2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease

Journal of the American College of Cardiology, Journal Year: 2023, Volume and Issue: 82(9), P. 833 - 955

Published: July 20, 2023

Language: Английский

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Global Cardiovascular Diseases Death Rate Prediction

Current Problems in Cardiology, Journal Year: 2023, Volume and Issue: 48(5), P. 101622 - 101622

Published: Jan. 29, 2023

Language: Английский

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The Minderoo-Monaco Commission on Plastics and Human Health

Annals of Global Health, Journal Year: 2023, Volume and Issue: 89(1)

Published: Jan. 1, 2023

Plastics have conveyed great benefits to humanity and made possible some of the most significant advances modern civilization in fields as diverse medicine, electronics, aerospace, construction, food packaging, sports. It is now clear, however, that plastics are also responsible for harms human health, economy, earth's environment. These occur at every stage plastic life cycle, from extraction coal, oil, gas its main feedstocks through ultimate disposal into The extent these not been systematically assessed, their magnitude fully quantified, economic costs comprehensively counted.The goals this Minderoo-Monaco Commission on Human Health examine plastics' impacts across cycle on: (1) health well-being; (2) global environment, especially ocean; (3) economy; (4) vulnerable populations-the poor, minorities, world's children. On basis examination, offers science-based recommendations designed support development a Global Treaty, protect save lives.This report contains seven Sections. Following an Introduction, Section 2 presents narrative review processes involved production, use, notes hazards environment associated with each stages. 3 describes ocean potential enter marine web result exposure. 4 details health. 5 first-order estimate health-related costs. 6 examines intersection between plastic, social inequity, environmental injustice. 7 Commission's findings recommendations.Plastics complex, highly heterogeneous, synthetic chemical materials. Over 98% produced fossil carbon- oil gas. comprised carbon-based polymer backbone thousands additional chemicals incorporated polymers convey specific properties such color, flexibility, stability, water repellence, flame retardation, ultraviolet resistance. Many added toxic. They include carcinogens, neurotoxicants endocrine disruptors phthalates, bisphenols, per- poly-fluoroalkyl substances (PFAS), brominated retardants, organophosphate retardants. integral components many environment.Global production has increased almost exponentially since World War II, time more than 8,300 megatons (Mt) manufactured. Annual volume grown under Mt 1950 460 2019, 230-fold increase, track triple by 2060. More half all ever 2002. Single-use account 35-40% current represent rapidly growing segment manufacture.Explosive recent growth reflects deliberate pivot integrated multinational fossil-carbon corporations produce manufacture plastics. reducing fuels increasing manufacture. two principal factors decreasing demand due increases 'green' energy, massive expansion fracking.Plastic energy-intensive contributes significantly climate change. At present, estimated 3.7% greenhouse emissions, contribution Brazil. This fraction projected increase 4.5% 2060 if trends continue unchecked.The three phases: disposal. In carbon feedstocks-coal, gas, oil-are transformed energy-intensive, catalytic vast array products. Plastic use occurs aspect results widespread exposure contained plastic. constitute largest portion followed fibers construction.Plastic inefficient, recovery recycling rates below 10% globally. 22 waste enters year, much it single-use gigatons accumulated 1950. Strategies controlled uncontrolled landfilling, open burning, thermal conversion, export. Vast quantities exported year high-income low-income countries, where accumulates landfills, pollutes air water, degrades vital ecosystems, befouls beaches estuaries, health-environmental injustice scale. Plastic-laden e-waste particularly problematic.Plastics plastic-associated pollution. contaminate aquatic (marine freshwater), terrestrial, atmospheric environments destination found throughout ocean, including coastal regions, sea surface, deep sea, polar ice. appear resist breakdown could persist decades. Macro- micro-plastic particles identified hundreds species major taxa, consumed humans. Trophic transfer microplastic within them demonstrated. Although themselves (>10 µm) undergo biomagnification, hydrophobic bioaccumulate animals biomagnify webs. amounts fates smaller nanoplastic (MNPs <10 poorly understood, but harm worrying given mobility biological systems. Adverse pollution multiple levels molecular biochemical population ecosystem. MNP contamination seafood direct, though well chemicals. Marine endangers ecosystems upon which depends food, oxygen, livelihood, well-being.Coal