scholarly journals Cardio-oncology: the new frontier of clinical and preventive cardiology

2020 ◽  
Vol 90 (2) ◽  
Author(s):  
Sara Paris ◽  
Luigi Tarantini ◽  
Alessandro Navazio ◽  
Pompilio Faggiano
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Diseases ◽  
Checkpoint Inhibitors ◽  
Complex Interplay ◽  
Preventive Cardiology ◽  
Cardiovascular Side Effects ◽  
Number Of Patients ◽  
Increased Risk ◽  
Wide Range ◽  
Shared Risk

Even if cancer and cardiovascular diseases are considered two distinct diseases, an intricate interconnection between these conditions has been established. Increased risk of malignancy has been identified in patients with cardiovascular disease, as well as a greater propensity to the development of cardiovascular diseases has been observed in patients with cancer. The development of cardiotoxicity following exposure to certain anticancer drugs only partially explains this relationship. Shared risk factors and common pathogenic mechanisms suggest the existence of a common biology and a complex interplay between these two conditions. Due to improving longevity and therapeutic advances, the number of patients affected or potentially at risk of developing these two diseases is constantly increasing and currently, several drugs against cancer from anthracyclines to checkpoint inhibitors, can also cause a wide range of unexpected cardiovascular side effects. Management of these issues in clinical practice is an emerging challenge for cardiologists and oncologists, and led to the development of a new dedicated discipline called cardio-oncology. Surveillance and prevention strategies as well as interventions to reduce cardiovascular risk and prevent cardiotoxicities are the primary objectives of cardio-oncology. In this review, we explore the etiopathogenesis common to cardiovascular disease and cancer and the complex interplay between them. We also report the main characteristics of the drugs responsible for cardiotoxicity, highlighting the available strategies for optimal patient management based on a multidisciplinary approach in the cardio-oncology setting.

scholarly journals The incidence and prevalence of cardiovascular diseases in gout: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Peter Cox ◽  
Sonal Gupta ◽  
Sizheng Steven Zhao ◽  
David M. Hughes
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cardiovascular Diseases ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Random Effect ◽  
Small Sample ◽  
Future Research ◽  
Increased Risk

AbstractThe aims of this systematic review and meta-analysis were to describe prevalence of cardiovascular disease in gout, compare these results with non-gout controls and consider whether there were differences according to geography. PubMed, Scopus and Web of Science were systematically searched for studies reporting prevalence of any cardiovascular disease in a gout population. Studies with non-representative sampling, where a cohort had been used in another study, small sample size (< 100) and where gout could not be distinguished from other rheumatic conditions were excluded, as were reviews, editorials and comments. Where possible meta-analysis was performed using random-effect models. Twenty-six studies comprising 949,773 gout patients were included in the review. Pooled prevalence estimates were calculated for five cardiovascular diseases: myocardial infarction (2.8%; 95% confidence interval (CI)s 1.6, 5.0), heart failure (8.7%; 95% CI 2.9, 23.8), venous thromboembolism (2.1%; 95% CI 1.2, 3.4), cerebrovascular accident (4.3%; 95% CI 1.8, 9.7) and hypertension (63.9%; 95% CI 24.5, 90.6). Sixteen studies reported comparisons with non-gout controls, illustrating an increased risk in the gout group across all cardiovascular diseases. There were no identifiable reliable patterns when analysing the results by country. Cardiovascular diseases are more prevalent in patients with gout and should prompt vigilance from clinicians to the need to assess and stratify cardiovascular risk. Future research is needed to investigate the link between gout, hyperuricaemia and increased cardiovascular risk and also to establish a more thorough picture of prevalence for less common cardiovascular diseases.

