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Epidemiological studies indicate that skipping breakfast as a universal behavior, may have adverse effects on cardiovascular diseases [CVDs}and metabolic diseases. However, eating breakfast regularly, may increase satiety, thereby reducing overeating later in the day which prevents weight gain. Recent studies indicate that skipping breakfast increases the risk of obesity, metabolic syndrome, hypertension, hypercholesterolemia, type 2 diabetes mellitus (T2DM), coronary artery disease (CAD), and cardiovascular mortality as well as all-cause mortality. However, many studies also reported that regular taking of breakfast decreases the risk of CVDs and T2DM and all-cause mortality. Previous studies reported that heavy breakfast, in particular eating western diet may increase circadian rhythm of CVDs and sudden cardiac death. It seems that those who do not eat breakfast, they tend to eat refined and sweetened products, possibly, more in the night resulting in to greater risk of CVDs and T2DM. Breakfast skipping and eating in the night, may be associated with circadian misalignment in the central and peripheral clocks, leading to oxidative stress and inflammation. Increased systemic inflammation damages the adipocytes, beta cells of pancreas, endothelial cells and smooth muscle cells as well as neurons, which may produce dysfunction in these cells resulting in to related diseases. The beneficial effects of breakfast, may also be, at least in part, due to nutrient dense foods rather than time of eating. Eating regular breakfast, in particular rich in Indo-Mediterranean foods; vegetables, whole grains, fruits, spices and nuts may be protective against circadian increase in oxidative stress in the morning, resulting in to significant decline in the risk of CVDs and T2DM.

Prayer, meditation and mindfulness have been commonly used for healing in Vedic, Jainism, Buddhism, Egyptian, Greek and Mesopotemian cultures [1]. In Buddhism, mindfulness is a component of Eight Fold Path, therefore using mindfulness in the modern science is not absolutely correct. A definition of prayers of Mesopotamia was “praise to god followed by request.” The ancient mystic Hinduism wrote Rigveda prayer, Figure 1.\ud Meditation and prayer appear to be important practices for the management of emotional and spiritual wellbeing [1-4]. Prayer may also influence the physiology of circadian rhythms in our body and it has evolved possibly as adaptation to the rotation of the earth around its axis [4]. Circadian rhythms account for increased activity of the sympathetic nerves of the autonomic nervous system with marked releases of cortisol, catecholamines (norepinephrine and adrenaline), testosterone and thyroid hormones. In turn, these neurotransmitters and hormones occur at a circadian stage when endogenous melatonin level is decreased to low values in the morning [4]. There is a need to prevent the circadian rhythm of adverse biological functions observed between 6.00 to 12.00 hours during the day, because circadian dysfunction can predispose to cardiovascular diseases (CVDs). The circadian dysfunction may worsen due to risk factors, although protective factors such as prayer, meditation and moderate physical activity may prevent circadian dysfunction [2-4]. The aim of the present study is to emphasize the beneficial role of prayer, mindfulness and meditation in the protection against circadian dysregulation in the body, thereby preventing CVDs, especially sudden cardiac death (SCD).

Circadian rhythm of increased oxidative stress and deficiency of antioxidant vitamins is known to occur in the morning at 6.00 hours to 12.00 hours [1]. Apart from antioxidant and vitamin deficiency, there is also deficiency of catalase, super-oxide-dismutase (SDO) and glutathione peroxidase (GPO) due to increased requirement of antioxidant enzymes in the morning. Methylglyoxal (MGO) is a non-enzymatic metabolite in the glycolytic pathway and its concentration in blood and tissues is elevated in all the cardio-metabolic diseases, including obesity and diabetes mellitus (DM) [1, 2]. MGO is a reactive carbonyl species (RCS) and in turn it induces tissue injuries via reactive oxygen species (ROS), resulting in increased damage of target tissues, which may worsen in the morning. MGO also plays an important pathological role in the development of both cardiovascular diseases (CVDs) and diabetes via the AGEs exert irreversible effects on protein structure and function. As such, it is crucial to understand the underlying mechanism whereby MGO is inducing tissue damage. This mini-review aims to highlight the role of circadian dysfunction in the pathogenesis of diabetes mellitus and its complications.