miners, workers field who extract suffer mortality traumatic injury, coal workers' pneumoconiosis, silicosis, cardiovascular disease, chronic obstructive pulmonary lung cancer. risk leukemia, lymphoma, hepatic angiosarcoma, brain cancer, breast mesothelioma, neurotoxic decreased fertility. Workers producing textiles die bladder interstitial disease rates. toxic metal poisoning, neuropathy, Residents "fenceline" communities adjacent sites experience risks premature birth, low birth weight, asthma, childhood cancer.During disposal, release additives residual monomers people. National biomonitoring surveys USA document population-wide exposures disrupt function births, neurodevelopmental disorders, male reproductive defects, infertility, obesity, renal cancers. Chemical-laden MNPs formed degradation can living organisms, Emerging, albeit still incomplete evidence indicates may cause toxicity physical toxicological effects acting vectors transport bacterial pathogens tissues cells.Infants womb young children populations high plastic-related effects. Because exquisite sensitivity early hazardous children's unique patterns exposure, linked prematurity, stillbirth, defects organs, impairment, impaired growth, Early-life non-communicable diseases later life.Plastic's We 2015 exceeded $250 billion (2015 Int$) globally, alone disability caused PBDE, BPA DEHP $920 Int$). (GHG) emissions equivalent 1.96 dioxide (CO2e) annually. Using US Environmental Protection Agency's (EPA) cost metric, we annual GHG be $341 Int$).These costs, large they are, certainly underestimate full losses resulting negative All costs-and costs-are externalized petrochemical manufacturing industry borne citizens, taxpayers, governments countries around world without compensation.The adverse economy evenly distributed. disproportionately affect disempowered, marginalized workers, racial ethnic communities, Indigenous groups, women, children, whom had little do creating crisis lack political influence or resources address it. Plastics' harmful keenly felt South, small island states, disenfranchised areas North. Social justice (SEJ) principles require reversal inequitable burdens ensure no group bears disproportionate share those benefit economically bear fair currently costs.It clear sustainable societal injustices.The driver worsening exponential accelerating production. further magnified long persistence environment.The plastics-monomers, additives, processing agents, non-intentionally substances-include amongst number known disruptors, neurotoxicants, persistent organic pollutants. planetary leach out plastics, pollution, disease. efforts reduce must chemicals.To at-risk populations, put end 2040, supports urgent adoption nations strong comprehensive Treaty accord mandate set forth March 2022 resolution United Nations Environment Assembly (UNEA).International measures needed curb because transcend national boundaries, scale, well-being people poorest nations. Effective implementation will international action coordinated complemented interventions national, regional, local levels.This urges cap targets, timetables, contributions central provision Treaty. recommend inclusion following provisions:The needs extend beyond microplastics litter plastics.The banning severely restricting unnecessary, avoidable, problematic items, items manufactured microbeads.The requirements extended producer responsibility (EPR) make producers, manufacturers products legally financially safety end-of-life management materials sell.The reductions complexity products; health-protective standards additives; requirement non-toxic materials; disclosure components; traceability components. International cooperation essential implementing enforcing standards.The SEJ remedies fill gaps community knowledge advance both distributional procedural equity.This encourages calling exploration listing least pollutants (POPs) Stockholm Convention.This interface Basel London Conventions enhance slow exports least-developed countries.This recommends creation Permanent Science Policy Advisory Body guide Treaty's implementation. priorities would Member States other stakeholders evaluating solutions effective consumption, enhancing recycling, curbing generation waste. assess trade-offs among evaluate safer alternatives monitor transnational export coordinate robust oceanic-, land-, air-based monitoring programs.This investment research crisis. need determine cost-effective context particular proposed solutions. Oceanographic better measure concentrations µm understand distribution fate Biomedical elucidate MNPs.This finds boon stealth threat enormous benefits, linear pay attention design safe near absence recovery, reuse, grave damage, injustices. worsening.While there remain about uncertainties magnitude, available today demonstrates unequivocally severity intervention Manufacture continue. However, reckless ever-increasing unnecessary products, curbed.Global against failure act immense.