Abstract 6238: Clarifying the Opportunities to Improve Survival After MI in Diabetic Patients

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Lance S Longmore ◽  
Kimberly J Reid ◽  
Mikhail Kosiborod ◽  
Frederick A Masoudi ◽  
Verna Welch ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Patient Characteristics ◽  
Psychosocial Health ◽  
Diabetic Patients ◽  
Biological Factors ◽  
Increased Risk ◽  
Wide Range ◽  
Patients With Diabetes ◽  
Multivariable Models ◽  
Adjusted Model

While diabetes is known to be associated with increased mortality after MI, whether these differences in outcome are due to patient characteristics, treatment, or other biological factors is unknown. We analyzed a contemporary cohort of MI survivors to comprehensively adjust for demographics, comorbidities, psychosocial, health status, clinical and treatment factors to determine if residual disparities in outcomes exist. We studied 2481 hospital survivors of MI in the prospective, 19-center PREMIER study (29% with diabetes). Multivariable models with sequential adjustment were employed to identify the extent to which variation in a wide range of patient characteristics (Figure ) accounted for differences in 3-year mortality in patients with and without diabetes. Unadjusted mortality was more than 2.5-fold greater for patients with diabetes (HR 2.55, 95% CI 2.08–3.14). Mortality was most attenuated by diabetes-related comorbidities (Figure ). The fully-adjusted model identified a significant, albeit attenuated, excess 3-year mortality among patients with diabetes (HR 1.57, 95% CI 1.22–1.99). Patients with diabetes experience a substantially increased risk for 3-year mortality after MI, even after accounting for a wide range of patient and treatment characteristics. This suggests that unmeasured, biologic variables associated with diabetes may mediate this difference. Further inquiry into the pathogenesis of diabetic cardiovascular disease is needed to identify new opportunities to improve the prognosis of patients with diabetes.

scholarly journals The Effects of Cannabidiol, a Non-Intoxicating Compound of Cannabis, on the Cardiovascular System in Health and Disease

2020 ◽  
Vol 21 (18) ◽  
pp. 6740
Author(s):  
Aleksandra Kicman ◽  
Marek Toczek
Keyword(s):  
Cardiovascular Diseases ◽  
Cardiovascular System ◽  
Heart Diseases ◽  
Ischemia Reperfusion ◽  
Antioxidant Properties ◽  
Positive Effects ◽  
Nitrative Stress ◽  
Cardiovascular Side Effects ◽  
Wide Range ◽  
Health And Disease

Cannabidiol (CBD) is a non-intoxicating and generally well-tolerated constituent of cannabis which exhibits potential beneficial properties in a wide range of diseases, including cardiovascular disorders. Due to its complex mechanism of action, CBD may affect the cardiovascular system in different ways. Thus, we reviewed the influence of CBD on this system in health and disease to determine the potential risk of cardiovascular side effects during CBD use for medical and wellness purposes and to elucidate its therapeutic potential in cardiovascular diseases. Administration of CBD to healthy volunteers or animals usually does not markedly affect hemodynamic parameters. Although CBD has been found to exhibit vasodilatory and antioxidant properties in hypertension, it has not affected blood pressure in hypertensive animals. Hypotensive action of CBD has been mainly revealed under stress conditions. Many positive effects of CBD have been observed in experimental models of heart diseases (myocardial infarction, cardiomyopathy, myocarditis), stroke, neonatal hypoxic ischemic encephalopathy, sepsis-related encephalitis, cardiovascular complications of diabetes, and ischemia/reperfusion injures of liver and kidneys. In these pathological conditions CBD decreased organ damage and dysfunction, oxidative and nitrative stress, inflammatory processes and apoptosis, among others. Nevertheless, further clinical research is needed to recommend the use of CBD in the treatment of cardiovascular diseases.

scholarly journals Cardiovascular Vulnerability to COVID-19 in Cancer Survivors

2020 ◽  
Author(s):  
Beshay Zordoky
Keyword(s):  
Cardiovascular Diseases ◽  
Cancer Survivors ◽  
Cancer Treatment ◽  
Myocardial Damage ◽  
Cardiovascular Complications ◽  
World Health ◽  
Global Pandemic ◽  
Increased Risk ◽  
Health Organization ◽  
Shared Risk

