Prevalence of Dietary Supplement Use in Patients with Proven or Suspected Cardiovascular Disease

Systematic search of bibliographic databases was conducted to describe the prevalence of dietary supplement use in cardiac patients. Included for review were studies that investigated supplement use in people with cardiovascular risk factors or proven cardiovascular disease. Databases searched were Medline, EMBASE, CINAHL, AMED, Meditext, H&S and IPA. Over five hundred articles were retrieved and twenty studies met the criteria for this review. Dietary supplements were taken by a median 36% (interquartile range: 26–42%) of cardiac patients; 36% (IQR 18–43%) reported taking a vitamin/mineral supplement and 12% (IQR 7–21%) used herbal supplements. Many users indicated that supplements were taken specifically for heart health and 16–64% of users reported using supplements alongside prescription medications. However 39–95% of treating physicians were unaware of patients' supplement use. Dietary supplement use in patients with cardiovascular disease appears common, as does the concurrent use of supplements with prescription medicines. This information is often not communicated to doctors and treating physicians may need to be more proactive in asking about supplement use

Pharmacokinetic Considerations for Digoxin in Older People

Objective: This review aims to arm readers with a deep understanding of pharmacokinetics of digoxin. Data Sources: Pharmacology and pharmacokinetic references texts, and peer reviewed medical journal manuscripts indexed on Medline included based on currency, accuracy and appropriateness. Results: Physiologic changes and disease associated with aging have an impact on pharmacokinetics and pharmacodynamics of medications. Altered drug response and increased adverse reactions are common amongst the elderly. The narrow therapeutic index of digoxin and pharmacokinetic changes associated with aging increases the risk of toxicity. In the aging population, a number of factors combine to increase the risk, severity and likelihood of hospitalisation or death due to adverse drug effects: • changes to absorption, distribution, metabolism and excretion, • increased susceptibility to drug sensitivity, • co-existing pathology, • polypharmacy. Conclusion: A thorough und erstanding of digoxin pharmacokinetics in the older person is essential for improved therapeutic outcomes, improved compliance, reduced morbidity and improved quality of life.6 page(s

Adenosine pharmacologic stress myocardial perfusion tomographic imaging in patients with significant aortic stenosis Diagnostic efficacy and comparison of clinical, hemodynamic and electrocardiographic variables with 100 age-matched control subjects

AbstractObjectives. This study assessed the safety and diagnostic accuracy of adenosine stress myocardial perfusion scintigraphy for the detection of coronary artery disease using single-photon emission computed tomography (SPECT) in patients with significant aortic stenosis.Background. Exercise cardiac stress testing in patients with significant aortic stenosis is generally avoided because of concerns for safety. In addition, those studies that have analyzed the utility of exercise testing both with and without myocardial thallium-201 scintigraphy for the diagnosis of coronary artery disease have yielded low specificity. Currently, no safe and accurate means exists to noninvasively assess the presence, extent and severity of coronary artery disease in patients with significant aortic stenosis.Methods. The study included 35 patients with moderate to severe aortic stenosis (mean [±SD] aortic valve area 0.84 ± 0.16 cm2, range 0.5 to 1.2; mean maximal instantaneous aortic valve gradient 44.4 ± 15.9 mm Hg, range 20 to 84). All patients underwent a 6-min adenosine infusion (140 μg/kg body weight per min) protocol and either separate acquisition rest thallium-201/stress technetium-99m sestamibi or stress and 4-h redistribution thallium-201 SPECT. Visual 20-segment SPECT analysis used a standard five-point scoring system from 0 (normal tracer uptake) to 4 (absent uptake). The SPECT results were considered abnormal if more than two segments had a stress score ≥2. Hemodynamic, electrocardiographic and clinical responses were compared with those in a reference group of 100 consecutive age-matched patients undergoing adenosine SPECT who did not have aortic stenosis.Results. Hemodynamic responses during adenosine stress testing between the study and control patients demonstrated no significant difference in the net change in systolic blood pressure (18% of baseline vs. 14%, patients with aortic stenosis vs. control subjects), heart rate (21% vs. 19%), rate-pressure product (0% vs. 2%) or incidence of chest pain (23% vs. 35%) or transient second- (9% vs. 9%) or third-degree atrioventricular block (3% vs. 1%). In the 20 patients who had coronary angiography, sensitivity for detection of coronary artery disease was 92% (12 of 13) and specificity was 71% (5 of 7).Conclusions. In this preliminary study, adenosine was found to be well tolerated and diagnostically accurate in patients with moderate to severe aortic stenosis

"Photobiomics" : can light, including photobiomodulation, alter the microbiome?