Language: Английский

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Obesity and heart failure with preserved ejection fraction: new insights and pathophysiological targets

Cardiovascular Research, Journal Year: 2022, Volume and Issue: 118(18), P. 3434 - 3450

Published: July 26, 2022

Abstract Obesity and heart failure with preserved ejection fraction (HFpEF) represent two intermingling epidemics driving perhaps the greatest unmet health problem in cardiovascular medicine 21st century. Many patients HFpEF are either overweight or obese, recent data have shown that increased body fat its attendant metabolic sequelae widespread, protean effects systemically on system leading to symptomatic HFpEF. The paucity of effective therapies underscores importance understanding distinct pathophysiological mechanisms obese develop novel therapies. In this review, we summarize current non-cardiovascular features phenotype HFpEF, how adiposity might pathophysiologically contribute phenotype, these processes be targeted therapeutically.

Language: Английский

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Spontaneous Intracerebral Hemorrhage

New England Journal of Medicine, Journal Year: 2022, Volume and Issue: 387(17), P. 1589 - 1596

Published: Oct. 26, 2022

Spontaneous brain hemorrhages result from chronic hypertension, anticoagulation, or amyloid angiopathy. Tissue disruption the hematoma can be followed by edema and expansion of clot that worsen prognosis.

Language: Английский

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Stroke Risk Prediction with Machine Learning Techniques

Sensors, Journal Year: 2022, Volume and Issue: 22(13), P. 4670 - 4670

Published: June 21, 2022

A stroke is caused when blood flow to a part of the brain stopped abruptly. Without supply, cells gradually die, and disability occurs depending on area affected. Early recognition symptoms can significantly carry valuable information for prediction promoting healthy life. In this research work, with aid machine learning (ML), several models are developed evaluated design robust framework long-term risk occurrence. The main contribution study stacking method that achieves high performance validated by various metrics, such as AUC, precision, recall, F-measure accuracy. experiment results showed classification outperforms other methods, an AUC 98.9%, F-measure, precision recall 97.4% accuracy 98%.

Language: Английский

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Dexmedetomidine attenuates myocardial ischemia/reperfusion-induced ferroptosis via AMPK/GSK-3β/Nrf2 axis

Biomedicine & Pharmacotherapy, Journal Year: 2022, Volume and Issue: 154, P. 113572 - 113572

Published: Aug. 18, 2022

The present study aimed to investigate whether dexmedetomidine (Dex) exerts cardioprotection effect through inhibiting ferroptosis. Myocardial ischemia/reperfusion injury (MIRI) was induced in Sprague-Dawley rats Langendorff preparation. hemodynamic parameters were recorded. Triphenyltetrazolium chloride (TTC) staining used determine infarct size. In the vitro study, model of hypoxia/reoxygenation (HR) established H9c2 cells. Cell viability and apoptosis detected using cell counting kit 8 (CCK-8), AV/PI dual respectively. Lipid peroxidation as measured by fluorescence fatty acid analog C11-BODIPY581/591 probe intracellular ferrous iron levels Phen Green SK (PGSK) probe, whereas immunofluorescence transmission electron microscopy also examine Protein investigated Western blot. interactions AMPK/GSK-3β signaling with Nrf2 assessed AMPK inhibition GSK-3β overexpression. Our findings indicated that Dex significantly alleviated myocardial infarction, improved heart function, decreased HR-induced accumulation Fe2+ lipid cardiomyocytes. increased expression Nrf2, SLC7A11, GPX4. However, ML385 blunted protective HR-treated Inhibition a specific inhibitor or siRNA phosphorylation Dex. Overexpression resulted lower nuclear depression enhanced expressions Nrf2. conclusion, protects hearts against MIRI-induced ferroptosis via activation pathway.

