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Contains fulltext : 283453.pdf (Publisher’s version ) (Closed access) Cardiovascular (CV) disease (CVD) remains the leading cause of major morbidity and CVD- and all-cause mortality in most of the world. It is now clear that regular physical activity (PA) and exercise training (ET) induces a wide range of direct and indirect physiologic adaptations and pleiotropic benefits for human general and CV health. Generally, higher levels of PA, ET, and cardiorespiratory fitness (CRF) are correlated with reduced risk of CVD, including myocardial infarction, CVD-related death, and all-cause mortality. Although exact details regarding the ideal doses of ET, including resistance and, especially, aerobic ET, as well as the potential adverse effects of extreme levels of ET, continue to be investigated, there is no question that most of the world's population have insufficient levels of PA/ET, and many also have lower than ideal levels of CRF. Therefore, assessment and promotion of PA, ET, and efforts to improve levels of CRF should be integrated into all health professionals' practices worldwide. In this state-of-the-art review, we discuss the exercise effects on many areas related to CVD, from basic aspects to clinical practice.

Background: Both cardiopulmonary exercise testing (CPET) and run field test are recommended by the American Heart Association for assessing maximal oxygen uptake (VO 2 max) of youth. Power output was highly correlated with VO 2 max in a CPET. However, it is unclear the correlations of time and estimated power output (EPO) for a run field test with VO 2 max obtained from a CPET in young adults. Methods: This study included 45 participants, aged 20-40 years, from a sample of 1,120 military personnel who completed a 3000-m run field test in Taiwan in 2020. The participants subsequently received a CPET with the Bruce protocol to assess VO 2 max in the same year. According to the physics rule, EPO (watts) for the run field test was defined as a product of half body mass (kg) and [distance (3000-m)/time (s) for a run field test] 2 . Pearson product-moment correlation analyses were performed. Results: The Pearson correlation coefficient (r) of time against EPO for the run field test was estimated 0.708 (p 2 max (L/min) in a CPET was estimated 0.462 (p =0.001). By contrast, the correlation coefficient between time for the run field test and VO 2 max scaled to body mass in a CPET was estimated 0.729 (p 2 max in a CPET was estimated 0.813 (p Conclusion: In young adults, although time for a run field test was a reliable estimate of VO 2 max scaled to body mass, EPO proportionally to the mean velocity squared was found as a superior estimate of VO 2 max.

Stress cardiomyopathy was noted to occur at a higher incidence during coronavirus disease of 2019 (COVID-19) pandemic. This database analysis has been done to compare the in-hospital outcomes in patients with stress cardiomyopathy and concurrent COVID-19 infection with those without COVID-19 infection. The National Inpatient Sample database for the year 2020 was queried to identify all admissions diagnosed with stress cardiomyopathy. These patients were then stratified based on whether they had concomitant COVID-19 infection or not. A 1:1 propensity score matching was performed. Multivariate logistic regression analysis was done to identify predictors of mortality. We identified 41,290 hospitalizations for stress cardiomyopathy, including 1665 patients with concurrent diagnosis of COVID-19. The female preponderance was significantly lower in patients with stress cardiomyopathy and COVID-19. Patients with concomitant COVID-19 were more likely to be African American, diabetic and have chronic kidney disease. After propensity matching, the incidence of complications, including acute kidney injury (AKI), AKI requiring dialysis, coagulopathy, sepsis, cardiogenic shock, cases with prolonged intubation of >24 h, requirement of vasopressor and inpatient mortality, were noted to be significantly higher in patients with COVID-19. Concomitant COVID-19 infection was independently associated with worse outcomes and increased mortality in patients hospitalized with stress cardiomyopathy.

Atrial fibrillation (AF) is the most common clinically significant arrhythmia, and it increases stroke risk. A preventive approach to AF is needed because virtually all treatments such as cardioversion, antiarrhythmic drugs, ablation, and anticoagulation are associated with high cost and carry significant risk. A systematic review was performed to identify effective lifestyle-based strategies for reducing primary and secondary AF. A PubMed search was performed using articles up to March 1, 2021. Search terms included atrial fibrillation, atrial flutter, exercise, diet, metabolic syndrome, type 2 diabetes mellitus, obesity, hypertension, stress, tobacco smoking, alcohol, Mediterranean diet, sodium, and omega-3 fatty acids. Additional articles were identified from the bibliographies of retrieved articles. The control of hypertension, ideally with a renin-angiotensin-aldosterone system inhibitor, is effective for preventing primary AF and recurrence. Obstructive sleep apnea is a common cause of AF, and treating it effectively reduces AF episodes. Alcohol increases the risk of AF in a dose-dependent manner, and abstinence reduces risk of recurrence. Sedentary behavior and chronic high-intensity endurance exercise are both risk factors for AF; however, moderate physical activity is associated with lower risk of AF. Recently, sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 agonists have been associated with reduced risk of AF. Among overweight/obese patients, weight loss of ≥10% is associated with reduced AF risk. Lifestyle changes and risk factor modification are highly effective for preventing AF.