Objective: The objective of this review is to consider the dual effects of microbiome and photobiomodulation (PBM) on human health and to suggest a relationship between these two as a novel mechanism. Background: PBM describes the use of low levels of visible or near-infrared (NIR) light to heal and stimulate tissue, and to relieve pain and inflammation. In recent years, PBM has been applied to the head as an investigative approach to treat diverse brain diseases such as stroke, traumatic brain injury (TBI), Alzheimer's and Parkinson's diseases, and psychiatric disorders. Also, in recent years, increasing attention has been paid to the total microbial population that colonizes the human body, chiefly in the gut and the mouth, called the microbiome. It is known that the composition and health of the gut microbiome affects many diseases related to metabolism, obesity, cardiovascular disorders, autoimmunity, and even brain disorders. Materials and methods: A literature search was conducted for published reports on the effect of light on the microbiome. Results: Recent work by our research group has demonstrated that PBM (red and NIR light) delivered to the abdomen in mice, can alter the gut microbiome in a potentially beneficial way. This has also now been demonstrated in human subjects. Conclusions: In consideration of the known effects of PBM on metabolomics, and the now demonstrated effects of PBM on the microbiome, as well as other effects of light on the microbiome, including modulating circadian rhythms, the present perspective introduces a new term "photobiomics" and looks forward to the application of PBM to influence the microbiome in humans. Some mechanisms by which this phenomenon might occur are considered

Diabetes Mellitus, cognitive impairment, and traditional Chinese medicine

Diabetes mellitus (DM) is a metabolic disorder affecting a large number of people worldwide. Numerous studies have demonstrated that DM can cause damage to multiple systems, leading to complications such as heart disease, cancer, and cerebrovascular disorders. Numerous epidemiological studies have shown that DM is closely associated with dementia and cognition dysfunction, with recent research focusing on the role of DM-mediated cerebrovascular damage in dementia. Despite the therapeutic benefits of antidiabetic agents for the treatment of DM-mediated cognitive dysfunction, most of these pharmaceutical agents are associated with various undesirable side-effects and their long-term benefits are therefore in doubt. Early evidence exists to support the use of traditional Chinese medicine (TCM) interventions, which tend to have minimal toxicity and side-effects. More importantly, these TCM interventions appear to offer significant effects in reducing DM-related complications beyond blood glucose control. However, more research is needed to further validate these claims and to explore their relevant mechanisms of action. The aims of this paper are (1) to provide an updated overview on the association between DM and cognitive dysfunction and (2) to review the scientific evidence underpinning the use of TCM interventions for the treatment and prevention of DM-induced cognitive dysfunction and dementia

962-61 Late Redistribution T1-201/Stress Tc-99m Sestamibi Separate Acquisition Dual Isotope Myocardial Perfusion SPECT: A Feasibility Study

