Journal of Clinical Medicine

Research

12 pages, 677 KiB

Open AccessFeature PaperArticle

Metabolic Syndrome and Its Components Have a Different Presentation and Impact as Cardiovascular Risk Factors in Psoriatic and Rheumatoid Arthritis

by Fabiola Atzeni, Laura La Corte, Mariateresa Cirillo, Manuela Giallanza, James Galloway and Javier Rodríguez-Carrio

J. Clin. Med. 2023, 12(15), 5031; https://doi.org/10.3390/jcm12155031 - 31 Jul 2023

Viewed by 1058

Abstract

Patients with chronic inflammatory arthritis have a higher cardiovascular (CV) risk than the general population. Traditional CV risk factors are clearly implicated, while the impact of metabolic syndrome (MetS) is less defined. The aim of this study was to compare MetS prevalence and [...] Read more.

Patients with chronic inflammatory arthritis have a higher cardiovascular (CV) risk than the general population. Traditional CV risk factors are clearly implicated, while the impact of metabolic syndrome (MetS) is less defined. The aim of this study was to compare MetS prevalence and impact on the CV risk in psoriatic arthritis (PsA) versus rheumatoid arthritis (RA). A retrospective analysis of real-world data of PsA and RA patients referred to a rheumatology clinic was conducted. The following data were extracted and compared: demographic data; clinical data; presence of traditional CV risk factors and MetS. Univariate and multivariate models were used to compare the impact of MetS and its components in patients with PsA versus RA. Overall, 170 patients were included (PsA: 78; RA; 92). The two groups differed significantly in mean age, disease duration, and presence of MetS, while other variables were comparable. Univariate and multivariate analysis identified distinct predictors of MetS in PsA (hypertension) and RA (dyslipidemia). The history of CV events was similar in the two groups. Predictors of CV events were MetS and most of its components in PsA, while dyslipidemia was the strongest predictor in RA. These associations were stronger in PsA than in RA. In conclusion, the impact of MetS and its components is different in PsA and RA. The association of these risk factors with CV events is stronger in PsA than in RA. This suggests the implication of different mechanisms, which may require distinct strategies for the prevention of CV events in PsA and RA. Full article

(This article belongs to the Special Issue Cardiovascular Risk Factors and Intervention Strategies for the Prevention of Cardiovascular Disease)

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9 pages, 360 KiB

Open AccessArticle

Chromosome Y Haplogroup R Was Associated with the Risk of Premature Myocardial Infarction with ST-Elevation: Data from the CholeSTEMI Registry

by Rebeca Lorca, Andrea Aparicio, María Salgado, Rut Álvarez-Velasco, Isaac Pascual, Juan Gomez, Daniel Vazquez-Coto, Claudia Garcia-Lago, Lucinda Velázquez-Cuervo, Elías Cuesta-Llavona, Pablo Avanzas and Eliecer Coto

J. Clin. Med. 2023, 12(14), 4812; https://doi.org/10.3390/jcm12144812 - 21 Jul 2023

Cited by 3 | Viewed by 969

Abstract

Cardiovascular disease (CVD) is the leading cause of death worldwide, with coronary artery disease (CAD) being one of its main manifestations. Both environmental and genetic factors are widely known to be related to CAD, such as smoking, diabetes mellitus, dyslipidemia, and a family [...] Read more.

Cardiovascular disease (CVD) is the leading cause of death worldwide, with coronary artery disease (CAD) being one of its main manifestations. Both environmental and genetic factors are widely known to be related to CAD, such as smoking, diabetes mellitus, dyslipidemia, and a family history of CAD. However, there is still a lack of information about other risk factors, especially those related to genetic mutations. Sex represents a classic CAD risk factor, as men are more likely to suffer CAD, but there is lack of evidence with regard to sex-specific genetic factors. We evaluated the Y chromosome haplogroups in a cohort of young Spanish male patients who suffered from STEMI. In this cohort, haplogroup R was significantly more frequent in STEMI patients. Full article

