Current Cardiovascular Risk Reports

Publications in this journal

• Article: Type 2 diabetes in older people; the importance of blood pressure control.

  Ankur Jindal, Adam Whaley-Connell, James R Sowers
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  ABSTRACT: Diabetes and hypertension often coexist and their coexistence substantially promote cardiovascular disease (CVD) and chronic kidney disease. Control of blood pressure to a level of 140/90 mm Hg in people with diabetes can prevent or at least delay CVD and chronic kidney disease.. In the past many society treatment guidelines have stressed tight blood pressure control (=< 130/80) for people with diabetes. But recommendations for such tight blood pressure control have not been supported by recent large randomized control trials, especially in in elderly. Here we review the recent literature regarding the benefits of blood pressure control in elderly patients with diabetics. We further focus on evidence for specific levels of blood pressure treatment goals, in this population subset..
  Current Cardiovascular Risk Reports 06/2013; 7(3):233-237.
• Article: Breast Arterial Calcification: a New Marker of Cardiovascular Risk?

  Carlos Iribarren, Sabee Molloi
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  ABSTRACT: Mammographically-detected breast arterial calcifications (BAC) are considered to be an incidental finding without clinical importance since they are not associated with increased risk of breast cancer. The goal of this article is to review existing evidence that the presence of BAC on mammography correlates with several (but not all) traditional cardiovascular disease (CVD) risk factors and with prevalent and incident CVD. Thus, BAC detected during routine mammography is a noteworthy finding that could be valuable in identifying asymptomatic women at increased future CVD risk that may be candidates for more aggressive management. In addition, there are notable differences in measures of subclinical atherosclerosis burden in women (ie, coronary artery calcification) by race/ethnic background, and the same appears to be true for BAC, although data are very limited. Another noteworthy limitation of prior research on BAC is the reliance on absence vs presence of BAC; no study to date has determined gradation of BAC. Further research is thus required to elucidate the role of BAC gradation in the prediction of CVD outcomes and to determine whether adding BAC gradation to prediction models based on traditional risk factors improves classification of CVD risk.
  Current Cardiovascular Risk Reports 04/2013; 7(2):126-135.
• Article: The Ups and Downs of Insulin Resistance and Type 2 Diabetes: Lessons from Genomic Analyses in Humans.

  Vicencia Sales, Mary-Elizabeth Patti
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  ABSTRACT: We are in the midst of a worldwide epidemic of type 2 diabetes (T2D) and obesity. Understanding the mechanisms underlying these diseases is critical if we are to halt their progression and ultimately prevent their development. The advent and widespread implementation of microarray technology has allowed analysis of small samples of human skeletal muscle, adipose, liver, pancreas and blood. While patterns differ in each tissue, several dominant themes have emerged from these studies, including altered expression of genes indicating increased inflammation and altered lipid and mitochondrial oxidative metabolism and insulin signaling in patients with T2D, and in some cases, in those at risk for disease. Unraveling which changes in gene expression are primary, and which are secondary to an insulin resistant or diabetes metabolic milieu remains a scientific challenge but we are one step closer.
  Current Cardiovascular Risk Reports 02/2013; 7(1):46-59.
• Article: Behavioral Interventions and Cardiovascular Risk in Obese Youth: Current Findings and Future Directions.

  Anna Vannucci, Denise E Wilfley
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  ABSTRACT: The identification and early intervention of pediatric obesity is critical to reducing cardiovascular disease (CVD). Family-based behavioral interventions have consistently demonstrated efficacy in reducing adiposity and CVD risk factors (i.e., blood pressure, cholesterol, fasting glucose levels, insulin resistance, metabolic syndrome). Even modest weight loss in severely obese youth can lead to sustained improvement in CVD risk factors. However, weight regain following treatment cessation remains a challenge in the contemporary obesogenic environment. Intensive family-based interventions spanning socioenvironmental contexts (i.e., home, peer, community) show promise in sustaining weight loss in the long-term. Despite having effective treatments for pediatric obesity and CVD risk factors, families rarely have access to these programs and so increasing the role of healthcare providers in screening and referral efforts is imperative. Moving forward, it is also essential to establish communication and cooperative networks across sectors build sustainable prevention and intervention programs and to provide cohesive health messages.
  Current Cardiovascular Risk Reports 12/2012; 6(6):567-578.
• Article: Very low nicotine content cigarettes and potential consequences on cardiovascular disease.