Rest TI201(TI)/stress Tc-sestamibi dual isotope SPECT (DIMPS) is an efficient myocardial perfusion protocol. Patients with rest defects, however, frequently require late TI redistribution imaging the next day. Thus, we recently implemented a modified DIMPS (M-DIMPS), with 3.5 mCi TI injected at rest the night before stress testing. On the day of stress testing, 12–18 hr redistribution TI (late TI) SPECT was performed prior to stress sestamibi study. To assess image quality of late TI, we prospectively studied 107 patients who underwent M-DIMPS. For purposes of comparison between conventional DIMPS and M-DIMPS, a subset (group A, n=41) also had rest TI(25sec/stop, 60 stops) the night before M-DIMPS. Late TI used 30sec/stop. Prereconstruction processing used a 20 Butterworth filter (cut-off: 0.5/order 10 for rest TI, 0.35/order 10 for late TI). Comparisons were made for cardiac counts (counts/pixel) and quantitative heart to background ratio (H/B ratio). Image quality was assessed visually using a 5 point score (0=unacceptable, 4=excellent), based on the evaluation of image uniformity, defect clarity, left ventricular border definition and the apparent H/B ratio, Comparisons between rest TI and late TI in 41 group A patients yielded quantitative H/B ratio of 1.63±0.39 and 1.49±0,31 (p=0.002), and total myocardial counts of 41.4±18.1 and 29.3±11.6 (p<0.001), respectively. Image quality agreement between rest TI and late TI was 90%, with 31 concordant good to excellent and 6 concordant fair studies. Analysis of the 107 late TI studies by patient weight revealed:<150 Ibs (n = 31)150–200 Ibs (n = 60)>200 Ibs (n = 16)pcardiac counts30.4±9.628.9±13.828.9±7.5nsH/B ratio1.49±0.241.46±0.321.42±0.25nsquality = 3 or 490%90%63%<0.05**> 200lbs vs. the other two weight categoriesConclusionAlthough quantitatively different, late TI has acceptable count statistics and comparable visual image quality to rest TI, establishing the feasibility of late TI/stress Tc-sestamibi dual isotope SPECT in non-obese (<200 Ibs) patients. The protocol allows for final reporting on the same day as stress testing, potentially decreasing the length of hospitalization

A randomized placebo-controlled study of a transcranial photobiomodulation helmet in Parkinson’s disease : post-hoc analysis of motor outcomes

Emerging evidence is increasingly supporting the use of transcranial photobiomodulation (tPBM) to improve symptoms of neurodegenerative diseases, including Parkinson’s disease (PD). The objective of this study was to analyse the safety and efficacy of tPBM for PD motor symptoms. The study was a triple blind, randomized placebo-controlled trial with 40 idiopathic PD patients receiving either active tPBM (635 nm plus 810 nm LEDs) or sham tPBM for 24 min per day (56.88J), six days per week, for 12 weeks. The primary outcome measures were treatment safety and a 37-item MDS-UPDRS-III (motor domain) assessed at baseline and 12 weeks. Individual MDS-UPDRS-III items were clustered into sub-score domains (facial, upper-limb, lower-limb, gait, and tremor). The treatment produced no safety concerns or adverse events, apart from occasional temporary and minor dizziness. There was no significant difference in total MDS-UPDRS-III scores between groups, presumably due to the placebo effect. Additional analyses demonstrated that facial and lower-limb sub-scores significantly improved with active treatment, while gait and lower-limb sub-scores significantly improved with sham treatment. Approximately 70% of participants responded to active treatment (≥5 decrease in MDS-UPDRS-III score) and improved in all sub-scores, while sham responders improved in lower-limb sub-scores only. tPBM appears to be a safe treatment and improved several PD motor symptoms in patients that responded to treatment. tPBM is proving to be increasingly attractive as a possible non-pharmaceutical adjunct therapy

Does Tai Chi improve psychological well-being and quality of life in patients with cardiovascular disease and/or cardiovascular risk factors? : a systematic review protocol

Introduction: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Psychological risk factors such as stress, anxiety and depression are known to play a significant and independent role in the development and progression of CVD and its risk factors. Tai Chi has been reported to be potentially effective for health and well-being. It is of value to assess the effectiveness and safety of Tai Chi on psychological well-being and quality of life in people with CVD and/or cardiovascular risk factors. Methods and analysis: We will include all relevant randomised controlled trials on Tai Chi for stress, anxiety, depression, psychological well-being and quality of life in people with CVD and cardiovascular risk factors. Literature searching will be conducted until 31 December 2016 from major English and Chinese databases. Two authors will conduct data selection and extraction independently. Quality assessment will be conducted using the risk of bias tool recommended by the Cochrane Collaboration. We will conduct data analysis using Cochrane’s RevMan software. Forest plots and summary of findings tables will illustrate the results from a meta-analysis if sufficient studies are identified. Ethics and dissemination: Ethics approval is not required as this study will not involve patients. The results of this study will be submitted to a peer-reviewed journal for publication, to inform both clinical practice and further research on Tai Chi and CVDs. Discussion: This review will summarise the evidence on Tai Chi for psychological well-being and quality of life in people with CVD and their risk factors. We anticipate that the results of this review would be useful for healthcare professionals and researchers on Tai Chi and CVDs

