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Coffee and tea are amongst the most consumed beverages worldwide, and are the main source of caffeine in adults. In this review we present findings on the effects of habitual coffee and tea consumption on cardiovascular disease (CVD) prevention. Mild-moderate coffee/ caffeine consumption, at 2-3 cups/day, is associated with beneficial effects on metabolic syndrome, including hypertension and diabetes mellitus, although may elevate lipid levels. Furthermore, coffee consumption reduces the risk of coronary heart disease, heart failure, arrhythmia, stroke, CVD and all cause mortality. Higher tea consumption, in particular green tea, confers similar cardiovascular benefits to coffee with 3 cups/day associated with improved survival in population based studies.

Background The study aims to predict and assess cardiovascular disease (CVD) patterns in highly affected countries such as Pakistan, India, China, Kenya, the USA, and Sweden. The data for CVD deaths was gathered from 2005 to 2019. Methods We utilized non-homogenous discrete grey model (NDGM) to predict growth of cardiovascular deaths in selected countries. We take this process a step further by utilizing novel Synthetic Relative Growth Rate (RGR) and Synthetic Doubling Time (Dt) model to assess how many years it takes to reduce the cardiovascular deaths double in numbers. Results The results reveal that the USA and China may lead in terms of raising its number of deaths caused by CVDs till 2027. However, doubling time model suggests that USA may require 2.3 years in reducing the cardiovascular deaths. Conclusions This study is significant for the policymakers and health practitioners to ensure the execution of CVD prevention measures to overcome the growing burden of CVD deaths.

Background: Periodontitis is a chronic multifactorial inflammatory disease of the supportive tissues of the teeth. Pathophysiological evidence suggests a possible common inflammatory background between periodontitis and cardiovascular diseases (CVD). Pathological and epidemiological associations between these two diseases have been presented, but are still debated. This study aimed to investigate the association between the inflammatory burden of periodontitis and the presence and extent of coronary calcification. Secondary aims were to study other cardiovascular parameters and cardiovascular risk predictors in relation to periodontitis and dental health.Methods: Healthy periodontitis or non-periodontitis patients 45-70 years of age were included in a prospective cross-sectional study. Full-mouth examinations were performed by a periodontist to determine their Periodontal Inflamed Surface Area (PISA) score and other dental parameters. To assess the cardiovascular conditions, Coronary Artery Calcium (CAC) scores, endothelial function assessments by the EndoPAT ™, and several physical and biochemical examinations were performed.Results: Seventy-one patients were included. Elevated CAC scores and endothelial dysfunction were not significantly related to PISA or dental health. PISA was significantly related to the Framingham and Reynolds CVD risk predictors, but were no longer significant after correction for confounders. The same applied to the significant relations between tooth loss, dental plaque and bleeding scores and the CVD risk predictors.Conclusions: Periodontitis is associated with increased CVD risk, but is not an independent risk factor. This link is still important to make to bridge the gap between dentistry and general medicine and to identify patients at risk for CVD in an earlier stage.

In Victoria, Australia, a statewide salt reduction partnership was launched in 2015. The aim was to measure Na intake, food sources of Na (level of processing, purchase origin) and discretionary salt use in a cross-section of Victorian adults prior to a salt reduction initiative. In 2016/2017, participants completed a 24-h urine collection (n338) and a subsample completed a 24-h dietary recall (n142). Participants were aged 41·2 (sd13·9) years, and 56 % were females. Mean 24-h urinary excretion was 138 (95 % CI 127, 149) mmol/d for Na. Salt equivalent was 8·1 (95 % CI 7·4, 8·7) g/d, equating to about 8·9 (95 % CI 8·1, 9·6) g/d after 10 % adjustment for non-urinary losses. Mean 24-h intake estimated by diet recall was 118 (95 % CI 103, 133) mmol/d for Na (salt 6·9 (95 % CI 6·0, 7·8 g/d)). Leading dietary sources of Na were cereal-based mixed dishes (12 %), English muffins, flat/savoury/sweet breads (9 %), regular breads/rolls (9 %), gravies and savoury sauces (7 %) and processed meats (7 %). Over one-third (38 %) of Na consumed was derived from discretionary foods. Half of all Na consumed came from ultra-processed foods. Dietary Na derived from foods was obtained from retail stores (51 %), restaurants and fast-food/takeaway outlets (28 %) and fresh food markets (9 %). One-third (32 %) of participants reported adding salt at the table and 61 % added salt whilst cooking. This study revealed that salt intake was above recommended levels with diverse sources of intake. Results from this study suggest a multi-faceted salt reduction strategy focusing on the retail sector, and food reformulation would most likely benefit Victorians and has been used to inform the ongoing statewide salt reduction initiative.

In 2018, cardiovascular disease (CVD) was the leading cause of death among women, and current CVD prevention paradigms may not be sufficient in this group. In that context, it has recently ...

Primary care providers (PCPs) are uniquely positioned to promote physical activity for cardiovascular health. We sought to determine the types of physical activity that PCPs most often recommend to patients at risk for cardiovascular disease (CVD) and how these recommendations vary by PCPs' physical activity counseling practices. We examined the types of physical activity (walking, supervised exercise sessions, or other) PCPs most often suggested for CVD prevention among respondents to the 2018 DocStyles survey (N = 1,088). Most PCPs (80.0%) suggested walking to their patients at risk for CVD; however, PCPs who infrequently discussed physical activity with their patients at risk for CVD suggested walking less often than those who more frequently discussed physical activity. Walking is an easy and low-cost form of physical activity, and opportunities exist for certain PCPs to promote walking as part of their physical activity counseling practices for CVD prevention.

