Recent advances in the epidemiology of gout

Gout remains among the most common of all inflammatory arthridities with an incidence that appears to have risen. Evidence is accumulating to support lifestyle and dietary factors, such as heavy consumption of beer and liquor as well as diets rich in meats and seafood as important gout risk factors. There is also a renewed interest in important associations between gout and other comorbidities like hypertension and cardiovascular disease. The importance of hyperuricemia on health considerations beyond the musculoskeletal system is an area worthy of even more study.     

Recent advances in the epidemiology of gout

Gout remains among the most common of all inflammatory arthridities with an incidence that appears to have risen. Evidence is accumulating to support lifestyle and dietary factors, such as heavy consumption of beer and liquor as well as diets rich in meats and seafood as important gout risk factors. There is also a renewed interest in important associations between gout and other comorbidities like hypertension and cardiovascular disease. The importance of hyperuricemia on health considerations beyond the musculoskeletal system is an area worthy of even more study.     

Controversies in hypertension

Hypertension remains the most common risk factor for cardiovascular morbidity and mortality. Its incidence is rising in both ageing and obese populations, but its control remains inadequate worldwide. We address several persisting controversies that may interfere with appropriate management of hypertension. They include: the reasons behind the increasing incidence of hypertension and the possible ways to slow the process, especially by lifestyle changes; the need for overall cardiovascular risk assessment; the major issues in the decision to institute drug therapy and the choice of drugs; and the importance of screening for various identifiable causes. We provide the background for these controversies, followed by some opinions on how to guide practitioners to offer more effective management of hypertension.     

Influence of Food Patterns on Endothelial Biomarkers: A Systematic Review

The purpose of this study was to conduct a systematic review on the association of food patterns (FPs) and endothelial biomarkers. An electronic literature search from 1990 to 2012 was conducted and reference lists and experts were consulted. Studies without dietary intervention and without language restrictions were considered. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines were employed. Methodological quality was assessed by Strengthening the Reporting of Observational Studies in Epidemiology guidelines. A total of 546 references were identified, of which 8 were finally included. Several FPs were identified. Healthy FPs (abundant in fruits and vegetables) had a beneficial impact on endothelial function as estimated by circulating levels of biomarkers such as C‐reactive protein, soluble intercellular adhesion molecule 1, soluble vascular adhesion molecule 1, and E‐selectin molecules. Westernized patterns (higher intakes of processed meats, sweets, fried foods, and refined grains) were positively associated with inflammation molecules and atherogenic promoters. The study of FPs in relation to endothelial function contributes to the development of dietary recommendations for improved cardiovascular health and therefore a better lifestyle.     

Cardiovascular effects of alcohol consumption

Alcohol consumption has a major but complex impact on cardiovascular diseases. Both irregular and chronic heavy drinking occasions detrimentally impact on most major cardiovascular disease categories, whereas light to moderate drinking has been associated with beneficial effects on ischemic heart disease and ischemic stroke. Both detrimental and beneficial effects of alcohol consumption have been corroborated by biochemical pathways. The impact of alcohol consumption on cardiovascular disease should be evaluated within the context of other effects of alcohol on health.     

Controversies in Brugada syndrome

The Brugada syndrome is an inherited channelopathy associated with increased risk of ventricular arrhythmias and sudden death, often occurring during sleep or resting conditions. Although this entity has been described more than 20 years ago, it remains one of the most debated among channelopathies, with several open questions on its genetic substrate, arrhythmia mechanisms, and clinical management. Studies on the genetics and physiopathology bases of the Brugada syndrome have opened novel investigative pathways and concepts that are now entering the field of cardiovascular genetics and are applied to other inherited arrhythmias. In this perspective, Brugada syndrome can be seen as an example on how basic science discoveries have influenced clinical management and led to novel therapeutic approaches.     

Controversies of oral antiplatelet therapy in acute coronary syndromes and percutaneous coronary intervention

Platelet activation is a pivotal event in the pathophysiology of acute coronary syndromes (ACS) and percutaneous coronary intervention (PCI) and has a substantial impact on the outcomes in these settings. Aggressive implementation of antiplatelet therapy has significantly decreased adverse cardiovascular events, such as death, myocardial infarction (MI), stroke, and repeat revascularization. Although the widespread use of aspirin has contributed to this improvement, many patients continue to have a significant risk of recurrent events during the ensuing months to years. The advent of other antiplatelet agents, notably the thienopyridine clopidogrel bisulfate has heralded a new era of combined antiplatelet blockade, offering the hope of better outcomes. Recently, clinical trials have tested the use of dual oral antiplatelet blockade and have shown impressive results. Notably, the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial found that dual therapy with clopidogrel and aspirin in ACS reduced adverse cardiovascular events by 20% at 1 year (p < 0.001). The PCI-CURE substudy of CURE and the Clopidogrel for the Reduction of Events During Observation (CREDO) trial demonstrated that these benefits extend to patients undergoing both urgent and elective PCI. This article will explore the current role of and controversies in oral antiplatelet therapy after ACS and PCI.     

