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Primary and Secondary Cardiovascular Disease Risk Factors, Prevention and Therapy

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: closed (15 August 2024) | Viewed by 15032

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Special Issue Editors

Prof. Dr. Pompilio Faggiano

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Guest Editor

Cardiology Division, Spedali Civili and University of Brescia, Brescia, Italy
Interests: cardiovascular prevention and rehabilitation; echocardiography; valve disease

Prof. Dr. Roberto Lorusso

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Guest Editor

Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC+), 6202 AZ Maastricht, The Netherlands
Interests: cardio-thoracic surgery

Special Issue Information

Dear Colleagues,

Cardiovascular diseases (CVDs) remain the number one cause of morbidity and mortality worldwide.

In the last few decades, several advancements in the diagnosis and treatment, both medical and surgical, of overt CVD have been developed and have entered clinical practice. This has caused a reduction in the mortality and hospitalization rates associated with several conditions, such as acute myocardial infarction, multivessel coronary artery disease, advanced valve disease and heart failure. However, the incidence rates of new cases of cardiac disease and their serious complications remain very high.

The prevention of both primary and secondary CVD represents a fundamental approach to reduce the burden of CVD worldwide. The aim of this Special Issue of JCM is to offer updated information in the field of CVD prevention.

List of potential topics:

The epidemiology of cardiovascular disease and risk factors worldwide;
The pathogenesis of atherosclerotic plaque and mechanisms leading to acute cardiovascular events;
Population and patient strategies for primary CVD;
Strategies to improve lifestyle habits;
From the international guidelines for CVD prevention to real-world data: the gap between theory and practice;
The issue of therapeutic adherence: a new risk factor;
Combination therapy and polypill;
After acute coronary syndrome: from the first month to the first year and beyond: how to reduce the long-term risk;
After cerebrovascular and peripheral artery disease: should the same secondary prevention as for coronary artery disease be used?;
How to prevent stent disease or graft venous disease;
How to prevent biologic valve degeneration;
How to prevent left ventricle remodeling;
Coronary artery and valve disease post mediastinal irradiation;
Ischemic left ventricular dysfunction and advanced heart failure: prevention strategies.

The topics of interest are not limited to this list; many more are welcome.

Researchers are invited to submit original and review manuscripts related to all aspects of CVD prevention.

Prof. Dr. Pompilio Faggiano
Prof. Dr. Roberto Lorusso
Guest Editors

Manuscript Submission Information

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Keywords

cardiovascular disease
atherosclerotic plaque
risk factors of cardiovascular disease
epidemiology
peripheral artery disease
coronary artery disease
graft venous disease
valve degeneration
left ventricle remodeling
ischemic left ventricular dysfunction
advanced heart failure
therapy
prevention

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Published Papers (9 papers)

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Research

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11 pages, 649 KiB

Open AccessArticle

Association between Atherogenic Dyslipidemia and Subclinical Myocardial Injury in the General Population

by Nada S. Elbadawi, Moaze H. Sobih, Mai Z. Soliman, Mohamed A. Mostafa, Richard Kazibwe and Elsayed Z. Soliman

J. Clin. Med. 2024, 13(16), 4946; https://doi.org/10.3390/jcm13164946 - 22 Aug 2024

Viewed by 811

Abstract

Background: Subclinical myocardial injury (SCMI) is associated with an increased risk of poor cardiovascular disease (CVD) outcomes. Understanding the underlying risk factors for SCMI is crucial for the prevention and management of CVD. We hypothesized that atherogenic dyslipidemia, a combination of high triglycerides (TG) and low high-density lipoprotein cholesterol (HDL-C), is associated with an increased risk of SCMI. Methods: This analysis from the third National Health and Nutrition Examination Survey (NHANES-III) included 7093 participants (age 59.3 ± 13.4 years, 52.8% women, and 49.4% White) free of CVD. Atherogenic dyslipidemia was defined as TG ≥ 150 mg/dL and HDL-C < 40 mg/dL in men or <50 mg/dL in women. A validated electrocardiographic-based cardiac infarction injury score (CIIS) ≥ 10 was considered positive for SCMI. Multivariable logistic regression analysis was used to examine the association of different combinations of TG and HDL-C groups, including atherogenic dyslipidemia with SCMI. Results: About 22.5% (n = 1594) of participants had atherogenic dyslipidemia, and 26.3% (n = 1862) had SCMI. Compared to participants with normal TG and normal HDL-C, those with atherogenic dyslipidemia had a higher prevalence of SCMI (31.2% vs. 23.9%, p-value < 0.001). In a multivariable logistic regression model, atherogenic dyslipidemia was associated with the highest odds of SCMI followed by high TG/normal HDL-C, then low HDL-C/normal TG [OR (95% CI): 131 (1.14, 1.52), 1.13 (0.97, 1.33), and 1.01 (0.86, 1.20), respectively). Conclusions: Atherogenic dyslipidemia is associated with a higher risk of SCMI, which highlights the role of nontraditional risk factors in the development of subclinical CVD. Full article