(This article belongs to the Special Issue Cardiovascular Risk Factors and Intervention Strategies for the Prevention of Cardiovascular Disease)

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11 pages, 1470 KiB

Open AccessArticle

Both Moderate and Heavy Alcohol Use Amplify the Adverse Cardiovascular Effects of Smoking in Young Patients with Hypertension

by Paolo Palatini, Lucio Mos, Francesca Saladini, Olga Vriz, Claudio Fania, Andrea Ermolao, Francesca Battista, Mattia Canevari and Marcello Rattazzi

J. Clin. Med. 2023, 12(8), 2792; https://doi.org/10.3390/jcm12082792 - 9 Apr 2023

Cited by 1 | Viewed by 1730

Abstract

Aim: To evaluate the association of alcohol and smoking combined with cardiovascular and renal events and investigate whether moderate and heavy alcohol consumption have a different impact on this association. Methods: The study was conducted in 1208 young-to-middle-age stage 1 hypertensive patients. Subjects [...] Read more.

Aim: To evaluate the association of alcohol and smoking combined with cardiovascular and renal events and investigate whether moderate and heavy alcohol consumption have a different impact on this association. Methods: The study was conducted in 1208 young-to-middle-age stage 1 hypertensive patients. Subjects were classified into three categories of cigarette smoking and alcohol use, and the risk of adverse outcomes was assessed over a 17.4-year follow-up. Results: In multivariable Cox models, smoking showed a different prognostic impact on alcohol drinkers and abstainers. In the former, an increase in the risk of cardiovascular and renal events was observed compared to nonsmokers (hazard ratio, 2.6, 95% CI, 1.5–4.3, p < 0.001), whereas in the latter, the risk did not achieve the level of statistical significance (p = 0.27) with a significant interaction between smoking and alcohol use (p < 0.001). Among the heavy smokers who also drank alcoholic beverages, the hazard ratio from the fully adjusted model was 4.3 (95% CI, 2.3–8.0, p < 0.0001). In the subjects with moderate alcohol consumption, the risk of smoking and alcohol combined was similar to that found in the whole population (hazard ratio, 2.7; 95% CI, 1.5–3.9, p < 0.001). Among the subjects with heavy alcohol consumption, the hazard ratio was 3.4 (95% CI, 1.3–8.6, p = 0.011). Conclusion: These findings indicate that the detrimental cardiovascular effects of smoking can be worsened by concomitant alcohol use. This synergistic effect occurs not only for heavy alcohol consumption but also for moderate use. Smokers should be aware of the increased risk associated with concomitant alcohol consumption. Full article

(This article belongs to the Special Issue Cardiovascular Risk Factors and Intervention Strategies for the Prevention of Cardiovascular Disease)

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Review

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12 pages, 267 KiB

Open AccessReview

Dietary Salt Restriction and Adherence to the Mediterranean Diet: A Single Way to Reduce Cardiovascular Risk?

by Lanfranco D’Elia and Pasquale Strazzullo

J. Clin. Med. 2024, 13(2), 486; https://doi.org/10.3390/jcm13020486 - 16 Jan 2024

Cited by 2 | Viewed by 1220

Abstract

The dietary restriction of salt intake and the adhesion to Mediterranean dietary patterns are among the most recommended lifestyle modifications for the prevention of cardiovascular diseases. A large amount of evidence supports these recommendations; indeed, several studies show that a higher adherence to [...] Read more.