Coronavirus disease 2019 (COVID-19) has been declared a global pandemic by the World Health Organization on March 11, 2020. COVID-19 is caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-Cov-2). Although primarily a respiratory disease, cardiovascular complications of COVID-19 have been increasingly recognized. In addition, higher fatality has been reported in COVID-19 patients with underlying cardiovascular diseases. Cancer survivors have a considerably increased risk for premature cardiovascular diseases, mainly due to cardiotoxic cancer treatments. Therefore, it is foreseeable that cancer survivors will be more vulnerable to cardiovascular complications caused by COVID-19. In this review, three scenarios for increased cardiovascular complications of COVID-19 in cancer patients are proposed. In the first scenario, cardiotoxic cancer treatment and COVID-19 synergize to exacerbate direct myocardial damage. In the second scenario, cardiotoxic cancer treatment leads to a reduced cardiac reserve in cancer survivors, making them more vulnerable to COVID-19 in a “two-hit” model. The third scenario suggests that several shared risk factors may aggravate cardiovascular complications caused by both cancer treatment and COVID-19. Taken together, cancer survivors may be more vulnerable to cardiovascular complications when challenged by the COVID-19, and special cardiovascular care should be given to these patients.

scholarly journals Risk and predictors of in-hospital mortality from COVID-19 in patients with diabetes and cardiovascular disease

2020 ◽  
Author(s):  
Hadith Rastad ◽  
Hossein Karim ◽  
Hanieh-Sadat Ejtahed ◽  
Ramin Tajbakhsh ◽  
Mohammad Noorisepehr ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Hospital Mortality ◽  
Lymphocyte Count ◽  
Mortality Data ◽  
Diabetic Patients ◽  
Logistic Regression Models ◽  
Risk Of Death ◽  
Number Of Patients ◽  
Increased Risk ◽  
Novel Coronavirus

Abstract Background: Diabetes mellitus (DM) and cardiovascular disease (CVD) are present in a large number of patients with novel Coronavirus disease 2019 (COVID-19). We aimed to determine the risk and predictors of in-hospital mortality from COVID-19 in patients with DM and CVD.Methods: This retrospective cohort study included hospitalized patients aged ≥ 18 years with confirmed COVID-19 in Alborz province, Iran, from 20 February 2020 to 25 March 2020. Data on demographic, clinical and outcome (in-hospital mortality) data were obtained from electronic medical records. Self-reported comorbidities were classified into the following groups: “DM” (having DM with or without other comorbidities), “only DM” (having DM without other comorbidities), “CVD” (having CVD with or without other comorbidities), “only CVD” (having CVD without other comorbidities), and “having any comorbidity”. Multivariate logistic regression models were fitted to quantify the risk and predictors of in-hospital mortality from COVID-19 in patients with these comorbidities.Results: Among 2957 patients with COVID-19, 2656 were discharged as cured, and 301 died. In multivariate model, DM (OR: 1.62 (95%CI: 1.14-2.30)) and only DM (1.69 (1.05-2.74)) increased the risk of death from COVID-19; but, both CVD and only CVD showed non-significant associations (p>0.05). Moreover, “having any comorbidities” increased the risk of in-hospital mortality from COVID-19 (OR: 2.66 (95%CI: 2.09 -3.40)). Significant predictors of mortality from COVID-19 in patients with DM were lymphocyte count, creatinine and C-reactive protein (CRP) level (all P- values < 0.05).Conclusions: Our findings suggest that diabetic patients have an increased risk of in-hospital mortality following COVID-19; also, lymphocyte count, creatinine and CRP concentrations could be considered as significant predictors for the death of COVID-19 in these patients.

scholarly journals Ultra-processed food intake and cardiovascular disease risk in the NutriNet-Santé prospective cohort

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
B Srour ◽  
L K Fezeu ◽  
E Kesse-Guyot ◽  
B Allès ◽  
E Chazelas ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Diseases ◽  
Disease Risk ◽  
Saturated Fatty Acids ◽  
Cardiovascular Disease Risk ◽  
Food Additives ◽  
Cerebrovascular Diseases ◽  
Sensitivity Analyses ◽  
Processed Food ◽  
Increased Risk