(This article belongs to the Special Issue Primary and Secondary Cardiovascular Disease Risk Factors, Prevention and Therapy)

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8 pages, 519 KiB

Open AccessArticle

Carotid Plaques and Hypertension as Risk Factors for Cardiovascular Disease and All-Cause Mortality in Middle-Aged Adults

by Vilma Dženkevičiūtė, Tadas Adomavičius, Gabrielė Tarutytė, Egidija Rinkūnienė, Vytautas Kasiulevičius and Jolita Badarienė

J. Clin. Med. 2024, 13(10), 2804; https://doi.org/10.3390/jcm13102804 - 9 May 2024

Cited by 1 | Viewed by 1213

Abstract

Background/Objectives: Both hypertension and carotid atherosclerosis are independent risk factors for cardiovascular disease. We aim to investigate the synergistic effects of hypertension and carotid plaques on cardiovascular events and all-cause mortality. Methods: A follow-up study was conducted at the Preventive Cardiology Department of Vilnius University Hospital Santaros Klinikos between 2012 and 2021. The study recruited participants aged 40–65 who did not have overt cardiovascular disease (CVD) and were part of the Lithuanian High Cardiovascular Risk primary preventive program. The study collected demographic and clinical data, including an ultrasound assessment of carotid plaque. Results: The participants were monitored for 4–10 years for CVD events and all-cause mortality. Among 6138 participants, 954 (16%) experienced CVD events. The presence of carotid plaque on both sides was significantly associated with CVD events, myocardial infarction, and all-cause mortality. However, the combination of hypertension and carotid plaque did not significantly increase the risk for CVD events or all-cause mortality. Conclusions: The risk of CVD events or all-cause mortality was not significantly increased by the combination of hypertension and carotid plaque. Cardiovascular events depend on the extent of atherosclerosis in the carotid arteries. Full article

(This article belongs to the Special Issue Primary and Secondary Cardiovascular Disease Risk Factors, Prevention and Therapy)

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8 pages, 226 KiB

Open AccessArticle

Association between Blood Lead Levels and Silent Myocardial Infarction in the General Population

by Mohamed A. Mostafa, Mohammed A. Abueissa, Mai Z. Soliman, Muhammad Imtiaz Ahmad and Elsayed Z. Soliman

J. Clin. Med. 2024, 13(6), 1582; https://doi.org/10.3390/jcm13061582 - 10 Mar 2024

Viewed by 1278

Abstract

Background: Although the link between lead exposure and patterns of cardiovascular disease (CVD) has been reported, its association with silent myocardial infarction (SMI) remains unexplored. We aimed to assess the association between blood lead levels (BLLs) and SMI risk. Methods: We included 7283 (mean age 56.1 ± 2.52 years, 52.5% women) participants free of CVD from the Third National Health and Nutrition Examination Survey. BLL was measured using graphite-furnace atomic absorption spectrophotometry. SMI was defined as ECG evidence of myocardial infarction (MI) without history of MI. The association between SMI and BLLs was examined using multivariable logistic regression. Results: SMI was detected in 120 participants with an unweighted prevalence of 1.65%. Higher BLL correlated with higher SMI prevalence across BLL tertiles. In multivariable-adjusted models, participants in the third BLL tertile had more than double the odds of SMI (OR: 3.42, 95%CI: 1.76–6.63) compared to the first tertile. Each 1 µg/dL increase in BLL was linked to a 9% increase in SMI risk. This association was consistent across age, sex, and race subgroups. Conclusions: Higher BLLs are associated with higher odds of SMI in the general population. These results underscore the significance of the ongoing efforts to mitigate lead exposure and implement screening strategies for SMI in high-risk populations. Full article

(This article belongs to the Special Issue Primary and Secondary Cardiovascular Disease Risk Factors, Prevention and Therapy)

