Review of trials in the treatment of coronary artery disease: theoretical expectations versus lack of practical success--how can we explain the differences?

Urolithin A provides cardioprotection and mitochondrial quality enhancement preclinically and improves human cardiovascular health biomarkers

Cardiovascular diseases (CVDs) remain the primary cause of global mortality. Nutritional interventions hold promise to reduce CVD risks in an increasingly aging population. However, few nutritional interventions are proven to support heart health and act mostly on blood lipid homeostasis rather than at cardiac cell level. Here, we show that mitochondrial quality dysfunctions are common hallmarks in human cardiomyocytes upon heart aging and in chronic conditions. Preclinically, the post-biotic and mitophagy activator, urolithin A (UA), reduced both systolic and diastolic cardiac dysfunction in models of natural aging and heart failure. At a cellular level, this was associated with a recovery of mitochondrial ultrastructural defects and mitophagy. In humans, UA supplementation for 4 months in healthy older adults significantly reduced plasma ceramides clinically validated to predict CVD risks. These findings extend and translate UA's benefits to heart health, making UA a promising nutritional intervention to support cardiovascular function as we age.

Lifestyle Changes Following Acute Myocardial Infarction: Patients Perspectives

BACKGROUND

Cardiovascular disease accounts for 39% of all deaths in Ireland each year. Many of these deaths are due to acute myocardial infarction (AMI). The diagnosis of AMI has major implications for individuals in terms of health and social gain, health related quality of life and living and adapting to a chronic illness. The diagnosis requires lifestyle changes such as changes to diet, smoking habit, physical activity, and stress management.

AIMS

The aim of this descriptive qualitative study was to explore patients' perspectives of making lifestyle changes following AMI.

METHODS

Using a descriptive qualitative approach, ten participants were interviewed 6 weeks following discharge about their experiences. Data were collected using in depth interviews and analysed using thematic analysis.

RESEARCH FINDINGS

Four themes emerged: lifestyle warning signs, taking responsibility for lifestyle changes, professional support and looking forward to the future. The findings offer insight into the everyday realities, which patients experience regarding lifestyle changes particularly in relation to smoking cessation and stress management. The difficulties encountered by participants 6 weeks following discharge reflect the implementation of too many life style changes at once as well as the lack of professional help in the community to support participants in their endeavours to make lifestyle changes. In addition, overprotection by family members was a source of frustration and aggravation for participants.

CONCLUSION

The study highlights the need for the development of primary care services and cardiac rehabilitation programmes to support patients as well as providing information to families to reduce anxiety and fear.

Systemic hypertension and coronary artery disease

In the United States alone, it is estimated that 60 million people have hypertension, the estimate varying according to whether hypertension is defined as a blood pressure of >140/90 mm Hg or, as has emerged from the Sixth Joint National Commission on Hypertension (JNC VI) consensus conference, of >130/90 mm Hg. Coronary artery disease frequently accompanies hypertension. In our studies of >5,000 patients with coronary artery disease, half had hypertension. The reasons are numerous. Hypertension is a major risk factor for CAD. The incidence of both conditions increases with age, so that the majority of individuals >65 years of age with coronary artery disease probably also have hypertension. Some authorities predict that, due to the increasing size of the elderly population, there will be a doubling in the prevalence of both coronary artery disease and hypertension in the next century. This is of vital concern to all clinicians. This article reviews some of the prevalence and population trends in coronary artery disease and hypertension, and some of the pathogenic mechanisms involved, as well the results of some current outcome trials.