  Danielle L Joel, Rachel L Denlinger, Sarah S Dermody, Dorothy K Hatsukami, Neal L Benowitz, Eric C Donny
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  ABSTRACT: Cigarette smoking remains highly prevalent in the U.S. and contributes significantly to cardiovascular disease (CVD). Tobacco control policies, including product regulation, can reduce smoking-related harm. One approach being considered in the U.S. is for the FDA to set a low nicotine standard for cigarettes. Such a standard could result in multiple beneficial outcomes including reduced cardiovascular toxicity related to nicotine, reduced smoking intensity in current smokers, increased cessation rates, decreased development of smoking dependence in youth, and decreased passive smoke exposure. Consequently, CVD risk in the U.S. could be dramatically improved by nicotine reduction in cigarettes. Possible pathways linking nicotine reduction in cigarettes to decreased CVD risk are discussed, while potential unintended consequences that could offset expected gains are also presented. Gaps in the literature, including limited data on CVD biomarkers and long-term CVD outcomes following the use of very low nicotine cigarettes, are discussed to highlight areas for new research.
  Current Cardiovascular Risk Reports 12/2012; 6(6):534-541.
• Article: Cardiovascular Risk in Children and Adolescents with Type 1 and Type 2 Diabetes Mellitus.

  Sheela N Magge
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  ABSTRACT: Rising rates of both type 1 and type 2 diabetes mellitus in children have led to increased concern regarding cardiovascular disease (CVD) risk during childhood. Diabetic children face prolonged exposure to hyperglycemia, and have increased risk of both microvascular and macrovascular disease. These circumstances may result in a generation of young adults presenting with cardiovascular outcomes, a tremendous personal and public health toll. In this article, we review CVD risk in type 1 and type 2 diabetes, discuss aspects of pathophysiology, and review current methods of CVD risk assessment. We also identify crucial areas in need of future research in order to devise effective prevention and treatment of CVD risk in children.
  Current Cardiovascular Risk Reports 12/2012; 6(6):591-600.
• Article: Genetics of Calcific Aortic Stenosis – Time to Move Forward

  G. Thanassoulis
  Current Cardiovascular Risk Reports 12/2012; 6:556.
• Article: Weight Loss Drugs and Cardiovascular Risks

  Paul Poirier
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  ABSTRACT: Overweight and obesity have been rising dramatically worldwide and are an independent risk factor for cardiovascular disease (CVD). The majority of overweight and obese patients who achieve a significant short-term weight loss fail to maintain their lower weight in the long term. As a result, there has been focus on the role of pharmacotherapy for long-term weight management. Since the beginning, the quest for weight loss drugs has encountered warnings from regulatory agencies and withdrawals from the market. Accordingly, fenfluramine, dexfenfluramine, rimonabant, and sibutramine have been withdrawn from the market due to unacceptable side effects. Nevertheless, there is still intense research for the development of new anti-obesity compounds. The effect of these molecules on CVD risk factors has been reported, but one must remember that beyond CVD risk factor management, anti-obesity drugs should be safe for the long term. KeywordsObesity–Weight loss drugs–Cardiovascular disease
  Current Cardiovascular Risk Reports 05/2012; 5(2):138-144.
• Article: Ambulatory blood pressure monitoring in patients with diabetes mellitus: Current evidence and future trends

  Walter Palmas
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  ABSTRACT: Type 2 diabetes has reached epidemic proportions in our society, affecting many of our elderly. Much of the high risk of cardiovascular events (heart attacks, strokes, and death) is associated with the height of blood pressure. Ambulatory blood pressure monitoring has been shown to predict cardiovascular risk better than office blood pressure in many populations, but the value of ambulatory monitoring to predict cardiovascular risk in people with diabetes requires further evaluation. Currently available data suggest that ambulatory monitoring may prove useful in that regard, but more longitudinal studies are critically needed if this noninvasive method is to become part of the standard of care when managing people with diabetes.
  Current Cardiovascular Risk Reports 05/2012; 1(3):209-215.
• Article: Valvular Heart Disease in the Elderly

  Peter J. Cawley, Catherine M. Otto
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  ABSTRACT: Clinicians are increasingly caring for elderly patients with valvular heart disease due in part to an aging population and a decline in rheumatic heart disease. Aortic stenosis (AS) and mitral regurgitation (MR) are the most common valve lesions encountered. Calcific AS represents a disease spectrum from aortic sclerosis to severe, symptomatic AS; the latter of which has a significantly limited prognosis. Surgical aortic valve replacement is the recommended therapy and can improve life expectancy. Although increased age is associated with a slight increase in surgical risk, co-morbidities are primarily associated with increased surgical risk. If approved, transcatheter aortic valve implantation may be an option in some patient subsets pending the results of multi-center randomized controlled trials. MR in the elderly population may be associated with primary left ventricular dysfunction (functional MR) or primary MR (leaflet disease). Both are associated with heart failure and can result in increased morbidity. Therapy for functional MR is aimed at the medical treatment for heart failure. Therapy for primary MR is aimed at surgery if accepted indications exist. KeywordsAortic stenosis–Mitral regurgitation–Valve disease–Valvular heart disease–Elderly
  Current Cardiovascular Risk Reports 05/2012; 5(5):413-421.
• Article: Simplifying the ECG Diagnosis of Left Ventricular Hypertrophy