Controversies in atrial fibrillation

Atrial fibrillation is the most common sustained cardiac arrhythmia, and contributes greatly to cardiovascular morbidity and mortality. Many aspects of the management of atrial fibrillation remain controversial. We address nine specific controversies in atrial fibrillation management, briefly focusing on the relations between mechanisms and therapy, the roles of rhythm and rate control, the definition of optimum rate control, the need for early cardioversion to prevent remodelling, the comparison of electrical with pharmacological cardioversion, the selection of patients for long-term oral anticoagulation, the roles of novel long-term anticoagulation approaches and ablation therapy, and the potential usefulness of upstream therapy targeting substrate development. The background of every controversy is reviewed and our opinions expressed. Here, we hope to inform physicians about the most important controversies in this specialty and stimulate investigators to address unresolved issues.     

The Exposome and Cardiovascular Health

The study of the interplay between social factors, environmental hazards, and health has garnered much attention in recent years. The term “exposome“ was coined to describe the total impact of environmental exposures on an individual’s health and well-being, serving as a complementary concept to the genome. Studies have shown a strong correlation between the exposome and cardiovascular health, with various components of the exposome having been implicated in the development and progression of cardiovascular disease. These components include the natural and built environment, air pollution, diet, physical activity, and psychosocial stress, among others. This review provides an overview of the relationship between the exposome and cardiovascular health, highlighting the epidemiologic and mechanistic evidence of environmental exposures on cardiovascular disease. The interplay between various environmental components is discussed, and potential avenues for mitigation are identified.     

Implantable pacing devices and sleep apnea: implications for diagnosis and therapy

Sleep apnea has been increasingly recognized for its prevalence and its impact on cardiovascular health. The disorder has considerable impact on cardiovascular disease states, particularly congestive heart failure. Implantable cardiac pacing devices may have a role in both the diagnosis and therapy of sleep apnea, which may be of particular importance given the seemingly wide coprevalence of cardiac disorders and sleep apnea.     

Impact of the Educational Level on Non-Fatal Health Outcomes following Myocardial Infarction

Notwithstanding a decrease in the incidence and mortality of cardiovascular diseases during the last decades, notable disparities in health outcomes depending on a patient´s socioeconomic position persist and are most visible in acute myocardial infarction and ischemic heart disease. Education is a pivotal indicator of the socioeconomic position. Effects of the social determinants of health on the incidence, prevalence and mortality of cardiovascular diseases were previously effectually investigated and shown to be inversely associated but evidence on non-fatal health outcomes such as heart failure, ability to return to work or rehospitalizations still remain insufficiently examined. We provide a literature review dealing with the impact that formal education has on non-fatal health outcomes including major adverse cardiovascular events, clinical outcomes, depression, use of cardiac rehabilitation, quality of life, self-perceived health and social participation after a myocardial infarction from a global and comprehensive perspective.     

Infections and Cardiovascular Disease: JACC Focus Seminar 1/4

The burden of cardiovascular diseases is sharply rising in low- and middle-income countries (LMICs). Along with the increasing rates of cardiovascular risk factors in these regions, there is a growing recognition of the contribution of neglected tropical diseases and other infections. Several cardiac implications of these infections have been reported but have not yet been validated by robust population data. This is in part due to limited access to health care and insufficient data collection infrastructure in many LMICs. Therefore, the true impact of these infections on the cardiovascular system may be underestimated, because of both underdiagnosis and underreporting bias. There is an urgent need to thoroughly delineate the cardiac impact of these conditions with elevated prevalence in LMICs and to propose strategies to reduce the negative consequences of these diseases in health systems with limited resources.     

理想心血管健康行为和因素对新发缺血性脑卒中的影响

目的探讨理想心血管健康行为和因素对新发缺血性脑卒中的影响。方法采用前瞻性队列研究方法,以参加2006-07-2007-10开滦集团健康查体的职工为研究对象,排除既往患脑梗死、心肌梗死及与该研究有关的数据和资料不全者,最终91698名职工进入观察队列,观察随访该队列发生新发缺血性脑卒中的情况;依据美国心脏协会定义的理想心血管健康行为和因素,用K-M法计算不同理想心血管健康行为和因素组的缺血性脑卒中累积发病率,并经Log-rank检验;采用Cox比例风险模型分缺血性脑卒中的影响因素。结果具备5～7项理想心血管健康行为和因素的个体只占研究人群的9.1%,其中具备所有7项的只有93例,占研究人群的0.1%,不足4项者占69.4%。具有0～1、2、3、4、5～7项理想心血管健康行为和因素的人群缺血性脑卒中的累积发病率逐渐降低(P<0.01);Cox比例风险模型表明,校正性别、年龄、收入水平、受教育水平后,具备1～6项理想心血管健康行为和因素的人群发生缺血性脑卒中的风险为无健康行为和因素人群的0.99、0.71、0.51、0.35、0.24、0.28倍。结论理想心血管健康行为和因素对脑血管具有保护作用,随着理想心血管健康行为和因素的个数增多,缺血性脑卒中的累积发病率呈下降趋势。     