Obesity has become a public global health problem. More than 13% of the world’s 7.8 billion people (11% of men and 15% of women) are obese, defined as having a body mass index above 30 kg/m2. In North America and several Middle Eastern Countries, more than 30% of adults are obese. The alarming problem is that children as young as twelve years of age are now becoming obese. Obesity with high-fat and high-sugar diets is a risk factor for type 2 diabetes mellitus (T2DM), hypertension and early-onset heart failure (HF) with preserved ejection fraction (HFpEF) that leads to frequent hospitalizations. It is possible that diet, inactivity and other modern lifestyle factors may have an important role in the development of heart failure, either with or without decrease in ejection fraction [1]. This mini review discusses whether circadian oscillations in metabolism and inflammation could be responsible for the time-of-day-dependence of adverse cardio-vascular events in patients with HFpEF by increasing production of cytotoxic a-dicarbonyl species methylglyoxal (MG) and by decreasing expression of the primary MG-degrading enzyme glyoxalase-1 (Glo1), respectively.

The coronavirus 2 (SARS‐CoV‐2) induces severe acute respiratory distress syndrome (ARDS)via the coronavirus receptor angiotensin‐converting enzyme 2 (ACE2) in the host cell to facilitate entry into the lungs Over activation of the renin‐angiotensin system (RAS) and the down regulation of ACE2 expression are involved in SARS‐CoV induced lung injury. RAS is the main system that has a regulatory roleinmaintaining electrolyte balance, blood pressure, vascular tone and cardiovascular remodeling in the body. Angiotensin II receptor blockers (ARBs) and Inhibitors (ACEIs) are vital medications that are widely used for the treatment of cardiovascular diseases (CVDs). The question which now arises is: It is possible to continue using either ARBs or ACEIsor both medications in patients with SARS-CoV2? Both ARBs and ACEIs can facilitate COVID-19 entry into the host cell due to increase expression of ACE2. On the other hand, ARBs have a greater potential to reduce downstream pathogenicity of the SARS-CoV2 via different cell signaling pathways including free radical generation, up regulation of NF-κB pathway, toll-like receptors (TLRs) and pro-apoptotic protein by blocking the renin–angiotensin system more severely compared to the effect of ACEIs. The current hypothesis is that ARBs can perform better therapeutically compared to ACEIs in respiratory disorders such as ARDS which is induced by viral infection especially since more than 40 % of angiotensin II can be synthesized by other enzymes such as chymase, cathepsin. ARBs treatment can increase the levels of both angiotensin II (Ang II) and the ACE2 enzyme making Ang II a target substrate for hydrolysis by ACE2 into Ang 1-7 which in turn exerts anti-inflammatory, anti-apoptotic and anti-oxidant activities. These effects are achieved by the binding of Ang 1-7 to both angiotensin-type 2 receptor (AT2) and receptor mas’ axis (Mas) and also by its ability to block Ang II/AT1 receptor-induced TLR4/MyD88 signaling thereby highlighting the potential therapeutic use of ARB sin preventing injury induced by COVID-19 virus. It is concluded that patients who are already on ARBs medications must continue to use them daily since ARBs have protective effects against COVID-19 virus. Moreover, ARB sexert their beneficial effects via their anti-inflammatory, anti-apoptotic, anti-oxidant and anti-fibrotic properties. On the other hand, those patients who are on ACEIs medications must change to other safe drugs since ACEIs can facilitate an increase in COVID-19 virus entry into the body as well as reducing levels and protecting effect of Ang 1-7.

