Phytoestrogens and breast cancer prevention: possible mechanisms of action

OBJECTIVE: Phytoestrogens display an array of pharmacologic properties, and in recent years investigation of their potential as anticancer agents has increased dramatically. In this article we review the published literature related to phytoestrogens and breast cancer as well as suggest the possible mechanisms that may underlie the relationship between phytoestrogens and breast cancer. DATA SOURCES: Electronic searches on phytoestrogens and breast cancer were performed on MEDLINE and EMBASE in June 2007. No date restriction was placed on the electronic search. DATA EXTRACTION: We focused on experimental data from published studies that examined the characteristics of phytoestrogens using in vivo or in vitro models. We also include human intervention studies in this review. DATA SYNTHESIS: We evaluated evidence regarding the possible mechanisms of phytoestrogen action. Discussions of these mechanisms were organized into those activities related to the estrogen receptor, cell growth and proliferation, tumor development, signaling pathways, and estrogen-metabolizing enzymes. CONCLUSIONS: We suggest that despite numerous investigations, the mechanisms of phytoestrogen action in breast cancer have yet to be elucidated. It remains uncertain whether these plant compounds are chemoprotective or whether they may produce adverse outcomes related to breast carcinogenesis.     

Genetic variation associated with ischemic heart failure: a HuGE review and meta-analysis

The ischemic etiology of heart failure is an independent prognostic factor associated with worse long-term outcome. Recent evidence indicates a role for genetic susceptibility to ischemic heart failure. The authors systematically reviewed all known case-control studies that investigated the association between genetic variants and ischemic heart failure. Twenty-two articles, which examined 24 gene polymorphisms, were identified. In 22 polymorphisms, the variant form had a functional effect. Twenty-two polymorphisms were variants of genes involved in the maladaptive neurohormonal activation. Seven polymorphisms (ACE I/D, AGT M235T, ADRA2C Del322-325, ADRB2 Arg16Gly, ADRB2 Gln27Glu, EDN1 Lys198Asn, VEGF G-405C) showed a significant association in individual studies. Five polymorphisms (ACE I/D, ADRB1 Arg389Gly, ADRB2 Arg16Gly, ADRB2 Gln27Glu, TNF G308A) were examined by more than one study, and meta-analyses were performed. The meta-analyses showed no significant sign of heterogeneity. In all settings, there was no significant association, except for polymorphism ADRB2 Arg16Gly under a recessive model (fixed-effects odds ratio = 1.32, 95% confidence interval: 1.05, 1.65). Taking into account that ischemic heart failure is a complex disease with multifactorial etiology, a minor contributing pathogenetic role of the investigated gene polymorphisms cannot be totally excluded. Case-control studies that investigate gene-gene and gene-environment interactions might further elucidate the genetics of ischemic heart failure.     

Diastolic heart failure: a review and primary care perspective

Previously the subject of much debate, there is now consensus that diastolic heart failure (DHF) represents a distinct form of heart failure. Epidemiologic data indicate that DHF is common. Indeed, there is evidence that, among elderly persons, DHF is more common than systolic heart failure (SHF). Like SHF, DHF is associated with significant morbidity, mortality, and cost; however, few clinical trials focusing on isolated DHF have been completed. Much of the treatment of DHF is based on current concepts of the pathophysiology of DHF, small clinical studies, and experience gained from treating patients with SHF. The diagnosis of DHF is clinical; data supporting the establishment of a diagnosis of DHF are limited. Differences exist in prognosis and treatment between diastolic and systolic heart failure. This article reviews diastolic heart failure with emphasis on evidence-based management, aimed at primary care physicians who routinely provide care to patients with DHF.     

The water factor and mortality from ischemic heart disease: a review and possible explanations for inconsistent findings with additional data from Manitoba.