Current Controversies in Robotic Prolapse Repair

The purpose of this article is to update the debate on the impact of robotic surgery for pelvic organ prolapse with recent literature. Review of this subject will continue the analysis of the expansion of robotic surgery and its impact on the value and quality of pelvic organ prolapse surgery. Up until recently, this area of study was dominated by retrospective data with conflicting evidence. The quality of literature on the subject has improved in the past 5 years. Randomized control trials have started reporting results that are more consistent between studies. Additionally, high-quality patient data from a Nationwide Inpatient Sample database has been available since introduction of the robotic modifier code for robotic surgery in 2008. Meta-analyses examining the differences amongst studies will also be discussed. This article will review the literature and examine the debate on the impact of robotic surgery on cost, patient safety, outcomes, and training.     

Cardiovascular Care Delivery During the Second Wave of COVID-19 in Canada

Hospitals and ambulatory facilities significantly reduced cardiac care delivery in response to the first wave of the COVID-19 pandemic. The deferral of elective cardiovascular procedures led to a marked reduction in health care delivery with a significant impact on optimal cardiovascular care. International and Canadian data have reported dramatically increased wait times for diagnostic tests and cardiovascular procedures, as well as associated increased cardiovascular morbidity and mortality. In the wake of the demonstrated ability to rapidly create critical care and hospital ward capacity, we advocate a different approach during the second and possible subsequent COVID-19 pandemic waves. We suggest an approach, informed by local data and experience, that balances the need for an expected rise in demand for health care resources to ensure appropriate COVID-19 surge capacity with continued delivery of essential cardiovascular care. Incorporating cardiovascular care leaders into pandemic planning and operations will help health care systems minimise cardiac care delivery disruptions while maintaining critical care and hospital ward surge capacity and continuing measures to reduce transmission risk in health care settings. Specific recommendations targeting the main pillars of cardiovascular care are presented: ambulatory, inpatient, procedural, diagnostic, surgical, and rehabilitation.     

Update: Systemic Diseases and the Cardiovascular System (II). The endocrine system and the heart: a review

Normal endocrine function is essential for cardiovascular health. Disorders of the endocrine system, consisting of hormone hyperfunction and hypofunction, have multiple effects on the cardiovascular system. In this review, we discuss the epidemiology, diagnosis, and management of disorders of the pituitary, thyroid, parathyroid, and adrenal glands, with respect to the impact of endocrine dysfunction on the cardiovascular system. We also review the cardiovascular benefits of restoring normal endocrine function.Full English text available from: www.revespcardiol.org     

Dietary strategies for cardiovascular health

Cardiovascular disease is developed across a lifetime accumulation of risk. Numerous independent and synergistic cardiovascular risk factors can be induced by unhealthy dietary patterns. Epidemiological, mechanistic, clinical, and translational research point to refined sugars, processed and fatty meats, synthetic oils, and sodium as major dietary risk factors. The purpose of this review is to integrate these learnings into key principles for dietary frameworks aimed at improving overall cardiovascular health.     

Eliminating disparities in cardiovascular health: six strategic imperatives and a framework for action

Disparities in cardiovascular health are among the most serious public health problems in the United States today. Despite the remarkable declines in cardiovascular mortality observed nationally over the last 3 decades, many population subgroups defined by race, ethnicity, gender, socioeconomic status, educational level, or geography show striking, and often widening, disparities in cardiovascular health. The pervasive nature of these disparities and compelling evidence of the adverse impact they have on clinical outcomes and quality of life have been well documented. The elimination of these disparities is 1 of the 2 overarching goals of the Healthy People 2010 national public health agenda; however, few publications provide guidance on what actions to take. In this review, 6 strategic imperatives within a framework for action are presented. Other key elements of the framework include 10 focal areas and 6 major settings within which the framework calls for accelerated interventions to eliminate disparities in cardiovascular health. Success in this endeavor will require innovative and comprehensive interventions built on a foundation of sound clinical and public health science. Strategic partnerships with communities, community-based organizations, state and local governments, and public and private partners from both health and nonhealth sectors are essential. Additionally, investment in local-level disparities surveillance, community-based participatory research, and development of a diverse clinical and public health workforce will be invaluable.