Further proof of a paradoxical relationship between high-density lipoprotein levels and adverse cardiovascular outcomes - Are there implications for cardiovascular disease prevention?

Cardiovascular disease (CVD), mainly coronary heart disease, persists as the leading cause of disease burden and deaths in the world; in 2019, it was the cause of 6.2 million deaths among individuals between the ages of 30 and 70 years.1 Major cardiovascular risk factors include core health behaviours and health factors such as smoking, physical activity, diet, weight, lipids, blood pressure, and glucose control, which contribute to cardiovascular health.2 High systolic blood pressure and smoking were the first and second leading years of life lost (YLL) risk factors globally.2 The major lipids that are generally accepted as risk factors for CVD include total cholesterol, LDL cholesterol (LDL-C), HDL cholesterol (HDL-C) and triglycerides.3 High LDL-C remains a major threat to public health, due to elevated CVD risk, and its overall burden in terms of mortality and YLLs is on the increase globally.1 </p

The multifaceted benefits of passive heat therapies for extending the healthspan: A comprehensive review with a focus on Finnish sauna

Passive heat therapy is characterized by exposure to a high environmental temperature for a brief period. There are several types of passive heat therapy which include hot tubs, Waon therapy, hydrotherapy, sanarium, steam baths, infrared saunas and Finnish saunas. The most commonly used and widely studied till date are the Finnish saunas, which are characterized by high temperatures (ranging from 80–100°C) and dry air with relative humidity varying from 10–20%. The goal of this review is to provide a summary of the current evidence on the impact of passive heat therapies particularly Finnish saunas on various health outcomes, while acknowledging the potential of these therapies to contribute to the extension of healthspan, based on their demonstrated health benefits and disease prevention capabilities. The Finnish saunas have the most consistent and robust evidence regarding health benefits and they have been shown to decrease the risk of health outcomes such as hypertension, cardiovascular disease, thromboembolism, dementia, and respiratory conditions; may improve the severity of musculoskeletal disorders, COVID-19, headache and flu, while also improving mental well-being, sleep, and longevity. Finnish saunas may also augment the beneficial effects of other protective lifestyle factors such as physical activity. The beneficial effects of passive heat therapies may be linked to their anti-inflammatory, cytoprotective and anti-oxidant properties and synergistic effects on neuroendocrine, circulatory, cardiovascular and immune function. Passive heat therapies, notably Finnish saunas, are emerging as potentially powerful and holistic strategies to promoting health and extending the healthspan in all populations

Why binge television viewing can be bad for you

Non-communicable diseases accounted for 74% of deaths globally in 2019, with cardiovascular disease (CVD) persisting as the leading cause of death [1]. Atherosclerotic CVD or arterial thrombotic disease, which includes ischemic heart disease and cerebrovascular disease (mainly ischemic stroke) [2], are the main clinical manifestations of CVD. Atherosclerotic CVD poses immense health and economic burdens globally. Major risk factors for atherosclerotic CVD include age, sex, family history, race, hypertension, high cholesterol levels, smoking, diabetes, overweight or obesity, physical inactivity, unhealthy diet, and stress [3]. Given the significant challenges attributed to CVDs in the United States (US), the American Heart Association (AHA) developed a metric to tackle the burden of CVD among the US population, which is based on positively modifying four health behaviors (smoking, body mass index (BMI), physical activity, and diet) and three health factors (blood pressure (BP), fasting blood glucose and total cholesterol levels) [4].</p

Serum albumin, cardiometabolic and other adverse outcomes: systematic review and meta-analyses of 48 published observational cohort studies involving 1,492,237 participants.