Background: Cardiorespiratory fitness (CRF) is a predictor of chronic disease that is impractical to routinely measure in primary care settings. We used a new estimated cardiorespiratory fitness (eCRF) algorithm that uses information routinely documented in electronic health care records to predict abnormal blood glucose incidence. Methods: Participants were adults (17.8% female) 20–81 years old at baseline from the Aerobics Center Longitudinal Study between 1979 and 2006. eCRF was based on sex, age, body mass index, resting heart rate, resting blood pressure, and smoking status. CRF was measured by maximal treadmill testing. Cox proportional hazards regression models were established using eCRF and CRF as independent variables predicting the abnormal blood glucose incidence while adjusting for covariates (age, sex, exam year, waist girth, heavy drinking, smoking, and family history of diabetes mellitus and lipids). Results: Of 8602 participants at risk at baseline, 3580 (41.6%) developed abnormal blood glucose during an average of 4.9 years follow-up. The average eCRF of 12.03 ± 1.75 METs was equivalent to the CRF of 12.15 ± 2.40 METs within the 10% equivalence limit. In fully adjusted models, the estimated risks were the same (HRs = 0.96), eCRF (95% CIs = 0.93−0.99), and CRF (95% CI of 0.94−0.98). Each 1-MET increase was associated with a 4% reduced risk. Conclusions: Higher eCRF is associated with a lower risk of abnormal glucose. eCRF can be a vital sign used for research and prevention.

The prevalence of obesity has reached pandemic proportions worldwide and certainly in the United States. Obesity is a well-established independent risk factor for development of many cardiovascular diseases (CVD), including heart failure, coronary heart disease, atrial fibrillation, and hypertension. Therefore, it is logical to expect obesity would have a strong correlation with CVD mortality. However, a substantial body of literature demonstrates a paradox with improved prognosis of overweight and obese patients with established CVD compared to lean patients with the identical CVD. Surprisingly, similar data has also shown that cardiovascular fitness, rather than weight loss alone, influences the relationship between obesity and mortality in those with established CVD. The impact of fitness, exercise, physical activity (PA), and weight loss and their relationship to the obesity paradox are all reviewed here.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus causing coronavirus disease 2019 (COVID-19), has affected human lives across the globe. On 11 December 2020, the US FDA granted an emergency use authorization for the first COVID-19 vaccine, and vaccines are now widely available. Undoubtedly, the emergence of these vaccines has led to substantial relief, helping alleviate the fear and anxiety around the COVID-19 illness for both the general public and clinicians. However, recent cases of vaccine complications, including myopericarditis, have been reported after administration of COVID-19 vaccines. This article discusses the cases, possible pathogenesis of myopericarditis, and treatment of the condition. Most cases were mild and should not yet change vaccine policies, although prospective studies are needed to better assess the risk-benefit ratios in different groups.

The purpose of this paper is to put forward some evidence-based lessons that can be learned from how to respond to a Pandemic that relate to healthy living behaviours (HLB). A 4-step methodology was followed to conduct a narrative review of the literature and to present a professional practice vignette. The narrative review identified 8 lessons: 1) peer review; 2) historical perspectives; 3) investing in resilience and protection; 4) unintended consequences; 5) protecting physical activity; 6) school closures; 7) mental health; and 8) obesity. As in all probability there will be another Pandemic, it is important that the lessons learned over the last three years in relation to HLB are acted upon. Whilst there will not always be a consensus on what to emphasise, it is important that many evidence-based positions are presented. The authors of this paper recognise that this work is a starting point and that the lessons presented here will need to be revisited as new evidence becomes available.

Twenty percent of deaths in the United States are secondary to cardiovascular diseases (CVD). In patients with hyperlipidemia and hypertriglyceridemia, studies have shown high atherosclerotic CVD (ASCVD) event rates despite the use of statins. Given the association of high triglyceride (TG) levels with elevated cholesterol and low levels of high-density lipoprotein cholesterol, the American Heart Association (AHA)/American College of Cardiology (ACC) cholesterol guidelines recommend using elevated TGs as a “risk-enhancing factor” for ASCVD and using omega 3 fatty acids (Ω3FAs) for patients with persistently elevated severe hypertriglyceridemia. Ω3FA, or fish oils (FOs), have been shown to reduce very high TG levels, hospitalizations, and CVD mortality in randomized controlled trials (RCTs). We have published the largest meta-analysis to date demonstrating significant effects on several CVD outcomes, especially fatal myocardial infarctions (MIs) and total MIs. Despite the most intensive research on Ω3FAs on CVD, their benefits have been demonstrated to cluster across multiple systems and pathologies, including autoimmune diseases, infectious diseases, chronic kidney disease, central nervous system diseases, and, most recently, the COVID-19 pandemic. A review and summary of the controversies surrounding Ω3FAs, some of the latest evidence-based findings, and the current and most updated recommendations on Ω3FAs are presented in this paper.