The dietary restriction of salt intake and the adhesion to Mediterranean dietary patterns are among the most recommended lifestyle modifications for the prevention of cardiovascular diseases. A large amount of evidence supports these recommendations; indeed, several studies show that a higher adherence to Mediterranean dietary patterns is associated with a reduced risk of cardiovascular disease. Likewise, findings from observational and clinical studies suggest a causal role of excess salt intake in blood pressure increase, cardiovascular organ damage, and the incidence of cardiovascular diseases. In this context, it is also conceivable that the beneficial effects of these two dietary patterns overlap because Mediterranean dietary patterns are typically characterized by a large consumption of plant-based foods with low sodium content. However, there is little data on this issue, and heterogeneous results are available on the relationship between adherence to salt restriction and to Mediterranean dietary patterns. Thus, this short review focuses on the epidemiological and clinical evidence of the relationship between the adherence to Mediterranean dietary patterns and dietary salt restriction in the context of cardiovascular risk. Full article

(This article belongs to the Special Issue Cardiovascular Risk Factors and Intervention Strategies for the Prevention of Cardiovascular Disease)

11 pages, 838 KiB

Open AccessReview

Effects of Different Kinds of Physical Activity on Vascular Function

by Francesca Saladini

J. Clin. Med. 2024, 13(1), 152; https://doi.org/10.3390/jcm13010152 - 27 Dec 2023

Viewed by 1019

Abstract

Regular exercise is one of the main non-pharmacological measures suggested by several guidelines to prevent and treat the development of hypertension and cardiovascular disease through its impact on the vascular system. Routine aerobic training exerts its beneficial effects by means of several mechanisms: [...] Read more.

Regular exercise is one of the main non-pharmacological measures suggested by several guidelines to prevent and treat the development of hypertension and cardiovascular disease through its impact on the vascular system. Routine aerobic training exerts its beneficial effects by means of several mechanisms: decreasing the heart rate and arterial pressure as well as reducing the activation of the sympathetic system and inflammation process without ignoring the important role that it plays in the metabolic profile. Through all these actions, physical training counteracts the arterial stiffening and aging that underlie the development of future cardiovascular events. While the role of aerobic training is undoubted, the effects of resistance training or combined-training exercise on arterial distensibility are still questioned. Moreover, whether different levels of physical activity have a different impact on normotensive and hypertensive subjects is still debated. Full article

(This article belongs to the Special Issue Cardiovascular Risk Factors and Intervention Strategies for the Prevention of Cardiovascular Disease)

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12 pages, 1080 KiB

Open AccessReview

Polypill Therapy for Cardiovascular Disease Prevention and Combination Medication Therapy for Hypertension Management

by Keisuke Narita, Satoshi Hoshide and Kazuomi Kario

J. Clin. Med. 2023, 12(23), 7226; https://doi.org/10.3390/jcm12237226 - 22 Nov 2023

Cited by 1 | Viewed by 2035

Abstract

Although various guidelines for cardiovascular disease prevention have been established, the optimal drug therapy is often not implemented due to poor medication adherence and the clinical inertia of healthcare practitioners. Polypill strategies are one solution to this problem. Previous studies have established the [...] Read more.

Although various guidelines for cardiovascular disease prevention have been established, the optimal drug therapy is often not implemented due to poor medication adherence and the clinical inertia of healthcare practitioners. Polypill strategies are one solution to this problem. Previous studies have established the usefulness of polypills, i.e., combination tablets including three or more medications, for the prevention of cardiovascular disease. For this purpose, the polypills generally contain an antiplatelet medication, an antihypertensive medication, and a statin. For the specific management of hypertension, combination therapy including more than two classes of antihypertensive medications is recommended by most international guidelines. Combination tablets including two classes of antihypertensive medications, such as renin-angiotensin system (RAS) inhibitors (angiotensin-converting enzyme inhibitors [ACEIs] and angiotensin receptor blockers [ARBs]) and Ca-channel blockers or thiazide diuretics, have been reported to be useful for cardiovascular disease prevention and lowering blood pressure (BP) levels. The use of RAS inhibitors is recommended for a wide range of complications, including diabetes, chronic heart failure, and chronic kidney disease. The combination of an RAS inhibitor and diuretic or Ca-channel blocker is thus recommended for the management of hypertension. Finally, we expect that novel medications such as angiotensin receptor neprilysin inhibitors (ARNIs) and sodium glucose cotransporter 2 inhibitors (SGLT2i), which have a more diverse range of effects in hypertension, heart failure, or diabetes, may be a solution to the problem of polypharmacy. Evidence is accumulating on the benefits of polypill strategies in cardiovascular disease prevention. Combination tablets are also effective for the treatment of hypertension. Full article

