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Ornish D, Madison C, Kivipelto M, Kemp C, McCulloch CE, Galasko D, Artz J, Rentz D, Lin J, Norman K, Ornish A, Tranter S, DeLamarter N, Wingers N, Richling C, Kaddurah-Daouk R, Knight R, McDonald D, Patel L, Verdin E, E Tanzi R, Arnold SE. Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer's disease: a randomized, controlled clinical trial. Alzheimers Res Ther 2024; 16:122. [PMID: 38849944 PMCID: PMC11157928 DOI: 10.1186/s13195-024-01482-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/15/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Evidence links lifestyle factors with Alzheimer's disease (AD). We report the first randomized, controlled clinical trial to determine if intensive lifestyle changes may beneficially affect the progression of mild cognitive impairment (MCI) or early dementia due to AD. METHODS A 1:1 multicenter randomized controlled phase 2 trial, ages 45-90 with MCI or early dementia due to AD and a Montreal Cognitive Assessment (MoCA) score of 18 or higher. The primary outcome measures were changes in cognition and function tests: Clinical Global Impression of Change (CGIC), Alzheimer's Disease Assessment Scale (ADAS-Cog), Clinical Dementia Rating-Sum of Boxes (CDR-SB), and Clinical Dementia Rating Global (CDR-G) after 20 weeks of an intensive multidomain lifestyle intervention compared to a wait-list usual care control group. ADAS-Cog, CDR-SB, and CDR-Global scales were compared using a Mann-Whitney-Wilcoxon rank-sum test, and CGIC was compared using Fisher's exact test. Secondary outcomes included plasma Aβ42/40 ratio, other biomarkers, and correlating lifestyle with the degree of change in these measures. RESULTS Fifty-one AD patients enrolled, mean age 73.5. No significant differences in any measures at baseline. Only two patients withdrew. All patients had plasma Aβ42/40 ratios <0.0672 at baseline, strongly supporting AD diagnosis. After 20 weeks, significant between-group differences in the CGIC (p= 0.001), CDR-SB (p= 0.032), and CDR Global (p= 0.037) tests and borderline significance in the ADAS-Cog test (p= 0.053). CGIC, CDR Global, and ADAS-Cog showed improvement in cognition and function and CDR-SB showed significantly less progression, compared to the control group which worsened in all four measures. Aβ42/40 ratio increased in the intervention group and decreased in the control group (p = 0.003). There was a significant correlation between lifestyle and both cognitive function and the plasma Aβ42/40 ratio. The microbiome improved only in the intervention group (p <0.0001). CONCLUSIONS Comprehensive lifestyle changes may significantly improve cognition and function after 20 weeks in many patients with MCI or early dementia due to AD. TRIAL REGISTRATION Approved by Western Institutional Review Board on 12/31/2017 (#20172897) and by Institutional Review Boards of all sites. This study was registered retrospectively with clinicaltrials.gov on October 8, 2020 (NCT04606420, ID: 20172897).
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Affiliation(s)
- Dean Ornish
- Preventive Medicine Research Institute, 900 Bridgeway, Sausalito, CA, USA.
- University of California, San Francisco and University of California, San Diego, USA.
| | - Catherine Madison
- Preventive Medicine Research Institute, 900 Bridgeway, Sausalito, CA, USA
- Ray Dolby Brain Health Center, California Pacific Medical Center, San Francisco, CA, USA
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Karolinska vägen 37 A, SE-171 64, Solna, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Karolinska vägen 37 A, SE-171 64, Stockholm, Solna, Sweden
- The Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, St Mary's Hospital, Norfolk Place, London, W2 1PG, United Kingdom
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 8, 70210, Kuopio, Finland
| | - Colleen Kemp
- Clinical Services, Preventive Medicine Research Institute, Bridgeway, Sausalito, CA, 900, USA
| | - Charles E McCulloch
- Division of Biostatistics, Department of Epidemiology & Biostatistics, UCSF, San Francisco, CA, USA
| | | | - Jon Artz
- Clinical Neurology, School of Medicine, University of Nevada, Reno, USA
- Renown Health Institute of Neurosciences, Reno, NV, USA
| | - Dorene Rentz
- Harvard Medical School, Boston, MA, USA
- Center for Alzheimer Research and Treatment, Boston, MA, USA
- Mass General Brigham Alzheimer Disease Research Center, Boston, MA, USA
| | - Jue Lin
- Elizabeth Blackburn Lab, UCSF, San Francisco, CA, USA
| | | | - Anne Ornish
- Preventive Medicine Research Institute, 900 Bridgeway, Sausalito, CA, USA
| | - Sarah Tranter
- Clinical Services, Preventive Medicine Research Institute, Bridgeway, Sausalito, CA, 900, USA
| | - Nancy DeLamarter
- Preventive Medicine Research Institute, 900 Bridgeway, Sausalito, CA, USA
| | - Noel Wingers
- Preventive Medicine Research Institute, 900 Bridgeway, Sausalito, CA, USA
| | - Carra Richling
- Preventive Medicine Research Institute, 900 Bridgeway, Sausalito, CA, USA
| | - Rima Kaddurah-Daouk
- Departments of Medicine and Psychiatry, Duke University Medical Center and Member, Duke Institute of Brain Sciences, Durham, NC, USA
| | - Rob Knight
- Department of Pediatrics; Department of Computer Science & Engineering; Department of Bioengineering; Center for Microbiome Innovation, Halıcıoğlu Data Science Institute, University of California, San Diego, La Jolla, CA, USA
| | - Daniel McDonald
- Department of Pediatrics and Scientific Director, American Gut Project and The Microsetta Initiative, University of California San Diego, La Jolla, CA, USA
| | - Lucas Patel
- Bioinformatics and Systems Biology Program; Rob Knight Lab; Medical Scientist Training Program, University of California, San Diego, La Jolla, CA, USA
| | - Eric Verdin
- Buck Institute for Research on Aging, San Francisco, CA, USA
- University of California, San Francisco, CA, USA
| | - Rudolph E Tanzi
- Harvard Medical School, Boston, MA, USA
- Genetics and Aging Research Unit, Boston, MA, USA
- McCance Center for Brain Health, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Steven E Arnold
- Harvard Medical School, Boston, MA, USA
- Interdisciplinary Brain Center, Massachusetts General Hospital, Boston, MA, USA
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Lippman D, Stump M, Veazey E, Guimarães ST, Rosenfeld R, Kelly JH, Ornish D, Katz DL. Foundations of Lifestyle Medicine and its Evolution. Mayo Clin Proc Innov Qual Outcomes 2024; 8:97-111. [PMID: 38304165 PMCID: PMC10831813 DOI: 10.1016/j.mayocpiqo.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Lifestyle Medicine (LM) is a rapidly growing discipline that focuses on the role of lifestyle factors in preventing, managing, and reversing chronic disease. At this point in the field's evolution, there is strong evidence that the 6 pillars of LM-a whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connections-are central in the creation and maintenance of health. Previous publications, many of them randomized controlled studies and meta-analyses, have solidified the evidence base for the use of the 6 pillars within the field of LM. As data emerged, so did its governing body, the American College of Lifestyle Medicine (ACLM), and with it a rich history began to unfold. Several articles have been written on the early history of the ACLM and the growth of the field; however, this review article explores the history and foundation of LM, aiming to provide a comprehensive understanding of its relevance and impact on health care. It underscores landmark studies that have defined the field and provides a road map detailing national and global barriers and areas of potential future growth.
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Affiliation(s)
| | - Mariah Stump
- Warren Alpert Medical School, Brown University, Providence, RI
| | - Erica Veazey
- St. Mark’s Family Medicine Residency, Salt Lake City, UT
| | | | - Richard Rosenfeld
- Department of Otolaryngology, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - John H. Kelly
- American College of Lifestyle Medicine, Chesterfield, MO
| | - Dean Ornish
- Preventive Medicine Research Institute, University of California, San Francisco, CA
| | - David L. Katz
- American College of Lifestyle Medicine, Chesterfield, MO
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Ahmed AI, Saad JM, Alahdab F, Han Y, Nayfeh M, Alfawara MS, Al-Rifai M, Al-Mallah M. Prognostic value of positron emission tomography derived myocardial flow reserve: A systematic review and meta-analysis. Atherosclerosis 2023; 382:117280. [PMID: 37742396 DOI: 10.1016/j.atherosclerosis.2023.117280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND AND AIMS Positron Emission Tomography (PET)-derived myocardial flow reserve (MFR) has been shown to have a role in the diagnosis and prognosis of patients with coronary artery disease (CAD). We performed a systematic review and meta-analysis to summarize the body of literature and synthesize the evidence on the prognostic role of PET-derived MFR in patients with known or suspected CAD. METHODS A comprehensive literature search of the Medline database from its inception to August 2023, in humans, in any language, was conducted for clinical studies examining the prognostic value of PET imaging in patients of any age, sex, and CAD status. Systematic screening and data extraction of the identified studies were followed by quantitative meta-analysis of PET-MFR's role in predicting adverse clinical events using random effect model. Studies were appraised using the modified Newcastle-Ottawa tool. RESULTS A total of 21 studies assessing the prognostic role of PET derived MFR in 46,815 patients with known and/or suspected CAD were included (mean (SD) age 66 (4) years, 48% women). The mean follow-up duration was 36 months (range 10-96). Cardiovascular risk factors were prevalent (73% hypertension, 35% diabetes and 67% dyslipidemia). The definition of the composite outcome varied between studies, with various combinations of mortality, non-fatal myocardial infarction, hospitalization, and coronary revascularization. Pooled impaired MFR was significantly associated with an increased risk of adverse outcomes (RR = 2.94, 95% CI 2.42-3.56, p < 0.001). Results were similar in a subgroup of patients with suspected CAD. CONCLUSIONS The available body of evidence shows that impaired PET-derived MFR measured using different tracers and PET systems is strongly associated with an increased risk of adverse cardiovascular events. Limitations of this review include observational nature of studies, marked heterogeneity in patient populations, inconsistency in thresholds to define abnormal MFR, and differing components for the composite outcome.
