Circulation, Journal Year: 2024, Volume and Issue: 149(24)
Published: May 14, 2024
The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in treatment patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, limb-threatening ischemia, and acute limb ischemia).
Language: Английский
Circulation, Journal Year: 2022, Volume and Issue: 146(5)
Published: June 29, 2022
In 2010, the American Heart Association defined a novel construct of cardiovascular health to promote paradigm shift from focus solely on disease treatment one inclusive positive promotion and preservation across life course in populations individuals. Extensive subsequent evidence has provided insights into strengths limitations original approach defining quantifying health. response, convened writing group recommend enhancements updates. The definition quantification each metrics (Life’s Simple 7) were evaluated for responsiveness interindividual variation intraindividual change. New considered, age spectrum was expanded include entire course. foundational contexts social determinants psychological addressed as crucial factors optimizing preserving This presidential advisory introduces an enhanced assessing health: Life’s Essential 8. components 8 diet (updated), physical activity, nicotine exposure sleep (new), body mass index, blood lipids glucose pressure. Each metric new scoring algorithm ranging 0 100 points, allowing generation composite score (the unweighted average all components) that also varies points. Methods implementing assessment longitudinal monitoring are discussed, potential data sources tools widespread adoption policy, public health, clinical, institutional, community settings.
Language: Английский
Citations
1386
Stroke, Journal Year: 2022, Volume and Issue: 53(7)
Published: May 17, 2022
Language: Английский
Citations
833
Signal Transduction and Targeted Therapy, Journal Year: 2022, Volume and Issue: 7(1)
Published: Dec. 16, 2022
Aging is a gradual and irreversible pathophysiological process. It presents with declines in tissue cell functions significant increases the risks of various aging-related diseases, including neurodegenerative cardiovascular metabolic musculoskeletal immune system diseases. Although development modern medicine has promoted human health greatly extended life expectancy, aging society, variety chronic diseases have gradually become most important causes disability death elderly individuals. Current research on focuses elucidating how endogenous exogenous stresses (such as genomic instability, telomere dysfunction, epigenetic alterations, loss proteostasis, compromise autophagy, mitochondrial cellular senescence, stem exhaustion, altered intercellular communication, deregulated nutrient sensing) participate regulation aging. Furthermore, thorough pathogenesis to identify interventions that promote longevity caloric restriction, microbiota transplantation, nutritional intervention) clinical treatment methods for (depletion senescent cells, therapy, antioxidative anti-inflammatory treatments, hormone replacement therapy) could decrease incidence turn healthy longevity.
Language: Английский
Citations
700
Circulation, Journal Year: 2023, Volume and Issue: 148(9)
Published: July 20, 2023
AIM: The “2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease” provides an update to and consolidates new evidence since “2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Diagnosis Stable Ischemic Heart corresponding “2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update Disease.” METHODS: A comprehensive literature search was conducted from September 2021 May 2022. Clinical studies, systematic reviews meta-analyses, other on human participants were identified that published in English MEDLINE (through PubMed), EMBASE, Cochrane Library, Agency Healthcare Research Quality, selected databases relevant this guideline. STRUCTURE: This guideline evidenced-based patient-centered approach management patients with chronic coronary disease, considering social determinants health incorporating principles shared decision-making team-based care. Relevant topics include general approaches treatment decisions, guideline-directed therapy reduce symptoms future cardiovascular events, pertaining revascularization recommendations special populations, patient follow-up monitoring, gaps, areas need research. Where applicable, based availability cost-effectiveness data, cost–value are also provided clinicians. Many previously guidelines have been updated evidence, created when supported by data.