Objectives. A general body of evidence suggests that low serum albumin might be associated with increased risk of adverse cardiometabolic outcomes, but findings are divergent. We aimed to quantify associations of serum albumin with the risk of type 2 diabetes (T2D), cardiovascular disease (CVD), all-cause mortality, and other adverse outcomes using a systematic review and meta-analyses of published observational cohort studies. Design. MEDLINE, Embase, Web of Science, and manual search of relevant bibliographies were systematically searched to January 2020. Relative risks (RRs) with 95% confidence intervals (CIs) comparing top versus bottom thirds of serum albumin levels were pooled. Results. Fifty-four articles based on 48 unique observational cohort studies comprising of 1,492,237 participants were eligible. Multivariable adjusted RRs (95% CIs) comparing the top vs bottom third of serum albumin levels were: 1.03 (0.86-1.22) for T2D; 0.60 (0.53-0.67) for CVD; 0.74 (0.66-0.84) for coronary heart disease (CHD); 0.57 (0.36-0.91) for CHD death; 0.76 (0.65-0.87) for myocardial infarction; 0.66 (0.55-0.77) for all-cause mortality; 0.71 (0.61-0.83) for venous thromboembolism; 0.65 (0.48-0.88) for cancer mortality; and 0.62 (0.46-0.84) for fracture. Heterogeneity between contributing studies of T2D was partly explained by sample sizes of studies (p for meta-regression = .035). Conclusions. Elevated levels of serum albumin are associated with reduced risk of vascular outcomes, all-cause mortality, certain cancers, and fracture. Inconsistent findings for T2D may be attributed to selective reporting by studies. Further research is needed to assess any potential causal relevance to these findings and the role of serum albumin concentrations in disease prevention.Systematic review registration: PROSPERO 2019: CRD42019125869

'Weekend warrior' and regularly active physical activity patterns confer similar cardiovascular and mortality benefits: a systematic meta-analysis

It is well documented that physical activity (PA) is associated with a lower risk of non-communicable diseases including cardiovascular disease (CVD) as well as mortality.1–3 Previous PA guidelines as well as recent guidelines by the World Health Organization have recommended that all adults should aim for 150–300 min of moderate intensity PA per week or 75–150 min of vigorous intensity PA per week or an equivalent combination of moderate-intensity and vigorous-intensity PA per week.4 Evidence suggests these levels provide substantial health benefits in most people.2 Despite guideline recommendations and population-wide strategies to promote PA levels, most populations do not adhere to PA recommendations. A major reason for the low levels of adherence is the lack of time. The balance between frequency, duration, and intensity, which are components of PA, plays an important part in the protective effects of PA. To derive maximal benefits from PA, an appropriate intensity, frequency, and duration, which comprise the volume is essential. However, emerging evidence suggests that the intensity of PA may be more important than the quantity (frequency or duration).5 It is uncertain if the majority of PA concentrated into a few days confers similar cardiovascular benefits as that spread over more days. Following the seminal study by Lee et al.,6 a few recent reports have evaluated whether guideline recommended PA patterns concentrated in one or two sessions per week (commonly called the ‘weekend warrior’ pattern) or patterns spread over multiple sessions per week (i.e. regularly active pattern) may differ with respect to cardiovascular outcomes and mortality. Some studies have reported similar benefits,7 whereas other reports suggest that regularly active PA patterns confer more benefits than weekend warrior PA patterns.6,8 Given the sparseness and inconsistency of the data, there is a need to systematically synthesize the existing evidence. Furthermore, given the relatively low sample size of some of these previous studies, pooling the overall evidence will provide adequate power to reveal any true associations. In this context, we aimed to assess and compare the associations of weekend warrior and regularly active PA patterns vs. inactive PA patterns with the risk of adverse cardiovascular outcomes using a systematic review and meta-analysis of all published observational cohort studies conducted on the topic.</p

A Sour Note: Sweetened Beverages Linked to Incident Heart Failure

To what extent can the detrimental effects escalate? The consumption of sweetened beverages is implicated in the risk of heart failure. Undeniably, every rose has its thorn. Heart failure (HF), an end-stage manifestation of various forms of cardiovascular disease (CVD), accounts for over 60 million deaths worldwide, making it a global pandemic.1 The prevalence of HF is increasing due to improvements in diagnosis and treatment, as well as the growing aging population.1 The burden posed by HF on healthcare expenditure is worrisome, and if no effective and timely interventions are taken, the economic consequences could worsen in the near future. One crucial public health strategy is to prevent the development of CVDs.2 Avoiding tobacco, engaging in regular brisk physical activity most days of the week, and adherence to a healthy dietary pattern are key lifestyle factors for the prevention of CVD. The consumption of beverages, as a dietary component, has become increasingly prevalent in modern societies. Sweetened beverages have been linked to various adverse cardiovascular and metabolic conditions, but their relationship with HF is uncertain.</p

