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1.
BMJ ; 374: n1593, 2021 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-34465575

RESUMO

Age is an independent risk factor for cardiovascular disease. With the accelerated growth of the population of older adults, geriatric and cardiac care are becoming increasingly entwined. Although cardiovascular disease in younger adults often occurs as an isolated problem, it is more likely to occur in combination with clinical challenges related to age in older patients. Management of cardiovascular disease is transmuted by the context of multimorbidity, frailty, polypharmacy, cognitive dysfunction, functional decline, and other complexities of age. This means that additional insight and skills are needed to manage a broader range of relevant problems in older patients with cardiovascular disease. This review covers geriatric conditions that are relevant when treating older adults with cardiovascular disease, particularly management considerations. Traditional practice guidelines are generally well suited for robust older adults, but many others benefit from a relatively more personalized therapeutic approach that allows for a range of medical circumstances and idiosyncratic goals of care. This requires weighing of risks and benefits amidst the patient's aggregate clinical status and the ability to communicate effectively about this with patients and, where appropriate, their care givers in a process of shared decision making. Such a personalized approach can be particularly gratifying, as it provides opportunities to optimize an older patient's function and quality of life at a time in life when these often become foremost therapeutic priorities.


Assuntos
Doenças Cardiovasculares/terapia , Tomada de Decisão Compartilhada , Fatores Etários , Serviços de Saúde para Idosos , Humanos , Fatores de Risco
2.
Artigo em Russo | MEDLINE | ID: mdl-34486851

RESUMO

In The Russian Federation, increasing of life expectancy and decreasing of mortality related to diseases of circulatory system are the priorities of state policy. The purpose of study was to develop approaches to the classification of cardiovascular diseases by severity degree within the framework of development of general health management model based on health care activities at the regional level. The article describes methodology of calculating indices of cardiovascular diseases severity based on statistical data of appealability for out-patient, in-patient and emergency medical care. The set of balancing coefficients reflecting input of rate of accessing for various types of medical care, as well as aggravating input of concomitant pathology, based on expert evaluation of cardiologists involved is presented. On the basis of analysis of distribution of severity index in standard region of the Russian Federation, the system of criteria was developed to classify cardiovascular diseases (according to ICD-10 sub-classes) on four degrees of severity. The approbation of the proposed method demonstrated adequacy of the results obtained to judging of experts (cardiologists). So, in standard region of the Russian Federation, in the class of diseases of circulatory system (I00-I99), 79.6% of all cases are of first degree of severity, 8.6% of cases are of second degree of severity, 3.8% of cases are of third degree, and 8% of cases are of fourth degree. The methodology is unified and can be applied to classify entire spectrum of diseases by degree of severity. Besides, the proposed methodological approaches are suitable to be applied in population health management at the municipal, regional and national levels in the Russian Federation.


Assuntos
Doenças Cardiovasculares , Sistema Cardiovascular , Serviços Médicos de Emergência , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Humanos , Expectativa de Vida , Assistência ao Paciente
4.
J Fam Pract ; 70(4): 189-204, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34339362

RESUMO

The Task Force has expanded the age range for screening for hepatitis C virus infection in adolescents and adults, and now endorses behavioral counseling for all adults with any CVD risk factors.


Assuntos
Terapia Comportamental/normas , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/terapia , Hepatite C/diagnóstico , Programas de Rastreamento/normas , Guias de Prática Clínica como Assunto , Medicina Preventiva/normas , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos , Adulto Jovem
5.
J Am Heart Assoc ; 10(16): e020255, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34387100