12 pages, 1000 KiB

Open AccessFeature PaperArticle

Safety and Efficacy of PCSK9 Inhibitors in Patients with Acute Coronary Syndrome Who Underwent Coronary Artery Bypass Grafts: A Comparative Retrospective Analysis

by Giuseppe Nasso, Claudio Larosa, Francesco Bartolomucci, Mario Siro Brigiani, Gaetano Contegiacomo, Maria Antonietta Demola, Walter Vignaroli, Alessandra Tripoli, Cataldo Girasoli, Rosanna Lisco, Marialisa Trivigno, Roberto Michele Tunzi, Tommaso Loizzo, Dritan Hila, Rosalba Franchino, Vincenzo Amodeo, Simone Ventra, Giuseppe Diaferia, Giacomo Schinco, Felice Eugenio Agrò, Maddalena Zingaro, Isabella Rosa, Roberto Lorusso, Armando Del Prete, Giuseppe Santarpino and Giuseppe Speziale Show full author list Hide full author list

J. Clin. Med. 2024, 13(3), 907; https://doi.org/10.3390/jcm13030907 - 4 Feb 2024

Cited by 1 | Viewed by 1504

Abstract

Background. The in-hospital reduction in low-density lipoprotein cholesterol (LDL-C) levels following acute coronary syndrome (ACS) is recommended in the current clinical guidelines. However, the efficacy of proprotein convertase subtilisin–kexin type 9 (PCSK9) inhibitors in those patients undergoing coronary artery bypass graft (CABG) has never been demonstrated. Methods. From January 2022 to July 2023, we retrospectively analyzed 74 ACS patients characterized by higher LDL-C levels than guideline targets and who underwent coronary bypass surgery. In the first period (January 2022–January 2023), the patients increased their statin dosage and/or added Ezetimibe (Group STEZE, 43 patients). At a later time (February 2023–July 2023), the patients received not only statins and Ezetimibe but also Evolocumab 140 mg every 2 weeks starting as early as possible (Group STEVO, 31 patients). After one and three months post-discharge, the patients underwent clinical and laboratory controls with an evaluation of the efficacy lipid measurements and every adverse event. Results. The two groups did not differ in terms of preoperative risk factors and Euroscore II (STEVO: 2.14 ± 0.75 vs. STEZE: 2.05 ± 0.6, p = 0.29). Also, there was no difference between the groups in terms of ACS (ST-, Instable angina, or NSTE) and time of symptoms onset regarding total cholesterol, LDL-C, and HDL-C trends from the preprocedural period to 3-month follow-up, but there was a more significant reduction in LDL-C and total cholesterol in the STEVO group (p = 0.01 and p = 0.04, respectively) and no difference in HDL-C rise (p = 0.12). No deaths were reported. In three STEZE group patients, angina recurrence posed the need for percutaneous re-revascularization. No STEVO patients developed significant adverse events. The statistical difference in these serious events, 7% in STEZE vs. 0% in STEVO, was not significant (p = 0.26). Conclusions. Evolocumab initiated “as soon as possible” in ACS patients submitted to CABG with high-intensity statin therapy and Ezetimibe was well tolerated and resulted in a substantial and significant reduction in LDL-C levels at discharge, 1 month, and 3 months. This result is associated with a reduction but without a statistical difference between groups. Full article

(This article belongs to the Special Issue Primary and Secondary Cardiovascular Disease Risk Factors, Prevention and Therapy)

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13 pages, 668 KiB

Open AccessArticle

Emergent Conversion to Open Heart Surgery during Transcatheter Aortic Valve Implantation: The Presence of a Rescue Team Improves Outcomes

by Giuseppe Nasso, Walter Vignaroli, Gaetano Contegiacomo, Alfredo Marchese, Khalil Fattouch, Pasquale D’Alessandro, Mario Siro Brigiani, Vincenza Vitobello, Vera Triggiani, Maria Antonietta Demola, Stefano Tonioni, Domenico Paparella, Stefano Sechi, Raffaele Bonifazi, Giuseppe Santarpino, Fabrizio Resta, Francesco Bartolomucci, Roberto Lorusso, Claudio Larosa, Giovanni Valenti, Antonio Tito, Marco Moscarelli, Vito Margari, Flavio Fiore, Ignazio Condello and Giuseppe Speziale Show full author list Hide full author list