One of the major concerns in global health is the deteriorating control of dyslipidemia (DLD), which is a very strong modifiable risk factor for untoward cardiovascular disease (CVD) outcomes. It serves as a foundation for atherosclerotic lesions that can be destabilized by co-inflammatory processes leading to distal clot migration and other related CVD events. There are many misconceptions regarding the management of DLD. Many health sectors advocate for weight loss without a clear-cut target to achieve better CVD outcomes. There is growing evidence that exercise training compliance regardless of weight change is a more reliable indicator of favorable outcomes. This review is intended to understand the relationship between exercise training, lipoprotein readings, and with CVD and all-cause morbidity and mortality.Aerobic exercise training (aET) and resistance exercise training (rET) increase cardiorespiratory fitness (CRF) and muscular strength (MusS), respectively. Regardless of weight loss, aET and rET are both known to independently reduce mortality possibly partly through improvement of lipid profiles. Of the two modes of exercise, rET has propensity for enhanced compliance because of its significant lipid and mortality-attenuating effect even with just brief exercise sessions. However, there are several studies showing that participation in both modes of exercise causes more pronounced improvements in DLD and CVD-related mortality compared with either mode of exercise training alone. In addition, Lipoprotein-a [Lp(a)] has been increasingly acknowledged to be atherogenic because of its LDL core. The close proximity of Lp(a) with macrophages triggers the development of atheromas, plaque formation, and growth. This causes a cascade of inflammatory processes that increase the development of ischemic CVD and calcific aortic valve stenosis. Although exercise training is known to reduce plasma LDL-C levels, it has no direct effect on Lp(a) levels as the latter lipoprotein is not influenced by motion nor exercise. Reviews of multiple studies lead us to infer that exercise training may potentially have an indirect impact on Lp(a) attenuation because of the ability of exercise training to inhibit Proprotein Convertase Subtisilin/Kexin type-9 (PCSK-9), as some studies using pharmacologic therapy with PCSK-9 inhibitors were able to show a concomitant decrease in Lp(a) levels.It is clear that normal-to-overweight populations who are highly active have better CVD outcomes and lipid profiles than their sedentary counterparts, and those who were underweight and unfit fared much worse. This allows us to take a more precise approach in the management of DLD rather than plainly focusing on gross weight in patients. Exercise training certainly has beneficial impact on longevity owing to its advantageous effect on lipoprotein levels and particle size. As such, reputable health societies, such as the ESC, ACC, and AHA have prescribed the ideal exercise training regimen, which have noticeable similarities. Increasing the use of wearable devices may help improve our ability to prescribe, quantify, and precisely track physical activity in our continuing efforts to combat increasing morbidity related to unhealthy lifestyles and inactivity.

Background: The optimal antithrombotic (antiplatelet or anticoagulant) treatment of patients undergoing extracranial carotid artery interventions is a subject of debate. The aim of this multidisciplinary document was to critically review the recommendations of current guidelines, taking into consideration the results of recently published studies. Methods: The various antithrombotic strategies reported were evaluated for asymptomatic and symptomatic patients undergoing extracranial carotid artery interventions (endarterectomy, transfemoral carotid artery stenting [CAS] or transcarotid artery revascularization [TCAR]). Based on a critical review, a series of recommendations were formulated by an international expert panel. Results: For asymptomatic patients, we recommend low-dose aspirin (75–100 mg/day) or clopidogrel (75 mg/day) with the primary goal to reduce the risk of myocardial infarction and cardiovascular event rates rather than to reduce the risk of stroke. For symptomatic patients, we recommend dual antiplatelet treatment (DAPT) initiated within 24 h of the index event to reduce the risk of recurrent events. We suggest that following transfemoral CAS or TCAR, patients continue DAPT for 1 month after which a single antiplatelet agent is used. High level of evidence to support anticoagulant treatment for patients with carotid artery disease is lacking. Conclusions: The antithrombotic treatment offered to carotid patients should be individualized, taking into account the presence of symptoms, the type of intervention and the goal of the treatment. The duration and type of DAPT (ticagrelor instead of clopidogrel) should be evaluated in future trials.