(This article belongs to the Special Issue Cardiovascular Risk Factors and Intervention Strategies for the Prevention of Cardiovascular Disease)

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24 pages, 1072 KiB

Open AccessReview

Management of Residual Risk in Chronic Coronary Syndromes. Clinical Pathways for a Quality-Based Secondary Prevention

by Simona Giubilato, Fabiana Lucà, Maurizio Giuseppe Abrignani, Laura Gatto, Carmelo Massimiliano Rao, Nadia Ingianni, Francesco Amico, Roberta Rossini, Giorgio Caretta, Stefano Cornara, Irene Di Matteo, Concetta Di Nora, Silvia Favilli, Anna Pilleri, Andrea Pozzi, Pier Luigi Temporelli, Marco Zuin, Antonio Francesco Amico, Carmine Riccio, Massimo Grimaldi, Furio Colivicchi, Fabrizio Oliva and Michele Massimo Gulizia Show full author list Hide full author list

J. Clin. Med. 2023, 12(18), 5989; https://doi.org/10.3390/jcm12185989 - 15 Sep 2023

Cited by 3 | Viewed by 1377

Abstract

Chronic coronary syndrome (CCS), which encompasses a broad spectrum of clinical presentations of coronary artery disease (CAD), is the leading cause of morbidity and mortality worldwide. Recent guidelines for the management of CCS emphasize the dynamic nature of the CAD process, replacing the [...] Read more.

Chronic coronary syndrome (CCS), which encompasses a broad spectrum of clinical presentations of coronary artery disease (CAD), is the leading cause of morbidity and mortality worldwide. Recent guidelines for the management of CCS emphasize the dynamic nature of the CAD process, replacing the term “stable” with “chronic”, as this disease is never truly “stable”. Despite significant advances in the treatment of CAD, patients with CCS remain at an elevated risk of major cardiovascular events (MACE) due to the so-called residual cardiovascular risk. Several pathogenetic pathways (thrombotic, inflammatory, metabolic, and procedural) may distinctly contribute to the residual risk in individual patients and represent a potential target for newer preventive treatments. Identifying the level and type of residual cardiovascular risk is essential for selecting the most appropriate diagnostic tests and follow-up procedures. In addition, new management strategies and healthcare models could further support available treatments and lead to important prognostic benefits. This review aims to provide an overview of the diagnostic and therapeutic challenges in the management of patients with CCS and to promote more effective multidisciplinary care. Full article

(This article belongs to the Special Issue Cardiovascular Risk Factors and Intervention Strategies for the Prevention of Cardiovascular Disease)

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13 pages, 3158 KiB

Open AccessReview

Dual PPRαϒ Agonists for the Management of Dyslipidemia: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

by Antonio da Silva Menezes Junior, Vinícius Martins Rodrigues Oliveira, Izadora Caiado Oliveira, André Maroccolo de Sousa, Ana Júlia Prego Santana, Davi Peixoto Craveiro Carvalho, Ricardo Figueiredo Paro Piai, Fernando Henrique Matos, Arthur Marot de Paiva and Gabriel Baêta Branquinho Reis

J. Clin. Med. 2023, 12(17), 5674; https://doi.org/10.3390/jcm12175674 - 31 Aug 2023

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Abstract

Saroglitazar is a novel medication for dyslipidemia, but its specific effects remain unclear. Therefore, we performed a systematic review and meta-analysis to assess the efficacy and safety of saroglitazar for managing dyslipidemia. The PubMed, Scopus, and EMBASE databases were systematically searched for randomized [...] Read more.

