Promoting patient utilization of outpatient cardiac rehabilitation: A joint International Council and Canadian Association of Cardiovascular Prevention and Rehabilitation position statement

Background: Cardiac Rehabilitation (CR) is a recommendation in international clinical practice guidelines given its’ benefits, however use is suboptimal. The purpose of this position statement was to translate evidence on interventions that increase CR enrolment and adherence into implementable recommendations. Methods: The writing panel was constituted by representatives of societies internationally concerned with preventive cardiology, and included disciplines that would be implementing the recommendations. Patient partners served, as well as policy-makers. The statement was developed in accordance with AGREE II, among other guideline checklists. Recommendations were based on our update of the Cochrane review on interventions to promote patient utilization of CR. These were circulated to panel members, who were asked to rate each on a 7-point Likert scale in terms of scientific acceptability, actionability, and feasibility of assessment. A web call was convened to achieve consensus and confirm strength of the recommendations (based on GRADE). The draft underwent external review and public comment. Results: The 3 drafted recommendations were that to increase enrolment, healthcare providers, particularly nurses (strong), should promote CR to patients face-to-face (strong), and that to increase adherence part of CR could be delivered remotely (weak). Ratings for the 3 recommendations were 5.95±0.69 (mean ± standard deviation), 5.33±1.12 and 5.64±1.08, respectively. Conclusions: Interventions can significantly increase utilization of CR, and hence should be widely applied. We call upon cardiac care institutions to implement these strategies to augment CR utilization, and to ensure CR programs are adequately resourced to serve enrolling patients and support them to complete programs

Effectiveness-based guidelines for the prevention of cardiovascular disease in women-2011 update: A Guideline from the American Heart Association

"Substantial progress has been made in the awareness, treatment, and prevention of cardiovascular disease (CVD) in women since the first women-specific clinical recommendations for the prevention of CVD were published by the American Heart Association (AHA) in 1999.1 The myth that heart disease is a “man's disease” has been debunked; the rate of public awareness of CVD as the leading cause of death among US women has increased from 30% in 1997 to 54% in 2009.2 The age-adjusted death rate resulting from coronary heart disease (CHD) in females, which accounts for about half of all CVD deaths in women, was 95.7 per 100 000 females in 2007, a third of what it was in 1980.3,4 Approximately 50% of this decline in CHD deaths has been attributed to reducing major risk factors and the other half to treatment of CHD including secondary preventive therapies.4 Major randomized controlled clinical trials such as the Women's Health Initiative have changed the practice of CVD prevention in women over the past decade.5 The investment in combating this major public health issue for women has been significant, as have the scientific and medical achievements. Despite the gains that have been made, considerable challenges remain. In 2007, CVD still caused ≈1 death per minute among women in the United States.6 These represent 421 918 deaths, more women's lives than were claimed by cancer, chronic lower respiratory disease, Alzheimer disease, and accidents combined.6 Reversing a trend of the past 4 decades, CHD death rates in US women 35 to 54 years of age now actually appear to be increasing, likely because of the effects of the obesity epidemic.4 CVD rates in the United States are significantly higher for black females compared with their white counterparts (286.1/100 000 versus 205.7/100 000). This disparity parallels the substantially lower rate of awareness of heart disease and stroke that has been documented among black versus white women.2,6–8 Of concern is that in a recent AHA national survey, only 53% of women said the first thing they would do if they thought they were having a heart attack was to call 9-1-1. This distressing lack of appreciation by many women for the need for emergency care for acute cardiovascular events is a barrier to optimal survival among women and underscores the need for educational campaigns targeted to women.2

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

The Relationships Between \u3cem\u3eFAM5C\u3c/em\u3e SNP (rs10920501) Variability and Metabolic Syndrome and Inflammation in Women With Coronary Heart Disease

Introduction: The leading cause of death among women is coronary heart disease (CHD), a multifactorial disease with polygenic heritability estimated at 50%. Polymorphisms in the family with sequence similarity 5, member C′ (FAM5C) gene have been associated with myocardial infarction (MI). FAM5C also corresponds directly with the inflammatory biomarker monocyte chemoattractant protein 1 (MCP-1) and metabolic syndrome. Method: The purpose of this descriptive gene association pilot study was to investigate the variability of FAM5C (rs10920501) in 91 women with CHD. The authors also examined the associations between the variability of FAM5C (rs10920501) and metabolic syndrome, inflammatory markers, and early onset CHD. Results: No women in this study with the homozygous variant (TT) had an MI. Women with a history of MI and the heterozygous (AT) genotype had a later age of onset of CHD compared to those with the homozygous wild type (AA; F(3, 34) = 5.00, p \u3c .01). These findings suggest a protective effect of the T allele in women with a history of MI. The genotype of FAM5C rs10920501 explained approximately 7% of the variability of age of onset of CHD in women who have had an MI, while holding body mass index (BMI) and smoking history constant. There was no significant relationship between FAM5C (rs10920501) and metabolic syndrome or any inflammatory biomarkers in this sample. Conclusion: FAM5C remains a gene of interest in a complex disease process

The Association Between Variants on Chromosome 9p21 and Inflammatory Biomarkers in Ethnically Diverse Women With Coronary Heart Disease: A Pilot Study