Language: Английский

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Management of Patients at Risk for and With Left Ventricular Thrombus: A Scientific Statement From the American Heart Association

Circulation, Journal Year: 2022, Volume and Issue: 146(15)

Published: Sept. 15, 2022

Despite the many advances in cardiovascular medicine, decisions concerning diagnosis, prevention, and treatment of left ventricular (LV) thrombus often remain challenging. There are only limited organizational guideline recommendations with regard to LV thrombus. Furthermore, management issues current practice increasingly complex, including concerns about adding oral anticoagulant therapy dual antiplatelet therapy, availability direct anticoagulants as a potential alternative option traditional vitamin K antagonists, use diagnostic modalities such cardiac magnetic resonance imaging, which has greater sensitivity for detection than echocardiography. Therefore, this American Heart Association scientific statement was commissioned goals addressing 8 key clinical questions related thrombus, prevention after myocardial infarction, dilated cardiomyopathy, mural (laminated) imaging an warfarin, treatments other (eg, fibrinolysis, surgical excision), approach persistent despite anticoagulation therapy. Practical suggestions form text, tables, flow diagrams based on careful critical review actual study data formulated by multidisciplinary writing committee given.

Language: Английский

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Management of Acute Coronary Syndrome in the Older Adult Population: A Scientific Statement From the American Heart Association

Circulation, Journal Year: 2022, Volume and Issue: 147(3)

Published: Dec. 12, 2022

Diagnostic and therapeutic advances during the past decades have substantially improved health outcomes for patients with acute coronary syndrome. Both age-related physiological changes accumulated cardiovascular risk factors increase susceptibility to syndrome over a lifetime. Compared younger patients, in large growing demographic of older adults are relatively worse. Increased atherosclerotic plaque burden complexity anatomic disease, compounded by noncardiovascular comorbid conditions, contribute worse prognosis observed individuals. Geriatric syndromes, including frailty, multimorbidity, impaired cognitive physical function, polypharmacy, other complexities care, can undermine efficacy guidelines-based treatments resiliency survive recover, as well. In this American Heart Association scientific statement, we (1) review that predispose management complexity; (2) describe influence commonly encountered geriatric syndromes on disease outcomes; (3) recommend age-appropriate guideline-concordant revascularization strategies, transitions use cardiac rehabilitation, palliative care services, holistic approaches. The primacy individualized assessment patient-centered decision-making is highlighted throughout.

Language: Английский

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Systemic immune-inflammation index as a potential biomarker of cardiovascular diseases: A systematic review and meta-analysis

Frontiers in Cardiovascular Medicine, Journal Year: 2022, Volume and Issue: 9

Published: Aug. 8, 2022

Several studies have investigated the value of systemic immune-inflammation index (SII) for predicting cardiovascular disease (CVD), but results were inconsistent. Therefore, a meta-analysis and systematic review conducted to assess correlation between SII risk CVD.Two investigators systematically searched PubMed, Embase, Web Science, Cochrane library, CINAHL databases identify all that examined association levels CVD. The estimates CVD people with high compared those low weighted mean difference (WMD) control groups pooled using fixed- or random-effects models based on heterogeneity test. We used Newcastle-Ottawa Scale bias in eligible studies, Grading Recommendations Assessment, Development, Evaluation (GRADE) system was applied rate certainty evidence.A total 13 152,996 participants included analysis. overall showed higher significantly associated an increased (HR = 1.39, 95%CI: 1.20-1.61, P < 0.001). This could be observed almost subtypes, including ischemic stroke 1.31, 1.06-1.63, 0.013), hemorrhagic 1.22, 1.10-1.37, 0.001), myocardial infarction 1.11, 1.01-1.23, 0.027), peripheral arterial 1.51, 1.18-1.93, There no significant still similar trends venous thrombosis 4.65, 0.66-32.71, 0.122), cerebral small vessel 1.09, 0.95-1.25, 0.233), acute coronary syndrome 1.08, 0.96-1.22, 0.200). Furthermore, at onset than general population (WMD 355.2, 234.8-475.6, which consistent across different subtypes. GRADE assessment suggested quality current evidence from observational very low.This study indicated may potential biomarker development elevated is However, generally low. Additional well-designed are necessary determine optimal cutoff characterize benefited population.

Language: Английский

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