Background. Obesity and type 2 diabetes mellitus (T2DM) are two interrelated and preventable disorders. However, they are responsible for significant global mortality from cardiovascular diseases (CVDs). Clinical studies have demonstrated that global longitudinal strain (GLS) using speckle tracking echocardiography (STE), can assess myocardial function accurately in apparently, healthy patients with diabetes and obesity in the settings of acute and chronic ischemia and suspected cardiomyopathy without heart failure. No such studies have been published to date regarding subclinical detection of cardiac dysfunction among obese patients with T2DM. This study aims to investigate the role of STE in the early pre-clinical diagnosis of impairment of diastolic and systolic dysfunction in obese patients with T2DM. This study also investigated whether it is possible to detect early pre-clinical impairment of diastolic and systolic dysfunction in obese T2DM patients, via Tissue Doppler Imaging (TDI), maximum rate of left ventricular pressure development (peak dP/dt) and GLS using STE for comparison.\ud Subjects and Methods. After clearance from the review board of Dibba- Hospital, Alfujairah, UAE, all the available records of patients with the diagnosis of obesity and diabetes were examined. The study included 214 patients presenting with obesity in conjunction with diabetes and 93 age-matched healthy control subjects. STE was performed among all the patients and subjects along with Tissue Doppler Imaging (TDI). This study assessed maximal rate of pressure rise during ventricular contraction (peak dP/dt) and global longitudinal strain (GLS) using STE methods. Transthoracic echocardiography, myocardial Doppler-derived systolic (sm), early diastolic velocity (em) and GLS were also obtained, among all the subjects.\ud Results. The results show that cardiac functions via conventional echocardiography (CE) were similar in the 2 groups. Using TDI and conventional mitral Doppler flow, obese subjects with diabetes showed an evidence of diastolic function abnormalities in the form of lower Ea velocity (9.5 ± 2.9 vs. 18.4 ± 3.5 cm/s, p < 0.0001), an increased Aa velocity (16.5 ± 2.4 vs. 14.1 ± 2.2 cm/s p < 0.05), higher left ventricular filling pressure (E/Ea = \ud 12 ± 4.4 vs 8±3.1), p < 0.05), as well as a reduced Ea/Aa ratio (1.00 ± 0.2 vs. 1.45 ± 0.3, p < 0.0001, in the study group versus control group. respectively. This study also showed that severely obese subjects (BMI >35) (n = 26) had reduced LV systolic and diastolic function compared with healthy controls. Regarding, systolic function indices, the findings revealed lower average longitudinal peak systolic strain, sm and reduced em, although, LV ejection fraction remained normal (56.48% ± 8.81). Among subjects with severe obesity (n = 26), the findings reveal that global longitudinal presystolic strain (GLPSS) is highly correlated with maximum rate of pressure development of LV (dp/dt), although the LVEF remained normal, in comparison to systolic strain and dp/dt. (.5% ±1.4 vs -19.54% ± 4.5; \ud p < 0.001), in the age-matched healthy subjects. However, the frequency/grade of DCM detected by STE, among patients having obesity with T2DM, correlated closely with the degree of obesity, metabolic abnormalities and clustering of other major risk factors, especially high blood pressure. The findings also revealed that chest pain due to coronary heart disease (CAD), dyspnea and DCM were more common among female patients compared to men.\ud Conclusion. The results indicate that patients having obesity with T2DM should be advised to undertake early TDI and STE for early diagnosis of decreased cardiac diastolic and systolic dysfunctions and cardiomyopathy, which is likely to be missed by conventional echocardiography. Significant differences in regional and global strain were also identified between the severely obese diabetic (BMI ≥ 35), (GLPSS (-13) patients compared to less obese subjects.

Hypertensive Cardiomyopathy (HTN-CM) is a structural cardiac disorder generally accompanied by concentric or eccentric Left Ventricular Hypertrophy (LVH) associated with diastolic or/and systolic dysfunction in patients with persistent systemic hypertension. It occurs in the absence of other cardiac diseases capable of causing myocardial hypertrophy or cardiac dysfunction. Long standing arterial hypertension (HTN) leads to structural and functional myocardial abnormalities resulting in myocardial ischemia, fibrosis, and hypertrophy. HTN-CM is predominantly a disease of impaired relaxation rather than impaired contractility, although subtle myocardial systolic abnormalities could be detected recently by Global Longitudinal Systolic Strain (GLS) Speckle Tracking Echocardiography (STE). Importantly, the accompanying LVH is itself a risk factor for mortality and morbidity and is considered an independent predictor for Sudden Cardiac Death (SCD). Therefore, early detection of LVH development in patients with Hypertensive Hypertrophic Cardiomyopathy (HTN-CM) is crucial for optimal treatment. In addition to pathological findings, echocardiography and cardiac magnetic resonance imaging are ideal tools for the diagnosis of HTN-CM and can differentiate it from Hypertrophic Cardiomyopathy (HCM). Timely diagnosis of this condition and utilization of appropriate treatment are required to improve morbidity and mortality in hypertensive patients. This review presents an overview of utilization of multidisciplinary imaging modalities approach for proper diagnosis of HTN-CM and its differentiation from HCM. Relevant article highlighted key points in differentiation of HTN-CM from HCM and the effects of hypertension on cardiac hypertrophy and heart failure development are discussed in clinical case study.