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Affiliation(s)
- Ahmed Ibrahim Ahmed
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA; Yale School of Medicine, New Haven, CT, USA
| | - Jean Michel Saad
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Fares Alahdab
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Yushui Han
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Malek Nayfeh
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | | | - Mahmoud Al-Rifai
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Mouaz Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
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Wang T, Masedunskas A, Willett WC, Fontana L. Vegetarian and vegan diets: benefits and drawbacks. Eur Heart J 2023; 44:3423-3439. [PMID: 37450568 PMCID: PMC10516628 DOI: 10.1093/eurheartj/ehad436] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
Plant-based diets have become increasingly popular thanks to their purported health benefits and more recently for their positive environmental impact. Prospective studies suggest that consuming vegetarian diets is associated with a reduced risk of developing cardiovascular disease (CVD), diabetes, hypertension, dementia, and cancer. Data from randomized clinical trials have confirmed a protective effect of vegetarian diets for the prevention of diabetes and reductions in weight, blood pressure, glycosylated haemoglobin and low-density lipoprotein cholesterol, but to date, no data are available for cardiovascular event rates and cognitive impairment, and there are very limited data for cancer. Moreover, not all plant-based foods are equally healthy. Unhealthy vegetarian diets poor in specific nutrients (vitamin B12, iron, zinc, and calcium) and/or rich in highly processed and refined foods increase morbidity and mortality. Further mechanistic studies are desirable to understand whether the advantages of healthy, minimally processed vegetarian diets represent an all-or-nothing phenomenon and whether consuming primarily plant-based diets containing small quantities of animal products (e.g. pesco-vegetarian or Mediterranean diets) has beneficial, detrimental, or neutral effects on cardiometabolic health outcomes. Further, mechanistic studies are warranted to enhance our understanding about healthy plant-based food patterns and the biological mechanisms linking dietary factors, CVD, and other metabolic diseases.
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Affiliation(s)
- Tian Wang
- Charles Perkins Center, University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Andrius Masedunskas
- Charles Perkins Center, University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Walter C Willett
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Luigi Fontana
- Charles Perkins Center, University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Department of Clinical and Experimental Sciences, Brescia University, Brescia, Lombardy, Italy
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Najjar RS. The Impacts of Animal-Based Diets in Cardiovascular Disease Development: A Cellular and Physiological Overview. J Cardiovasc Dev Dis 2023; 10:282. [PMID: 37504538 PMCID: PMC10380617 DOI: 10.3390/jcdd10070282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the United States, and diet plays an instrumental role in CVD development. Plant-based diets have been strongly tied to a reduction in CVD incidence. In contrast, animal food consumption may increase CVD risk. While increased serum low-density lipoprotein (LDL) cholesterol concentrations are an established risk factor which may partially explain the positive association with animal foods and CVD, numerous other biochemical factors are also at play. Thus, the aim of this review is to summarize the major cellular and molecular effects of animal food consumption in relation to CVD development. Animal-food-centered diets may (1) increase cardiovascular toll-like receptor (TLR) signaling, due to increased serum endotoxins and oxidized LDL cholesterol, (2) increase cardiovascular lipotoxicity, (3) increase renin-angiotensin system components and subsequent angiotensin II type-1 receptor (AT1R) signaling and (4) increase serum trimethylamine-N-oxide concentrations. These nutritionally mediated factors independently increase cardiovascular oxidative stress and inflammation and are all independently tied to CVD development. Public policy efforts should continue to advocate for the consumption of a mostly plant-based diet, with the minimization of animal-based foods.
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Affiliation(s)
- Rami Salim Najjar
- Institute for Biomedical Sciences, Georgia State University, Atlanta, GA 30303, USA
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Ahmed AI, Al Rifai M, Alahdab F, Saad JM, Han Y, Alfawara MS, Nabi F, Mahmarian JJ, Al-Mallah MH. Incremental prognostic value of digital positron emission tomography derived myocardial flow reserve: A prospective cohort study. Int J Cardiol 2023; 371:465-471. [PMID: 36096273 DOI: 10.1016/j.ijcard.2022.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/23/2022] [Accepted: 09/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Positron Emission Tomography (PET) Myocardial Perfusion Imaging (MPI) is a robust diagnostic and prognostic test in patients with suspected or known coronary artery disease (CAD). We aimed to assess the incremental prognostic value of myocardial flow reserve (MFR) using the latest generation of digital PET scanners. METHODS Consecutive patients with clinically indicated PET MPI for suspected or known CAD were included. Myocardial blood flow (MBF) in ml/min/g was obtained from dynamic images at rest and peak hyperemia, and the myocardial flow reserve (MFR) was calculated as the ratio of stress to rest MBF. Patients were followed from the date of PET imaging for the occurrence of the primary outcome (composite of all-cause death, myocardial infarction, and Percutaneous Coronary Intervention or Coronary Artery Bypass Graft occurring >90 days after imaging). Nested multivariable Cox regression models were used to assess the incremental prognostic role of MFR over traditional risk factors and PET relative perfusion parameters. RESULTS The final cohort consisted of 3534 patients (mean age 67 ± 12 years, 48% female, 67% Caucasian, 53% obese, 55% hypertension, 32% diabetes, 42% dyslipidemia). During a median follow-up of 8.5 (3.0-15.4) months, 229 patients (6.5%, 6.4 per 1000 person-years) experienced the primary outcome. In nested multivariable Cox models, impaired MFR (MFR < 2) was significantly associated with the primary outcome (HR 2.9, 95% CI 2.0-4.1, p < 0.001) and significantly improved discrimination (Harrell's C 0.77, p = 0.002). CONCLUSION MFR derived from digital PET scanners has an independent and incremental prognostic role in patients with suspected or known CAD.
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Affiliation(s)
| | - Mahmoud Al Rifai
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Fares Alahdab
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Jean Michel Saad
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Yushui Han
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | | | - Faisal Nabi
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - John J Mahmarian
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
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Physical and Psychological Outcomes of Patients Undergoing Traditional Cardiac Rehabilitation and Intensive Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2023; 43:31-38. [PMID: 35836336 DOI: 10.1097/hcr.0000000000000707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Both traditional cardiac rehabilitation (TCR) and intensive cardiac rehabilitation (ICR) have proven benefits for patients with cardiovascular disease. The aim of this study was to compare ICR versus TCR on cardiac rehabilitation (CR) outcomes in patients with cardiovascular disease. METHODS In a retrospective cohort study of 970 patients (n = 251, ICR; n = 719, TCR) who were referred for CR between January 2018 and December 2019, 693 (71.4%) patients completed it. The TCR sessions were 90 min (60-min exercise) three times/wk for 12 wk, while ICR sessions were 4 hr (60-min exercise) two times/wk for 9 wk. Primary endpoints were change in cardiorespiratory fitness (CRF) (by difference in exercise prescription metabolic equivalents [METs] between the last session and the average of the second and third sessions), anxiety (Generalized Anxiety Disorder-7) scores, percent depression (Patient Health Questionnaire-9 or Center for Epidemiologic Studies Depression Scale) scores, and health status (36-item Short Form Health Survey physical and mental composite scores). Linear regression adjusted for imbalanced baseline characteristics (age, race, and diagnosis of angina). RESULTS Of the 693 patients who completed CR (ICR = 204/251 [81%] vs TCR = 489/719 [68%], P < .01), mean age was 66 yr and 31% were female. Patients in TCR had a higher improvement in CRF (CR session METs: ICR +1.5 ± 1.2 vs TCR +1.9 ± 1.5, P < .01) but no difference in health status scores. Conversely, patients in ICR had more reduction in anxiety scores (-2 ± 4 vs -1 ± 3, P < .01) and percent reduction in depression scores (-8.3 ± 13.7% vs -5.0 ± 11.7%, P < .01) than patients in TCR. CONCLUSIONS Patients in TCR had higher improvement in CRF while patients in ICR had higher improvement in anxiety and depression scores.
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Caiati C, Iacovelli F, Mancini G, Lepera ME. Hidden Coronary Atherosclerosis Assessment but Not Coronary Flow Reserve Helps to Explain the Slow Coronary Flow Phenomenon in Patients with Angiographically Normal Coronary Arteries. Diagnostics (Basel) 2022; 12:diagnostics12092173. [PMID: 36140575 PMCID: PMC9497914 DOI: 10.3390/diagnostics12092173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/27/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
The significance of the slow coronary flow phenomenon (SCFph), as visualized in patients (pts) with angiographically normal coronary arteries, is controversial. Absolute coronary flow reserve (CFR) in the left anterior descending coronary artery (LAD), non-invasively assessed by a transthoracic color-guided pulsed-wave Doppler (E-Doppler TTE), is a reliable parameter to assess coronary microcirculatory dysfunction (CMD). Mild and angiographically hidden epicardial atherosclerosis (Hath), as visualized by intracoronary ultrasound (IVUS), which could be the clue to atherosclerotic coronary microvascular involvement, has never been investigated together with CFR in patients. This study was aimed at assessing the value of CFR and HA in explaining the SCFph. Methods. Both non-invasive assessment of CFR in the LAD and corrected TIMI frame count assessment of the coronary contrast runoff were performed in 124 pts with angiographically normal coronary arteries. Among the whole group, 32 patients also underwent intracoronary ultrasounds in the LMCA and LAD, and the maximal plaque burden was assessed (Lesion external elastic (EEM) cross sectional area (CSA)—Lesion Lumen CSA/Lesion EEM CSA * 100). We found that 24 of the 124 pts (group 1) had the SCFph and the remaining 100 had a normal runoff (group 2). CFR, evaluated in both groups, was not significantly different, being 2.79 ± 0.79 (Mean ± SD) in group 1 and 2.90 ± 0.8 in group 2 (p = ns); in the pts also examined by IVUS (32 pts), the SCFph was always associated with hidden atherosclerosis, and a plaque burden of ≥33%. On the contrary, in the normal runoff group, any grade of PB was observed (from no athero to a PB > 70%) and remarkably, 10 pts had no signs of athero or just a minimal plaque burden. This resulted in a ROC curve analysis in which PB < 33% had a high negative predictive value (100%) in ruling out the SCFph. In addition, considering a CFR value < 2.21 as an index of coronary microcirculatory dysfunction, we found CMD in 15 pts (15%) in group 1 and in 7 pts (29%) in group 2 (p = ns). In conclusion, the SCFph is strongly connected to epicardial athero to the extent that the absence of hidden coronary athero has a very high negative predictive power in ruling out SCFph. CFR that is based on an endothelium-independent mechanism remains fairly normal in this condition. An endothelium-dependent microcirculatory constriction at rest due to atherosclerotic involvement of the coronary microvascular network is a possible explanation of the SCFph.