The question of the relationship between water hardness and mortality from cardiovascular diseases is far from being settled. Marked discrepancies in the results of various studies in this area exist and there is a great need for closer examination of the reliability of measuring water hardness and other water characteristics. There is also a need for standardizing these measurements and for accounting for certain important questions in designing studies of this nature. This article reviews the results of various studies on the "water factor," points out their discrepancies, presents additional evidence from the Province of Manitoba against the "water factor;" and explains possible sources for discrepancies in the findings of various studies. Based on the evidence so far available, it is too early to universally accept the "water story" and to make recommendations for discouraging the softening of hard water as a measure for preventing cardiovascular disease mortality.     

心力衰竭的流行病学与防治现状

心力衰竭（Heart failure,简称心衰）是指任何原因引起心肌损伤,造成心肌结构和功能发生改变,致使心室泵血功能降低不能满足机体代谢需要的临床综合征,是各种心脏病的终末阶段。随着冠心病、高血压等常见病发病率上升和人口老龄化的进一步加快,特别是冠心病诊疗水平的提高,急诊溶栓和直接经皮冠状动脉介入治疗（PCI）等梗死后再灌注治疗的广泛开展使急性心肌梗死早期存活率明显改善,后期心衰患病率逐步升高。     

A review of levosimendan in the treatment of heart failure

Heart failure is a relatively important public health problem due to its increasing incidence, poor prognosis, and frequent need of re-hospitalization. Intravenous positive inotropic agents play an important role in treating acute decompensation of patients with heart failure due to left ventricular systolic dysfunction. Although frequently used, the inotropic agents beta-adrenergic agonists and phosphodiesterase inhibitors seem effective for improving symptoms in the short term; it has been shown that they increase morbidity and mortality by elevating intracellular cyclic adenosine monophosphate (cAMP) and calcium levels. Levosimendan is a new positive inotropic agent having ATP-dependent potassium-channel-opening and calcium-sensitizing effects. In studies on its effects without increasing intracellular calcium concentrations and on its effects that depend on available intracellular calcium levels, it has been shown to have favorable characteristics different from those of current inotropic agents, which exert their effects by increasing calcium concentrations. This study aims to review other important studies about levosimendan by revealing the underlying mechanisms of its activity, efficiency, and safety.     

Molecular and cellular mechanisms for protecting the respiratory organs from hazardous effects

Knowledge of the mechanisms of the body's defense from poor exposures underlies the pathogenetical approach to examining the influence of environmental factors on human health. The respiratory organs are protected from poor exposures by several interrelated systems and mechanisms. The most important ones are an inspired air conditioning system, a respiratory tract self-cleansing system, a pulmonary non-specific bactericidal protection system, an alveolar respiratory surface self-cleansing system, a toxic substance metabolic and neutralizing system, and a specific immune defense system. Free radicals also play a great role in the physiology and pathology.     

The experience of living with chronic heart failure: a narrative review of qualitative studies

Background  

Chronic heart failure (CHF) is the leading cause of all hospitalisations and readmissions in older people, accounting for a large proportion of developed countries' national health care expenditure. CHF can severely affect people's quality of life by reducing their independence and ability to undertake certain activities of daily living, as well as affecting their psychosocial and economic capacity. This paper reports the findings of a systematic narrative review of qualitative studies concerning people's experience of living with CHF, aiming to develop a wide-ranging understanding of what is known about the patient experience.     

Systematic review of studies on telemonitoring of patients with congestive heart failure: a meta-analysis

We conducted a systematic review of large, well-conducted randomised trials designed to evaluate the effectiveness of telemonitoring on patients with congestive heart failure (CHF). Two people reviewed 125 articles independently and selected 13 articles for final review. These studies concerned 3480 patients. The follow-up period of the studies was 3-15 months. Pooled estimate results showed that there was an overall reduction in all-cause mortality (P = 0.02). There was no overall reduction in all-cause hospital admission (P = 0.84), although there was a reduction in CHF hospital admission (P = 0.0004). There was no reduction in all-cause emergency admission (P = 0.67). There was no significant difference in length of stay in hospital, medication adherence or cost. Telemonitoring in conjunction with nurse home visiting and specialist unit support can be effective in the clinical management of patients with CHF and help to improve their quality of life.     