Saroglitazar is a novel medication for dyslipidemia, but its specific effects remain unclear. Therefore, we performed a systematic review and meta-analysis to assess the efficacy and safety of saroglitazar for managing dyslipidemia. The PubMed, Scopus, and EMBASE databases were systematically searched for randomized controlled trials (RCTs) comparing 2 and 4 mg of saroglitazar with placebos for treating dyslipidemia. A random-effects model calculated the pooled mean differences for continuous outcomes with 95% confidence intervals. The study included seven RCTs involving 1975 patients. Overall, 340 (31.0%) and 513 (46.8%) participants received 2 and 4 mg of saroglitazar, respectively; 242 (22.11%) received the placebo. The mean ages ranged from 40.2 to 62.6 years, and 436 (39.8%) were women. Compared to the control group, 4 mg of saroglitazar significantly decreased the triglyceride and low-density lipoprotein (LDL) cholesterol levels but did not affect the high-density lipoprotein cholesterol level. Furthermore, the alanine aminotransferase level significantly decreased, the creatine level significantly increased, and body weight did not differ between the groups. Finally, 4 mg of saroglitazar, compared to 2 mg, significantly lowered the triglyceride level. Saroglitazar (4 mg) may be an effective treatment, but safety concerns remain. Full article

(This article belongs to the Special Issue Cardiovascular Risk Factors and Intervention Strategies for the Prevention of Cardiovascular Disease)

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14 pages, 761 KiB

Open AccessReview

Microcirculation in Hypertension: A Therapeutic Target to Prevent Cardiovascular Disease?

by Damiano Rizzoni, Claudia Agabiti-Rosei, Gianluca E. M. Boari, Maria Lorenza Muiesan and Carolina De Ciuceis

J. Clin. Med. 2023, 12(15), 4892; https://doi.org/10.3390/jcm12154892 - 25 Jul 2023

Cited by 3 | Viewed by 1245

Abstract

Arterial hypertension is a common condition worldwide and an important risk factor for cardio- and cerebrovascular events, renal diseases, as well as microvascular eye diseases. Established hypertension leads to the chronic vasoconstriction of small arteries as well as to a decreased lumen diameter [...] Read more.

Arterial hypertension is a common condition worldwide and an important risk factor for cardio- and cerebrovascular events, renal diseases, as well as microvascular eye diseases. Established hypertension leads to the chronic vasoconstriction of small arteries as well as to a decreased lumen diameter and the thickening of the arterial media or wall with a consequent increased media-to-lumen ratio (MLR) or wall-to-lumen ratio (WLR). This process, defined as vascular remodeling, was firstly demonstrated in small resistance arteries isolated from subcutaneous biopsies and measured by micromyography, and this is still considered the gold-standard method for the assessment of structural alterations in small resistance arteries; however, microvascular remodeling seems to represent a generalized phenomenon. An increased MLR may impair the organ flow reserve, playing a crucial role in the maintenance and, probably, also in the progressive worsening of hypertensive disease, as well as in the development of hypertension-mediated organ damage and related cardiovascular events, thus possessing a relevant prognostic relevance. New non-invasive techniques, such as scanning laser Doppler flowmetry or adaptive optics, are presently under development, focusing mainly on the evaluation of WLR in retinal arterioles; recently, also retinal microvascular WLR was demonstrated to have a prognostic impact in terms of cardio- and cerebrovascular events. A rarefaction of the capillary network has also been reported in hypertension, which may contribute to flow reduction in and impairment of oxygen delivery to different tissues. These microvascular alterations seem to represent an early step in hypertension-mediated organ damage since they might contribute to microvascular angina, stroke, and renal dysfunction. In addition, they can be markers useful in monitoring the beneficial effects of antihypertensive treatment. Additionally, conductance arteries may be affected by a remodeling process in hypertension, and an interrelationship is present in the structural changes in small and large conductance arteries. The review addresses the possible relations between structural microvascular alterations and hypertension-mediated organ damage, and their potential improvement with antihypertensive treatment. Full article