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Affiliation(s)
- Carlo Caiati
- Correspondence: ; Tel.: +39-080-5592117; Fax: +39-080-5478796
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Aggarwal M, Ros E, Allen K, Sikand G, Agarwala A, Aspry K, Kris-Etherton P, Devries S, Reddy K, Singh T, Litwin SE, Keefe JO, Miller M, Andrus B, Blankstein R, Batiste C, Belardo D, Wenger C, Batts T, Barnard ND, White BA, Ornish D, Williams KA, Ostfeld RJ, Freeman AM. Controversial Dietary Patterns: A High Yield Primer for Clinicians. Am J Med 2022; 135:680-687. [PMID: 35134371 DOI: 10.1016/j.amjmed.2022.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 12/20/2022]
Abstract
In cardiology clinic visits, the discussion of optimal dietary patterns for prevention and management of cardiovascular disease is usually very limited. Herein, we explore the benefits and risks of various dietary patterns, including intermittent fasting, low carbohydrate, Paleolithic, whole food plant-based diet, and Mediterranean dietary patterns within the context of cardiovascular disease to empower clinicians with the evidence and information they need to maximally benefit their patients.
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Affiliation(s)
| | - Emilio Ros
- Lipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona and Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | | | - Geeta Sikand
- Heart Disease Prevention Program, University of California Irvine
| | - Anandita Agarwala
- Cardiovascular Division, Baylor Scott and White the Heart Hospital - Plano, Texas
| | - Karen Aspry
- Division of Cardiology, Lifespan Cardiovascular Institute, East Providence, RI; Brown University, Providence, RI
| | - Penny Kris-Etherton
- Department of Nutritional Sciences, Penn State University, University Park, Pa
| | - Stephen Devries
- Gaples Institute for Integrative Cardiology, Deerfield, Ill; Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Koushik Reddy
- Division of Cardiology, James A Haley VA Medical Center, University of South Florida, Tampa
| | - Tamanna Singh
- Division of Cardiovascular Medicine, Heart, Vascular, Thoracic Institute Cleveland Clinic, Ohio
| | - Sheldon E Litwin
- Division of Cardiology, Medical University of South Carolina, Charleston; Division of Cardiology, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - James O' Keefe
- Saint Luke's Mid America Heart Institute, Kansas City, Mo
| | - Michael Miller
- Division of Cardiology, University of Maryland School of Medicine, Baltimore
| | - Bruce Andrus
- Division of Cardiology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Ron Blankstein
- Division of Cardiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Columbus Batiste
- Division of Cardiology, Kaiser Permanente Riverside Medical Center, Charleston, SC
| | | | | | - Travis Batts
- Division of Cardiology, Department of Medicine, Wilford Hall Ambulatory Surgical Center, San Antonio, Texas
| | - Neal D Barnard
- George Washington University School of Medicine, Washington, DC; Physicians Committee for Responsible Medicine, Washington, DC
| | - Beth A White
- Division of Cardiology Marshall Health, Joan C. Edward School of Medicine, Huntington, WV
| | - Dean Ornish
- Preventive Medicine Research Institute, Sausalito, Calif; University of California, San Francisco
| | - Kim A Williams
- Division of Cardiology, Rush University Medical Center, Chicago, Ill
| | | | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colo
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Morton KF, Pantalos DC, Ziegler C, Patel PD. A Place for Plant-Based Nutrition in US Medical School Curriculum: A Survey-Based Study. Am J Lifestyle Med 2022; 16:271-283. [PMID: 35706597 PMCID: PMC9189581 DOI: 10.1177/1559827620988677] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Purpose. To evaluate medical students' and family medicine residents' perceptions of their current degree of nutrition training in general and regarding a whole-foods, plant-based (WFPB) diet. Methods. An original survey instrument was administered to medical students and family medicine residents. Quantitative and qualitative data were collected to evaluate perceptions of nutrition education in medical training, a WFPB diet, and ideas for nutrition-focused curricular reform. Results. Of the 668 trainees surveyed, 200 responded (response rate = 30%). Of these, 22% agreed that they received sufficient nutrition education in medical school and 41% agreed that a WFPB diet should be a focus. Respondents with personal experiences with a plant-based diet were more willing to recommend it to future patients. Common ideas for curricular reform were instruction on a WFPB diet along with other healthy dietary patterns, patient counseling, a dedicated nutrition course, and electives. Conclusions. Nutrition education in US medical training needs improvement to address the growing burden of obesity-related chronic disease. Proper nutrition and lifestyle modification should therefore play a larger role in the education of future physicians. A focus on plant-predominant diets, such as the WFPB diet, may be an acceptable and effective addition to current medical school curriculum, and deserves further study.
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Affiliation(s)
- Kara F. Morton
- Department of Undergraduate Medical Education,
University of Louisville School of Medicine, Louisville, Kentucky
| | - Diana C. Pantalos
- Department of Pediatrics, University of
Louisville, Louisville, Kentucky
| | - Craig Ziegler
- University of Louisville Office of Undergraduate
Medical Education, Louisville, Kentucky
| | - Pradip D. Patel
- Department of Pediatrics, University of
Louisville, Louisville, Kentucky
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11
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Morton KF, Pantalos DC, Ziegler C, Patel PD. Whole-Foods, Plant-Based Diet Perceptions of Medical Trainees Compared to Their Patients: A Cross-Sectional Pilot Study. Am J Lifestyle Med 2022; 16:318-333. [PMID: 35706594 PMCID: PMC9189575 DOI: 10.1177/15598276211041551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Purpose: To evaluate medical trainees' and patients' perceptions of the utility of a whole-foods, plant-based (WFPB) diet for chronic disease management. Methods: A cross-sectional study using two original survey tools was implemented. Quantitative and qualitative data were collected from trainees and patients to evaluate perceived motivations and barriers to WFPB diet implementation. Results: Two hundred trainees and 52 patients responded to the surveys. Nearly half (48%) of patients were willing to try a WFPB diet, expressing a desire for additional information and help with its practical application. Over half (53%) of trainees were willing to recommend a WFPB diet to patients but expressed concern about its acceptability and feasibility. Patients perceived significantly more barriers related to personal enjoyment of animal products while trainees perceived more socioeconomic barriers. Conclusion: Poor diet has been identified as the United States' leading risk factor for mortality from chronic diseases. Plant-predominant diets, such as a WFPB diet, are associated with improved health outcomes and may be an acceptable solution for many patients. WFPB dietary modification could be pursued with a motivational interviewing approach that targets patients' individual goals. Medical providers should address their own assumptions regarding the dietary changes their patients are willing to make.
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Affiliation(s)
- Kara F. Morton
- Department of Undergraduate Medical Education, University of Louisville School of
Medicine, Louisville, KY, USA, (KFM, CZ); Department of Pediatrics, University of Louisville School of
Medicine, Louisville, KY, USA, (DCP. PDP)
| | - Diana C. Pantalos
- Department of Undergraduate Medical Education, University of Louisville School of
Medicine, Louisville, KY, USA, (KFM, CZ); Department of Pediatrics, University of Louisville School of
Medicine, Louisville, KY, USA, (DCP. PDP)
| | - Craig Ziegler
- Department of Undergraduate Medical Education, University of Louisville School of
Medicine, Louisville, KY, USA, (KFM, CZ); Department of Pediatrics, University of Louisville School of
Medicine, Louisville, KY, USA, (DCP. PDP)
| | - Pradip D. Patel
- Department of Undergraduate Medical Education, University of Louisville School of
Medicine, Louisville, KY, USA, (KFM, CZ); Department of Pediatrics, University of Louisville School of
Medicine, Louisville, KY, USA, (DCP. PDP)
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12
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Armenia EM, Schwartz RG. ISCHEMIA questions and MITNEC answers: Defining and standardizing clinical ischemic jeopardy with SPECT myocardial perfusion imaging. J Nucl Cardiol 2021; 28:2726-2729. [PMID: 32613475 DOI: 10.1007/s12350-020-02237-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Erin M Armenia
- University of Rochester Medical Center, Rochester, NY, USA
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13
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Petersen MR, Freeman AM, Madrid M, Aggarwal M. Strategies for Incorporating Lifestyle Medicine in Everyday Hospital Practice. Am J Lifestyle Med 2021; 15:531-537. [PMID: 34646102 PMCID: PMC8504330 DOI: 10.1177/15598276211006664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cardiovascular disease and its associated risk factors such as hypertension, obesity, and diabetes are contributing to a large portion of morbidity, mortality, and health care costs in the United States. Diet and lifestyle education have been shown to be beneficial in reducing cost, mortality, and morbidity associated with these diseases. However, the lack of implementation of diet and lifestyle tools into clinical practices and into hospital systems leaves much room for improvement. Obstacles such as poor physician education, financial concerns, patient preference, and social resistance to change have made it difficult to promote healthy lifestyle and nutrition practices throughout all aspects of health systems. Some hospital systems and hospital-based clinical practices have had important successes in creating prevention clinic models, implementing plant-based menus in their hospital systems, and incorporating intensive rehabilitation programs that will pave the way for more future change. This review describes the current deficits, obstacles, and innovative strategies for implementing lifestyle medicine into hospital systems.