  Paolo Verdecchia, Fabio Angeli, Giovanni Mazzotta, Giuseppe Ambrosio, Gianpaolo Reboldi
  Current Cardiovascular Risk Reports 05/2012; 5(1):1-4.
• Article: Strategies for smoking cessation

  Hilary Tindle
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  ABSTRACT: Cigarette smoking is the leading preventable cause of death in the United States, accounting for more than 400,000 deaths annually. Recent advances in the treatment of smoking cessation and prevention of relapse offer promise to many smokers, especially vulnerable smokers such as those with coronary heart disease and other cardiovascular disease. Varenicline, a newly approved medication for smoking cessation, is a welcome addition to the clinician’s treatment arsenal. Other options for treatment include new uses of traditional nicotine replacement therapy (NRT), such as the simultaneous use of two forms of NRT or starting NRT prior to the quit-smoking date. A combination of pharmacologic and nonpharmacologic strategies is appropriate for most smokers and effectively doubles quit rates compared with rates in smokers who try to quit without the help of a clinician. Drawing appropriately from existing therapeutic options, the clinician should aim to treat smokers at all levels of interest in quitting.
  Current Cardiovascular Risk Reports 05/2012; 1(5):366-372.
• Article: Heritability and genetics of atrial fibrillation

  Ryan G. Aleong, Calum A. MacRae, Patrick T. Ellinor
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  ABSTRACT: In the past 5 years, it has become increasingly clear that atrial fibrillation (AF) is a heritable condition. Mutations in six different ion channels have been described in families and individuals with AF, although screening of patients with AF reveals that these gene mutations appear to account for only rare cases of the disease. Recently, a genome-wide association study has identified a novel region of susceptibility for AF on chromosome 4. Our hope is that the identification of the genetic basis of AF will ultimately lead to the discovery of new pathways and therapeutic targets for this common arrhythmia.
  Current Cardiovascular Risk Reports 05/2012; 1(5):414-419.
• Article: Vitamin D, Hypertension, Left Ventricular Hypertrophy, and Diastolic Dysfunction

  Sagar U. Nigwekar, Ishir Bhan, Ravi Thadhani
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  ABSTRACT: The extra-skeletal effects of vitamin D have been increasingly recognized in the recent years and its effects on blood pressure and cardiac function are areas of active investigation. This article reviews the current state of knowledge about vitamin D with respect to blood pressure and left ventricular hypertrophy. Potential biological mechanisms implicated in linking vitamin D deficiency with hypertension and cardiac dysfunction are outlined along with data from both observational and randomized controlled trials on this topic. KeywordsVitamin D–Hypertension–Systolic blood pressure–Diastolic blood pressure–Left ventricular hypertrophy
  Current Cardiovascular Risk Reports 04/2012; 5(4):314-322.
• Article: Prolonged Sitting and the Risk of Cardiovascular Disease and Mortality

  Wendell C. Taylor
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  ABSTRACT: Prolonged sitting behaviors are a distinct subset of sedentary behaviors. They include television viewing, computer and video use, sitting in automobiles, and workplace sitting. I reviewed scientific literature from 2005 to 2010 to assess the effects of prolonged sitting on cardiovascular disease mortality and risk factors. I conclude that prolonged sitting is positively associated with cardiovascular disease risk factors and increases in mortality risk, independent of physical activity. The weakness of the current literature is an over-reliance on self-reports of prolonged sitting. Also, a better understanding is needed of the unique biomarkers and metabolic alterations related to prolonged sitting, as well as whether sitting displaces light-intensity physical activity. Overall, the findings support previous recommendations to consider guidelines and strategies to reduce and interrupt prolonged sitting. KeywordsBreaks in sedentary time–Metabolic health–Coronary heart disease–Cardiovascular disease–Metabolic syndrome–Sedentary behavior–Physical inactivity–Television viewing–Computer use–Occupational sitting–Screen time–Booster breaks–Obesity and overweight–Diabetes mellitus–Blood pressure–Office treadmill–Active transport–Exercise–Lifestyle–Mortality–Obesity–Risk factors–Sedentary lifestyle–Sitting in automobiles
  Current Cardiovascular Risk Reports 04/2012; 5(4):350-357.
• Article: Management of Resistant Hypertension