Television viewing and venous thrombo-embolism: a systematic review and meta-analysis

Arterial thrombotic disease (atherosclerotic cardiovascular disease, CVD) and venous thrombo-embolism (VTE; comprising of deep vein thrombosis and pulmonary embolism) are two closely related diseases, which share common risk factors (obesity and smoking) and pathophysiological pathways (such as coagulation, platelet activation, and dyslipidaemia).1 Both disease states are associated with substantial morbidity, premature mortality, and high healthcare costs. It is well established that physical activity has an inverse and dose–response relationship with atherosclerotic CVD.2 Conversely, physical inactivity or prolonged sedentary behaviour is consistently associated with an increased risk of vascular diseases including atherosclerotic CVD.3 Though the evidence on the relationship between physical activity and VTE risk has mostly been inconsistent,4,5 a recent pooled analysis of 14 population-based prospective studies showed that regular physical activity was also associated with a reduced risk of VTE compared with physical inactivity.6 Physical activity and physical inactivity are not the same risk factor, but the evidence suggests that physical inactivity may also be associated with an increased risk of VTE. Television (TV) viewing is a major component of leisure sedentary time (physical inactivity) and there is documented evidence on its relationship with atherosclerotic CVD.7 Given the overall evidence, it is plausible that prolonged TV viewing may be associated with an increased VTE risk. However, the evidence so far has been inconsistent. Whereas some studies have reported an increased risk of VTE with prolonged TV viewing,8,9 others have reported no significant evidence of an association.10 Given the sparse and divergent evidence, there is a need for aggregation of the previous evidence, which will provide more power (in a larger sample of participants) to re-evaluate the association. In this context, using a systematic review and meta-analysis of all published observational cohort studies conducted on the topic, we sought to evaluate the nature and magnitude of the prospective association between TV viewing and VTE risk.</p

Benefits and harms of sodium-glucose co-transporter-2 inhibitors (SGLT2-I) and renin–angiotensin–aldosterone system inhibitors (RAAS-I) versus SGLT2-Is alone in patients with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials

IntroductionIt is uncertain if the combination of sodium-glucose co-transporter 2 inhibitors (SGLT2-Is) and renin-angiotensin-aldosterone system inhibitors (RAAS-Is) provides better cardio-renal clinical outcomes in people with type 2 diabetes mellitus (T2DM) compared with SGLT2-Is alone. Using a systematic review and meta-analysis of randomized controlled trials (RCTs), we evaluated the efficacy and safety with respect to cardio-renal outcomes of the combination of SGLT2 and RAAS inhibitors vs SGLT2-Is in patients with T2DM.MethodsStudies were identified from MEDLINE, Embase, the Cochrane Library and search of bibliographies to May 2021. The Cochrane risk of bias tool was used to assess the risk of bias of each study. Study-specific risk ratios (RRs) with 95% confidence intervals (CIs) were pooled. Quality of the evidence was assessed using GRADE.ResultsNine articles comprising 8 RCT evaluations (n = 34,551 participants) that compared SGLT2-Is with placebo in patients with T2DM against a background of standard care and reported subgroup results for those treated with or without RAAS-Is at baseline were included. No RCT specifically investigated the combination of SGLT2 and RAAS inhibitors compared with SGLT2-Is alone. The RRs (95% CIs) for composite cardiovascular outcome and composite CVD death/heart failure hospitalization comparing SGLT2-Is vs placebo in patients on RAAS-Is were 0.93 (0.85–1.01) and 0.88 (0.76–1.02), respectively. The corresponding estimates for patients not on RAAS-Is were 0.78 (0.65–0.93) and 0.73 (0.65–0.82), respectively. There was no evidence of interactions between RAAS-I status and the effects of SGLT2-Is for both outcomes. Single study results showed that SGLT2-Is vs placebo reduced the risk of composite kidney outcome and cardiovascular death in patients with RAAS inhibition. The effect of SGLT2 inhibition vs placebo on kidney parameters, genital infections, volume depletion, hyperkalaemia, hypokalaemia, hypoglycaemia and other adverse events was similar in patients with or without RAAS inhibition. The quality of the evidence ranged from very low to moderate.ConclusionsAggregate published data suggest that the combination of SGLT2 and RAAS inhibitors in the treatment of patients with T2DM may be similar in efficacy and safety if not superior to SGLT2-Is alone. Head-to-head comparisons of the two interventions are warranted to inform T2DM management. The use of SGLT2 inhibition as a first-line therapy in T2DM or its early use in the prevention of renal deterioration and cardiovascular complications in addition to its glycaemic control deserves further study.</div