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Affiliation(s)
- Matthew R. Petersen
- Department of Medicine, Shands Hospital at the University of Florida, Gainesville, Florida
| | - Andrew M. Freeman
- the Department of Medicine, Division of Cardiology, National Jewish Health, Denver, Colorado
| | - Marcy Madrid
- Community Health, Midland Health, Midland, Texas
| | - Monica Aggarwal
- the Division of Cardiology, University of Florida, Gainesville, Florida (MA)
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14
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Bokhari S, Schneider RH, Salerno JW, Rainforth MV, Gaylord-King C, Nidich SI. Effects of cardiac rehabilitation with and without meditation on myocardial blood flow using quantitative positron emission tomography: A pilot study. J Nucl Cardiol 2021; 28:1596-1607. [PMID: 31529385 PMCID: PMC9178923 DOI: 10.1007/s12350-019-01884-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/21/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Psychosocial stress is recognized as a risk factor for coronary heart disease (CHD). High rates of CHD in African-Americans may be related to psychosocial stress. However, standard cardiac rehabilitation (CR) usually does not include a systematic stress-reduction technique. Previous studies suggest that the Transcendental Meditation (TM) technique may reduce CHD risk factors and clinical events. This pilot study explored the effects of standard CR with and without TM on a measure of CHD in African-American patients. METHODS Fifty-six CHD patients were assigned to CR, CR + TM, TM alone, or usual care. Testing was done at baseline and after 12 weeks. The primary outcome was myocardial flow reserve (MFR) assessed by 13N-ammonia positron emission tomography (PET). Secondary outcomes were CHD risk factors. Based on guidelines for analysis of small pilot studies, data were analyzed for effect size (ES). RESULTS For 37 patients who completed posttesting, there were MFR improvements in the CR + TM group (+20.7%; ES = 0.64) and the TM group alone (+12.8%; ES = 0.36). By comparison, the CR-alone and usual care groups showed modest changes (+ 5.8%; ES = 0.17 and - 10.3%; ES = - 0.31), respectively. For the combined TM group, MFR increased (+ 14%, ES = 0.56) compared to the combined non-TM group (- 2.0%, ES = - 0.08). CONCLUSIONS These pilot data suggest that adding the TM technique to standard cardiac rehabilitation or using TM alone may improve the myocardial flow reserve in African-American CHD patients. These results may be applied to the design of controlled clinical trials to definitively test these effects. TRIAL REGISTRATION ClinicalTrials.gov registration # NCT01810029.
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Affiliation(s)
- Sabahat Bokhari
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Robert H Schneider
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, 2100 Mansion Drive, Maharishi Vedic City, IA, 52556, USA.
| | - John W Salerno
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, 2100 Mansion Drive, Maharishi Vedic City, IA, 52556, USA
| | - Maxwell V Rainforth
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, 2100 Mansion Drive, Maharishi Vedic City, IA, 52556, USA
| | - Carolyn Gaylord-King
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, 2100 Mansion Drive, Maharishi Vedic City, IA, 52556, USA
| | - Sanford I Nidich
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, 2100 Mansion Drive, Maharishi Vedic City, IA, 52556, USA
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15
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Kahleova H, McCann J, Alwarith J, Rembert E, Tura A, Holubkov R, Barnard ND. A plant-based diet in overweight adults in a 16-week randomized clinical trial: The role of dietary acid load. Clin Nutr ESPEN 2021; 44:150-158. [PMID: 34330460 DOI: 10.1016/j.clnesp.2021.05.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/02/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Evidence suggests that changes in dietary acid load may influence body weight, body composition, and insulin sensitivity. METHODS Participants (n = 244) were randomly assigned to an intervention (vegan) (n = 122) or control group (n = 122) for 16 weeks. Before and after the intervention period, body composition was measured by dual X-ray absorptiometry. Insulin resistance was assessed with the Homeostasis Model Assessment (HOMA-IR) index and predicted insulin sensitivity index (PREDIM). Repeated measure ANOVA was used for statistical analysis. RESULTS Potential Renal Acid Load (PRAL) and Net Endogenous Acid Production (NEAP) decreased significantly in the vegan group with no change in the control group (treatment effect -24.7 mEq/day [95% CI -30.2 to -19.2]; p < 0.001; and -23.8 mEq/day [95% CI -29.6 to -18.0]; p < 0.001, respectively). Body weight decreased by 6.4 kg in the vegan group, compared with 0.5 kg in the control group (treatment effect -5.9 kg [95% CI -6.8 to -5.0]; Gxt, p < 0.001), largely due to a reduction in fat mass and visceral fat. HOMA-IR index decreased and PREDIM increased in the vegan group. After adjustment for energy intake, changes in PRAL and NEAP correlated positively with changes in body weight (r = +0.37; p < 0.001; and r = +0.37; p < 0.001, respectively), fat mass (r = +0.32; p < 0.001; and r = +0.32; p < 0.001, respectively), visceral fat (r = +0.19; p = 0.006; and r = +0.15; p = 0.03, respectively), and HOMA (r = +0.17; p = 0.02; and r = +0.20; p = 0.006, respectively), and negatively with changes in PREDIM (r = -0.22; p = 0.002; and r = -0.27; p < 0.001, respectively). CONCLUSION Dietary acid load as part of a plant-based diet was associated with changes in body weight, body composition, and insulin sensitivity, independent of energy intake. Mechanistic explanations suggest that the relationship may be causal. TRIAL REGISTRATION ClinicalTrials.gov number, NCT03698955.
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Affiliation(s)
- Hana Kahleova
- Physicians Committee for Responsible Medicine, Washington, DC, USA.
| | - James McCann
- Physicians Committee for Responsible Medicine, Washington, DC, USA
| | - Jihad Alwarith
- Physicians Committee for Responsible Medicine, Washington, DC, USA
| | - Emilie Rembert
- Physicians Committee for Responsible Medicine, Washington, DC, USA
| | - Andrea Tura
- Metabolic Unit, CNR Institute of Neuroscience, Padua, Italy
| | | | - Neal D Barnard
- Physicians Committee for Responsible Medicine, Washington, DC, USA; Adjunct Faculty, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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16
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Davies A, Fox K, Galassi AR, Banai S, Ylä-Herttuala S, Lüscher TF. Management of refractory angina: an update. Eur Heart J 2021; 42:269-283. [PMID: 33367764 DOI: 10.1093/eurheartj/ehaa820] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/17/2020] [Accepted: 10/03/2020] [Indexed: 12/15/2022] Open
Abstract
Despite the use of anti-anginal drugs and/or percutaneous coronary interventions (PCI) or coronary artery bypass grafting, the proportion of patients with coronary artery disease who have daily or weekly angina ranges from 2% to 24%. Refractory angina refers to long-lasting symptoms (for >3 months) due to established reversible ischaemia, which cannot be controlled by escalating medical therapy with the use of 2nd- and 3rd-line pharmacological agents, bypass grafting, or stenting. While there is uncertain prognostic benefit, the treatment of refractory angina is important to improve the quality of life of the patients affected. This review focuses on conventional pharmacological approaches to treating refractory angina, including guideline directed drug combination and dosages. The symptomatic and prognostic impact of advanced and novel revascularization strategies such as chronic total occlusion PCI, transmyocardial laser revascularization, coronary sinus occlusion, radiation therapy for recurrent restenosis, and spinal cord stimulation are also covered and recommendations of the 2019 ESC Guidelines on the Diagnosis and Management of Chronic Coronary Syndromes discussed. Finally, the potential clinical use of current angiogenetic and stem cell therapies in reducing ischaemia and/or pain is evaluated.
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Affiliation(s)
- Allan Davies
- National Heart and Lung Institute, Imperial College, Guy Scadding Building, Dovehouse Street, London SW3 6LY, UK.,Royal Brompton & Harefield Hospitals, London, UK
| | - Kim Fox
- National Heart and Lung Institute, Imperial College, Guy Scadding Building, Dovehouse Street, London SW3 6LY, UK.,Royal Brompton & Harefield Hospitals, London, UK
| | | | - Shmuel Banai
- Slezak Super Centre for Cardiac Research, Tel Aviv University, Tel Aviv, Israel.,Tel Aviv Medical Centre, Tel Aviv, Israel
| | | | - Thomas F Lüscher
- National Heart and Lung Institute, Imperial College, Guy Scadding Building, Dovehouse Street, London SW3 6LY, UK.,Royal Brompton & Harefield Hospitals, London, UK.,University of Zurich, Center for Molecular Cardiology, University of Zurich, Switzerland
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17
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Aggarwal M, Ornish D, Josephson R, Brown TM, Ostfeld RJ, Gordon N, Madan S, Allen K, Khetan A, Mahmoud A, Freeman AM, Aspry K. Closing Gaps in Lifestyle Adherence for Secondary Prevention of Coronary Heart Disease. Am J Cardiol 2021; 145:1-11. [PMID: 33454343 DOI: 10.1016/j.amjcard.2021.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 01/02/2021] [Accepted: 01/05/2021] [Indexed: 12/14/2022]
Abstract
The secondary prevention (SP) of coronary heart disease (CHD) has become a major public health and economic burden worldwide. In the United States, the prevalence of CHD has risen to 18 million, the incidence of recurrent myocardial infarctions (MI) remains high, and related healthcare costs are projected to double by 2035. In the last decade, practice guidelines and performance measures for the SP of CHD have increasingly emphasized evidence-based lifestyle (LS) interventions, including healthy dietary patterns, regular exercise, smoking cessation, weight management, depression screening, and enrollment in cardiac rehabilitation. However, data show large gaps in adherence to healthy LS behaviors and low rates of enrollment in cardiac rehabilitation in patients with established CHD. These gaps may be related, since behavior change interventions have not been well integrated into traditional ambulatory care models in the United States. The chronic care model, an evidence-based practice framework that incorporates clinical decision support, self-management support, team-care delivery and other strategies for delivering chronic care is well suited for both chronic CHD management and prevention interventions, including those related to behavior change. This article reviews the evidence base for LS interventions for the SP of CHD, discusses current gaps in adherence, and presents strategies for closing these gaps via evidence-based and emerging interventions that are conceptually aligned with the elements of the chronic care model.