RESUMO

Background The acuity and magnitude of the first wave of the COVID-19 epidemic in New York mandated a drastic change in healthcare access and delivery of care. Methods and Results We retrospectively studied patients admitted with an acute cardiovascular syndrome as their principal diagnosis to 13 hospitals across Northwell Health during March 11 through May 26, 2020 (first COVID-19 epidemic wave) and the same period in 2019. Three thousand sixteen patients (242 COVID-19 positive) were admitted for an acute cardiovascular syndrome during the first COVID-19 wave compared with 9422 patients 1 year prior (decrease of 68.0%, P<0.001). During this time, patients with cardiovascular disease presented later to the hospital (360 versus 120 minutes for acute myocardial infarction), underwent fewer procedures (34.6% versus 45.6%, P<0.001), were less likely to be treated in an intensive care unit setting (8.7% versus 10.8%, P<0.001), and had a longer hospital stay (2.91 [1.71-6.05] versus 2.87 [1.82-4.95] days, P=0.033). Inpatient cardiovascular mortality during the first epidemic outbreak increased by 111.1% (3.8 versus 1.8, P<0.001) and was not related to COVID-19-related admissions, all cause in-hospital mortality, or incidence of out-of-hospital cardiac deaths in New York. Admission during the first COVID-19 surge along with age and positive COVID-19 test independently predicted mortality for cardiovascular admissions (odds ratios, 1.30, 1.05, and 5.09, respectively, P<0.0001). Conclusions A lower rate and later presentation of patients with cardiovascular pathology, coupled with deviation from common clinical practice mandated by the first wave of the COVID-19 pandemic, might have accounted for higher in-hospital cardiovascular mortality during that period.


Assuntos
COVID-19 , Doenças Cardiovasculares/mortalidade , Mortalidade Hospitalar/tendências , Hospitalização , Pacientes Internados , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Adulto Jovem
6.
Medicine (Baltimore) ; 100(31): e26861, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397862

RESUMO

ABSTRACT: Cardiac rehabilitation (CR) can improve clinical indicators in patients with cardiovascular diseases. The literature reports a 20% reduction in all-cause mortality and a 27% reduction in heart-disease mortality following CR. Although its clinical efficacy has been established, there is uncertainty whether center-based (CBCR) is more effective than home-based (HBCR) programs in acute and subacute phases. We aimed to verify significant differences in their effectiveness for the improvement of cardiopulmonary function by analyzing cardiopulmonary exercise (CPX) with laboratory tests following both CR programs.A single-center cohort study of 37 patients, recently diagnosed with underlying cardiovascular diseases, underwent CBCR(18) and HBCR(19). CBCR group performed a supervised exercise regimen at the CR center, for 1 hour, 2 to 3 days a week, for a total of 12 to18 weeks. HBCR group completed a self-monitored exercise program at home under the same guidelines as CBCR. Participants were evaluated by CPX with laboratory tests at 1- and 6-month, following the respective programs.There was no statistical significance in clinical characteristics and laboratory findings. Pre-post treatment comparison showed significant improvement in VO2/kg, minute ventilation/carbon dioxide production slope, breathing reserve, tidal volume (VT), heart rate recovery, oxygen consumption per heart rate, low-density lipoprotein (LDL), LDL/HDL ratio, total cholesterol, ejection fraction (EF) (P < .05). CBCR approach showed greater improvement with significance in VO2/kg, metabolic equivalents, and EF on between groups analysis (P < .05).The time effect of CPX test and laboratory data showed improvement in cardiopulmonary function and serum indicators for both groups. VO2/kg, metabolic equivalents, and EF were among the variables that showed significant differences between groups. In the acute and subacute phases of 1 to 6 months, the CBCR group showed a greater cardiac output improvement than the HBCR group.


Assuntos
Biomarcadores/sangue , Reabilitação Cardíaca , Doenças Cardiovasculares , Terapia por Exercício , Serviços de Assistência Domiciliar/estatística & dados numéricos , Centros de Reabilitação/estatística & dados numéricos , Reabilitação Cardíaca/métodos , Reabilitação Cardíaca/normas , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/terapia , Pesquisa Comparativa da Efetividade , Teste de Esforço/métodos , Terapia por Exercício/métodos , Terapia por Exercício/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , República da Coreia/epidemiologia , Testes de Função Respiratória/métodos , Testes de Função Respiratória/estatística & dados numéricos , Resultado do Tratamento
7.
Artigo em Inglês | MEDLINE | ID: mdl-34360420

