Modification of age-related changes in cardiovascular structure and function using exercise training

Increasing age is associated with substantial changes in cardiovascular structure and function, the cause and permanence of which are unknown. Diastolic function in particular alters appreciably in older adults but non-invasive measurement of cardiac function during diastole has significant limitations. Magnetic resonance imaging with tagging was used to identify changes in three dimensional myocardial strain in older compared to young normal volunteers. This technique identified significantly delayed myocardial relaxation with more myocardial strain persisting in early diastole in older compared to younger individuals. These findings were thought to be attributable to the aging process.Epidemiological studies and small, non-randomised trials suggest that physical activity might slow cardiovascular aging and improve diastolic function in older adults. A randomised controlled trial was therefore performed to assess whether exercise training could modify age-related changes in older, normal volunteers who had been screened to exclude significant cardiovascular disease. The intervention group underwent six months of supervised exercise training whilst participants in the control group were asked to maintain their pre-trial levels of activity. Measurements made at baseline and after six months included transthoracic echocardiography, cardiac MRI, body composition, blood lipid concentrations, applanation tonometry, quality of life and maximal exercise capacity.Despite significant increases in exercise capacity in the intervention group, no other significant changes in cardiovascular structure or function, body composition, cholesterol concentration or quality of life were observed when compared to changes seen in the control group.Six months of exercise training in previously sedentary older adults are insufficient to modify cardiovascular function and structure despite causing marked improvements in exercise capacity. These findings contrast with previously reported non-randomised trials of exercise training in older people. However, they add important, robust information regarding the likely effects of short periods of exercise training on cardiovascular function and structure in older normal adults

Preventing cardiotoxicity in patients with breast cancer and lymphoma: protocol for a multicentre randomised controlled trial (PROACT)

Introduction: Anthracyclines are included in chemotherapy regimens to treat several different types of cancer and are extremely effective. However, it is recognised that a significant side effect is cardiotoxicity; anthracyclines can cause irreversible damage to cardiac cells and ultimately impaired cardiac function and heart failure, which may only be evident years after exposure. The PROACT trial will establish the effectiveness of the ACE inhibitor enalapril maleate (enalapril) in preventing cardiotoxicity in patients with breast cancer and non-Hodgkin’s lymphoma (NHL) receiving anthracycline-based chemotherapy. Methods and analysis: PROACT is a prospective, randomised, open-label, blinded end-point, superiority trial which will recruit adult patients being treated for breast cancer and NHL at NHS hospitals throughout England. The trial aims to recruit 106 participants, who will be randomised to standard care (high-dose anthracycline-based chemotherapy) plus enalapril (intervention) or standard care alone (control). Patients randomised to the intervention arm will receive enalapril (starting at 2.5 mg two times per day and titrating up to a maximum dose of 10 mg two times per day), commencing treatment at least 2 days prior to starting chemotherapy and finishing 3 weeks after their last anthracycline dose. The primary outcome is the presence or absence of cardiac troponin T release at any time during anthracycline treatment, and 1 month after the last dose of anthracycline. Secondary outcomes will focus on cardiac function measured using echocardiogram assessment, adherence to enalapril and side effects. Ethics and dissemination: A favourable opinion was given following research ethics committee review by West Midlands—Edgbaston REC, Ref: 17/WM/0248. Trial findings will be disseminated through engagement with patients, the oncology and cardiology communities, NHS management and commissioning groups and through peer-reviewed publication

Identifying the science and technology dimensions of emerging public policy issues through horizon scanning

Public policy requires public support, which in turn implies a need to enable the public not just to understand policy but also to be engaged in its development. Where complex science and technology issues are involved in policy making, this takes time, so it is important to identify emerging issues of this type and prepare engagement plans. In our horizon scanning exercise, we used a modified Delphi technique [1]. A wide group of people with interests in the science and policy interface (drawn from policy makers, policy adviser, practitioners, the private sector and academics) elicited a long list of emergent policy issues in which science and technology would feature strongly and which would also necessitate public engagement as policies are developed. This was then refined to a short list of top priorities for policy makers. Thirty issues were identified within broad areas of business and technology; energy and environment; government, politics and education; health, healthcare, population and aging; information, communication, infrastructure and transport; and public safety and national security.Public policy requires public support, which in turn implies a need to enable the public not just to understand policy but also to be engaged in its development. Where complex science and technology issues are involved in policy making, this takes time, so it is important to identify emerging issues of this type and prepare engagement plans. In our horizon scanning exercise, we used a modified Delphi technique [1]. A wide group of people with interests in the science and policy interface (drawn from policy makers, policy adviser, practitioners, the private sector and academics) elicited a long list of emergent policy issues in which science and technology would feature strongly and which would also necessitate public engagement as policies are developed. This was then refined to a short list of top priorities for policy makers. Thirty issues were identified within broad areas of business and technology; energy and environment; government, politics and education; health, healthcare, population and aging; information, communication, infrastructure and transport; and public safety and national security