Cardiorespiratory fitness (CRF) has been proposed as a vital sign for the past several years, supported by a wealth of evidence demonstrating its significance as a predictor of health trajectory, exercise/functional capacity, and the quality of life. According to the Fick equation, oxygen consumption (VO

Many occupations can influence the development of metabolic syndrome (MetS). This systematic review aims to evaluate studies on MetS prevalence in different occupational groups from different countries. An integrative review of the literature was conducted within the PubMed and Web of Science databases between January 2005 and February 2022. Only studies with over 3000 subjects that presented data about the prevalence of MetS in different occupational groups were included. The classification of occupational groups was based on the statistical category of economic activities in the European Community (EC). Of a total of 1942 screened records, ten studies were included, showing that MetS is a common health (main) risk factor in all occupational groups. However, the prevalence of MetS varies between nationalities, between and within occupational groups, and between genders. The reasons for this variation appear complex and supported by several causal explanations. The prevalence of MetS was highest among women in a group of Korean skilled agricultural, forestry, and fishery workers (Prevalence: 39.2%). Similarly, among men, the highest prevalence was found in Korean equipment, machine operating, and assembling workers (Prevalence: 35.4%). Male information and communication technology professionals from the Netherlands (Prevalence: 6.2%) and Spanish female catering and hospitality, personal, and security service workers (Prevalence: 5.9%) had the lowest rates of MetS. Overall, the results indicated that valid data on this topic are insufficient, and more randomized controlled trials are needed. Moreover, the different definitions of MetS complicate the accurate comparison between studies, paving the way to achieving consensus on a universal definition of MetS.

Sugar-sweetened and artificially sweetened beverages are routinely consumed worldwide. Given their popularity, there has been much debate about the effect that these beverages have on cardiovascular health. We sought to determine the exact relationship between sugar-sweetened and artificially sweetened beverages consumption on cardiovascular health.All studies that reported an association between sugar-sweetened/artificially sweetened beverages consumption and cardiovascular health were extracted from database inception to September 2022 using keywords from several databases. We used the DerSimonianLaird random-effects method for the analysis.Of the total 16 prospective studies, 1,405,375 individuals were followed for a median follow-up of 14.8 years. Compared with low sugar-sweetened and artificially sweetened beverage consumption, a higher consumption of sugar-sweetened and artificially sweetened beverages was associated with greater cardiovascular outcomes (hazard ratio [HR] of 1.27, 95% confidence interval [CI] of 1.16-1.40 and risk ratios of 1.16, 95% CI of 1.02-1.33). Similarly, compared with low artificially sweetened beverages consumption, a higher consumption of artificially sweetened beverages was associated with greater cardiovascular outcomes (HR of 1.32, 95% CI of 1.12-1.57). Likewise, compared with low sugar-sweetened beverages consumption, a higher consumption of sugar-sweetened beverages was associated with greater cardiovascular outcomes (HR of 1.21, 95% CI of 1.07-1.37 and risk ratios of 1.22, 95% CI of 1.09-1.35).Increasing consumption of sugar-sweetened and artificially sweetened beverages may be correlated with an increased risk of developing cardiovascular/vascular complications and mortality, albeit without causality of cardiovascular/vascular morbidity.

Background: Greater muscular strength (MusS) has been found to have an inverse association with subclinical atherosclerosis in children, as well as with mortality from cardiovascular diseases (CVDs) in middle-aged and elderly individuals. However, the association of the degree of MusS with atherosclerosis may differ by sex and has not been clarified in young adults. Methods and Results: A total of 1021 Taiwanese military personnel, aged 18–40 years, participated in annual health examinations in 2018–2020. MusS was separately assessed by 2-min push-up and 2-min sit-up numbers. Subclinical atherosclerosis was measured by the left carotid bulb intima–media thickness (cIMT) using high-resolution ultrasonography. Multiple linear regression with adjustments for age, sex, alcohol intake, cigarette smoking, anthropometric indices, blood pressure, and lipid profiles was utilized to determine the correlation between MusS and cIMT. Both 2-min push-up and 2-min sit-up numbers were inversely correlated with cIMT (standardized β: −0.089 and −0.072, respectively; both p-values < 0.05). In men, both 2-min push-up and 2-min sit-up numbers were inversely correlated with cIMT (standardized β: −0.076 and −0.086, respectively; both p-values < 0.05), while in women, 2-min push-up numbers but not 2-min sit-up numbers were inversely correlated with cIMT (standardized β: −0.204 and −0.01; p = 0.03 and 0.99, respectively). Conclusions: Among young adults, there was an inverse association between MusS and cIMT, emphasizing the beneficial impact of MusS on the regression of atherosclerosis. The study also revealed a sex difference and suggested that training of the upper arm muscles may be an effective preventive measure for young women to reduce the risk of early cardiovascular diseases.