RESUMO

Acceptance and commitment therapy (ACT) is an adapted form of cognitive behavioural therapy. ACT focuses on how thinking affects behaviour and promotes psychological flexibility. The prevalence of psychological distress among people living with cardiovascular disease (CVD) and/or type 2 diabetes mellitus (T2DM) is high, and ACT may offer an alternative treatment approach. This scoping review explored the use of ACT as an intervention to support adults living with CVD and/or T2DM. A systematic search of the literature resulted in the inclusion of 15 studies. Studies were reviewed using the Joanna Briggs Institute approach to conducting scoping reviews. Most studies (n = 13) related to people living with T2DM, and most (n = 10) used a pre-post design, four studies were randomised controlled trials, and one was a qualitative study. Eight studies reported an improvement in the outcome(s) assessed post-intervention, suggesting that ACT was an acceptable and valid intervention to support people living with CVD or T2DM. However, studies were underpowered and only limited studies involved people living with CVD. ACT was assessed as a valuable approach to improve a range of patient-reported outcomes for those living with CVD or T2DM, and further research involving robust study designs and larger cohorts are warranted.


Assuntos
Terapia de Aceitação e Compromisso , Doenças Cardiovasculares , Terapia Cognitivo-Comportamental , Diabetes Mellitus Tipo 2 , Adulto , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Atenção à Saúde , Diabetes Mellitus Tipo 2/terapia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Life Sci ; 283: 119841, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34298036

RESUMO

Sympathetic vasomotor overactivity is a major feature leading to the cardiovascular dysfunction related to obesity. Considering that the retroperitoneal white adipose tissue (rWAT) is an important fat visceral depot and receives intense sympathetic and afferent innervations, the present study aimed to evaluate the effects evoked by bilateral rWAT denervation in obese rats. Male Wistar rats were fed with HFD for 8 consecutive weeks and rWAT denervation was performed at the 6th week. Arterial pressure, splanchnic and renal sympathetic vasomotor nerve activities were assessed and inflammation and the components of the renin -angiotensin system were evaluated in different white adipose tissue depots. HFD animals presented higher serum levels of leptin and glucose, an increase in arterial pressure and splanchnic sympathetic nerve activity; rWAT denervation, normalized these parameters. Pro-inflammatory cytokines levels were significantly increased, as well as RAAS gene expression in WAT of HFD animals; rWAT denervation significantly attenuated these changes. In conclusion, HFD promotes vasomotor sympathetic overactivation and inflammation with repercussions on the cardiovascular system. In conclusion, the neural communication between WAT and the brain is fundamental to trigger sympathetic vasomotor activation and this pathway is a possible new therapeutic target to treat obesity-associated cardiovascular dysfunction.


Assuntos
Doenças Cardiovasculares , Denervação , Dieta Hiperlipídica/efeitos adversos , Gordura Intra-Abdominal , Obesidade , Nervos Esplâncnicos , Animais , Pressão Sanguínea , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/terapia , Sistema Cardiovascular/metabolismo , Sistema Cardiovascular/fisiopatologia , Gordura Intra-Abdominal/inervação , Gordura Intra-Abdominal/metabolismo , Gordura Intra-Abdominal/fisiopatologia , Masculino , Obesidade/induzido quimicamente , Obesidade/metabolismo , Obesidade/fisiopatologia , Obesidade/terapia , Ratos , Ratos Wistar , Sistema Renina-Angiotensina , Nervos Esplâncnicos/metabolismo , Nervos Esplâncnicos/patologia , Nervos Esplâncnicos/fisiopatologia
9.
Life Sci ; 283: 119851, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34324916

RESUMO

Sleep disorders frequently comorbid with several cardiovascular diseases (CVDs), attracting increasing scientific attention and interest. Sleep disorders include insomnia, sleep-disordered breathing, restless legs syndrome, etc. It is well known that inflammation, sympathetic activation, and endothelial dysfunction play critical roles in sleep disorders, all of which are predisposing factors for CVDs. The comorbidity of sleep disorders and CVDs may have a bidirectional relationship. Patients with CVDs may have a high incidence of sleep disorders and vice versa. This review focused on the comorbidity of sleep disorders and CVDs and discussed the potential pathophysiological mechanisms and therapeutic strategies. In addition to the existing mechanisms, this review summarized novel potential mechanisms underlying comorbidities, such as gut microbiota, orexin, and extracellular vesicles, which may provide a theoretical basis for further basic research and clinical investigations on improving therapeutic outcomes.


