Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R et al.. European guidelines on cardiovascular disease prevention in clinical practice: full text. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil 14 (Suppl 2), S1-S113
Other experts who contributed to parts of the guidelines: Edmond Walma, Tony Fitzgerald, Marie Therese Cooney, Alexandra Dudina
Available from: Gianluca Castelnuovo
- "In the final document, along with the classic risk factors such as hypertension, diabetes, and obesity, psychosocial factors were also considered. The assessment of depression using simple and straightforward instruments was also suggested . "
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ABSTRACT: It is highly recommended to promptly assess depression in heart disease patients as it represents a crucial risk factor which may result in premature deaths following acute cardiac events and a more severe psychopathology, even in cases of subsequent nonfatal cardiac events. Patients and professionals often underestimate or misjudge depressive symptomatology as cardiac symptoms; hence, quick, reliable, and early mood changes assessments are warranted. Failing to detect depressive signals may have detrimental effects on these patients' wellbeing and full recovery. Choosing gold-standard depression investigations in cardiac patients that fit a hospitalised cardiac setting well is fundamental. This paper will examine eight well established tools following Italian and international guidelines on mood disorders diagnosis in cardiac patients: the Hospital Anxiety and Depression Scale (HADS), the Cognitive Behavioural Assessment Hospital Form (CBA-H), the Beck Depression Inventory (BDI), the two and nine-item Patient Health Questionnaire (PHQ-2, PHQ-9), the Depression Interview and Structured Hamilton (DISH), the Hamilton Rating Scale for Depression (HAM-D/HRSD), and the Composite International Diagnostic Interview (CIDI). Though their strengths and weaknesses may appear to be homogeneous, the BDI-II and the PHQ are more efficient towards an early depression assessment within cardiac hospitalised patients.
Available from: Guilherme Veiga Guimaraes
- "Regular physical exercise reduces systemic blood pressure (BP) and is broadly recommended by current hypertension guidelines  . A recent study showed that conventional exercise has positive effects on BP in patients with resistant hypertension . "
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ABSTRACT: Regular exercise is an effective intervention to decrease blood pressure (BP) in hypertension, but no data are available concerning the effects of heated water-based exercise (HEx). This study examines the effects of HEx on BP in resistant hypertensive patients.
This is a parallel, randomized controlled trial. 125 nonconsecutive sedentary patients with resistant hypertension from a hypertension outpatient clinic in a university hospital were screened; 32 patients fulfilled the study requirements. The training was performed for 60-minute sessions in a heated pool (32°C), three times a week for 12weeks. The HEx protocol consisted of callisthenic exercises and walking inside the pool. The control group was asked to maintain habitual activities. The main outcome measure was change in mean 24-hour ambulatory BP (ABPM).
32 patients (HEx n=16; control n=16) were randomized; none were lost to follow-up. Office BPs decreased significantly after heated water exercise (36/12mmHg). HEx decreased 24-hour systolic (from 137±23 to 120±12mmHg, p=0.001) and diastolic BPs (from 81±13 to 72±10mmHg, p=0.009); daytime systolic (from 141±24 to 120±13mmHg, p<0.0001) and diastolic BPs (from 84±14 to 73±11mmHg, p=0.003); and nighttime systolic (from 129±22 to 114±12mmHg, p=0.006) and diastolic BPs (from 74±11 to 66±10mmHg, p<0.0001). The control group after 12weeks significantly increased in 24-hour systolic and diastolic BPs, and daytime and nighttime diastolic BPs.
HEx reduced office BPs and 24-hour ABPM levels in resistant hypertensive patients. These effects suggest that HEx may be a potential new therapeutic approach in these patients.
Available from: Fiona E Lithander
- "Dietary fat intake plays a significant role in the development of cardiovascular disease (CVD) through its effect on lipoprotein metabolism . It is well accepted that dietary saturated fatty acid (SFA) is positively associated with cardiovascular (CV) risk and whilst current dietary recommendations advise a decrease in SFA intake [2,3], it is unclear which nutrient should replace SFA in the diet . The chronic substitution of SFA with monounsaturated fat (MUFA) is attractive since a decrease in serum markers of CVD risk such as fasting LDL-cholesterol has been shown in a number of studies [5,6]. "
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ABSTRACT: Arterial stiffness is a component of vascular function and an established risk factor for cardiovascular disease. There is a lack of conclusive evidence on the effect of a meal rich in monounsaturated fat (MUFA) compared with an isoenergetic meal rich in saturated fat (SFA) on postprandial vascular function and specifically on arterial stiffness.
Twenty healthy, non-smoking males (BMI 24 +/- 2 kg/m2; age 37.7 +/- 14.4 y) participated in this single-blind, randomised, cross-over dietary intervention study. Each subject was randomised to receive a high-fat test-meal (3 MJ; 56 +/- 2 g fat) at breakfast on 2 separate occasions, one rich in oleic acid (MUFA-meal) and one rich in palmitic acid (SFA-meal), and the meals were isoenergetic. Blood pressure (BP), arterial stiffness (PWV) and arterial wave reflection (augmentation index, AIx) were measured using applanation tonometry at baseline and every 30 minutes up to 4 hours after the ingestion of the test-meals.
All subjects completed both arms of the dietary intervention. There was no significant difference in BP parameters, PWV or AIx at baseline between the two treatments (P > 0.05). There was a significant increase in brachial and aortic BP, mean arterial pressure (MAP), heart rate and PVW (time, P < 0.05) over the four hours after consumption of the fat-rich test-meal although the increase in PWV was no longer significant when adjusted for the increase in MAP. There was no difference in PWV between the two treatments (treatment*time, P > 0.05). There was a significant reduction in AIx (time, P < 0.05) over the four hour postprandial period although this was no longer significant when adjusted for the increase in heart rate and MAP (time, P > 0.05). There was no difference in AIx between the two treatments (treatment*time, P > 0.05). However, the reduction in heart rate corrected augmentation index (AIx75) was significant when corrected for the increase in MAP (time, P < 0.01) with no differential effect of the treatments (treatment*time, P > 0.05).
This study has demonstrated a BP dependent increase in PWV and a decrease in arterial wave reflection in the four hour period in response to a high-fat meal. There was no evidence however that replacement of some of the SFA with MUFA had a differential effect on these parameters. The study highlights the need for further research to understand the effects of the substitution of SFA with MUFA on non-serum, new and emerging risk factors for CVD such as arterial stiffness.
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