J. Clin. Med. 2023, 12(24), 7705; https://doi.org/10.3390/jcm12247705 - 15 Dec 2023

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Abstract

Objective: Transcatheter aortic valve implant (TAVI) is the gold standard for the high-surgical-risk group of patients with aortic valve disease and it is an alternative to surgery in patients at intermediate risk. Lethal complications can occur, and many of these are manageable only with emergent conversion to open heart surgery. We retrospectively evaluate the outcome of all patients undergoing TAVI in our departments and the impact of a complete cardiac rescue team to reduce 30-day mortality. Methods: Data from all patients undergoing TAVI between January 2020 and August 2023 in our center were analyzed. An expert complete rescue was present in catheter laboratory. Primary outcomes were in-hospital and at 30-day mortality and evaluation of all cases needed for emergent conversion to open heart surgery. Results: 825 patients were enrolled. The total mortality was 19/825 (2.3%). Eleven of the total patients (1.3%) required emergent conversion to open heart surgery. Among them, eight were alive (73%), with a theoretical decrease of 0.98% in overall mortality. Conclusions: surgical treatment is rare during TAVI. The presence of an expert complete rescue team as support means an increase in survival. Surgery must be used only to restore circulatory and to treat complication while percutaneous approaches should complete the procedure. Full article

(This article belongs to the Special Issue Primary and Secondary Cardiovascular Disease Risk Factors, Prevention and Therapy)

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10 pages, 876 KiB

Open AccessArticle

Effects of Antihypertensive Treatment on Left and Right Ventricular Global Longitudinal Strain and Diastolic Parameters in Patients with Hypertension and Obstructive Sleep Apnea: Randomized Clinical Trial of Chlorthalidone plus Amiloride vs. Amlodipine

by Juliano A. Jorge, Murilo Foppa, Angela B. S. Santos, Fábio T. Cichelero, Denis Martinez, Marcelo B. Lucca, Geórgia P. F. de Oliveira, Flávio D. Fuchs and Sandra C. Fuchs

J. Clin. Med. 2023, 12(11), 3785; https://doi.org/10.3390/jcm12113785 - 31 May 2023

Cited by 1 | Viewed by 1468

Abstract

Hypertension is highly prevalent in patients with obstructive sleep apnea (OSA), and fluid retention with its nighttime rostral distribution is one potential mechanism. We tested whether or not diuretics differ from amlodipine in their impact on echocardiographic parameters. Patients with moderate OSA and hypertension were randomized to receive diuretics (chlorthalidone plus amiloride) or amlodipine daily for 8 weeks. We compared their effects on left and right ventricular global longitudinal strain (LV-GLS and RV-GLS, respectively), on LV diastolic parameters, and on LV remodeling. In the 55 participants who had echocardiographic images feasible for strain analysis, all echocardiographic parameters were within normal ranges. After 8 weeks, the 24 h blood pressure (BP) reduction values were similar, while most echocardiographic metrics were kept unchanged, except for LV-GLS and LV mass. In conclusion, the use of diuretics or amlodipine had small and similar effects on echocardiographic parameters in patients with moderate OSA and hypertension, suggesting that they do not have important effects on mediating the interaction between OSA and hypertension. Full article

(This article belongs to the Special Issue Primary and Secondary Cardiovascular Disease Risk Factors, Prevention and Therapy)

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Review

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9 pages, 809 KiB

Open AccessReview

Prevention of Natural Disaster-Induced Cardiovascular Diseases

by Minako Yamaoka-Tojo and Taiki Tojo

J. Clin. Med. 2024, 13(4), 1004; https://doi.org/10.3390/jcm13041004 - 9 Feb 2024

Cited by 1 | Viewed by 2167

Abstract

Natural disasters, such as floods and landslides caused by heavy rainfall, earthquakes, and tsunamis, can induce stress, which may contribute to the onset and aggravation of various cardiovascular diseases. The circulatory system is most susceptible to the effects of stress, and stress-related cardiovascular diseases, such as Takotsubo cardiomyopathy, pulmonary thromboembolism, hypertension, stroke triggered by increased blood pressure, and acute myocardial infarction, can occur during natural disasters. The risk of developing angina pectoris, arrhythmia, sudden cardiac death, and heart failure increases rapidly and can persist for several months. Moreover, treating cardiovascular diseases is essential during the acute phase, and continuous disease management is necessary during the chronic phase. However, disaster medical care for the victims must be given priority during natural disasters, which may cause a delay in diagnosis or access to necessary treatment for pre-existing medical conditions that could worsen or may cause death in patients with cardiovascular diseases. In this review, we summarize the predisposing factors for cardiovascular diseases that have been obtained through disasters such as major earthquakes and provide potential insights to help medical staff prevent the onset and aggravation of cardiovascular diseases during disasters. Full article