Abstract Objective To assess the prospective associations between consumption of ultra-processed foods (UPF) and the risk of cardiovascular diseases. Methods 105159 participants aged at least 18 years (median age 41.5 years) from the French NutriNet-Santé cohort (2009-2018) were included. Dietary intakes were collected using repeated 24 hour dietary records, designed to register participants’ usual consumption for 3300 different food items, and categorized according to their degree of processing by the NOVA classification. Associations between UPF intake and risk of cardiovascular, coronary heart, and cerebrovascular diseases assessed by multivariable Cox proportional hazard models, adjusted for known risk factors. Results UPF intake was associated with higher cardiovascular disease risk (n = 1409 cases; HR for an absolute increment of 10 in the percentage of UPF = 1.12(1.05-1.20); P = 0.0008), coronary heart disease risk (n = 665 cases; HR = 1.13(1.02-1.24); P = 0.02), and cerebrovascular disease risk (n = 829 cases; HR = 1.11(1.01-1.22); P = 0.02). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (saturated fatty acids, sodium and sugar intakes, dietary fiber or a Healthy pattern derived by principal component analysis) and after a large range of sensitivity analyses. Conclusions In this large observational prospective study, higher consumption of UPF was associated with higher risks of cardiovascular, coronary heart, and cerebrovascular diseases. These results need to be confirmed in other populations and settings, and causality remains to be established. Key messages The consumption of ultra-processed food is associated with an increased risk of cardiovascular diseases. As the French Public Helath agency recommends, their consumption should be limited. Nutritional composition, food additives, contact materials, or neoformed contaminants might play a role in these associations and further studies are needed to understand their relative contribution.

Chronic Inflammatory Diseases and Atherosclerotic Cardiovascular Disease: Innocent Bystanders or Partners in Crime?

2018 ◽  
Vol 24 (3) ◽  
pp. 281-290 ◽  
Author(s):  
Peter Riis Hansen
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Inflammatory Diseases ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Chronic Inflammatory Diseases ◽  
Increased Risk ◽  
Shared Risk

Inflammation plays a significant role in atherosclerosis and cardiovascular disease (CVD). Patients with chronic inflammatory diseases are at increased risk of CVD, but it is debated whether this association is causal or dependent on shared risk factors, other exposures, genes, and/or inflammatory pathways. The current review summarizes epidemiological, clinical, and experimental data supporting the role of shared inflammatory mechanisms between atherosclerotic CVD and rheumatoid arthritis, psoriasis, inflammatory bowel disease, and periodontitis, respectively, and provides insights to future prospects in this area of research. Awareness of the role of inflammation in CVD in patients with chronic inflammatory diseases and the potential for anti-inflammatory therapy, e.g., with tumor necrosis factor-α inhibitors, to also reduce atherosclerotic CVD has evolved into guideline- based recommendations. These include regular CVD risk assessment, aggressive treatment of traditional CVD risk factors, and recognition of reduced CVD as an added benefit of strict inflammatory disease control. At present, chronic inflammatory diseases would appear to qualify as partners in crime and not merely innocent bystanders to CVD. However, definite incremental contributions of inflammation versus effects of the complex interplay with other CVD risk factors may never be fully elucidated and for the foreseeable future, inflammation is posed to maintain its current position as both a marker and a maker of CVD, with clinical utility both for identification of patient at risk of CVD and as target for therapy to reduce CVD.

Cardiovascular disease risk in survivors of 20 adult cancers.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11571-11571
Author(s):  
Helen Strongman ◽  
Sarah Gadd ◽  
Anthony Matthews ◽  
Kathryn Mansfield ◽  
Susannah Jane Stanway ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cancer Survivors ◽  
Cox Regression ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Cancer Site ◽  
Cvd Risk ◽  
Increased Risk ◽  
Wide Range

11571 Background: There are concerns about long-term cardiovascular disease (CVD) risk in cancer survivors, but few studies have quantified the risks for a wide range of cancers and specific CVD outcomes. Methods: Using UK electronic health records, we identified cohorts of adults alive one year after a cancer diagnosis at 20 different sites. Risks of a range of CVD outcomes were compared to age, sex and general practice matched cancer free controls using Cox regression; crude and adjusted models were compared to investigate the role of shared cancer/CVD risk factors (e.g. smoking and diabetes). Results: 126 120 cancer survivors and 603 144 controls were followed over a median (IQR) 4.6 (2.5-8.1) and 5.6 (3.2-9.2) years. Crude and adjusted hazard ratios (HRs) were similar. In adjusted models, there was strong evidence (p<0.01) of increased risk of CVDs among cancer survivors compared with controls: venous thromboembolism (VTE, 18 cancers), heart failure/cardiomyopathy (7 cancers), arrhythmia (4 cancers), and stroke (3 cancers). In stratified analyses HRs were higher in younger people and continued beyond 5 years post diagnosis. Conclusions: We found increased long term CVD risk among survivors of several cancers compared to the general population, which varied by cancer site and specific CVD outcome.[Table: see text]