Identifying Asian subgroups with higher risk of premature coronary heart disease (CHD) can help implement targeted strategies to prevent future CHD events. We conducted this National Health Interview Survey study from 2006 to 2015 among participants with history of CHD to compare the risk of premature CHD (65 for women and55 years old for men) across Whites, Chinese, Asian Indians, Filipinos, and "other Asians" (Japanese, Korean, and Vietnamese individuals) using univariate and multi-variable logistic regression models. A total of 17,266 participants with history of CHD (mean age, 66.0 ± 0.2; 39% women) were included. Risk of premature CHD was higher among Asian Indians (OR = 1.77, 1.05-2.97) and "other Asians" (OR = 1.68, 1.17-2.42) than Whites adults. Compared with Chinese, the risk of premature CHD was significantly higher for Asian Indians in the unadjusted models (OR = 2.72, 1.19-6.3). "Other Asians" exhibited significantly higher risk in crude (OR = 2.88, 1.32-6.27) and adjusted models (aOR = 2.29, 1.01-5.18). Among younger adults (50 years) with CHD, Asian Indian adults (aOR = 2.43, 1.26-4.70) and other Asian adults (aOR = 1.86, 1.14-3.02) showed higher odds of premature CHD compared with White adults. The risk of premature CHD varies across Asian populations. More studies with an adequate sampling of Asian subgroups are needed to identify the risk and determinants of premature CHD.

Intermittent fasting (IF) has recently gained popularity, and has been used for centuries in many religious practices. The Ramadan fasting is a mandatory form of IF practiced by millions of healthy adult Muslims globally for a whole lunar month every year. In Islam, the “Sunna” also encourages Muslims to practice IF all along the year (e.g.;two days a week). The 2019-Coronavirus disease (COVID-19) pandemic in the context of Ramadan has raised the question whether fasting is safe practice during the COVID-19 pandemic health crisis, and what would be the healthy lifestyle behaviors while fasting that would minimize the risk of infection. As COVID-19 lacks a specific therapy, IF and physical activity could help promote human immunity and be part of holistic preventive strategy against COVID-19. In this commentary, the authors focus on this dilemma and provide recommendations to the fasting communities for safely practicing physical activity in time of COVID-19 pandemic. © 2021 Institute of Sport. All rights reserved.

Item does not contain fulltext PURPOSE: To examine the associations of total steps/day and faster aerobic steps/day (≥60 steps/min) with the development of frailty in older adults with hypertension (HTN) using a two-phased cross-sectional and prospective approach. METHODS: The sample consisted of 427 older adults with HTN from the Physical Activity and Aging Study (PAAS), aged ≥65 years, with valid step data from an accelerometer-based pedometer. Participants were classified into tertiles of total steps/day (low, mid, high) and three categories of aerobic steps/day (none, low, high). Frailty was defined using a modified Fried score with 5 subdomains including shrinking, weakness, slowness, low physical activity (PA), and exhaustion. RESULTS: We observed a negative dose-response relationship across categories of total steps/day and aerobic steps/day for the prevalence of frailty and the subdomains of slowness, low PA, and exhaustion (all p for trends

Background Current evidence from randomized controlled trials on statins for primary prevention of cardiovascular disease (CVD) in older people, especially those aged > 75 years, is still lacking. We conducted a systematic review and meta-analysis of observational studies to extend the current evidence about the association of statin use in older people primary prevention group with risk of CVD and mortality. Methods PubMed, Scopus, and Embase were searched from inception until March 18, 2021. We included observational studies (cohort or nested case-control) that compared statin use vs non-use for primary prevention of CVD in older people aged ≥ 65 years; provided that each of them reported the risk estimate on at least one of the following primary outcomes: all cause-mortality, CVD death, myocardial infarction (MI), and stroke. Risk estimates of each relevant outcome were pooled as a hazard ratio (HR) with a 95% confidence interval (CI) using the random-effects meta-analysis model. The quality of the evidence was rated using the GRADE approach. Results Ten observational studies (9 cohorts and one case-control study; n = 815,667) fulfilled our criteria. The overall combined estimate suggested that statin therapy was associated with a significantly lower risk of all-cause mortality (HR: 0.86 [95% CI 0.79 to 0.93]), CVD death (HR: 0.80 [95% CI 0.78 to 0.81]), and stroke (HR: 0.85 [95% CI 0.76 to 0.94]) and a non-significant association with risk of MI (HR 0.74 [95% CI 0.53 to 1.02]). The beneficial association of statins with the risk of all-cause mortality remained significant even at higher ages (> 75 years old; HR 0.88 [95% CI 0.81 to 0.96]) and in both men (HR: 0.75 [95% CI: 0.74 to 0.76]) and women (HR 0.85 [95% CI 0.72 to 0.99]). However, this association with the risk of all-cause mortality remained significant only in those with diabetes mellitus (DM) (HR 0.82 [95% CI 0.68 to 0.98]) but not in those without DM. The level of evidence of all the primary outcomes was rated as “very low.” Conclusions Statin therapy in older people (aged ≥ 65 years) without CVD was associated with a 14%, 20%, and 15% lower risk of all-cause mortality, CVD death, and stroke, respectively. The beneficial association with the risk of all-cause mortality remained significant even at higher ages (> 75 years old), in both men and women, and in individuals with DM, but not in those without DM. These observational findings support the need for trials to test the benefits of statins in those above 75 years of age.