Perceptions of participants on trial participation and adherence to Tai Chi : a qualitative study

Purpose: Trial participation and adherence to interventions can directly influence the evaluation of outcomes in clinical trials for real world applications. The factors that influence trial participation and adherence to Tai Chi interventions in people with cardiovascular diseases remains unknown. This study aimed to explore participants’ perceptions of influential factors on their trial participation and adherence to a Tai Chi intervention within a trial setting. Patients and Methods: Participants had coronary heart disease and/or hypertension in a randomized controlled trial comparing Tai Chi with a waitlist control. Data were collected via face-to-face, semi-structured interviews and analyzed using thematic analysis. Results: Thirty-four participants from the Tai Chi group who completed the randomized trial were interviewed. Six dominating themes and four sub-themes are discussed under the facilitators of internal and external motivation, positive feelings, benefits of Tai Chi and future practice with an overall internal motivation to improve health. Positive feelings had three sub-themes: positive feelings toward Tai Chi, the project, and the learning experience. The Tai Chi instructor(s) was found to be a crucial element in motivating participants’ adherence to Tai Chi. Conclusion: From the perception of participants, the facilitators to their trial participation and adherence to a Tai Chi intervention included internal and external motivation, positive feelings towards Tai Chi, the project and the learning experience, and perceived benefits of Tai Chi. Perceived barriers included concerns about the safety and complexity of Tai Chi practice, lack of group atmosphere outside of class, and scheduling conflicts. Future researchers can address these factors to improve trial recruitment and implementation of Tai Chi and other mind-body interventions in research and for real world applications

Effective risk stratification using exercise myocardial perfusion SPECT in women: Gender-related differences in prognostic nuclear testing

AbstractObjectives. This study was designed to evaluate the incremental prognostic value over clinical and exercise variables of rest thallium-201/exercise technetium-99m sestamibi single-photon emission computed tomography (SPECT) in women compared with men and to determine whether this test can be used to effectively risk stratify patients of both genders.Background. To minimize the previously described gender-related bias in the evaluation of coronary artery disease in women, there is a need to identify a noninvasive testing strategy that is able to accurately and effectively risk stratify women.Methods. We identified 4,136 consecutive patients (2,742 men, 1,394 women) who underwent dual-isotope SPECT. The incremental value of nuclear testing was determined using both a stepwise Cox proportional hazards model and Kaplan-Meier survival analysis. Receiver operating characteristic curve analysis was performed to determine test discrimination for high risk patients in men and women.Results. The patient population was followed up for 20 ± 5 months for events (cardiac death or nonfatal myocardial infarction). During this time, 63 myocardial infarctions and 32 cardiac deaths occurred in the men, and 31 myocardial infarctions and 14 cardiac deaths occurred in the women. Nuclear testing significantly stratified both men and women irrespective of their rest electrocardiogram. Cox proportional hazards analysis revealed that nuclear testing added incremental prognostic value in both men and women after inclusion of the most predictive clinical and exercise variables (overall chi-square 89 in men vs. 120 in women, p < 0.005). Kaplan-Meier survival analysis demonstrated that nuclear testing further stratified men and women with both intermediate to high and low prescan likelihoods of coronary artery disease (p < 0.005 for all). Receiver operating characteristic curve analysis demonstrated superior discrimination for the nuclear scan results in identifying high risk women than men (area under the curve: 0.84 ± 0.03 vs. 0.71 ± 0.03 in men, p < 0.0005). The odds ratio comparing event rates in patients with abnormal versus those with normal scan results was greater in women than in men, suggesting superior stratification using nuclear testing in women.Conclusions. Dual-isotope myocardial perfusion imaging yields incremental prognostic value in both men and women. This modality identifies low risk women and men equally well but relatively high risk women more accurately than relatively high risk men and, thus, is able to stratify women more effectively than men