  William J. Elliott
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  ABSTRACT: “Resistant” hypertension has been variously defined, but most authors accept a definition that includes a blood pressure ≥140/90mm Hg after prescription of a diuretic and typically two other appropriately chosen antihypertensive drugs at near-maximal doses. Patients with resistant hypertension are of great public health importance because they have a high absolute cardiovascular and renal risk, greater health care expenditures, a higher prevalence of secondary hypertension and target-organ damage, and are, by definition, more “difficult to control” than hypertensive patients who are controlled with only one or two medications. Centers that specialize in these patients report that more than 90% can be diagnosed with a specific cause of their treatment resistance, and more than 50% can be controlled in a relatively short time after an appropriate intervention. This article reviews the differential diagnosis, evaluation, and outcomes of treatment paradigms for such patients, and emphasizes the role of hypertension specialists in their management. KeywordsResistant hypertension–Refractory hypertension–Difficult hypertension–Secondary hypertension–White-coat hypertension–Dietary salt restriction–Sleep apnea–Hyperaldosteronism–Devices
  Current Cardiovascular Risk Reports 04/2012; 5(5):373-382.
• Article: The Role of Nutrition in Secondary Prevention of Coronary Artery Disease

  Alison M. Hill, Michael A. Roussell, Penny M. Kris-Etherton
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  ABSTRACT: Secondary prevention strategies are designed to target multiple risk factors through pharmacologic and lifestyle intervention. Therefore, diet therapy plays an important role in secondary prevention of CHD. Epidemiologic studies have identified several dietary patterns that are associated with reduced risk for CHD morbidity and mortality, such as the Mediterranean diet and a “Prudent” diet. These dietary patterns exhibit a number of similarities with current dietary recommendations for primary and secondary prevention; they are nutrient rich (from fruits, vegetables, whole grains, nuts, seeds, and plant oils, reduced-fat and fat-free milk products, seafood, and lean animal and plant proteins) and low in saturated and trans fatty acids, cholesterol, and sodium. There also is strong evidence from secondary prevention studies that long chain omega-3 fatty acids from marine sources are effective for cardiovascular disease risk reduction. In addition, there is some evidence of benefits of dietary patterns including a Mediterranean diet, a very low-fat diet, a diet high in omega-6 polyunsaturated fatty acids as well as a Mediterranean-style diet high in alpha-linolenic acid (all of which are low in saturated fatty acids). It is apparent that there are multiple dietary treatment strategies available to clinicians that enable individualized treatment plans and optimal therapeutic outcomes for patients with coronary disease. KeywordsCoronary artery disease–Dietary recommendations–Secondary prevention
  Current Cardiovascular Risk Reports 04/2012; 5(5):383-390.
• Article: Peripheral Artery Disease in the Elderly: Prevalence, Clinical Implications, and Therapy

  Ulf G. Bronas, Diane Treat-Jacobson
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  ABSTRACT: Peripheral artery disease (PAD) is a progressive atherosclerotic occlusive disease associated with aging that affects 8 million Americans. Approximately 20% of Americans older than 70years of age are affected by PAD. This disease is associated with increased morbidity, reduced quality of life and functional capacity, and premature mortality. Treatment of PAD includes pharmacologic and therapeutic lifestyle changes to improve functional capacity and to modify cardiovascular disease risk factors such as smoking cessation, hypertension, diabetes, and dyslipidemia. Despite tremendous advances in our understanding of PAD and its associated outcomes, PAD remains underdiagnosed and undertreated. Further research is needed to fully understand the pathophysiology of PAD and to optimize recognition and treatment of PAD in older patients. Keywords Peripheral Artery Disease–Claudication–Aging
  Current Cardiovascular Risk Reports 04/2012; 5(5):457-466.
• Article: Managing Chronic Illness in Seniors: Innovative Approaches to Care

  Kathy Berra, Linda Klieman, Leigha Winters
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  ABSTRACT: Seniors comprise the largest population of adults over the age of 18years. It is expected that by 2030, 74 million Americans will be over the age of 65years, with a substantial number of these over age 85. Seniors experience more chronic illnesses, are responsible for the majority of outpatient clinic visits, take significantly more medications, and are more often hospitalized compared to younger adults. Managing chronic illness in seniors involves lifestyle change and medical therapies/interventions. As time constraints increase for providers and the population of seniors requiring additional medical attention grows, the capacity of providers to comprehensively address these needs will decrease. It is imperative that we find new, innovative, and better ways to provide the level of health care that is needed and deserved by seniors. This article reviews options for the management of chronic illness, with a focus on cardiovascular diseases, for seniors. KeywordsCare management–Case management–Health and aging–Cardiovascular disease prevention–Seniors
  Current Cardiovascular Risk Reports 04/2012; 5(5):473-479.