Progress in cardiovascular diseases最新文献

Purpose

The study examined effects of 9-yrs of multicomponent exercise training during the menopause interval on cardiometabolic health in hypertensive women.

Methods

Sedentary, middle-aged women (n = 25) with mild-to-moderate arterial hypertension were randomized into a soccer training (multicomponent exercise; EX; n = 12) or control group (CON; n = 13). EX took part in 1-h football training sessions, 1–3 times weekly, for a consecutive 9-years, totaling ∼800 training sessions, while CON did not take part in regular exercise training. 22 participants entered menopause during the intervention.

Results

A time×group interaction effect (P = 0.04) of 8.5 mmHg in favour of EX was observed for changes in mean arterial pressure (MAP) (EX: −4.8 [−10.7;1.1] mmHg, CON +3.7 [−2.0;9.3] mmHg). Time×group interaction effects in favour of EX were also observed for total body weight (4.6 kg, P = 0.008, EX: +0.7 [−1.7;3.0] kg, CON: +5.3 [3.0;7.6] kg, total fat percentage (5.7%-points, P = 0.02; EX (−1.9 [−4.4;0.6] %-points; P = 0.13), CON +3.8 [1.4;6.2] %-points and for total cholesterol (1.2 mmol/l, P = 0.03, EX: −0.5 [−1.0;-0.1] mmol/l, CON: +0.7 [0.2;1.1] mmol/l. EX reduced (P = 0.02) plasma low-density lipoprotein cholesterol by −0.4 [−0.8;-0.1] mmol/l, whereas an increase (P = 0.01) of 0.4 [0.1;0.8] mmol/l occurred in CON (interaction. P < 0.001). A time×group interaction (P = 0.004) existed for changes in exercise capacity in favour of EX. Fasting glucose remained unchanged in EX and increased (P < 0.001) by 0.7 [0.4;1.0] mmol/l in CON (time×group interaction P = 0.02).

Conclusion

In conclusion, long-term multicomponent exercise training fully counteracts the detrimental effects of the menopause transition on cardiometabolic health in hypertensive women.

According to the World Health Organization, 30 countries currently have a life expectancy of ≥80 years: the United States (U.S.) is not among this group of countries. The current analysis assesses the ability of key lifestyle behaviors and characteristics to predict a life expectancy of ≥80 years. Only 577 (19%) of the 3066 U.S. Counties assessed had a life expectancy ≥80 years. These counties had significantly higher life expectancy (81 ± 3 vs. 76 ± 2 years) and lower percent of the population who are physically inactive (20.7 ± 3.9 vs. 27.0 ± 4.7%), actively smoke (15.9 ± 3.1 vs. 21.1 ± 3.6%), obese (31.7 ± 4.7 vs. 37.3 ± 3.9%) and have limited access to healthy food (7.1 ± 6.8 vs. 8.4 ± 6.6%) (all p < 0.001). Binary logistic regression revealed percent adults who currently smoke, percent obese, percent physically inactive, and percent with limited access to healthy food were all significant univariate predictors of </≥80 years life expectancy (p < 0.001) and retained in the multivariate regression (p < 0.05). A better understanding of the driving forces that increase healthy living behaviors should be a primary goal in the effort to increase U.S. life expectancy: an individualized approach recognizing unique regional cultures may significantly improve adoption and maintenance of desirable health behaviors and outcomes.

Maturity-onset diabetes of the young (MODY) is a spectrum of clinically heterogenous forms of monogenic diabetes mellitus characterized by autosomal dominant inheritance, onset at a young age, and absence of pancreatic islets autoimmunity. This rare form of hyperglycemia, with clinical features overlapping with type 1 and type 2 diabetes mellitus, has 14 subtypes with differences in prevalence and complications occurrence which tailor therapeutic approach. MODY phenotypes differ based on the gene involved, gene penetrance and expressivity. While MODY 2 rarely leads to diabetic complications and is easily managed with lifestyle interventions alone, more severe subtypes, such as MODY 1, 3, and 6, require an individualized treatment approach to maintain a patient's quality of life and prevention of complications. This review summarizes current evidence on the presentation, diagnosis, and management of MODY, an example of a genetic cause of hyperglycemia that calls for a precision medicine approach.

Background

The Cardiovascular safety of testosterone replacement therapy (TRT) among men with hypogonadism is not well established to date. Hence, we sought to evaluate the cardiovascular disease (CVD) outcomes among patients receiving testosterone therapy by using all recently published randomized controlled trials.

Methods

We performed a systematic literature search on PubMed, EMBASE, and Clinicaltrial.gov for relevant randomized controlled trials (RCTs) from inception until September 30th, 2023.

Results

A total of 30 randomized trials with 11,502 patients were included in the final analysis. The mean age was ranging from 61.61 to 61.82 years. Pooled analysis of primary and secondary outcomes showed that the incidence of any CVD events (OR, 1.12 (95%CI: 0.77–1.62), P = 0.55), stroke (OR, 1.01 (95%CI: 0.68–1.51), P = 0.94), myocardial infarction (OR, 1.05 (95%CI: 0.76–1.45), P = 0.77), all-cause mortality (OR, 0.94 (95%CI: 0.76–1.17), P = 0.57), and CVD mortality (OR, 0.87 (95%CI: 0.65–1.15), P = 0.31) was comparable between TRT and placebo groups.

Conclusion

Our analysis indicates that for patients with hypogonadism, testosterone replacement therapy does not increase the CVD risk and all-cause mortality.

The traditional approach to management of cardiovascular disease relies on grouping clinical presentations with common signs and symptoms into pre-specified disease pathways, all uniformly treated according to evidence-based guidelines (“one-size-fits-all”). The goal of precision medicine is to provide the right treatment to the right patients at the right time, combining data from time honoured sources (e.g., history, physical examination, imaging, laboratory) and those provided by multi-omics technologies. In patients with ischemic heart disease, biomarkers and intravascular assessment can be used to identify endotypes with different pathophysiology who may benefit from distinct treatments. This review discusses strategies for the application of stratified management to patients with acute and chronic coronary syndromes.