The United States Preventive Services Taskforce (USPSTF) recently released recommendations for statin therapy eligibility for the primary prevention of cardiovascular disease (CVD). We report the proportion and the absolute number of US adults who would be eligible for statin therapy under these recommendations and compare them with the previously published 2018 American Heart Association (AHA)/ American College of Cardiology (ACC)/ Multisociety (MS) Cholesterol guidelines.We used data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 of adults aged 40-75 years without prevalent self-reported atherosclerotic CVD (ASCVD) and low-density lipoprotein-cholesterol190 mg/dL. The 2022 USPSTF recommends statin therapy for primary prevention in those with a 10-year ASCVD risk of ≥10% and ≥ 1 CVD risk factor (diabetes mellitus, dyslipidemia, hypertension, or smoking). The 2018 AHA/ ACC/ MS Cholesterol guideline recommends considering statin therapy for primary prevention for those with diabetes mellitus, or 10-year ASCVD risk ≥20% or 10-year ASCVD risk 7.5 to20% after accounting for risk-enhancers and shared decision making. Survey recommended weights were used to project these proportions to national estimates.Among 1799 participants eligible for this study, the weighted mean age was 56.0 ± 0.5 years, with 53.0% women (95% confidence interval [CI] 49.7, 56.3), and 10.6% self-reported NH Black individuals (95% CI 7.7, 14.3). The weighted mean 10-year ASCVD risk was 9.6 ± 0.3%. The 2022 USPSTF recommendations and the 2018 AHA/ ACC/ MS Cholesterol guidelines indicated eligibility for statin therapy in 31.8% (95% CI 28.6, 35.1) and 46.8% (95% CI 43.0, 50.5) adults, respectively. These represent 33.7 million (95% CI 30.4, 37.2) and 49.7 million (95% CI 45.7, 53.7) adults, respectively. For those with diabetes mellitus, 2022 USPSTF recommended statin therapy in 63.0% (95% CI 52.1, 72.7) adults as compared with all adults with diabetes aged 40-75 years under the 2018 AHA/ ACC/ MS Cholesterol guidelines.In this analysis of the nationally representative US population from 2017 to 2020, approximately 15% (~16.0 million) fewer adults were eligible for statin therapy for primary prevention under the 2022 USPSTF recommendations as compared to the 2018 AHA/ ACC/ MS Cholesterol guideline.

A growing body of evidence suggests that diabetes mellitus (DM) is associated with an increased risk of new-onset atrial fibrillation (AF) and contributes to suboptimal arrhythmia control and poor prognosis in patients with AF. The high prevalence of AF among patients with DM is primarily attributed to common risk factors, shared pathophysiological mechanisms, and associated atrial remodeling and autonomic dysfunction.This comprehensive review covers the current data on the role of DM in the development and prognosis of AF. In addition, we review the impact of anti-DM medications on AF prevention and the role of anticoagulation in patients with coexisting DM and AF.DM is independently associated with new-onset AF, and the coexistence of these two conditions contributes to poor outcomes, from reduced quality of life to increased risks of thromboembolic events, heart failure, and mortality. Despite this strong link, the current evidence is insufficient to recommend routine screening for AF in patients with DM. Although some observations exist on preventing AF with anti-DM medications, randomized controlled trials are warranted to explore the proposed benefits of novel anti-DM medicines in reducing the risk of incident AF.

Background Poor oral health evaluated by presence of dental calculus has been associated with hypertension (HTN) among middle- and old-aged adults. However, it is unclear for the association of HTN phenotypes with dental calculus in young adults. Methods This study examined the association between dental calculus and HTN in 5,345 military personnel, aged 19–45 years, without antihypertensive medications therapy in Taiwan from 2018 to 2021. Dental calculus was defined as presence of supragingival calculus in any teeth, except impacted teeth, and third molar. Combined HTN (CHTN) was diagnosed as systolic blood pressure (SBP) ≥130 mm Hg and diastolic blood pressure (DBP) ≥80 mm Hg. Isolated systolic and diastolic HTN were, respectively, defined as SBP ≥130 mm Hg only (ISHTN) and DBP ≥80 mm Hg only (IDHTN). Multiple logistic regression with adjustments for sex, age, toxic substance use, anthropometrics, lipid profiles, fasting glucose, and blood leukocyte counts were used to determine the association between dental calculus and HTN phenotypes in young adults. Results The prevalence of those with dental calculus, CHTN, ISHTN, and IDHTN was 20.8%, 10.8%, 10.2%, and 7.0%, respectively. The dental calculus was associated a greater possibility with CHTN [odds ratio (OR) and 95% confidence interval: 1.60 (1.31–1.95)]. However, the associations of dental calculus with ISHTN and IDHTN were null [OR: 1.05 (0.81–1.27) and 1.12 (0.86–1.46), respectively]. Conclusions Our findings suggest that among young adults, poor oral health manifested by presence of dental calculus was associated with a greater possibility of CHTN, while not for ISHTN and IDHTN.