Disease-specific health-related quality of life questionnaires for heart failure: a systematic review with meta-analyses

Background  Heart failure (HF) is an increasingly common condition affecting patients’ health-related quality of life (HRQL). However, there is little literature comparing HF-specific instruments. Our aim was to evaluate and compare data on the conceptual model and metric properties (reliability, validity and responsiveness) of HF-specific HRQL instruments, by performing a systematic review with meta-analyses. Methods and results  Of 2,541 articles initially identified, 421 were full-text reviewed. Ninety-four reported data on five questionnaires: Minnesota Living with Heart Failure Questionnaire (MLHFQ), Chronic Heart Failure Questionnaire (CHFQ), Quality of Life Questionnaire for Severe Heart Failure (QLQ-SHF), Kansas City Cardiomyopathy Questionnaire (KCCQ) and Left Ventricular Dysfunction (LVD-36) questionnaire. Metric properties (reliability, validity and responsiveness) were summarised using meta-analysis for pools above five estimates. Cronbach’s alpha coefficients were generally high (0.83–0.95) for overall scores and scales measuring physical health. Associations with four validity criteria (New York Heart Association [NYHA] class, six-minute walk test [6MWT] and short form-36 [SF-36] ‘Physical’ and ‘Social Functioning’) were moderate to strong (0.41–0.84), except for those between two CHFQ domains (fatigue and dyspnoea) and the NYHA (0.19 and 0.22). Pooled estimates of change from eight meta-analyses showed the MLHFQ to be highly responsive, with changes in overall score ranging from −9.6 (95% confidence interval [CI]: −4.1; −15.2) for placebo to −17.7 (95% CI: −15.3; −20.2) for pacing devices. The CHFQ and KCCQ also showed good sensitivity to change. Conclusions  Most of the questionnaires studied met minimum psychometric criteria, though current evidence would primarily support the use of the MLHFQ, followed by the KCCQ and CHFQ. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Meaning-making and quality of life in heart failure interventions: a systematic review

Quality of Life Research - Heart failure (HF) patients often report high levels of psychological distress and diminished quality of life (QoL). As such, interventions aimed at improving their QoL...     

A systematic review of the literature on home monitoring for patients with heart failure

We conducted a systematic review of the literature for assessing the value of home monitoring for heart failure (HF) patients. The abstracts of 383 articles were read. We excluded those in which either no home monitoring was done or only the technical aspects of the telemedicine application were described. Forty-two studies met the selection criteria. We classified the results into feasibility (technical and institutional) and impact (on the clinical process, on patient health, on accessibility and acceptability of the health system, and on the economy). Evaluating the articles showed that home monitoring in HF patients is viable, given that: (1) it appears to be technically effective for following the patient remotely; (2) it appears to be easy to use, and it is widely accepted by patients and health professionals; and (3) it appears to be economically viable. Furthermore, home monitoring of HF patients has been shown to have a positive impact on: (1) the clinical process, supported by a significant improvement of patient follow-up by adjustment of treatment, diet or behaviour, as well as hospital readmissions and emergency visits reduction; (2) the patient's health, supported by a relevant improvement in quality of life, a reduction of days in hospital, and a decrease in mortality; and (3) costs resulting from the use of health resources.     

What to teach to patients with heart failure and why: the role of nurses in heart failure clinics

The most important objective of heart failure (HF) treatment is to reach and preserve patients' clinical stability. Several studies have shown that programs aimed at systematic education, developed by multidisciplinary teams, are positive strategies to work with these patients. Nurses active in HF clinics play a fundamental role in the educational process and continuity of patient care. The objectives of these processes are to teach, reinforce, improve and constantly evaluate patients' self-care abilities, which include weight monitoring, sodium and fluid restrictions, physical activities, regular medication use, monitoring signs and symptoms of disease worsening and early search for medical care. Therefore, education to understand HF and the development of self-care abilities are considered key points to improve adherence, avoid decompensation crises and, consequently, to maintain patients clinically stable. This article presents a careful review of the aspects involved in the patient education process by nurses in the context of HF clinics.     