Assuntos
Doenças Cardiovasculares , Microbioma Gastrointestinal , Transtornos do Sono-Vigília , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/microbiologia , Doenças Cardiovasculares/terapia , Vesículas Extracelulares/metabolismo , Humanos , Orexinas/metabolismo , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/metabolismo , Transtornos do Sono-Vigília/microbiologia , Transtornos do Sono-Vigília/terapia
10.
Curr Oncol Rep ; 23(8): 99, 2021 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-34259950

RESUMO

PURPOSE OF REVIEW: To give an overview of the role of social media (SoMe) in cardio-oncology during the COVID-19 pandemic. RECENT FINDINGS: SoMe has been critical in fostering education, outreach, awareness, collaboration, dissemination of information, and advocacy in cardio-oncology. This has become increasingly evident during the COVID-19 pandemic, during which SoMe has helped share best practices, community, and research focused on the impact of COVID-19 in cardiology and hematology/oncology, with cardio-oncology at the interface of these two subspecialty fields. A strength of SoMe is the ability to amplify a message in real-time, globally, with minimal investment of resources. This has been particularly beneficial for the emerging field of cardio-hematology/cardio-oncology, a field focused on the interplay of cancer and cardiovascular disease. SoMe field especially during the COVID-19 pandemic. We illustrate how social media has supported innovation (including telemedicine), amplification of healthcare workers' voice, and illumination of pre-existing and continued health disparities within the field of cardio-oncology during the pandemic.


Assuntos
COVID-19/complicações , Doenças Cardiovasculares/terapia , Neoplasias/terapia , SARS-CoV-2/isolamento & purificação , Mídias Sociais/estatística & dados numéricos , Telemedicina , COVID-19/transmissão , COVID-19/virologia , Doenças Cardiovasculares/virologia , Humanos , Disseminação de Informação , Neoplasias/virologia
11.
G Ital Cardiol (Rome) ; 22(8): 610-619, 2021 Aug.
Artigo em Italiano | MEDLINE | ID: mdl-34310563

RESUMO

The COVID-19 pandemic represents an unprecedented event that has brought deep changes in hospital facilities with reshaping of the health system organization, revealing inadequacies of current hospital and local health systems. When the COVID-19 emergency will end, further evaluation of the national health system, new organization of acute wards, and a further evolution of the entire health system will be needed to improve care during the chronic phase of disease. Therefore, new standards for healthcare personnel, more efficient organization of hospital facilities for patients with acute illnesses, improvement of technological approaches, and better integration between hospital and territorial services should be pursued. With experience derived from the COVID-19 pandemic, new models, paradigms, interventional approaches, values and priorities should be suggested and implemented.


Assuntos
COVID-19 , Cardiologia/organização & administração , Atenção à Saúde/organização & administração , Doenças Cardiovasculares/terapia , Pessoal de Saúde/organização & administração , Humanos , Itália , Programas Nacionais de Saúde/organização & administração
12.
Rev Cardiovasc Med ; 22(2): 343-351, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34258902

RESUMO

Coronavirus disease 2019 (COVID-19), a mystified cryptic virus has challenged the mankind that has brought life to a standstill. Catastrophic loss of life, perplexed healthcare system and the downfall of global economy are some of the outcomes of this pandemic. Humans are raging a war with an unknown enemy. Infections, irrespective of age and gender, and more so in comorbidities are escalating at an alarming rate. Cardiovascular diseases, are the leading cause of death globally with an estimate of 31% of deaths worldwide out of which nearly 85% are due to heart attacks and stroke. Theoretically and practically, researchers have observed that persons with pre-existing cardiovascular conditions are comparatively more vulnerable to the COVID-19 infection. Moreover, they have studied the data between less severe and more severe cases, survivors and non survivors, intensive care unit (ICU) patients and non ICU patients, to analyse the relationship and the influence of COVID-19 on cardiovascular health of an individual, further the risk of susceptibility to submit to the virus. This review aims to provide a comprehensive particular on the possible effects, either direct or indirect, of COVID-19 on the cardiovascular heath of an individual.