(This article belongs to the Special Issue Cardiovascular Risk Factors and Intervention Strategies for the Prevention of Cardiovascular Disease)

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Other

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7 pages, 233 KiB

Open AccessOpinion

Blood Pressure Variability as a Risk Factor for Cardiovascular Disease: Which Antihypertensive Agents Are More Effective?

by Alejandro de la Sierra

J. Clin. Med. 2023, 12(19), 6167; https://doi.org/10.3390/jcm12196167 - 24 Sep 2023

Cited by 2 | Viewed by 1179

Abstract

Blood pressure oscillations during different time scales, known as blood pressure variability (BPV), have become a focus of growing scientific interest. BPV can be measured at long-term (seasonal variability or visit-to-visit), at mid-term (differences in consecutive days or weeks) or at short-term (day-night [...] Read more.

Blood pressure oscillations during different time scales, known as blood pressure variability (BPV), have become a focus of growing scientific interest. BPV can be measured at long-term (seasonal variability or visit-to-visit), at mid-term (differences in consecutive days or weeks) or at short-term (day-night differences or changes induced by other daily activities and conditions). An increased BPV, either at long, mid or short-term is associated with a poor cardiovascular prognosis independently of the amount of blood pressure elevation. There is scarce evidence on the effect of different antihypertensive treatments on BPV, but some observational and interventional studies suggest that calcium channel blockers in general, and particularly amlodipine, either in monotherapy or combined with renin-angiotensin system blockers, can reduce BPV more efficiently than other antihypertensive drugs or combinations. Nevertheless, there are several aspects of the relationship between BPV, antihypertensive treatment, and clinical outcomes that are still unknown, and more work should be performed before considering BPV as a therapeutical target in clinical practice. Full article

(This article belongs to the Special Issue Cardiovascular Risk Factors and Intervention Strategies for the Prevention of Cardiovascular Disease)

17 pages, 4051 KiB

Open AccessSystematic Review

Ideal Cardiovascular Health and Risk of Cardiovascular Events or Mortality: A Systematic Review and Meta-Analysis of Prospective Studies

by Milan Radovanovic, Janko Jankovic, Stefan Mandic-Rajcevic, Igor Dumic, Richard D. Hanna and Charles W. Nordstrom

J. Clin. Med. 2023, 12(13), 4417; https://doi.org/10.3390/jcm12134417 - 30 Jun 2023

Cited by 2 | Viewed by 1466

Abstract

Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality worldwide, hence significant efforts have been made to establish behavior and risk factors associated with CVD. The American Heart Association proposed a 7-metric tool to promote ideal cardiovascular health (CVH). Recent data [...] Read more.

Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality worldwide, hence significant efforts have been made to establish behavior and risk factors associated with CVD. The American Heart Association proposed a 7-metric tool to promote ideal cardiovascular health (CVH). Recent data demonstrated that a higher number of ideal CVH metrics was associated with a lower risk of CVD, stroke, and mortality. Our study aimed to perform a systematic review and meta-analysis of prospective studies investigating the association of ideal CVH metrics and CVD, stroke, and cardiovascular mortality (CVM) in the general population. Medline and Scopus databases were searched from January 2010 to June 2022 for prospective studies reporting CVH metrics and outcomes on composite-CVD, coronary heart disease, myocardial infarction, stroke, and CVM. Each CVH metrics group was compared to another. Twenty-two studies totaling 3,240,660 adults (57.8% men) were analyzed. The follow-up duration was 12.0 ± 7.2 years. Our analysis confirmed that a higher number of ideal CVH metrics led to lower risk for CVD and CVM (statistically significant for composite-CVD, stroke, and CVM; p < 0.05). Conclusion: Even modest improvements in CVH are associated with CV-morbidity and mortality benefits, providing a strong public health message about the importance of a healthier lifestyle. Full article

(This article belongs to the Special Issue Cardiovascular Risk Factors and Intervention Strategies for the Prevention of Cardiovascular Disease)

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