Methodist DeBakey cardiovascular journal最新文献

This review explores the multifaceted exposures in the workplace that contribute to cardiovascular diseases (CVD), including physical, ergonomics, chemical, biological, psychosocial, and emerging occupational hazards. These well-documented occupational hazards have long been linked to heart disease. Exposures arising from these hazards present significant concerns for worker health and safety. Moreover, heat stress is an emerging and increasingly pervasive threat, exacerbated by climate change, particularly in outdoor, high-exposure industries like agriculture and construction. While the epidemiological links between heat and CVD are well established, there is a critical gap in research on the physiological impacts of heat on workers' cardiovascular health. In particular, migrant workers are especially vulnerable to these occupational hazards, particularly in the absence of targeted, equitable interventions. As global temperatures rise, addressing these occupational exposures is important for protecting the cardiovascular health of the workforce and the expanding field of occupational cardiology.

Cardiovascular disease (CVD) represents a significant financial burden on patients and families, compounded by both direct and indirect healthcare costs. The increasing prevalence of CVD, coupled with the rising costs of treatment, exacerbates financial toxicity-defined as the economic strain and associated physical, emotional, and behavioral consequences on patients. This review explores the scope of financial toxicity in CVD care, detailing its prevalence, associated risk factors, and the complex interplay with social determinants of health such as income, insurance status, and comorbidities. Drawing from models in oncology, we highlight key interventions aimed at mitigating financial toxicity, including patient counseling, financial navigation, and enhanced patient-physician cost discussions. By adopting these approaches, healthcare providers can better support patients with CVD in managing both their health and financial well-being, potentially improving clinical outcomes. Future research is needed to develop standardized assessment tools for financial toxicity in CVD and implement system-wide mitigation strategies.

Air pollution, mostly from fossil fuel sources, is the leading environmental cause of global morbidity and mortality and is intricately linked to climate change. There is emerging evidence indicating that air pollution imposes most of its risk through proximate cardiovascular kidney and metabolic (CKM) etiologies. Indeed, there is compelling evidence linking air pollution to the genesis of insulin resistance, type 2 diabetes, hypertension, and other risk factors. Air pollution frequently coexists with factors such as noise, with levels and risks influenced substantially by additional factors such as social determinants and natural and built environment features. Persistent disparities regarding the impact and new sources of air pollution, such as wildfires attributable to climate change, have renewed the urgency to better understand root sources, characterize their health effects, and disseminate this information for personal protection and policy impacts. In this review, we summarize evidence associating air pollution with cardiovascular health, the impact of air pollution on CKM health, and how interactions with other exposures and personal characteristics may modify these associations. Finally, we discuss new integrated approaches to capture risk from air pollution in the context of an exposomic framework.

This Points to Remember column discusses the differential diagnosis of acute myocardial infarction with normal coronary arteries, one example of which is Takotsubo cardiomyopathy. In the case presented below, the diagnosis of Takotsubo cardiomyopathy was based on the characteristic appearance of the left ventricular apical bulging, normal coronary arteries, and the resolution of the wall motion abnormalities within a relatively short period of time.

This review examines the multifaceted impact of neighborhood-level social determinants of health (SDOH) on cardiovascular disease (CVD) and outlines strategic interventions for mitigating cardiovascular health inequities. Research highlights that environmental and socioeconomic factors within a neighborhood-including education, unemployment, healthcare access, racial segregation, systemic inequities, air quality, housing quality, and other SDOH-influence CVD outcomes. Addressing CVD disparities necessitates a comprehensive strategy that integrates policy reform, enhanced community infrastructure, improved healthcare access, and community empowerment and leverages innovative technology to create equitable health outcomes across diverse populations.

Sylvia Plath (1932-1963) was an American author and poet, perhaps best known for her semi-autobiographical novel The Bell Jar. Her poetical oeuvre was filled with challenging themes of suicidality, mental illness, and a budding feminism, particularly in the poems composed toward the end of her tragically short life. One of these poems, "Lady Lazarus," pushes the bounds of expectation and, some would say, propriety. This short reflective Poet's Pen focuses on Sylvia Plath and the many themes-feminism, suicidality, self-rebirth-for which she would later be known. The poem itself is a melting pot of imagery, drawing themes from the Judeo-Christian perspective, cycles of death and rebirth, and the mythology of the phoenix rising from the ashes.

The cardiovascular exposome encompasses the array of external and internal factors affecting cardiovascular health throughout life, inviting comprehensive monitoring and analysis to enhance prevention, diagnosis, and treatment strategies. Wearable and digital technologies have emerged as promising tools in this domain, offering longitudinal, real-time data on physiological parameters such as heart rate, heart rhythm, physical activity, and sleep patterns. This review explores the advancements in wearable sensor technology, the methodologies for data collection and analysis, and the integration of these technologies into clinical practice and research. Primary findings indicate significant improvements in device accuracy and functionality, facilitated by enhanced sensor technology, artificial intelligence, and data connectivity. These advancements enable precise monitoring, early detection of cardiovascular anomalies, and personalized healthcare interventions. Ultimately, wearables and digital health technologies have the potential to facilitate a deeper understanding of cardiovascular disease and behavior and bridge gaps in traditional healthcare models to help usher in more efficient, personalized, patient-centered care.

The exposome encompasses the full range of environmental exposures throughout a person's lifetime and plays an important role in cardiovascular health. Interactions with the social, natural, and built components of the exposome significantly impact cardiovascular disease prevalence and mortality. Robust data analytics, including machine learning and geospatial analysis, have advanced our understanding of how these factors converge to influence cardiovascular disease risk. The integration of multiomics platforms and advanced computational approaches enhances our ability to characterize the exposome, leading to targeted public health interventions and innovative risk reduction strategies aimed at improving cardiovascular health globally. These multiomics platforms that integrate factors such as genomics, epigenomics, clinical data, social factors, environmental factors, and wearable technology will characterize the exposome in greater detail concerning cardiovascular health. In this review, we aimed to elucidate the components of the exposome and discuss recent literature regarding their relationship to cardiovascular health.

Social determinants of health (SDOH) are known to determine a significant portion of a person's health, influencing downstream outcomes and widespread disparities. Screening for SDOH in clinical practice can improve efficacy of medical care, highlighting the potential for polysocial risk scores (PsRS) to help evaluate a patient's risk of developing atherosclerotic cardiovascular disease and other conditions. This review highlights existing research about the efficacy of PsRS in practical risk assessment, current gaps in the literature, and opportunities to refine the design and implementation of PsRS in real-world clinical settings. PsRS present unique opportunities to improve traditional risk prediction models for heart disease and other conditions, particularly if they examine both individual and area-level SDOH. Future studies should assess novel methods for extracting SDOH data from patients' medical records as well as PsRS implementation strategies that promote efficiency and patient confidentiality in real-world clinical settings.

A 14-year-old child with recurrent cyanotic spells at the age of 9 months underwent echocardiography at that time, which revealed tetralogy of Fallot (TOF). Follow-up computed tomography angiography revealed TOF with valvular pulmonary stenosis and a right-sided aortic arch with mirror image branching. Interestingly, an unusual anomalous course of the left brachiocephalic vein was seen. Instead of coursing anterior to the aortic arch, the left brachiocephalic vein had a U-shaped course like a garland, where it descended vertically down behind the esophagus and the descending aorta, crossed the midline at T4 level of the vertebral body, and then ascended upwards to join the superior vena cava. This case highlights the role of computed angiography in depicting anomalous venous anatomy in TOF, which can have potential clinical implications.