Emerging data showed patients with chronic inflammatory disorders, including inflammatory bowel disease, are more likely to develop atherosclerotic cardiovascular diseases, heart failure, and atrial fibrillation. This article aims to review the evidence of those associations.PubMed was searched from inception to January 2022 using the keywords, including inflammatory bowel diseases, Crohn disease, ulcerative colitis, atherosclerotic cardiovascular disease, coronary artery disease, cardiovascular disease, atrial fibrillation, heart failure, and premature coronary artery disease. Relevant literature, including retrospective/prospective cohort studies, clinical trials, meta-analyses, and guidelines, were reviewed and summarized.Both ulcerative colitis and Crohn disease are associated with an increased risk of atherosclerotic cardiovascular diseases, cerebrovascular accidents, premature coronary artery disease, and atrial fibrillation. Ulcerative colitis is associated with an increased risk of heart failure. The increased atrial fibrillation occurred during inflammatory bowel disease flares and persistent activity but not during periods of remission. Hypotheses for the mechanism underlying the association of inflammatory bowel disease and atherosclerotic cardiovascular diseases include shared risk factors (ie, obesity, diabetes, smoking, diet) and pathophysiology (gut microbiome dysfunction) or adverse effects from inflammatory bowel disease itself or its treatment (ie, chronic inflammation, dyslipidemia, thrombocytosis, steroids).Inflammatory bowel disease is associated with an increased risk of atherosclerotic cardiovascular diseases, heart failure, and atrial fibrillation. A multidisciplinary team with gastroenterologists and cardiologists is needed to optimize the care for patients with inflammatory bowel disease and associated cardiac diseases.

Background: Whether higher cardiorespiratory fitness (CRF) confers protection against cardiovascular disease (CVD) in individuals with manifest hypercholesterolemia is poorly understood. Methods: Participants were 8920 men aged 20–82 years with hypercholesterolemia but no history of CVD and/or cancer and who received a preventive examination at the Cooper Clinic in Dallas, TX, USA, during 1974–2001. CRF was quantified as maximal treadmill test duration and was grouped for analysis as low, moderate, or high based on the traditional Aerobics Center Longitudinal Study cutpoints. Using Cox regression analyses, we computed hazard ratios and 95% confidence intervals for risk of mortality based on CRF. Results: During an average of 17 years of follow-up, 329 CVD and 290 cancer deaths occurred. After control for baseline age, examination year, body mass index, total cholesterol, smoking, alcohol intake, physical activity, hypertension, diabetes, and parental history of CVD, hazard ratios (95% confidence interval) for CVD deaths across moderate and high categories of CRF (with low fit as referent) were: 0.66 (0.50–0.87) and 0.55 (0.39–0.79), respectively. There was an inverse association between CRF and CVD death among normal-weight (trend p < 0.0001), younger (

Background: The relationship of cardiorespiratory fitness (CRF) with subclinical atherosclerosis affected by the body adiposity has been observed in children, whereas this relationship remains unclear in young adults. Methods and Results: A total of 1520 military recruits, aged 18–40 years, were included in Taiwan in 2018–2020. All subjects underwent detailed physical and blood laboratory examinations. CRF was evaluated by time for a 3000 m run, and subclinical atherosclerosis was evaluated by intima–media thickness of the bulb of the left common carotid artery (cIMT) utilizing high-resolution ultrasonography. Multivariable linear regression analysis with adjustments for age, sex, cigarette smoking, alcohol intake, systolic and diastolic blood pressure, high- and low-density lipoprotein cholesterols, fasting glucose, waist circumference, serum uric acid and serum triglycerides were utilized to determine the correlation between CRF and cIMT. CRF was independently correlated with cIMT (standardized β: 0.11, p < 0.001). Of the cardiometabolic risk markers, serum triglycerides were the only independent risk marker of cIMT (standardized β: 0.063, p = 0.03). In addition, the association of CRF with cIMT did not differ between those with a body mass index (BMI) ≥ 25 kg/m2 and those with BMI < 25 kg/m2 (standardized β: 0.103 and 0.117; p = 0.01 and 0.005, respectively). Conclusions: In physically active young men and women, there was an inverse association of cIMT with CRF, which was observed in both overweight/mild obesity and normal-weight individuals, highlighting the importance of endurance capacity on reducing risk of early atherosclerosis and implying that the moderation effect of body adiposity might not be present in this population.