Language: Английский
Citations
565
JAMA, Journal Year: 2023, Volume and Issue: 329(10), P. 827 - 827
Published: March 14, 2023
Heart failure with preserved ejection fraction (HFpEF), defined as HF an EF of 50% or higher at diagnosis, affects approximately 3 million people in the US and up to 32 worldwide. Patients HFpEF are hospitalized 1.4 times per year have annual mortality rate 15%.Risk factors for include older age, hypertension, diabetes, dyslipidemia, obesity. Approximately 65% patients present dyspnea physical examination, chest radiographic, echocardiographic, invasive hemodynamic evidence overt congestion (volume overload) rest. 35% "unexplained" on exertion, meaning they do not clear physical, echocardiographic signs HF. These elevated atrial pressures exercise measured stress testing estimated Doppler echocardiography testing. In unselected presenting unexplained dyspnea, H2FPEF score incorporating clinical (age, obesity, fibrillation status) resting (estimated pulmonary artery systolic pressure left pressure) variables can assist diagnosis (H2FPEF range, 0-9; >5 indicates more than 95% probability HFpEF). Specific causes syndrome normal other should be identified treated, such valvular, infiltrative, pericardial disease. First-line pharmacologic therapy consists sodium-glucose cotransporter type 2 inhibitors, dapagliflozin empagliflozin, which reduced hospitalization cardiovascular death by 20% compared placebo randomized trials. Compared usual care, training diet-induced weight loss produced clinically meaningful increases functional capacity quality life Diuretics (typically loop diuretics, furosemide torsemide) prescribed improve symptoms. Education self-care (eg, adherence medications dietary restrictions, monitoring symptoms vital signs) help avoid decompensation.Approximately HFpEF. exercise, self-care, diuretics needed maintain euvolemia, obesity
Language: Английский
Citations
295
Circulation, Journal Year: 2022, Volume and Issue: 146(11), P. 822 - 835
Published: June 29, 2022
The American Heart Association recently published an updated algorithm for quantifying cardiovascular health (CVH)-the Life's Essential 8 score. We quantified US levels of CVH using the new
Language: Английский
Citations
292
The Lancet, Journal Year: 2022, Volume and Issue: 399(10332), P. 1347 - 1358
Published: March 31, 2022
Language: Английский
Citations
262
Circulation, Journal Year: 2022, Volume and Issue: 146(8)
Published: July 18, 2022
Cardiovascular disease is the leading contributor to years lost due disability or premature death among adults. Current efforts focus on risk prediction and factor mitigation' which have been recognized for past half-century. However, despite advances, remains imprecise with persistently high rates of incident cardiovascular disease. Genetic characterization has proposed as an approach enable earlier potentially tailored prevention. Rare mendelian pathogenic variants predisposing cardiometabolic conditions long known contribute in some families. twin familial aggregation studies imply that diverse are heritable general population. Significant technological methodological advances since Human Genome Project facilitating population-based comprehensive genetic profiling at decreasing costs. Genome-wide association from such endeavors continue elucidate causal mechanisms diseases. Systematic cataloging alleles also enabled development polygenic scores. becoming widespread large-scale research, including health care-associated biobanks, randomized controlled trials, direct-to-consumer tens millions people. Thus, individuals their physicians increasingly presented scores clinical encounters. In this scientific statement, we review contemporary science, considerations, future challenges We selected 5 diseases (coronary artery disease, hypercholesterolemia, type 2 diabetes, atrial fibrillation, venous thromboembolic disease) response drug therapy offer provisional guidance care professionals, researchers, policymakers, patients.
Language: Английский
Citations
251
New England Journal of Medicine, Journal Year: 2022, Volume and Issue: 387(11), P. 967 - 977
Published: Aug. 26, 2022
A polypill that includes key medications associated with improved outcomes (aspirin, angiotensin-converting-enzyme [ACE] inhibitor, and statin) has been proposed as a simple approach to the secondary prevention of cardiovascular death complications after myocardial infarction.In this phase 3, randomized, controlled clinical trial, we assigned patients infarction within previous 6 months polypill-based strategy or usual care. The treatment consisted aspirin (100 mg), ramipril (2.5, 5, 10 atorvastatin (20 40 mg). primary composite outcome was death, nonfatal type 1 infarction, ischemic stroke, urgent revascularization. end point stroke.A total 2499 underwent randomization were followed for median 36 months. primary-outcome event occurred in 118 1237 (9.5%) group 156 1229 (12.7%) usual-care (hazard ratio, 0.76; 95% confidence interval [CI], 0.60 0.96; P = 0.02). secondary-outcome 101 (8.2%) 144 (11.7%) 0.70; CI, 0.54 0.90; 0.005). results consistent across prespecified subgroups. Medication adherence reported by higher than group. Adverse events similar between groups.Treatment containing aspirin, ramipril, resulted significantly lower risk major adverse (Funded European Union Horizon 2020; SECURE ClinicalTrials.gov number, NCT02596126; EudraCT 2015-002868-17.).
Language: Английский
Citations
232
JAMA, Journal Year: 2022, Volume and Issue: 328(18), P. 1849 - 1849
Published: Nov. 8, 2022
Importance Hypertension, defined as persistent systolic blood pressure (SBP) at least 130 mm Hg or diastolic BP (DBP) 80 Hg, affects approximately 116 million adults in the US and more than 1 billion worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (coronary heart disease, failure, stroke) death. Observations First-line therapy for hypertension lifestyle modification, including weight loss, healthy dietary pattern that includes low sodium high potassium intake, physical activity, moderation elimination alcohol consumption. The BP-lowering effects individual components are partially additive enhance efficacy pharmacologic therapy. decision to initiate antihypertensive medication should be based on level presence atherosclerotic CVD risk. drug consists a thiazide thiazidelike diuretic such hydrochlorothiazide chlorthalidone, an angiotensin-converting enzyme inhibitor angiotensin receptor blocker enalapril candesartan, calcium channel amlodipine titrated according office home SBP/DBP levels achieve most people target (<130/80 <65 years SBP <130 ≥65 years). Randomized clinical trials have established lowering reduce morbidity mortality. An reduction 10 decreases by 20% 30%. Despite benefits control, only 44% their controlled less 140/90 Hg. Conclusions Relevance worldwide leading cause consisting supplementation, pattern, limited When required, first-line therapies diuretics, blockers, blockers.
Language: Английский
Citations
221