The selected home-based exercise program is safe, feasible, and promotes a favorable impact on functional capacity and cardiovascular function in sickle cell disease patients.

Inflammaging as a link between autoimmunity and cardiovascular disease: the case of rheumatoid arthritis

Currently, traditional and non-traditional risk factors for cardiovascular disease have been established. The first group includes age, which constitutes one of the most important factors in the development of chronic diseases. The second group includes inflammation, the pathophysiology of which contributes to an accelerated process of vascular remodelling and atherogenesis in autoimmune diseases. Indeed, the term inflammaging has been used to refer to the inflammatory origin of ageing, explicitly due to the chronic inflammatory process associated with age (in healthy individuals). Taking this into account, it can be inferred that people with autoimmune diseases are likely to have an early acceleration of vascular ageing (vascular stiffness) as evidenced in the alteration of non-invasive cardiovascular tests such as pulse wave velocity. Thus, an association is created between autoimmunity and high morbidity and mortality rates caused by cardiovascular disease in this population group. The beneficial impact of the treatments for rheumatoid arthritis at the cardiovascular level has been reported, opening new opportunities for pharmacotherapy.

Inhibitory Activity of Quercetin 3-O-Arabinofuranoside and 2-Oxopomolic Acid Derived from Malus domestica on Soluble Epoxide Hydrolase

Flavonoids and triterpenoids were revealed to be the potential inhibitors on soluble epoxide hydrolase (sEH). The aim of this study is to reveal sEH inhibitors from Fuji apples. A flavonoid and three triterpenoids derived from the fruit of Malus domestica were identified as quercetin-3-O-arabinoside (1), ursolic acid (2), corosolic acid (3), and 2-oxopomolic acid (4). They had half-maximal inhibitory concentration of the inhibitors (IC50) values of 39.3 ± 3.4, 84.5 ± 9.5, 51.3 ± 4.9, and 11.4 ± 2.7 μM, respectively, on sEH. The inhibitors bound to allosteric sites of enzymes in mixed (1) and noncompetitive modes (2–4). Molecular simulations were carried out for inhibitors 1 and 4 to calculate the binding force of ligands to receptors. The inhibitors bound to the left (1) and right (4) pockets next to the enzyme’s active site. Based on analyses of their molecular docking and dynamics, it was shown that inhibitors 1 and 4 can stably bind sEH at 1 bar and 300 K. Finally, inhibitors 1 and 4 are promising candidates for further studies using cell-based assays and in vivo cardiovascular tests.

Hypertension, Exercises, Physical Therapy and Type 2 Diabetes Mellitus Elderly

Objective: As the cardiovascular disease produced by the association of the hypertension and type 2 diabetes mellitus in elderly people is a worldwide disturb of the actually, this work was done by a research at the PubMed database. Background: The cardiovascular characteristics expressed the quality of life meliorate, the risk factors that occurs, the use of non-invasive cardiovascular tests, the diabetes prevention programs, and the new physical therapies. Material and methods: The research was done through of the use of the key-words: hypertension and cardiovascular diseases and diabetes and elderly and therapy, and exercise in PubMed database. Results: It was founded 36 publications about this theme and put all together to find characteristics that are bellowed to these cardiovascular diseases. Conclusion: This new short review not pretends to fulfil the theme but it was to show ways of successful treatments.

Role of pentraxin-3 in risk assessment of patients with metabolic syndrome

Background Inflammation plays a major role in the development of metabolic syndrome (MetS) and its progression. Recent studies have shown that pentraxin-3 (PTX-3), osteoprogerin (OPG), and tumor necrosis factor-alpha (TNF-α) are key factors in MetS pathophysiology, but evidence for endorsing their clinical use is currently unclear and insufficient. Aim The study aimed to evaluate the association between the inflammatory biomarkers’ levels and the severity of MetS. Methods The study was observational, transversal, prospective, cohort, and analytical type. We enrolled 80 patients (M:F = 1, mean age = 55 ± 10.77 years) who met MetS criteria. The study protocol included: medical history, physical examination, 6-min walk test distance (6MWTD), biochemical tests, electrocardiogram, echocardiography, and carotid ultrasonography. We also performed plasmatic measurement of PTX-3, OPG, and TNF-α, in addition to standard biochemical tests. Results Subjects with severe MetS had higher values of body mass index (BMI) and waist circumference (p < 0.001, p = 0.001). PTX-3 levels were significantly higher in patients with severe MetS (p = 0.03) and the values were not influenced by age or gender. OPG positively correlated with BMI (r = 0.264, p = 0.018). 6MWTD was lower in patients with severe MetS (p = 0.005), whereas CCA-IMT was higher in this group of patients (p = 0.005). In addition, the receiver operating characteristic (ROC) curve analysis for PTX-3 identified a cut-off value of 10.7 ng/dl that differentiates between mild and severe MetS [AUC 0.656; sensitivity =47.1% (95% CI = 36.1%–62.3%); specificity = 78.9% (95% CI = 54.4%–93.9%)]. Conclusion PTX-3 was correlated with the severity of MetS, with other inflammatory parameters and cardiovascular tests. CCA-IMT and 6MWTD are useful in differentiating between mild and severe MetS.

