Protocol for the WARM Hearts study: examining cardiovascular disease risk in middle-aged and older women - a prospective, observational cohort study

INTRODUCTION

Cardiovascular disease (CVD) is a leading cause of death in women. Novel approaches to detect early signs of elevated CVD risk in women are needed. Enhancement of traditional CVD risk assessment approaches through the addition of procedures to assess physical function or frailty as well as novel biomarkers of cardiovascular, gut and muscle health could improve early identification. The Women's Advanced Risk-assessment in Manitoba (WARM) Hearts study will examine the use of novel non-invasive assessments and biomarkers to identify women who are at elevated risk for adverse cardiovascular events.

METHODS AND ANALYSIS

One thousand women 55 years of age or older will be recruited and screened by the WARM Hearts observational, cohort study. The two screening appointments will include assessments of medical history, gender variables, body composition, cognition, frailty status, functional fitness, physical activity levels, nutritional status, quality of life questionnaires, sleep behaviour, resting blood pressure (BP), BP response to moderate-intensity exercise, a non-invasive measure of arterial stiffness and heart rate variability. Blood sample analysis will be used to assess lipid and novel biomarker profiles and stool samples will support the characterisation of gut microbiota. The incidence of the adverse cardiovascular outcomes will be assessed 5 years after screening to compare WARM Hearts approaches to the Framingham Risk Score, the current clinical standard of assessing CVD risk in Canada.

ETHICS AND DISSEMINATION

The University of Manitoba Health Research Ethics Board (7 October 2019) and the St Boniface Hospital Research Review Committee (7 October 2019) approved the trial (Ethics Number HS22576 (H2019:063)). Recruitment started 10 October 2020. Data gathered from the WARM Hearts study will be published in peer-reviewed journals and presented at national and international conferences. Knowledge translation strategies will be created to share our findings with stakeholders who are positioned to implement evidence-informed CVD risk assessment programming.

TRIAL REGISTRATION NUMBER

NCT03938155.

Randomised controlled trial protocol for the PROTECT-CS Study: PROTein to Enhance outComes of (pre)frail paTients undergoing Cardiac Surgery

INTRODUCTION

In the past 20 years, the increasing burden of heart disease in an ageing population has resulted in cardiac surgery (CS) being offered to more frail and older patients with multiple comorbidities. Frailty and malnutrition are key geriatric syndromes that impact postoperative outcomes, including morbidity, mortality and prolonged hospital length of stay. Enhanced recovery protocols (ERPs), such as prehabilitation, have been associated with a reduction in complications after CS in vulnerable patients. The use of nutritional ERPs may enhance short-term and long-term recovery and mitigate frailty progression while improving patient-reported outcomes.

METHODS AND ANALYSIS

This trial is a two-centre, double-blinded, placebo, randomised controlled trial with blinded endpoint assessment and intention-to-treat analysis. One-hundred and fifty CS patients will be randomised to receive either a leucine-rich protein supplement or a placebo with no supplemented protein. Patients will consume their assigned supplement two times per day for approximately 2 weeks pre-procedure, during in-hospital postoperative recovery and for 8 weeks following discharge. The primary outcome will be the Short Physical Performance Battery score. Data collection will occur at four time points including baseline, in-hospital (pre-discharge), 2-month and 6-month time points post-surgery.

ETHICS AND DISSEMINATION

The University of Manitoba Biomedical Research Ethics Board (20 March 2018) and the St Boniface Hospital Research Review Committee (28 June 2019) approved the trial protocol for the primary site in Winnipeg, Manitoba, Canada. The second site's (Montreal, Quebec) ethics has been submitted and pending approval from the Research Ethics and New Technology Development Committee for the Montreal Heart Institute (December 2020). Recruitment for the primary site started February 2020 and the second site will begin January 2021. Data gathered from the PROTein to Enhance outComes of (pre)frail paTients undergoing Cardiac Surgery Study will be published in peer-reviewed journals and presented at national and international conferences. Knowledge translation strategies will be created to share findings with stakeholders who are positioned to implement evidence-informed change.

POTENTIAL STUDY IMPACT

Malnutrition and frailty play a crucial role in post-CS recovery. Nutritional ERPs are increasingly being recognised as a clinically relevant aspect of perioperative care. As such, this trial is to determine if leucine-rich protein supplementation at key intervals can mitigate frailty progression and facilitate enhanced postoperative recovery.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT04038294).

Self-criticism self-report measures: Systematic review

PURPOSE

Self-criticism is a transdiagnostic process that has been attracting research and clinical interest. The accurate measurement of this construct is therefore crucial; however, there are currently numerous measures of self-criticism and no guidelines about which to use in different contexts. This systematic review evaluated the measurement properties of self-report questionnaires of self-criticism.

METHODS

OvidSP and Web of Science were used to search through multiple databases, and an initial grey literature search was completed. Studies were included when the main focus was to evaluate the measurement properties of English version of scales or subscales that aimed to measure self-criticism in an adult population. Both the methodological quality of included studies and the specific measurement properties were evaluated; these ratings were then combined into a best evidence synthesis.

RESULTS

Five scales and five subscales were identified, described in 16 papers. The scales were designed to measure different types of self-criticism including trait or repetitive self-criticism and self-criticism in response to difficult situations or as a mood regulation strategy. The majority of included studies were either rated as having poor methodological quality, or were given indeterminate or negative ratings for the measurement properties they reported. Questionnaire content varied depending on how the authors conceptualized self-criticism. Issues were also highlighted in relation to the checklist used to rate methodological quality.

CONCLUSIONS

Tentative recommendations were made about two measures of self-criticism based on existing evidence; future research is required. Furthermore, questionnaire choice should be based on the type of self-criticism being assessed.

PRACTITIONER POINTS

Self-criticism has been associated with a range of clinical difficulties including depression and eating disorders and is increasingly the focus of research, including treatment studies directly targeting self-criticism. Since different researchers have conceptualized self-criticism differently, a number of self-criticism self-report questionnaires have been developed that vary in terms of design, structure, and content. This systematic review identified and evaluated the measurement properties of self-report questionnaires of self-criticism and makes tentative recommendations about their use in clinical and research settings and areas for future research.

Development of anin vivorat screen model to predict pharmacokinetic interactions of CYP3A4 substrates

With the advent of polytherapy, drug interactions have become a common clinical problem. Although in vitro data are routinely used for the prediction of drug interactions, in vitro systems are not dynamic and sometimes fail to predict drug interactions. We sought to use the rat as an in vivo screening model to predict pharmacokinetic interactions with ketoconazole. The pharmacokinetic studies were conducted following an oral dose of CYP3A substrates and an optimized oral regimen of ketoconazole. In vitro reaction phenotyping was conducted using individual human and rat cDNA-expressed CYP enzymes and human or rat liver microsomes in the presence of ketoconazole. The in vitro experiments indicated that the test compounds were largely metabolized by CYP3A in both human and rat. The compounds could be rank-ordered with respect to the increase in C(max) and area under the curve (AUC) values relative to midazolam in the presence of ketoconazole. The degree of pharmacokinetic interaction with ketoconazole was dependent, in part, upon their in vitro metabolism in the presence of rat CYP3A1/3A2 and in rat and human microsomes, co-incubated with ketoconazole, and on their fraction metabolized (f(m)) in the rat relative to other disposition pathways. Based on the rank-order of interaction, the compounds could be prioritized for further preclinical development.