(This article belongs to the Special Issue Primary and Secondary Cardiovascular Disease Risk Factors, Prevention and Therapy)

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18 pages, 669 KiB

Open AccessReview

Selected Exogenous (Occupational and Environmental) Risk Factors for Cardiovascular Diseases in Military and Aviation

by Ewelina Maculewicz, Agata Pabin, Łukasz Dziuda, Małgorzata Białek and Agnieszka Białek

J. Clin. Med. 2023, 12(23), 7492; https://doi.org/10.3390/jcm12237492 - 4 Dec 2023

Cited by 2 | Viewed by 1781

Abstract

Cardiovascular diseases are a group of disorders of heart and blood vessels which are the leading cause of death globally. They are also a very important cause of military unsuitability especially among military pilots. Some of the risk factors cannot be modified, but a large group of them can be modified by introducing healthy habits or behaviors, such as regular physical activity, quitting of tobacco smoking, cessation of harmful alcohol consumption, or stress avoidance. Specific occupational and environmental factors, such as acceleration, pressure changes, hypoxia, thermal stress, noise, vibration, prolonged sedentary posture, difficulties in moving the limbs, shifts, work shift irregularities, circadian dysrhythmia, variations in the microclimate, motion sickness, radiation, toxicological threats, occupational stress, emotional tension, highly demanding tasks especially during take-off and landing, predominance of intellectual over physical activity, and forced operation speed against time shortage are considered as characteristic for military personnel, especially military aircrews. They are of special concern as some of them are considered as potential CVD risk factors. The aim of this study was to discuss the influence of selected occupational and environmental factors (noise, altitude, hypoxia, acceleration forces, tobacco smoking, oral health, and stress) regarding their importance for CVD risk in military professionals and military aviators. The performed revision confirmed that they are exposed to certain characteristic conditions, which may influence the CVD risk but the number of solid scientific data regarding this subject are limited. There is a great need to perform complex studies on environmental and occupational risk factors for CVDs in military personnel and military aviators as well as how to minimize their influence to prolong the state of health and military suitability of this professional groups. Full article

(This article belongs to the Special Issue Primary and Secondary Cardiovascular Disease Risk Factors, Prevention and Therapy)

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25 pages, 3030 KiB

Open AccessSystematic Review

Prevalence of Cardiovascular Risk Factors in Spain: A Systematic Review

by Jennifer Sacramento-Pacheco, María Begoña Sánchez-Gómez, Juan Gómez-Salgado, María Mercedes Novo-Muñoz and Gonzalo Duarte-Clíments

J. Clin. Med. 2023, 12(21), 6944; https://doi.org/10.3390/jcm12216944 - 6 Nov 2023

Cited by 2 | Viewed by 2374

Abstract

Cardiovascular diseases are the leading cause of death in Spain, according to data from the National Institute of Statistics, with the lack of control of cardiovascular risk factors (CVRF) being the main contributing factor. The CVRFs of greatest clinical interest are high blood pressure (HBP), smoking, diabetes mellitus (DM2), overweight, obesity, hypercholesterolaemia, and sedentary lifestyle. The main objective of this review was to compare the prevalence of the different CVRFs according to population-based studies carried out in Spain. For this, a systematic review based on publications assessing CVRFs in the adult population and estimating their national prevalence was conducted. Pubmed and Dialnet databases were consulted, and the selected articles were analysed using the Critical Appraisal Skills Programme Español (CASPe) tool for cohort studies and the Berra et al. tool for cross-sectional studies. A total of 33 studies were obtained from the autonomous regions of Andalusia, the Canary Islands, Castilla-Leon, Castilla-La Mancha, Catalonia, Extremadura, the Balearic Islands, Madrid, Murcia, and Navarra. In all the population-based studies, there was a greater representation of women in the sample. The most prevalent CVRFs differed across the studies according to the autonomous region targeted, with dyslipidaemia, sedentary lifestyle, high blood pressure, hypercholesterolaemia, overweight, and obesity standing out. Numerous differences exist between the studies included in this review, such as the age range, the CVRFs analysed and their prevalence, and remarkable aspects such as the over-representation of the female sex in all cases. It can be concluded that, based on the presented results, the prevalence of CVRFs in Spain varies according to the autonomous region, the sex of the individual, and the studied age range. Full article

(This article belongs to the Special Issue Primary and Secondary Cardiovascular Disease Risk Factors, Prevention and Therapy)

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