Autonomic Testing

Autonomic testing is an important addition to neurological evaluations. While there are many excellent textbooks on autonomic disorders, only a few texts focus on how to perform and interpret autonomic tests. This manual fills the gap, dealing mainly with the practical aspects of autonomic testing. In accord with the maxim that “a good picture is worth a thousand words,” signal drawings are heavily used throughout the text to explain and illuminate test results. This book has two parts. The first part describes in detail the Brigham protocol of autonomic tests, which includes cardiovascular tests (deep breathing, Valsalva maneuver, tilt tests), sudomotor assessment (quantitative sudomotor axonal reflex test and electrochemical skin conductance), and skin biopsies for assessment of epidermal and sweat gland small fibers. The cardiovascular tests use heart rate, blood pressure, respiratory parameters (respiratory rate and end tidal CO2), and cerebral blood flow velocity. All tests are graded with an updated quantitative scale for cardiovascular reflex tests and transcranial Doppler—the Quantitative Sudomotor Axon Reflex Test (QASAT)—and small fiber (epidermal sensory and sweat gland) densities from skin biopsies. The second part of the book describes 100 cases covering a variety of autonomic disorders. The cases are thematically grouped into orthostatic intolerance syndromes (neurally mediated syncope, orthostatic hypotension, postural tachycardia syndrome, inappropriate sinus tachycardia, orthostatic cerebral hypoperfusion syndrome, hypocapnic cerebral hypoperfusion, and pseudosyncope), dysautonomia in neurodegenerative disorders, small fiber neuropathies (idiopathic, secondary, inflammatory), and autonomic overactivity. The case descriptions are presented in a consistent format featuring pertinent clinical information, autonomic tests results, interpretation of testing, conclusions, and recommendations. This text is intended to be a guide for autonomic fellows, and for residents in neurology, general medicine, and other specialties, and for anyone who is interested in performing and interpreting autonomic tests.

Risk factors cardiovascular autonomi c neuropathy in type 2 diabetes mellitus

Cardiac autonomic neuropathy (CAN) is one of the lifethreatening complications of diabetes mellitus (DM), increasing the mortality of patients with diabetes, cardiovascular morbidity and chronic kidney disease. The aim of this study was to investigate risk factors of CAN in patients with type 2 diabetes mellitus. Materials and methods. We examined 127 patients, 51 men and 76 women with type 2 DM. The diagnosis of CAN was performed by studying the heart rate variability (R-R intervals on the electrocardiogram) based on 5 cardiovascular tests for D. Ewing and the Poly-SpectrumRhythm.NET program module. The diagnosis of CAN was confirmed in patients who had 2 positive tests of 5 and a definite CAN — 3 and more positive of 5.The data analysis by SPSS statistical package version 23.0 for Windows. Results. CAN was diagnosed in 81,9% patients, definite CAN in 55,1% patients with type 2 DM. We found positive correlation between the definite CAN with glomerular filtration rate (OR=7,01, p<0,05) and body mass index (OR=1,69, p<0,05), negative correlation between the definite CAN with age (OR= -2,66, p<0,05), diabetes duration (OR= -2,59, p<0,05) and diastolic blood pressure (OR= -5,07, p<0,05). Conclusion. We found such risk factors for cardiovascular autonomic neuropathy in type 2 DM as age, duration of diabetes, BMI, GFR, DBP, therefore presence of diabetic nephropathy and arterial hypertension. These data can suggest the pathogenetic role of the impairment of autonomic nervous system and somatic nervous damage are different.