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Affiliation(s)
- Monica Aggarwal
- Division of Cardiology, University of Florida, Gainesville, Florida
| | - Dean Ornish
- Preventive Medicine Research Institute, Sausalito, California, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Richard Josephson
- Division of Cardiology, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Todd M Brown
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert J Ostfeld
- Division of Cardiology, Montefiore Health System, Bronx, New York
| | - Neil Gordon
- Medical and Science Office, INTERVENT International, Savannah, GA and Centre for Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shivank Madan
- Division of Cardiology, Montefiore Health System, Bronx, New York
| | - Kathleen Allen
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Aditya Khetan
- Division of Cardiology, Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Ahmed Mahmoud
- Division of Cardiology, University of Florida, Gainesville, Florida
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Karen Aspry
- Lifespan Cardiovascular Institute, and Department of Medicine, Division of Cardiology, Brown University, Alpert Medical School, Providence, Rhode Island.
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18
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Abstract
The development of potent cholesterol-reducing medications in the last decade of the twentieth century has altered the approach to prevention and treatment of cardiovascular disease (CVD). Initial experience with statins, and more recently with the addition of PCSK9 inhibitors, has proven that human CVD, like that in animal models, can be halted and regressed. Available clinical data show that the lower the achieved level of low-density lipoprotein cholesterol, the greater the regression of disease. Investigative studies are now aimed to understand those factors that both accelerate and impede this healing process. Some of these are likely to be modifiable, and the future of atherosclerotic CVD treatment is likely to be early screening, use of measures to repair atherosclerotic arteries, and prevention of most CVD events.
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Affiliation(s)
- Ira J Goldberg
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA;
| | - Gaurav Sharma
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA;
| | - Edward A Fisher
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA;
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19
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Freeman AM, Aggarwal M. Malnutrition in the Obese. J Am Coll Cardiol 2020; 76:841-843. [DOI: 10.1016/j.jacc.2020.06.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/24/2022]
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20
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Wackers FJT. K. Lance Gould, MD (born October 28, 1938). J Nucl Cardiol 2019; 26:1841-1843. [PMID: 31332659 DOI: 10.1007/s12350-019-01822-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
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21
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Abstract
PURPOSE OF REVIEW Obesity continues to be a growing concern globally due to association with a number of comorbidities and contributing significantly to increase in health care expenditures. Despite availability of a number of treatment modalities, lifestyle modification with dietary modification and exercise continues to be the foundation. However, the standard model of lifestyle modification is not efficacious or sustainable for many patients leading them to seek alternative approaches. We conducted a comprehensive literature review to present the data regarding efficacy and sustainability of many common dietary approaches. RECENT FINDINGS Building upon previous work, recent randomized controlled trials have compared many popular diets head to head in varying patient populations. Along with the weight changes, studies have investigated the changes in metabolic parameters, inflammatory markers, and cardiac risk factor reduction. Though the studies do not show superiority of one diet compared to the other, the preventive benefits and other favorable metabolic changes of the diets make them worthy of consideration.
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22
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Jones-O'Connor M, Natarajan P. Optimal Non-invasive Strategies to Reduce Recurrent Atherosclerotic Cardiovascular Disease Risk. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:38. [PMID: 31254118 PMCID: PMC6739861 DOI: 10.1007/s11936-019-0741-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) remains the leading cause of death worldwide, with coronary artery disease (CAD) responsible for the vast majority of these deaths. Incidence is increasing in developing countries, and prevalence is increasing globally as populations age. Once CAD is manifest, recurrent event risk remains high. RECENT FINDINGS Multiple therapeutic avenues have had significant recent developments, including diet, low-density lipoprotein cholesterol management, triglycerides, hypoglycemic agents, antiplatelet agents, and oral anticoagulants. Combined approaches involving specific, tailored lifestyle, and pharmacological interventions will provide the most effective strategy for reducing the risk of recurrent CVD events. Here, we review risk prediction and non-invasive non-pharmacologic and pharmacologic approaches to mitigate residual coronary artery disease risk.
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Affiliation(s)
- Maeve Jones-O'Connor
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Pradeep Natarajan
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Program in Medical and Population Genetics, Broad Institute of Harvard & MIT, Cambridge, MA, USA.
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23
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Williams KA, Patel H. Healthy Plant-Based Diet: What Does it Really Mean? J Am Coll Cardiol 2019; 70:423-425. [PMID: 28728685 DOI: 10.1016/j.jacc.2017.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 06/05/2017] [Accepted: 06/05/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Kim Allan Williams
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois.
| | - Hena Patel
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
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24
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25
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Di Carli MF, Hachamovitch R. Quantitative Coronary Flow Capacity for Risk Stratification and Clinical Decision Making: Is It Ready for Prime Time? J Nucl Med 2019; 60:407-409. [DOI: 10.2967/jnumed.118.219717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 12/19/2018] [Indexed: 11/16/2022] Open
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26
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Williams KA. Nutrition, risk factors, prevention, and imaging: The 2018 Mario Verani Lecture. J Nucl Cardiol 2019; 26:86-91. [PMID: 30397869 DOI: 10.1007/s12350-018-01506-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 10/27/2022]
Abstract
Heart disease has been the leading cause of death in the United States since 1918. Cardiac mortality rates have dramatically decreased in this era of advanced medical and interventional therapies. However, this has been aptly described as "mopping up the floor instead of turning off the faucet." With this recognition, prevention in cardiology is poised to become a central focus. Within prevention, dietary intervention is recognized as the single largest opportunity for improved cardiovascular outcomes, including improvement or elimination of cardiac risk factors, prevention of myocardial infarction, stroke and cardiovascular death, and reduction of plaque burden and myocardial ischemia. Cardiac imaging, particularly nuclear perfusion and coronary computed tomographic angiography, plays a critical role in early diagnosis and serial evaluation of myocardial ischemia and coronary artery disease. These techniques have the potential to help refine research protocols and evaluate their success by providing intermediate markers of improved myocardial blood flow and coronary plaque morphology.
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Affiliation(s)
- Kim Allan Williams
- James B. Herrick Professor, Division of Cardiology, Rush University Medical Center, 1717 W. Congress Parkway, Suite 303 Kellogg, Chicago, IL, 60612, USA.
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27
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Berry C, Bengel FM. Impaired coronary flow reserve: a pre-requisite for coronary revascularization. Cardiovasc Res 2019; 115:4-5. [PMID: 30535365 DOI: 10.1093/cvr/cvy288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Colin Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Golden Jubilee National Hospital, Clydebank, UK
| | - Frank M Bengel
- Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
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28
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Taqueti VR, Di Carli MF. Coronary Microvascular Disease Pathogenic Mechanisms and Therapeutic Options: JACC State-of-the-Art Review. J Am Coll Cardiol 2018; 72:2625-2641. [PMID: 30466521 PMCID: PMC6296779 DOI: 10.1016/j.jacc.2018.09.042] [Citation(s) in RCA: 355] [Impact Index Per Article: 59.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/06/2018] [Accepted: 09/25/2018] [Indexed: 12/11/2022]
Abstract
Coronary microvascular disease (CMD) refers to the subset of disorders affecting the structure and function of the coronary microcirculation, is prevalent in patients across a broad spectrum of cardiovascular risk factors, and is associated with an increased risk of adverse events. Contemporary evidence supports that most patients with CMD also have macrovessel atherosclerosis, which has important implications for their prognosis and management. In this state-of-the-art review, the authors summarize the pathophysiology of CMD, provide an update of diagnostic testing strategies, and classify CMD into phenotypes according to severity and coexistence with atherosclerosis. They examine emerging data highlighting the significance of CMD in specific populations, including obesity and insulin resistance, myocardial injury and heart failure with preserved ejection fraction, and nonobstructive and obstructive coronary artery disease. Finally, they discuss the role of CMD as a potential target for novel interventions beyond conventional approaches, representing a new frontier in cardiovascular disease reduction.
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Affiliation(s)
- Viviany R Taqueti
- Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. https://twitter.com/VTaqMD
| | - Marcelo F Di Carli
- Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Kim SC, Di Carli MF, Garg RK, Vanni K, Wang P, Wohlfahrt A, Yu Z, Lu F, Campos A, Bibbo CF, Smith S, Solomon DH. Asymptomatic hyperuricemia and coronary flow reserve in patients with metabolic syndrome. BMC Rheumatol 2018; 2:17. [PMID: 30886968 PMCID: PMC6390615 DOI: 10.1186/s41927-018-0027-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/11/2018] [Indexed: 12/22/2022] Open
Abstract
Background Patients with metabolic syndrome (MetS) are at increased risk of asymptomatic hyperuricemia (i.e., elevated serum uric acid (SUA) level without gout) and cardiovascular disease. We conducted a cross-sectional study to examine associations between SUA levels and coronary flow reserve and urate deposits in carotid arteries in patients with asymptomatic hyperuricemia and MetS. Methods Adults aged ≥40 years with MetS and SUA levels ≥6.5 mg/dl, but no gout, were eligible. Using a stress myocardial perfusion positron emission tomography (PET), we assessed myocardial blood flow (MBF) at rest and stress and calculated coronary flow reserve (CFR). CFR < 2.0 is considered abnormal and associated with increased cardiovascular risk. We also measured insulin resistance by homeostatic model assessment (HOMA-IR) method and urate deposits using dual-energy CT (DECT) of the neck for the carotid arteries. Results Forty-four patients with the median age of 63.5 years underwent a blood test, cardiac PET and neck DECT scans. Median (IQR) SUA was 7.8 (7.1-8.4) mg/dL. The median (IQR) CFR was abnormally low at 1.9 (1.7-2.4) and the median (IQR) stress MBF was 1.7 (1.3-2.2) ml/min/g. None had urate deposits in the carotid arteries detected by DECT. In multivariable linear regression analyses, SUA had no association with CFR (β = - 0.12, p = 0.78) or stress MBF (β = - 0.52, p = 0.28). Among non-diabetic patients (n = 25), SUA was not associated with HOMA-IR (β = 2.08, p = 0.10). Conclusions Among MetS patients with asymptomatic hyperuricemia, we found no relationship between SUA and CFR, stress MBF, and insulin resistance. No patients had any DECT detectable subclinical urate deposition in the carotid arteries.