Assuntos
COVID-19/virologia , Doenças Cardiovasculares/virologia , Sistema Cardiovascular/virologia , SARS-CoV-2/patogenicidade , Antivirais/uso terapêutico , COVID-19/tratamento farmacológico , COVID-19/mortalidade , COVID-19/fisiopatologia , COVID-19/terapia , Fármacos Cardiovasculares/uso terapêutico , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/terapia , Sistema Cardiovascular/efeitos dos fármacos , Sistema Cardiovascular/fisiopatologia , Comorbidade , Interações Hospedeiro-Patógeno , Humanos , Prognóstico , Medição de Risco , Fatores de Risco , SARS-CoV-2/efeitos dos fármacos
13.
Int J Mol Sci ; 22(14)2021 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-34299310

RESUMO

Oxidative stress is a major contributor to the pathogenesis of various inflammatory diseases. Accumulating evidence has shown that oxidative stress is characterized by the overproduction of reactive oxygen species (ROS). Previous reviews have highlighted inflammatory signaling pathways, biomarkers, molecular targets, and pathogenetic functions mediated by oxidative stress in various diseases. The inflammatory signaling cascades are initiated through the recognition of host cell-derived damage associated molecular patterns (DAMPs) and microorganism-derived pathogen associated molecular patterns (PAMPs) by pattern recognition receptors (PRRs). In this review, the effects of PRRs from the Toll-like (TLRs), the retinoic acid-induced gene I (RIG-I)-like receptors (RLRs) and the NOD-like (NLRs) families, and the activation of these signaling pathways in regulating the production of ROS and/or oxidative stress are summarized. Furthermore, important directions for future studies, especially for pathogen-induced signaling pathways through oxidative stress are also reviewed. The present review will highlight potential therapeutic strategies relevant to inflammatory diseases based on the correlations between ROS regulation and PRRs-mediated signaling pathways.


Assuntos
Inflamação/metabolismo , Receptores de Reconhecimento de Padrão/metabolismo , Alarminas/genética , Alarminas/imunologia , Alarminas/metabolismo , Animais , Autofagia , Doenças Cardiovasculares/imunologia , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/terapia , Proteína DEAD-box 58/genética , Proteína DEAD-box 58/imunologia , Proteína DEAD-box 58/metabolismo , Interações entre Hospedeiro e Microrganismos , Humanos , Inflamassomos/genética , Inflamassomos/imunologia , Inflamassomos/metabolismo , Inflamação/genética , Inflamação/imunologia , Doenças Inflamatórias Intestinais/imunologia , Doenças Inflamatórias Intestinais/metabolismo , Doenças Inflamatórias Intestinais/terapia , Modelos Biológicos , Proteínas NLR/genética , Proteínas NLR/imunologia , Proteínas NLR/metabolismo , Doenças Neurodegenerativas/imunologia , Doenças Neurodegenerativas/metabolismo , Doenças Neurodegenerativas/terapia , Estresse Oxidativo , Padrões Moleculares Associados a Patógenos/imunologia , Padrões Moleculares Associados a Patógenos/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Receptores de Reconhecimento de Padrão/genética , Receptores de Reconhecimento de Padrão/imunologia , Transdução de Sinais , Receptores Toll-Like/genética , Receptores Toll-Like/imunologia , Receptores Toll-Like/metabolismo , Ativação Transcricional
14.
Int J Mol Sci ; 22(12)2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34207151

RESUMO

Cardiovascular diseases (CVDs) are the number one cause of debilitation and mortality worldwide, with a need for cost-effective therapeutics. Autophagy is a highly conserved catabolic recycling pathway triggered by various intra- or extracellular stimuli to play an essential role in development and pathologies, including CVDs. Accordingly, there is great interest in identifying mechanisms that govern autophagic regulation. Autophagic regulation is very complex and multifactorial that includes epigenetic pathways, such as histone modifications to regulate autophagy-related gene expression, decapping-associated mRNA degradation, microRNAs, and long non-coding RNAs; pathways are also known to play roles in CVDs. Molecular understanding of epigenetic-based pathways involved in autophagy and CVDs not only will enhance the understanding of CVDs, but may also provide novel therapeutic targets and biomarkers for CVDs.