Background: The most consistently replicated genetic variants associated with coronary heart disease (CHD) in populations of European descent have been found on chromosome 9p21. Yet there is little known about these associations in ethnic groups of African ancestry. These disease-associated variants are located in a genomic region of unknown function. The purpose of this exploratory study was to examine the allelic frequencies and haplotype structure of single nucleotide polymorphisms (SNPs) for Black and White women with CHD. The authors also sought to explore the relationship between these genetic variants and biomarkers of inflammation. Methods: Using polymerase chain reaction amplification, the authors genotyped 8 SNPs in a 58-kilobase region of chromosome 9p21 in a cohort of women with CHD (n = 91). The authors examined the interethnic relationship between the SNPs and four inflammatory biomarkers (C-reactive protein, intercellular adhesion molecule-1, interleukin-6, and tumor necrosis factor-alpha) using analysis of variance (ANOVA). Results: We found considerable interethnic allelic and haplotype diversity across the 9p21 locus, with only two SNPs in perfect linkage disequilibrium (LD) in both races. A pair of high- and low-risk haplotypes was most common in White women, while about 41% of Blacks carried the risk alleles for three of the eight SNPs the authors examined. The interethnic associations between the SNP genotypes and inflammatory markers were divergent in both direction and magnitude. Conclusions: Our results lend support for the importance of ancestry-specific allelic context when examining variants on chromosome 9p21. Additional work is needed to elucidate the genetic contribution to inflammatory biomarkers for diverse racial groups

Examining Spatial Accessibility to COVID-19 Testing Sites in Florida

Massive and rapid testing is crucial for containing the spread of COVID-19. Health and policy planners must ensure that access to and uptake of SARS-CoV-2 testing is adequate and equitable. This study measures the spatial accessibility to testing sites in Florida at the census tract level at the end of May 2020, using the 2-step floating catchment area method that integrates both driving and walking modes. Accessibility scores were found to be heterogeneous across geographic regions and among different groups of people. In particular, many rural areas were in a testing desert. While people in larger cities tended to have better accessibility to testing, many did not have adequate accessibility at that time due to both capacity limitations and spatial factors. In particular, people without access to private vehicles and the elderly faced disadvantages in accessibility to testing sites even in urban areas. However, Black and low-income groups were disproportionally concentrated in neighbourhoods with above-average accessibility due to their closer proximity to testing sites. These results suggest that increased efforts are needed to reach vulnerable populations, including the elderly and those without private vehicles

Examining Spatial Accessibility to COVID-19 Testing Sites in Florida

Massive and rapid testing is crucial for containing the spread of COVID-19. Health and policy planners must ensure that access to and uptake of SARS-CoV-2 testing is adequate and equitable. This study measures the spatial accessibility to testing sites in Florida at the census tract level at the end of May 2020, using the 2-step floating catchment area method that integrates both driving and walking modes. Accessibility scores were found to be heterogeneous across geographic regions and among different groups of people. In particular, many rural areas were in a testing desert. While people in larger cities tended to have better accessibility to testing, many did not have adequate accessibility at that time due to both capacity limitations and spatial factors. In particular, people without access to private vehicles and the elderly faced disadvantages in accessibility to testing sites even in urban areas. However, Black and low-income groups were disproportionally concentrated in neighbourhoods with above-average accessibility due to their closer proximity to testing sites. These results suggest that increased efforts are needed to reach vulnerable populations, including the elderly and those without private vehicles

The Effects of a Cardiac Rehabilitation Program Tailored for Women on Global Quality of Life: A Randomized Clinical Trial

Background: Women with heart disease have adverse psychosocial profiles and poor attendance in cardiac rehabilitation (CR) programs. Few studies examine CR programs tailored for women for improving their quality of life (QOL). Methods: This randomized clinical trial (RCT) compared QOL among women in a traditional CR program with that of women completing a tailored program that included motivational interviewing guided by the Transtheoretical Model (TTM) of behavior change. Two measures of QOL, the Multiple Discrepancies Theory questionnaire (MDT) and the Self-Anchoring Striving Scale (SASS), were administered to 225 women at baseline, postintervention, and 6-month follow-up. Analysis of Variance (ANOVA) was used to compare changes in QOL scores over time. Results: Baseline MDT and SASS scores were 35.1 and 35.5 and 7.1 and 7.0 for the tailored and traditional CR groups, respectively. Postintervention, MDT and SASS scores increased to 37.9 and 7.9, respectively, for the tailored group compared with 35.9 and 7.1 for the traditional group. Follow-up scores were 37.7 and 7.6 for the tailored group and 35.7 and 7.1 for the traditional group. Significant group by time interactions were found. Subsequent tests revealed that MDT and SASS scores for the traditional group did not differ over time. The tailored group showed significantly increased MDT and SASS scores from baseline to posttest, and despite slight attenuation from posttest to 6-month follow-up, MDT and SASS scores remained higher than baseline. Conclusions: The CR program tailored for women significantly improved global QOL compared with traditional CR. Future studies should explore the mechanisms by which such programs affect QOL

The Relationship Between Polymorphisms on Chromosome 9p21 and Age of Onset of Coronary Heart Disease in Black and White Women

Aim: Genome-wide association studies have identified variants on chromosome 9p21 that are associated with coronary heart disease (CHD). The relationship between these variants and the age of onset of CHD is less clear. The aim of this study was to examine the allelic frequencies and haplotype structure of eight single-nucleotide polymorphisms (SNPs) on chromosome 9p21 in ethnically diverse women. We also explored the relationship between 9p21 SNPs and the age of CHD onset. Results: There was considerable interethnic allelic and haplotype diversity across the 9p21 locus with only two SNPs (rs10757274 and rs4977574) in perfect linkage disequilibrium in both races, and only a small proportion of the haplotypes shared between the racial groups. With the exception of rs1333040, whites with at least one copy of the 9p21 SNP risk alleles were found to have CHD from 1.45 (rs10116277) to 4.77 (rs2383206) years earlier than those with the wild-type alleles. Blacks carrying at least one copy of the risk allele (92%) for rs1333040 had a CHD age of onset that was 6.5 years earlier than those with the wild-type alleles. Conclusions: Different variants on chromosome 9p21 may influence CHD age of onset in whites and blacks