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Affiliation(s)
- Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120 USA.,Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Marcelo F Di Carli
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA.,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Rajesh K Garg
- Division of Endocrinology, Diabetes & Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Kathleen Vanni
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Penny Wang
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Alyssa Wohlfahrt
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Zhi Yu
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Fengxin Lu
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Anarosa Campos
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Courtney F Bibbo
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Stacy Smith
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Daniel H Solomon
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA 02120 USA.,Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
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Dal Lin C, Gola E, Brocca A, Rubino G, Marinova M, Brugnolo L, Plebani M, Iliceto S, Tona F. miRNAs may change rapidly with thoughts: The Relaxation Response after myocardial infarction. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Assessment of coronary vascular function with cardiac PET in relation to serum uric acid. PLoS One 2018; 13:e0192788. [PMID: 29438436 PMCID: PMC5811013 DOI: 10.1371/journal.pone.0192788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/30/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Elevated serum uric acid (SUA) levels have been independently associated with cardiovascular disease. Stress myocardial perfusion positron emission tomography (PET) allows for measurement of absolute myocardial blood flow (MBF) and quantification of global left ventricular coronary flow reserve (CFR). A CFR <2.0 is considered impaired coronary vascular function, and it is associated with increased cardiovascular risk. We evaluated the relationship between SUA and PET-measured markers of coronary vascular function. METHODS We studied adults undergoing a stress myocardial perfusion PET on clinical grounds (1/2006-3/2014) who also had ≥1 SUA measurement within 180 days from the PET date. Multivariable linear regression estimated the association between SUA and PET-derived MBF and CFR. We also stratified analyses by diabetes status. RESULTS We included 382 patients with mean (SD) age of 68.4 (12.4) years and mean (SD) SUA level of 7.2 (2.6) mg/dl. 36% were female and 29% had gout. Median [IQR] CFR was reduced at 1.6 [1.2, 2.0] and median [IQR] stress MBF was 1.5 [1.1, 2.1] ml/min/g. In the adjusted analysis, SUA was inversely associated with stress MBF (β = -0.14, p = 0.01) but not with CFR. Among patients without diabetes (n = 215), SUA had a negative association with CFR (β = -0.15, p = 0.02) and stress MBF (β = -0.19, p = 0.01) adjusting for age, sex, extent of myocardial scar and ischemia, serum creatinine and gout. In diabetic patients (n = 167), SUA was not associated with either CFR or MBF. CONCLUSIONS In this cross-sectional study, higher SUA is modestly associated with worse CFR and stress MBF among patients without diabetes.
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Schwartz RG. What is this image? 2017: Image 4 result : Improvement of ischemia with statin therapy. J Nucl Cardiol 2018; 25:22-24. [PMID: 29196912 DOI: 10.1007/s12350-017-1143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ronald G Schwartz
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Box 679, Rochester, NY, USA.
- Nuclear Medicine Division, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA.
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PET myocardial perfusion quantification: anatomy of a spreading functional technique. Clin Transl Imaging 2018. [DOI: 10.1007/s40336-018-0263-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Dal Lin C, Marinova M, Rubino G, Gola E, Brocca A, Pantano G, Brugnolo L, Sarais C, Cucchini U, Volpe B, Cavalli C, Bellio M, Fiorello E, Scali S, Plebani M, Iliceto S, Tona F. Thoughts modulate the expression of inflammatory genes and may improve the coronary blood flow in patients after a myocardial infarction. J Tradit Complement Med 2018; 8:150-163. [PMID: 29322004 PMCID: PMC5755999 DOI: 10.1016/j.jtcme.2017.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/27/2017] [Accepted: 04/28/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Mental stress is one of the main risk factors for cardiovascular disease. Meditation and music listening are two techniques that are able to counteract it through the activation of specific brain areas, eliciting the so-called Relaxing Response (RR). Epidemiological evidence reveals that the RR practice has a beneficial prognostic impact on patients after myocardial infarction. We aimed to study the possible molecular mechanisms of RR underlying these findings. METHODS We enrolled 30 consecutive patients after myocardial infarction and 10 healthy controls. 10 patients were taught to meditate, 10 to appreciate music and 10 did not carry out any intervention and served as controls. After training, and after 60 days of RR practice, we studied the individual variations, before and after the relaxation sessions, of the vital signs, the electrocardiographic and echocardiographic parameters along with coronary flow reserve (CFR) and the carotid's intima media thickness (IMT). Neuro-endocrine-immune (NEI) messengers and the expression of inflammatory genes (p53, Nuclear factor Kappa B (NfKB), and toll like receptor 4 (TLR4)) in circulating peripheral blood mononuclear cells were also all observed. RESULTS The RR results in a reduction of NEI molecules (p < 0.05) and oxidative stress (p < 0.001). The expression of the genes p53, NFkB and TLR4 is reduced after the RR and also at 60 days (p < 0.001). The CFR increases with the relaxation (p < 0.001) and the IMT regressed significantly (p < 0.001) after 6 months of RR practice. CONCLUSIONS The RR helps to advantageously modulate the expression of inflammatory genes through a cascade of NEI messengers improving, over time, microvascular function and the arteriosclerotic process.
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Affiliation(s)
- Carlo Dal Lin
- Department of Cardiac, Thoracic and Vascular Sciences, Padua University-Hospital, Via Giustiniani 2, 35100 Padua, Italy
| | - Mariela Marinova
- Department of Laboratory Medicine, University-Hospital, Via Giustiniani 2, 35100 Padua, Italy
| | - Giorgio Rubino
- Department of Cardiac, Thoracic and Vascular Sciences, Padua University-Hospital, Via Giustiniani 2, 35100 Padua, Italy
| | - Elisabetta Gola
- Department of Medicine, University-Hospital, Via Giustiniani 2, 35100 Padua, Italy
| | - Alessandra Brocca
- Department of Medicine, University-Hospital, Via Giustiniani 2, 35100 Padua, Italy
| | - Giorgia Pantano
- Department of Laboratory Medicine, University-Hospital, Via Giustiniani 2, 35100 Padua, Italy
| | - Laura Brugnolo
- Department of Laboratory Medicine, University-Hospital, Via Giustiniani 2, 35100 Padua, Italy
| | - Cristiano Sarais
- Department of Cardiac, Thoracic and Vascular Sciences, Padua University-Hospital, Via Giustiniani 2, 35100 Padua, Italy
| | - Umberto Cucchini
- Department of Cardiac, Thoracic and Vascular Sciences, Padua University-Hospital, Via Giustiniani 2, 35100 Padua, Italy
| | - Biancarosa Volpe
- Clinical Psychology, Department of Cardiac, Thoracic and Vascular Sciences, University-Hospital, Via Giustiniani 2, 35100 Padua, Italy
| | - Chiara Cavalli
- Clinical Psychology, Department of Cardiac, Thoracic and Vascular Sciences, University-Hospital, Via Giustiniani 2, 35100 Padua, Italy
| | - Maura Bellio
- Clinical Psychology, Department of Cardiac, Thoracic and Vascular Sciences, University-Hospital, Via Giustiniani 2, 35100 Padua, Italy
| | - Emilia Fiorello
- Clinical Psychology, Department of Cardiac, Thoracic and Vascular Sciences, University-Hospital, Via Giustiniani 2, 35100 Padua, Italy
| | - Sofia Scali
- Clinical Psychology, Department of Cardiac, Thoracic and Vascular Sciences, University-Hospital, Via Giustiniani 2, 35100 Padua, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University-Hospital, Via Giustiniani 2, 35100 Padua, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences, Padua University-Hospital, Via Giustiniani 2, 35100 Padua, Italy
| | - Francesco Tona
- Department of Cardiac, Thoracic and Vascular Sciences, Padua University-Hospital, Via Giustiniani 2, 35100 Padua, Italy
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Freeman AM, Morris PB, Barnard N, Esselstyn CB, Ros E, Agatston A, Devries S, O'Keefe J, Miller M, Ornish D, Williams K, Kris-Etherton P. Trending Cardiovascular Nutrition Controversies. J Am Coll Cardiol 2017; 69:1172-1187. [PMID: 28254181 DOI: 10.1016/j.jacc.2016.10.086] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 12/13/2022]
Abstract
The potential cardiovascular benefits of several trending foods and dietary patterns are still incompletely understood, and nutritional science continues to evolve. However, in the meantime, a number of controversial dietary patterns, foods, and nutrients have received significant media exposure and are mired by hype. This review addresses some of the more popular foods and dietary patterns that are promoted for cardiovascular health to provide clinicians with accurate information for patient discussions in the clinical setting.
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Affiliation(s)
- Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colorado.
| | - Pamela B Morris
- Medical University of South Carolina, Charleston, South Carolina
| | - Neal Barnard
- George Washington University School of Medicine; Physicians Committee for Responsible Medicine, Washington, DC
| | | | - Emilio Ros
- Lipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona and Ciber Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Arthur Agatston
- Herbert Wertheim College of Medicine, Florida International University and Baptist Health of South Florida, Miami, Florida
| | - Stephen Devries
- Gaples Institute for Integrative Cardiology, Deerfield, Illinois; Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James O'Keefe
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Michael Miller
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Dean Ornish
- Preventive Medicine Research Institute, Sausalito, California and University of California-San Francisco, San Francisco, California
| | - Kim Williams
- Rush University Medical Center, Chicago, Illinois
| | - Penny Kris-Etherton
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania
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Bober RM, Thompson CD, Morin DP. The effect of coronary revascularization on regional myocardial blood flow as assessed by stress positron emission tomography. J Nucl Cardiol 2017; 24:961-974. [PMID: 27021385 DOI: 10.1007/s12350-016-0442-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 02/02/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVES We examined whether regional improvement in stress myocardial blood flow (sMBF) following angiography-guided coronary revascularization depends on the existence of a perfusion defect on positron emission tomography (PET). BACKGROUND Percent stenosis on coronary angiography often is the main factor when deciding whether to perform revascularization, but it does not reliably relate to maximum sMBF. PET is a validated method of assessing sMBF. METHODS 19 patients (79% M, 65 ± 12 years) underwent PET stress before and after revascularization (17 PCI, 2 CABG). Pre- and post-revascularization sMBF for each left ventricular quadrant (anterior, septal, lateral, and inferior) was stratified by the presence or absence of a baseline perfusion defect on PET and whether that region was revascularized. RESULTS Intervention was performed on 40 of 76 quadrants. When a baseline perfusion defect existed in a region that was revascularized (n = 26), post-revascularization flow increased by 0.6 ± 0.7 cc/min/g (1.2 ± 0.4 vs 1.7 ± 0.8, P < 0.001). When no defect existed but revascularization was performed (n = 14), sMBF did not change significantly (1.7 ± 0.3 vs 1.5 ± 0.4 cc/min/g, P = 0.16). In regions without a defect that were not revascularized (n = 29), sMBF did not significantly change (2.0 ± 0.6 vs 1.9 ± 0.7, P = 0.7). CONCLUSIONS When a stress-induced perfusion defect exists on PET, revascularization improves sMBF in that region. When there is no such defect, sMBF shows no net change, whether or not intervention is performed in that area. PET stress may be useful for identifying areas of myocardium that could benefit from revascularization, and also areas in which intervention is unlikely to yield improvement in myocardial blood flow.