The disturbance of circadian variability helps predict, among others, the occurrence of cardiovascular diseases. Circadian Hyper Amplitude Tension (CHAT) is a psychosomatic disorder related to an inappropriate lifestyle (including unbalanced diet, stress-inducing environment/development) and genetic factors. Blood pressure and heart rate are phenotypes characterized by rhythmic fluctuations over time under influence of environmental/developmental (incl. psychosocial) and genetic conditions. These cardio-/cerebro-vascular fluctuations result from otherwise largely distributed internal biological rhythms regulated via complex and intertwined neuro-hormonal systems.The objective of this study was to identify a potential time-structure relationship between blood pressure/heart rate rhythmic fluctuations and nutritional/psychosocial conditions in a 43-year old woman exposed to new nutritional (omega-3 fatty acids supplementation) and psychosocial (divorce) factors.The study involved the use of a non-invasive device (ambulatory blood pressure monitor or ABPM, AD Ltd, Tokyo, Japan) for continuous (24/7) monitoring of heart functions and rhythms between October 2009 and March 2010, at 30-min intervals. As a result, 16 time-structure profiles (Sphygmochron) were obtained from Halberg Chronobiological Center (Minneapolis, MN, USA), each of them containing detailed analysis and interpretation of stacked data spanning 7-14 days. The study also involved a diary of daily nutritional (omega-3 fatty acids) / psychosocial (PANAS) events and their emotional and cognitive components.Both systolic (SBP) and diastolic blood pressure (DBP) steadily decreased during the time of the study. Three periods of elevated variability in SBP (diagnosed as CHAT) and one period of abnormally low DBP were recorded during the 6-month study at the time of negative affects (NA).A comparative analysis of diary records (omega-3 fatty acidsPANAS) and cardiovascular responses (Sphygmochron) showed that a person who is professionally and socially active in middle age can actively reduce her SBP/DBP with omega-3 fatty acids intervention. However, the person also displays disturbances in blood pressure variability predicted by the stress-strain hypothesis, whereby states of strain and relaxation are generated by the persons predetermined standards and objectives.

Paradoxical valvular aortic stenosis (VAS) is a challenging area of clinical cardiology for the practitioners. It involves a small aortic valve area, low flow rate and mean pressure gradient although there is normal left ventricular ejection fraction. The aim of this study was to assess left ventricular dysfunction in a symptomatic severe aortic valve stenosis which is of crucial importance in identifying patients at risk of heart failure, postoperative complications and increased mortality. There are new insights which are involved in assessment of LV myocardial function including global longitudinal strain (GLS), myocardial performance index (MPI) and maximum rate of LV pressure rise (+dP/dt) during isovolumetric contraction time of the ventricle. This information can provide both diagnostic and prognostic information in addition to standard echocardiographic and clinical parameters. However, a profound understanding of the complex interaction between loading conditions, chamber geometry and contractility is necessary for the correct interpretation of myocardial deformation in order to draw appropriate conclusions in patients with aortic valve disease. This mini review is related to new and novel insights into the assessment of left ventricular function (LVF) in paradoxical low flow aortic stenosis patients with normal left ventricular ejection fraction (LVEF).

Obesity is a major risk factor for diabetes mellitus (DM), which is a major global metabolic health disorder currently affecting over 460 million people and this number is rising rapidly. Heart failure (HF) is the major cause of death among diabetic patients. The disorder is due to elevated blood glucose or hyperglycemia (HG) beyond physiological level, which in turn leads to a number of long-term or end-organ complications over time and over 80% of all diabetics will eventually die from either HF or cardiomyopathy if left untreated. Treatment of DM is very costly and as such, patients turn to non-pharmacological or alternative forms of treatment, including weight loss, diet modifications and plant-based medicines, which are more cost-effective. There are several medicinal plants, which are currently used to treat for DM and they are known to exhibit anti-diabetic properties. One such plant is Momordica charantia, or bitter melon, which is used in many tropical countries as a traditional functional food and medicine, especially for the treatment of obesity, DM, hypertension and cancer. This review is related to the anti-oxidant beneficial effect of Momordica charantia in the treatment of diabetic cardiomyopathy (DCM). The beneficial effects of Momordica charantia in the treatment of obesity, diabetes and cardiovascular diseases (CVDs) have been reported in clinical and experimental animal studies and this review addresses some of these useful effects. However, the cellular and molecular mechanisms underlying its therapeutic antidiabetic effects of M charantia via its anti-oxidant activities are not fully known and further research studies need to be done.