The role of tree nuts and peanuts in the prevention of coronary heart disease: multiple potential mechanisms

Epidemiologic and clinical trial evidence has demonstrated consistent benefits of nut and peanut consumption on coronary heart disease (CHD) risk and associated risk factors. The epidemiologic studies have reported various endpoints, including fatal CHD, total CHD death, total CHD, and nonfatal myocardial infarct. A pooled analysis of 4 U.S. epidemiologic studies showed that subjects in the highest intake group for nut consumption had an approximately 35% reduced risk of CHD incidence. The reduction in total CHD death was due primarily to a decrease in sudden cardiac death. Clinical studies have evaluated the effects of many different nuts and peanuts on lipids, lipoproteins, and various CHD risk factors, including oxidation, inflammation, and vascular reactivity. Evidence from these studies consistently shows a beneficial effect on these CHD risk factors. The LDL cholesterol-lowering response of nut and peanut studies is greater than expected on the basis of blood cholesterol-lowering equations that are derived from changes in the fatty acid profile of the diet. Thus, in addition to a favorable fatty acid profile, nuts and peanuts contain other bioactive compounds that explain their multiple cardiovascular benefits. Other macronutrients include plant protein and fiber; micronutrients including potassium, calcium, magnesium, and tocopherols; and phytochemicals such as phytosterols, phenolic compounds, resveratrol, and arginine. Nuts and peanuts are food sources that are a composite of numerous cardioprotective nutrients and if routinely incorporated in a healthy diet, population risk of CHD would therefore be expected to decrease markedly.     

Model parameters influencing the cost-effectiveness of sacubitril/valsartan in heart failure: evidence from a systematic literature review

Objectives

To summarize cost-effectiveness (CE) evidence of sacubitril/valsartan for the treatment of heart failure (HF) patients with reduced ejection fraction (HFrEF). The impact of different modeling approaches and parameters on the CE results is also described.

Methods

We conducted a systematic literature review using multiple databases: Embase^®; MEDLINE^®; MEDLINE^®-In Process; NIHR CRD database including DARE, NHS EED, and HTA databases; and the Cost Effectiveness Analysis registry. We also reviewed HTA countries’ websites to identify CE reports of sacubitril/valsartan, published up to 25-July-2021. Articles published in English as full-texts, conference-abstracts, or HTA reports were included.

Results

We included 44 CE models [39 from 37 publications (22 full-texts; 15 conference-abstracts) and 5 HTAs; Europe, n = 20; North and South Americas, n = 14; Asia and Australia, n = 10]. Most models adopted a Markov structure with constant transition probabilities of events (n = 27) or a mix of Markov and regression-based models (n = 16), with variations in structural assumptions and chosen parameters. Study authors concluded sacubitril/valsartan to be a cost-effective therapy in 37/41 models in chronic HFrEF patients and 2/3 models in hospitalized patients stabilized after an acute decompensation for HF. CE models showing sacubitril/valsartan not to be a cost-effective treatment generally modeled a shorter time horizon. Effect of sacubitril/valsartan on cardiovascular and all-cause mortality, cost, duration of effect and time horizon was the main model drivers.

Conclusions

Most evidence indicated sacubitril/valsartan is cost-effective in HFrEF. The use of a lifetime horizon is recommended in future models as HF is a chronic disease. Data on the CE of sacubitril/valsartan in the inpatient setting were limited and further research is warranted.