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Affiliation(s)
- Robert M Bober
- John Ochsner Heart and Vascular Institute, Department of Cardiology, Ochsner Medical Center, New Orleans, LA, USA.
- Ochsner Clinical School, Queensland University School of Medicine, New Orleans, LA, USA.
| | - Caleb D Thompson
- John Ochsner Heart and Vascular Institute, Department of Cardiology, Ochsner Medical Center, New Orleans, LA, USA
| | - Daniel P Morin
- John Ochsner Heart and Vascular Institute, Department of Cardiology, Ochsner Medical Center, New Orleans, LA, USA
- Ochsner Clinical School, Queensland University School of Medicine, New Orleans, LA, USA
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Campbell TC. A plant-based diet and animal protein: questioning dietary fat and considering animal protein as the main cause of heart disease. J Geriatr Cardiol 2017; 14:331-337. [PMID: 28630612 PMCID: PMC5466939 DOI: 10.11909/j.issn.1671-5411.2017.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Thomas Colin Campbell
- Emeritus of Nutritional Biochemistry, Cornell University, 8 Fiddlers Green, Lansing, NY 14882, USA. E-mail:
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Merkouris A, Papathanassoglou EDE, Pistolas D, Papagiannaki V, Floros J, Lemonidou C. Staffing and Organisation of Nursing Care in Cardiac Intensive Care Units in Greece. Eur J Cardiovasc Nurs 2016; 2:123-9. [PMID: 14622637 DOI: 10.1016/s1474-5151(03)00029-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose: To explore staffing and organisational characteristics of nursing care in cardiac intensive care units (CICUs) in Greece. Methodology: An exploratory descriptive survey design with additional cross-sectional comparisons was employed. A specifically developed survey-type questionnaire, addressed to nurse managers, was distributed to all CICUs in Greece. Results: The response rate was 76.2% ( N=32 units). Nursing staff per bed ratios over 24 h (whole-time equivalent) were very low and exhibited a mean of 1.25 (±0.53). The total registered nurse to assistance nurse (RN/AN) ratio was 2.74, but a lot of variability was observed and in many units ANs operated in RNs positions. Only 42% of the nurses had participated at in-service continuing education programs and a systematic training program in cardio pulmonary resuscitation (CPR) was provided in only 12 (37.5%) units. The reported frequencies at which specific technical tasks were performed autonomously by nurses varied substantially and reflected a medium to low level of practice autonomy; the most frequently reported tasks were: peripheral IV line insertion, CPR chest compression, titration of vasoactive drugs and administration of analgesics. Higher percentages of nurses had received in-service training associated with the likelihood of performance of several technical tasks ( P<0.03). Conclusions: Future studies need to explore the effect of these organisational characteristics on patient outcomes. The endorsement of nation-wide standards for nursing staffing and training in CICUs is imperative.
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Abstract
Recent studies indicate that dietary interventions have the potential to prevent and even treat cardiovascular disease, which is the leading cause of death. Many of these studies have focused on various animal models that are able to recreate one or more conditions or elevate risk factors that characterize the disease. Here, we highlight macronutrient-focused interventions in both mammalian model organisms and humans with emphasis on some of the most relevant and well-established diets known to be associated with cardiovascular disease prevention and treatment. We also discuss more recent dietary interventions in rodents, monkeys, and humans, which affect atherosclerosis and cardiovascular diseases with focus on those that also delay aging.
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Padala SK, Sidhu MS, Hartigan PM, Maron DJ, Teo KK, Spertus JA, Mancini GJ, Sedlis SP, Chaitman BR, Heller GV, Weintraub WS, Boden WE. Effect of baseline exercise capacity on outcomes in patients with stable coronary heart disease (a post hoc analysis of the clinical outcomes utilizing revascularization and aggressive drug evaluation trial). Am J Cardiol 2015; 116:1509-15. [PMID: 26410604 DOI: 10.1016/j.amjcard.2015.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/04/2015] [Accepted: 08/04/2015] [Indexed: 02/05/2023]
Abstract
The impact of baseline exercise capacity on clinical outcomes in patients with stable ischemic heart disease randomized to an initial strategy of optimal medical therapy (OMT) with or without percutaneous coronary intervention (PCI) in the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial has not been studied. A post hoc analysis was performed in 1,052 patients of COURAGE (PCI + OMT: n = 527, OMT: n = 525) who underwent exercise treadmill testing at baseline. Patients were categorized into 2 exercise capacity groups based on metabolic equivalents (METs) achieved during baseline exercise treadmill testing (<7 METs: n = 464, ≥7 METs: n = 588) and were followed for a median of 4.6 years. The primary composite end point of death or myocardial infarction was similar in the PCI + OMT group and the OMT group for patients with exercise capacity <7 METs (19.1% vs 16.1%, p = 0.31) and ≥7 METs (13.3% vs 10.3%, p = 0.27). After adjusting for baseline covariates, the hazard ratio (99% confidence interval) for the primary end point for the PCI + OMT group versus the OMT group was 1.42 (0.90 to 2.23, p = 0.05) and for the exercise capacity subgroups of ≥7 METs and <7 METs was 0.75 (0.46 to 1.22, p = 0.13). There was no statistically significant interaction between the original treatment arm allocation (PCI + OMT vs OMT) and baseline exercise capacity. In conclusion, there was no difference in the long-term clinical outcomes in patients with exercise capacity <7 METs compared with ≥7 METs, irrespective of whether they were assigned to initial PCI. Patients with exercise capacity <7 METs did not derive a proportionately greater clinical benefit from PCI + OMT compared with those patients who received OMT alone.
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Cramer H, Lauche R, Paul A, Langhorst J, Michalsen A, Dobos G. Mind-Body Medicine in the Secondary Prevention of Coronary Heart Disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:759-67. [PMID: 26585187 PMCID: PMC4660854 DOI: 10.3238/arztebl.2015.0759] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/02/2015] [Accepted: 07/02/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND In mind-body medicine (MBM), conventional lifestyle modification measures such as dietary counseling and exercise are supplemented with relaxation techniques and psychological motivational elements. This review studied the effect of MBM on cardiac events and mortality in patients with coronary heart disease (CHD). METHODS This review is based on publications up to and including January 2015 that were retrieved by a systematic search in PubMed, the Cochrane Library, and Scopus. Randomized controlled trials of the effect of MBM programs (versus standard treatment) on cardiac events, overall mortality, and/or cardiac mortality were analyzed. Atherosclerosis, blood pressure, LDL cholesterol, and the body mass index (BMI) were chosen as secondary outcomes. Random-effects meta-analyses were performed. The risk of bias was assessed with the Cochrane tool. RESULTS Twelve trials, performed on a total of 1085 patients, were included in the analysis. Significant differences between groups were found with respect to cardiac events (odds ratio [OR]: 0.38; 95% confidence interval [CI]: 0.23-0.61; p<0.01; heterogeneity [I2]: 0%), but not overall mortality (OR: 0.82; 95% CI: 0.46-1.45; p = 0.49; I2: 0%) or cardiac mortality (OR: 0.98; 95% CI: 0.43-2.25; p = 0.97; I2: 0%). Significant differences between groups were also found with respect to atherosclerosis (mean difference [MD] = -7.86% diameter stenosis; 95% CI: -15.06-[-0.65]; p = 0.03; I2: 0%) and systolic blood pressure (MD = -3.33 mm Hg; 95% CI: -5.76-[-0.91]; p<0.01; I2: 0%), but not with respect to diastolic blood pressure, LDL cholesterol, or BMI. CONCLUSION In patients with CHD, MBM programs can lessen the occurrence of cardiac events, reduce atherosclerosis, and lower systolic blood pressure, but they do not reduce mortality. They can be used as a complement to conventional rehabilitation programs.
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Affiliation(s)
- Holger Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen
| | - Romy Lauche
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen
| | - Anna Paul
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen
| | - Jost Langhorst
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen
| | - Andreas Michalsen
- Department of Internal and Complementary Medicine, Immanuel Hospital, Berlin
- Institute for Social Medicine, Epidemiology, and Health Economics, Charité-Universitätsmedizin, Berlin
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen
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Dorbala S, Di Carli MF. Cardiac PET perfusion: prognosis, risk stratification, and clinical management. Semin Nucl Med 2015; 44:344-57. [PMID: 25234079 DOI: 10.1053/j.semnuclmed.2014.05.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Myocardial perfusion imaging (MPI) with PET has expanded significantly over the past decade. With the wider availability of PET scanners and the routine use of quantitative blood flow imaging, the clinical use of PET MPI is expected to increase further. PET MPI is a powerful tool to identify risk, to quantify risk, and to guide therapy in patients with known or suspected coronary artery disease. A large body of evidence supports the prognostic value of PET MPI and ejection fraction in intermediate- to high-risk subjects, in women, in obese individuals, and in post-coronary artery bypass grafting individuals. A normal perfusion study indicates low risk (<1% annualized rate of cardiac events of cardiac death and non-fatal myocardial infarction), while an abnormal study indicates high risk. With accurate risk stratification, high-quality images, and quantitation, PET MPI may transform the management of patients with known or suspected coronary artery disease.