Indirect impact of the COVID-19 pandemic on hospitalisations for cardiometabolic conditions and their management: A systematic review

BackgroundThe Coronavirus disease 2019 (COVID-19) pandemic has led to a dramatic crisis in health care systems worldwide. These may have significant implications for the management of cardiometabolic diseases. We conducted a systematic review of published evidence to assess the indirect impact of the COVID-19 pandemic on hospitalisations for cardiovascular diseases and their management.MethodsStudies that evaluated volume of hospitalisations for cardiometabolic conditions and their management with comparisons between the COVID-19 and pre-COVID periods were identified from MEDLINE, Embase and the reference list of relevant studies from January 2020 to 25 February 2021.ResultsWe identified 103 observational studies, with most studies assessing hospitalisations for acute cardiovascular conditions such as acute coronary syndrome, ischemic strokes and heart failure. About 89% of studies reported a decline in hospitalisations during the pandemic compared to pre-pandemic times, with reductions ranging from 20.2 to 73%. Severe presentation, less utilization of cardiovascular procedures, and longer patient- and healthcare-related delays were common during the pandemic. Most studies reported shorter length of hospital stay during the pandemic than before the pandemic (1–8 vs 2–12 days) or no difference in length of stay. Most studies reported no change in in-hospital mortality among hospitalised patients.ConclusionClinical care of patients for acute cardiovascular conditions, their management and outcomes have been adversely impacted by the COVID-19 pandemic. Patients should be educated via population-wide approaches on the need for timely medical contact and health systems should put strategies in place to provide timely care to patients at high risk.</div

Erectile dysfunction, phosphodiesterase-5 inhibitor use and risk of cardiovascular disease and mortality in people with diabetes: A systematic review and meta-analysis.

BackgroundPhosphodiesterase-5 inhibitors (PDE5-Is), used in the management of erectile dysfunction (ED), have potential cardioprotective benefits. The impact of PDE5-Is on reducing adverse cardiovascular outcomes in patients with diabetes mellitus (DM) and ED is uncertain. Using a systematic review and meta-analysis of observational cohort studies and randomised controlled trials (RCTs), we evaluated if (i) the association of PDE5-Is in people with ED and DM and their risk of cardiovascular disease (CVD) and mortality and (ii) ED confers an excess risk of CVD and mortality in patients with DM compared with no DM.MethodsStudies were identified from MEDLINE, Embase, the Cochrane Library, Web of Science citation search and search of bibliographies to April 2022. Study-specific risk ratios (RRs) with 95% confidence intervals (CIs) were pooled.ResultsEighteen unique studies reported on the cardiovascular impact of ED in patients with and without DM. In the general population, the RRs (95% CIs) of ED for composite CVD/MACE, all-cause mortality, CHD and stroke were 1.43 (1.31-1.55), 1.47 (1.31-1.65), 1.59 (1.39-1.82), and 1.34 (1.15-1.56), respectively. The respective estimates were 1.68 (1.15-2.45), 1.40 (0.90-2.18), 1.41 (1.24-1.61) and 1.32 (1.09-1.60) in the diabetes population. Interaction analyses suggested similar risk in both populations. Six studies reported the cardiovascular effects of PDE5-Is in people with ED and DM. Limited RCT data showed no significant differences in the risk of major adverse cardiac event (MACE), coronary heart disease (CHD) and all-cause mortality comparing PDE5-I use with non-use: RRs (95% CIs) of 3.47 (0.17-69.19), 1.31 (0.10-16.54) and 0.35 (0.12-1.05), respectively.ConclusionsED confers no excess risk of CVD and mortality in patients with DM compared with no DM. Limited and inadequately powered data shows no significant differences in the risk of adverse cardiovascular outcomes comparing use of PDE5-Is with non-use in patients with ED and DM. PROSPERO Registration: CRD42022324537