Assuntos
Autofagia/genética , Doenças Cardiovasculares/etiologia , Sistema Cardiovascular/metabolismo , Epigênese Genética , Regulação da Expressão Gênica , Animais , Biomarcadores , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/terapia , Gerenciamento Clínico , Suscetibilidade a Doenças , Histonas/metabolismo , Humanos , MicroRNAs/genética , Processamento de Proteína Pós-Traducional , RNA Longo não Codificante/genética , RNA Mensageiro/genética
16.
Complement Ther Clin Pract ; 44: 101426, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34139547

RESUMO

OBJECTIVE: The primary purpose of this study is to structure the available evidence relating to physical exercise programs and their impact on patients' cardiovascular system during the convalescence for breast cancer. METHODS: We searched six English databases and four Chinese databases from inception to May 19, 2021. Two reviewers independently screened literature, extracted data. They assessed the risk of bias according to the eligibility criteria, and the Cochrane Collaboration RevMan 5.3.0 version software and STATA 15.0 software were used for this meta-analysis. This study has been registered in the International Prospective Register of Systematic Reviews (CRD42021226319). RESULTS: In total, 3483 articles were screened and data from 11 randomized controlled trials (RCTs) involving 666 breast cancer patients were used in this meta-analysis. The results showed that exercise could decrease systolic blood pressure (SBP) (P = 0.006), diastolic blood pressure (DBP) (P = 0.0003), triglycerides (TG) levels (P < 0.00001), body mass index (BMI) (P = 0.009). Results also showed that exercise could significantly increase peak oxygen uptake (VO2peak) (P = 0.009), maximal oxygen consumption (VO2max) (P = 0.01), and High-density leptin cholesterol (HDL-C) levels (P < 0.0001). However, compared with the control group, there was no significant changes of mean arterial pressure (MAP), peak heart rate (HRpeak), and peak respiratory exchange ratio (PERpeak) (P > 0.05). CONCLUSIONS: Physical exercise could improve the cardiovascular system function associated with decreased the levels of SBP, DBP, TG, and increased the levels of VO2peak, VO2max, and HDL-C in breast cancer patients. These findings reveal that exercise may be a promising means for cardiovascular nursing.


Assuntos
Neoplasias da Mama , Doenças Cardiovasculares , Sistema Cardiovascular , Neoplasias da Mama/terapia , Doenças Cardiovasculares/terapia , Exercício Físico , Feminino , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
J Am Heart Assoc ; 10(12): e020910, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-34107743

RESUMO

Background Emerging evidence links acute kidney injury (AKI) in patients with COVID-19 with higher mortality and respiratory morbidity, but the relationship of AKI with cardiovascular disease outcomes has not been reported in this population. We sought to evaluate associations between chronic kidney disease (CKD), AKI, and mortality and cardiovascular outcomes in patients hospitalized with COVID-19. Methods and Results In a large multicenter registry including 8574 patients with COVID-19 from 88 US hospitals, data were collected on baseline characteristics and serial laboratory data during index hospitalization. Primary exposure variables were CKD (categorized as no CKD, CKD, and end-stage kidney disease) and AKI (classified into no AKI or stages 1, 2, or 3 using a modification of the Kidney Disease Improving Global Outcomes guideline definition). The primary outcome was all-cause mortality. The key secondary outcome was major adverse cardiac events, defined as cardiovascular death, nonfatal stroke, nonfatal myocardial infarction, new-onset nonfatal heart failure, and nonfatal cardiogenic shock. CKD and end-stage kidney disease were not associated with mortality or major adverse cardiac events after multivariate adjustment. In contrast, AKI was significantly associated with mortality (stage 1 hazard ratio [HR], 1.72 [95% CI, 1.46-2.03]; stage 2 HR, 1.83 [95% CI, 1.52-2.20]; stage 3 HR, 1.69 [95% CI, 1.44-1.98]; versus no AKI) and major adverse cardiac events (stage 1 HR, 2.17 [95% CI, 1.74-2.71]; stage 2 HR, 2.70 [95% CI, 2.07-3.51]; stage 3 HR, 3.06 [95% CI, 2.52-3.72]; versus no AKI). Conclusions This large study demonstrates a significant association between AKI and all-cause mortality and, for the first time, major adverse cardiovascular events in patients hospitalized with COVID-19.