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Affiliation(s)
- Sharmila Dorbala
- Noninvasive Cardiovascular Imaging Program, Heart and Vascular Center, Department of Radiology; Department of Medicine (Cardiology), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Marcelo F Di Carli
- Noninvasive Cardiovascular Imaging Program, Heart and Vascular Center, Department of Radiology; Department of Medicine (Cardiology), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Clinical Cardiac Positron Emission Tomography. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Effects of lifestyle modification programs on cardiac risk factors. PLoS One 2014; 9:e114772. [PMID: 25490202 PMCID: PMC4260956 DOI: 10.1371/journal.pone.0114772] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/13/2014] [Indexed: 11/21/2022] Open
Abstract
Medicare conducted a payment demonstration to evaluate the effectiveness of two intensive lifestyle modification programs in patients with symptomatic coronary artery disease: the Dr. Dean Ornish Program for Reversing Heart Disease (Ornish) and Cardiac Wellness Program of the Benson-Henry Mind Body Institute. This report describes the changes in cardiac risk factors achieved by each program during the active intervention year and subsequent year of follow-up. The demonstration enrolled 580 participants who had had an acute myocardial infarction, had undergone coronary artery bypass graft surgery or percutaneous coronary intervention within 12 months, or had documented stable angina pectoris. Of these, 98% completed the intense 3-month intervention, 71% the 12-month intervention, and 56% an additional follow-up year. Most cardiac risk factors improved significantly during the intense intervention period in both programs. Favorable changes in cardiac risk factors and functional cardiac capacity were maintained or improved further at 12 and 24 months in participants with active follow-up. Multivariable regressions found that risk-factor improvements were positively associated with abnormal baseline values, Ornish program participation for body mass index and systolic blood pressure, and with coronary artery bypass graft surgery. Expressed levels of motivation to lose weight and maintain weight loss were significant independent predictors of sustained weight loss (p = 0.006). Both lifestyle modification programs achieved well-sustained reductions in cardiac risk factors.
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Williams BA, Merhige ME. Comparing changes in severe versus mild perfusion defect size in patients who underwent serial rubidium-82 positron emission tomography myocardial perfusion imaging. Am J Cardiol 2014; 114:1512-7. [PMID: 25260944 DOI: 10.1016/j.amjcard.2014.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 08/05/2014] [Accepted: 08/05/2014] [Indexed: 11/18/2022]
Abstract
Serial myocardial perfusion imaging (MPI) is valuable for assessing coronary disease progression and treatment efficacy. Previous serial MPI studies emphasized severe perfusion defects, with no attention given to milder perfusion defects. Thus, this study sought to compare and identify predictors of change in severe versus mild perfusion defect size in patients who underwent serial positron emission tomography (PET) MPI. Serial PET MPI was performed in 551 patients with an average of 1.9 years between scans. Severe and mild perfusion defect size at both PETs were derived from automated software as percentage of left ventricular mass with relative tracer activity <60% (severe) and between 61% and 80% of maximum tracer activity (mild), respectively. Predictors of change in severe and mild perfusion defect size between PETs were determined. Overall, severe perfusion defect sizes improved (p <0.001) and mild perfusion defect sizes worsened (p <0.001) between PETs with individual changes being highly variable. In individuals with negligible changes in severe defect size (±2%), changes in mild defect size ranged from a worsening of 47% to an improvement of 48% of left ventricular mass. The strongest predictors of change in severe defect size were indicators of obstructive coronary disease including interval myocardial infarction, interval revascularization, history of myocardial infarction, and history of bypass surgery. Strong predictors of change in mild defect size were cardiac risk factors including male gender, body mass index, diabetes, and smoking. In conclusion, changes in mild perfusion defects may provide valuable secondary information for evaluating treatment efficacy in patients who underwent serial MPI.
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Affiliation(s)
- Brent A Williams
- Geisinger Health System, Danville, Pennsylvania; Coronary Disease Reversal and Prevention Center, Tonawanda, New York.
| | - Michael E Merhige
- Coronary Disease Reversal and Prevention Center, Tonawanda, New York
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Franklin BA, Durstine JL, Roberts CK, Barnard RJ. Impact of diet and exercise on lipid management in the modern era. Best Pract Res Clin Endocrinol Metab 2014; 28:405-21. [PMID: 24840267 DOI: 10.1016/j.beem.2014.01.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Unfortunately, many patients as well as the medical community, continue to rely on coronary revascularization procedures and cardioprotective medications as a first-line strategy to stabilize or favorably modify established risk factors and the course of coronary artery disease. However, these therapies do not address the root of the problem, that is, the most proximal risk factors for heart disease, including unhealthy dietary practices, physical inactivity, and cigarette smoking. We argue that more emphasis must be placed on novel approaches to embrace current primary and secondary prevention guidelines, which requires attacking conventional risk factors and their underlying environmental causes. The impact of lifestyle on the risk of cardiovascular disease has been well established in clinical trials, but these results are often overlooked and underemphasized. Considerable data also strongly support the role of lifestyle intervention to improve glucose and insulin homeostasis, as well as physical inactivity and/or low aerobic fitness. Accordingly, intensive diet and exercise interventions can be highly effective in facilitating coronary risk reduction, complementing and enhancing medications, and in some instances, even outperforming drug therapy.
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Affiliation(s)
- Barry A Franklin
- Preventive Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Royal Oak, MI, USA.
| | | | - Christian K Roberts
- Exercise and Metabolic Disease Research Laboratory, Translational Sciences Section, School of Nursing, University of California, Los Angeles, CA, USA
| | - R James Barnard
- Department of Physiological Science, University of California Los Angeles, Los Angeles, CA, USA
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DuttaRoy S, Nilsson J, Hammarsten O, Cider Å, Bäck M, Karlsson T, Wennerblom B, Borjesson M. High frequency home-based exercise decreases levels of vascular endothelial growth factor in patients with stable angina pectoris. Eur J Prev Cardiol 2014; 22:575-81. [DOI: 10.1177/2047487314529349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/05/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Smita DuttaRoy
- Department of Molecular and Clinical Medicine/Cardiology, University of Gothenburg, Sweden
| | - Jonas Nilsson
- Department of Molecular and Clinical Medicine/Cardiology, University of Gothenburg, Sweden
| | - Ola Hammarsten
- Department of Clinical Chemistry, University of Gothenburg, Sweden
| | - Åsa Cider
- Institute of Neuroscience and Physiology/Physiotherapy, University of Gothenburg, Sweden
- Department of Physiotherapy and Occupational Therapy, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
| | - Maria Bäck
- Department of Molecular and Clinical Medicine/Cardiology, University of Gothenburg, Sweden
- Department of Physiotherapy and Occupational Therapy, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
| | - Thomas Karlsson
- Centre for Applied Biostatisics, Occupational and Environmental Medicine, University of Gothenburg, Sweden
| | - Bertil Wennerblom
- Department of Molecular and Clinical Medicine/Cardiology, University of Gothenburg, Sweden
| | - Mats Borjesson
- Swedish School of Sport and Health Sciences, Sweden
- Karolinska University Hospital, Sweden
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Delgado RI, Swint JM, Lairson DR, Johnson NP, Gould KL, Sdringola S. Cost Analysis of PET and Comprehensive Lifestyle Modification for the Reversal of Atherosclerosis. J Nucl Med 2013; 55:80-7. [DOI: 10.2967/jnumed.113.119511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Dilsizian V, Taillefer R. Journey in evolution of nuclear cardiology: will there be another quantum leap with the F-18-labeled myocardial perfusion tracers? JACC Cardiovasc Imaging 2013; 5:1269-84. [PMID: 23236979 DOI: 10.1016/j.jcmg.2012.10.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 10/02/2012] [Accepted: 04/24/2012] [Indexed: 11/26/2022]
Abstract
The field of nuclear cardiac imaging has evolved from being rather subjective, more "art than a science," to a more objective, digital-based quantitative technique, providing insight into the physiological processes of cardiovascular disorders and predicting patient outcome. In a mere 4 decades of its clinical use, the technology used to image myocardial perfusion has made quantum leaps from planar to single-photon emission computed tomography (SPECT) and now to a more contemporary rapid SPECT, positron emission tomography (PET), and hybrid SPECT-computed tomography (CT) and PET-CT techniques. Meanwhile, radiotracers have flourished from potassium-43 and red blood cell-tagged blood pool imaging to thallium-201 and technetium-99m-labeled SPECT perfusion tracers along with rubidium-82, ammonia N-13, and more recently F-18 fluorine-labeled PET perfusion tracers. Concurrent with this expansion is the introduction of new quantitative methods and software for image processing, evaluation, and data interpretation. Technical advances, particularly in obtaining quantitative data, have led to a better understanding of the physiological mechanisms underlying cardiovascular diseases beyond discrete epicardial coronary artery disease to coronary vasomotor function in the early stages of the development of coronary atherosclerosis, hypertrophic cardiomyopathy, and dilated nonischemic cardiomyopathy. Progress in the areas of molecular and hybrid imaging are equally important areas of growth in nuclear cardiology. However, this paper focuses on the past and future of nuclear myocardial perfusion imaging and particularly perfusion tracers.
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Affiliation(s)
- Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201-1595, USA.
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Murthy VL, Di Carli MF. Non-invasive quantification of coronary vascular dysfunction for diagnosis and management of coronary artery disease. J Nucl Cardiol 2012; 19:1060-72; quiz 1075. [PMID: 22714648 PMCID: PMC6526508 DOI: 10.1007/s12350-012-9590-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Venkatesh L. Murthy
- Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Boston, MA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Marcelo F. Di Carli
- Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Boston, MA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Boston, MA
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