PURPOSE OF REVIEW: In this article, we review the most current evidence for initiation and maintenance of various antihypertension (HTN) drug classes, including other misconceptions with respect to common comorbidities in patients with HTN. RECENT FINDINGS: Although the currently available anti-HTN agents have broad applicability in treating HTN, additional agents, such as angiotensin receptor-neprilysin inhibitors and novel nonsteroidal mineralocorticoid antagonists, have recently gained clinical significance. In addition, there have been some anecdotal concerns regarding the adverse effects, indications, and risks of COVID-19 infection/mortality when using certain anti-HTN agents. SUMMARY: Current guidelines currently address the treatment of primary HTN. However, isolated HTN is uncommon and often involves comorbid diseases that require specific regimentation. Several experimental medications are currently in late-stage trials showing potential superiority over current drugs that are available in the market.

High-intensity interval training (HIIT) appears to be safe and effective in cardiovascular diseases. However, there is a paucity of data on the effect of HIIT for patients with acute pulmonary embolism (PE). The present randomized controlled trial (RCT) therefore examined the efficiency and safety of HIIT in patients with acute PE.In single-center parallel open-label RCT, 24 patients (5 women) discharged recently with a diagnosis of intermediate-high-risk acute PE were randomized (1:1) to supervised HIIT (n = 12) or control (n = 12) group. The primary outcomes were exercise capacity evaluated in terms of the estimated maximal oxygen uptake (eV˙O2max), lung function (forced expiratory volume in 1 s [FEV1]), right ventricular (RV) function (RV/left ventricular diameter [LV] ratio), and health-related quality of life (HRQoL). Safety was the secondary outcome.Eight weeks of HIIT improved eV˙O2max (+65%, P0.001), FEV1 (%) (+17%, P = 0.031), and RV/LV ratio diameter (-27%, P = 0.005), as well as HRQoL. All patients in the HIIT group tolerated exercise training without serious adverse events. The control group did not improve (P0.05) eV˙O2max, RV/LV ratio diameter, or HRQoL; however, FEV1 (%) was slightly reduced (-6%, P = 0.030).The present RCT of a tailored center-based HIIT intervention provides preliminary evidence that this intervention could improve exercise capacity, lung function, RV function, and HRQoL without serious adverse events, which could provide marked clinical benefits after PE. Further larger multicenter randomized controlled studies are needed to confirm these promising findings.

For the first time in the history of the modern era smoking tobacco is not the most popular inhaled product. After a flurry of legislature, cannabis has come to the forefront of both medicinal and recreational drug use. A confluence of evidence suggests, however, that marijuana consumption may confer a particularly worrisome cardiovascular risk profile. While combustible forms still contain many of the same harmful chemicals found in tobacco such as aromatic amines, polycyclic aromatic hydrocarbons (PAHs), and nitric oxide, some in even greater concentrations than tobacco, edible preparations have been evidenced to cause more cardiovascular-related emergency department visits. Importantly, this body of evidence suggests that cannabis use may be placing a younger, healthier population at risk of suffering major cardiovascular accidents particularly in the moments immediately following consumption. With males in their 30's apparently bearing the brunt of this burden, cannabis consumption has been associated with an increase in ischemic stroke-a blockage in the cerebral or cerebellar vasculature-and almost a fivefold increase in myocardial infarction. THC containing compounds have also been linked to vascular complications ranging from mild plaques to total arterial occlusion resulting in claudication, rest pain, ischemic ulceration and gangrene-recently termed cannabis arteritis. While this research remains in a nascent stage, marijuana consumption seems to be predisposing a youthful, traditionally low health risk cohort to a variety of major adverse cardiovascular events.

Background Class II obesity (body mass index BMI ≥35 kg/m2) is a contraindication to heart transplantation (HT). Although few single-center studies (case reports/series and small cohorts) have reported promising outcomes of bariatric surgery (BS) in patients with obesity and ventricular assist devices, low sample sizes have made their analysis and interpretation challenging. Methods and Results We conducted a systematic search in ClinicalTrials.gov, Cochrane, Embase, PubMed, Google Scholar, and most relevant bariatric and heart failure journals. We extracted baseline and outcome individual participant data for every ventricular assist device patient undergoing BS with reported postoperative BMI and their respective timepoints when BMI data were measured. Fourteen references with 29 patients were included. The mean age was 41.9 ± 12.2 years, 82.8% underwent laparoscopic sleeve gastrectomy, and 39.3% had reported perioperative adverse events. The mean pre-BS BMI was 45.5 ± 6.6 kg/m2 and decreased significantly during follow-up (rho –0.671; P Conclusions BS may help patients with obesity and ventricular assist devices to lose a significant amount of weight and improve their candidacy for HT or even achieve myocardial recovery.