Assuntos
COVID-19/mortalidade , Doenças Cardiovasculares/mortalidade , Insuficiência Renal Crônica/mortalidade , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , COVID-19/terapia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Causas de Morte , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Sistema de Registros , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Estados Unidos
18.
Vasc Health Risk Manag ; 17: 317-335, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34135590

RESUMO

Globally, about 400 million people reside at terrestrial altitudes above 1500 m, and more than 100 million lowlanders visit mountainous areas above 2500 m annually. The interactions between the low barometric pressure and partial pressure of O2, climate, individual genetic, lifestyle and socio-economic factors, as well as adaptation and acclimatization processes at high elevations are extremely complex. It is challenging to decipher the effects of these myriad factors on the cardiovascular health in high altitude residents, and even more so in those ascending to high altitudes with or without preexisting diseases. This review aims to interpret epidemiological observations in high-altitude populations; present and discuss cardiovascular responses to acute and subacute high-altitude exposure in general and more specifically in people with preexisting cardiovascular diseases; the relations between cardiovascular pathologies and neurodegenerative diseases at altitude; the effects of high-altitude exercise; and the putative cardioprotective mechanisms of hypobaric hypoxia.


Assuntos
Aclimatação , Altitude , Doenças Cardiovasculares/fisiopatologia , Sistema Cardiovascular/fisiopatologia , Aptidão Cardiorrespiratória , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Tolerância ao Exercício , Nível de Saúde , Fatores de Risco de Doenças Cardíacas , Humanos , Prognóstico , Medição de Risco
19.
Internist (Berl) ; 62(7): 706-717, 2021 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-34143249

RESUMO

Since the beginning of 2020 the coronavirus disease 2019 (COVID-19) pandemic has extensively impacted medical care in Germany and worldwide. Germany is currently facing the so-called third wave of the COVID-19 pandemic. This is exacerbated by emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mutants with increased virus transmission and severe courses of disease. Rising numbers of SARS-CoV­2 infections translate into an increasing number of severe COVID-19 cases requiring intensive care, which interacts with limited structural and personnel resources for COVID-19 and non-COVID-19 critically ill patients. Therefore, prioritization and triage for critically ill patients with allocation of intensive care capacities becomes necessary, as with all situations with higher strain on capacities. Both strategies are meaningful forms of organization and are not to be equated with a collapse of medical care. Cardiovascular comorbidities and cardiac involvement in COVID-19 are of particular importance for disease severity and the clinical course. In addition to the medical care of patients with SARS-CoV­2 infections due to the pandemic, other patients with acute sometimes life-threatening diseases must also continue to receive high-quality treatment. This article provides a current overview of proposed restructuring measures in German hospitals as well as the accompanying triage and prioritization algorithms. Moreover, it is necessary to adapt existing treatment algorithms to the pandemic situation. Due their special importance this is sketched using cardiovascular diseases as an example.


Assuntos
COVID-19 , Doenças Cardiovasculares , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Alemanha , Humanos , Pandemias , SARS-CoV-2 , Triagem
20.
Pediatr Cardiol ; 42(6): 1235-1240, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34181037

RESUMO

In this review, we provide a brief description of recently published articles addressing topics relevant to pediatric cardiologists. Our hope is to provide a summary of the latest articles published recently in other journals in our field. The articles reviewed in this manuscript address (1) long-term fate of the truncal valve, (2) comparison of combined heart‒liver vs heart-only transplantation in pediatric and young adult Fontan recipients showing non-inferior survival of heart-liver transplant in a small sample, (3) impact of palliation strategy on interstage feeding and somatic growth for infants with ductal-dependent pulmonary blood flow showing no difference in growth between ductal stenting and Blalock-Taussig shunt, (4) biventricular repair in interrupted aortic arch and ventricular septal defect with a small left ventricular outflow tract, (5) a randomized controlled trial comparing controlled reoxygenation and standard cardiopulmonary bypass in pediatric cardiac surgery, and (6) tricuspid valve and right ventricular function throughout the hybrid palliation strategy for hypoplastic left heart syndrome and variants.


Assuntos
Cardiologia , Pediatria , Publicações Periódicas como Assunto , Doenças Cardiovasculares/terapia , Criança , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
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