The Utility of Anti-Inflammatory Agents in Cardiovascular Disease

2018 ◽  
Vol 23 (6) ◽  
pp. 483-493 ◽  
Author(s):  
Santhosh J. Kottoor ◽  
Rohit R. Arora
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Diseases ◽  
New England ◽  
Treatment Options ◽  
Current Treatment ◽  
Adverse Outcomes ◽  
Treatment Modalities ◽  
Clear Understanding ◽  
Acute Phase Reactants ◽  
Increased Risk

Approximately 40% of heart attack survivors remain at increased risk of recurrent cardiovascular events, despite the current treatment options showing that atherothrombosis is not exclusively a disorder of lipoprotein aggregation in the arterial wall. Clinical and experimental data suggest that inflammation plays an important role in atherothrombosis independent of the cholesterol level. Acute-phase reactants, such as C-reactive protein, increase in patients with coronary artery disease and are known to predict adverse outcomes in such patients. The recent CANTOS trial published in The New England Journal of Medicine provides evidence that interleukin-1β along with other cytokines play central roles in the inflammatory reaction that drives the interleukin-6 signaling pathway and have profound effects on cardiovascular outcomes. Several other ongoing studies are focused on multiple immune mediators involved in this process to support the inflammatory hypothesis of cardiovascular diseases. These new classes of drugs could represent the biggest breakthrough in cardiovascular medicine, which could have the greatest impact on cardiovascular mortality since the advent of statins. The drug canakinumab has shown promise in lowering atherosclerosis, and other drugs, such as colchicine and methotrexate, are gaining interest and are being investigated in multiple ongoing trials. A major concern is the affordability of these drugs, as most cardiovascular diseases are noted among people of lower socioeconomic statuses. The LoDoCo trial showed some benefits of colchicine, and whether this old drug can be marketed with a new label for cardiovascular disease remains in question. Therefore, a clear understanding of the different inflammatory pathways involved in atherosclerosis is needed to help develop more effective treatment modalities that will benefit humankind.

scholarly journals Psychosocial distress and cardiovascular disease

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Y Natt och Dag ◽  
K Mehlig ◽  
A Rosengren ◽  
L Lissner ◽  
M Rosvall
Keyword(s):  
Public Health ◽  
Cardiovascular Disease ◽  
Psychological Distress ◽  
Psychological Health ◽  
Age Groups ◽  
Psychosocial Distress ◽  
Study Cohort ◽  
Increased Risk ◽  
Wide Range ◽  
The Impact

Abstract Background The contemporary increase in psychological distress observed in many countries is, by itself, a public health issue of great concern. Methods This prospective study aims to investigate the impact of psychological distress on incident cardiovascular disease, in different age groups and also with respect to sex, among participants in the Gothenburg-based InterGene Study cohort. This cohort comprises a total of 3614 men and women, aged 25-75 years. Included in the present study were individuals who were free of previous CVD diagnoses and who fully completed all baseline examinations. Inclusions took place during 2001-2004. Psychological distress at baseline was assessed by self-rating depression and anxiety scales. A wide range of physiological and behavioral parameters were also assessed, which allowed for relevant adjustments. The outcome was incident CVD, and with a 12 year follow-up. Cox-regression analyses were performed. Results The results showed an increased risk of incident CVD with higher scores on each of the scales. The majority of the findings persisted after adjustments for relevant confounders. It was most common for young women to score high on the anxiety and depression scales. Conclusions The associations between psychological distress and later life cardiovascular disease calls for enhanced public health measures aiming at ameliorating psychological health, not least in younger age groups. Key messages There was an increased risk of incident CVD with higher scores on psychosocial distress scales. The majority of the findings persisted after adjustments for relevant confounders.

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