     

A critical review of anti-adrenergic therapy in patients with heart failure and diabetes mellitus

Anti-adrenergic therapy has been widely accepted as an important therapeutic intervention in patients with chronic heart failure. However, there has been continuing controversy regarding the risks and clinical significance of metabolic effects of different anti-adrenergic drugs. This review summarizes what has been learned from clinical trial evidence regarding the benefits of anti-adrenergic drugs in diabetic patients with chronic heart failure.     

Dairy products and colorectal cancer. A review of possible mechanisms and epidemiological evidence

OBJECTIVES: This review provides an overview of the principal hypotheses and epidemiological evidence of the possible links between colorectal cancer and intake of milk and/or dairy products. METHODS: The first section outlines the main hypotheses about the possible effect of calcium, vitamin D, fats and other milk components. The possible role of acid lactic bacteria in fermented products is also discussed. The second section is a summary of the published epidemiological evidence. The results on milk, cheese and yoghurt are summarized using a meta-analytical approach. The results of studies on calcium and vitamin D are briefly described. RESULTS: Case-control studies are heterogeneous and, on average, do not provide evidence of association between total intake of total dairy products, milk, cheese or yoghurt and colorectal cancer risk. The average result from cohort studies support the hypothesis of a protective effect of total dairy products (odds ratio (OR): 0.62; 95% confidence interval (CI): 0.52-0.74; P heterogeneity test: 0.93) and for milk (OR: 0.80; 95% CI: 0.68-0.95; P heterogeneity: 0.77). No association was found between cheese (OR: 1.10; 95% CI: 0.88-1.36; P heterogeneity: 0.55) or yoghurt (OR: 1.03; 95% CI: 0.83-1.28; P heterogeneity: 0.69) in cohort studies. CONCLUSIONS: Cohort studies consistently found a protective effect of total dairy products and milk intake, but the evidence is not supported by case-control studies. No relationship was found with cheese or yoghurt intake. As the number of cohort studies is still limited, their results need to be confirmed by other prospective studies.     

Compliance and exercise in primary and secondary prevention of coronary heart disease: A review

Compliance with exercise programs in the primary and secondary prevention of coronary heart disease is reviewed. The evidence suggests that compliance with health behavior changes such as exercise is necessary for potential benefits to become apparent. However, the compliance rate with exercise programs is low and particular care must be taken in the interpretation of exercise studies as well as clinical trials because of self-selection bias. There appear to be certain characteristics that may help to identify the potential dropout; there are also certain programmatic features which should be considered in designing compliance-improving strategies to reduce dropout. Behavior modification techniques appear to have significant potential in reducing program dropout; however, there is a need to carefully investigate compliance-improving strategies before recommendations for a particular approach can be made.     

GAP-43蛋白表达与大鼠心力衰竭发病相关性分析

目的探讨生长相关蛋白43(GAP43)蛋白及与大鼠心力衰竭发病的关系。方法选取清洁级Wistar大鼠30只,随机分为模型组和假手术组,每组各15只,模型组采用阿霉素4 mg/kg腹腔注射建立心力衰竭模型[1],假手术组注射生理盐水,采用心脏超声评估大鼠左心室射血分数(LVEF),采用qRT-PCR检测心脏组织GAP-43 mRNA表达,Western blot检测心脏组织GAP-43蛋白表达。结果模型组心脏组织GAP-43 m RNA和蛋白相对表达量分别为(0.300±0.073)和(0.373±0.043),明显低于假手术组(0.902±0.089)和(1.210±0.133)(P<0.05);模型组造模4周后LVEF为(20.44±2.01)%,明显低于假手术组(70.28±3.62)%,差异有统计学意义(P<0.05);GAP-43 mRNA相对表达量与LVEF呈负相关(r=-0.707,P<0.05),GAP-43蛋白相对表达量与LVEF呈负相关(r=-0.600,P<0.05)。结论心力衰竭大鼠心脏组织GAP-43 m RNA和蛋白相对表达量明显下调,GAP-43蛋白的表达变化可能参与了心力衰竭的发病机制。