Primary Healthcare Service (PHS) is an important area of concern for the policy makers of every nation. Key components of PHS include preventive services that require early disease detection. One major disease where mortality rate can be reduced significantly, if diagnosed early, is Cardio Vascular Disease (CVD). In this work, we have used different Machine Learning models for CVD prediction to compare their performances in terms of accuracy, and found Multilayer Perceptron as a better suited model. Since prediction of the model depends on data set, the model needs as usual continuous learning post deployment too.

The “legacy effect” describes the long-term benefits that may persist for many years after the end of an intervention period, involving different biological processes. The legacy effect in cardiovascular disease (CVD) prevention has been evaluated by a limited number of studies, mostly based on pharmacological interventions, while few manuscripts on dietary interventions have been published. Most of these studies are focused on intensive treatment regimens, whose main goal is to achieve tight control of one or more cardiovascular risk factors. This review aims to summarise the legacy effect-related results obtained in those studies and to determine the existence of this effect in CVD prevention. There is sufficient data to suggest the existence of a legacy effect after intensive intervention on cardiovascular risk factors; however, this effect is not equivalent for all risk factors and could be influenced by patient characteristics, disease duration, and the type of intervention performed. Currently, available evidence suggests that the legacy effect is greater in subjects with moderately-high cardiovascular risk but without CVD, especially in those patients with recent-onset diabetes. However, preventive treatment for CVD should not be discontinued in high-risk subjects, as the level of existing evidence on the legacy effect is low to moderate.

Although progress had been made in reducing cardiovascular disease (CVD) mortality, the positive trend has reversed in recent years, and CVD remains the most common cause of mortality in US women and men. Youth represent the future of CVD prevention; emerging evidence suggests exposure to risk factors in children contributes to atherosclerosis and results in vascular changes and increased CVD events. The contributors to CVD include those commonly seen in adults. This article reviews hypercholesterolemia, hypertension, obesity, diabetes, and smoking. It discusses the prevalence of each disease, diagnosis, treatment, and cardiovascular complications.

Background: Diet plays a major role in cardiovascular disease (CVD) risk.\ud \ud Objectives: To determine the effectiveness of a Mediterranean-style diet for the primary and secondary prevention of CVD.\ud \ud Methods: We searched for randomised controlled trials (RCTs) of Mediterranean-style diets in healthy adults and those at increased risk of CVD (primary prevention) and with established CVD (secondary prevention).\ud \ud Results: Thirty RCTs were included, 22 in primary prevention and eight in secondary prevention. Clinical endpoints were reported in two trials where there was moderate quality evidence for a reduction in strokes for primary prevention, and low quality evidence for a reduction in total and CVD mortality in secondary prevention. We found moderate quality evidence of improvement in CVD risk factors for primary prevention and low quality evidence of little or no effect in secondary prevention.\ud \ud Conclusions: There is still some uncertainty regarding the effects of a Mediterranean-style diet in CVD prevention.

Cardiovascular disease (CVD) is one of the leading causes of mortality in virally suppressed people living with HIV (PLWH) and with an aging population, is likely to become one of the leading challenges in maintaining good health outcomes in HIV infection. However, factors driving the risk of CVD in PLWH are multiple and may be different from those of the general population, raising challenges to predicting and managing CVD risk in this population.In this review, we examine the relevant data regarding CVD in HIV infection including CVD prevalence, pathogenesis, and other contributing factors. We review the data regarding CVD risk prediction in PLWH and summarize factors, both general and HIV specific, that may influence CVD risk in this population. And finally, we discuss appropriate management of CVD risk in PLWH and explore potential therapeutic pathways which may mitigate CVD risk in the future in this population.Following a comprehensive review of CVD risk in PLWH, we give our opinion on the primary issues in risk prediction and management of CVD in HIV infected individuals and discuss the future direction of CVD management in this population.

Unmasking the residual cardiovascular risk is a major research challenge in the attempt to reduce cardiovascular disease (CVD) morbidity and mortality. Mounting evidence suggests that a high circulating level of trimethylamine N-oxide is a new potential CVD risk factor. We performed a systematic review of the published studies to clarify the association between circulating high levels of TMAO and cardiovascular events. Studies evaluating the association between TMAO and CVD events were searched by electronic databases up to December 2018. Pooled results were expressed as risk ratio (RR) with 95% pertinent confidence interval (CI). Three studies for a total of 923 patients at high/very high CVD risk were included in our analysis. Overall, a high TMAO level was associated with both major adverse cardiovascular events (RR = 2.05; 95% CI 1.61–2.61) and all-cause mortality (RR = 3.42; 95% CI 2.27–5.15). Our findings support a role of high TMAO levels in predicting CVD events. High levels of TMAO may be a new CVD risk factor, potentially useful to better plan personalized CVD prevention strategies.

The sex-specific effect of lipid-related biomarkers on 10-year first fatal/non fatal cardiovascular disease (CVD) incidence was evaluated. ATTICA study was conducted during 2001−2012. n = 1514 men and n = 1528 women (>18 years) from greater Athens area, Greece were recruited. Follow-up (2011−2012) was achieved in n = 2020 participants. Baseline lipid profile was measured. Overall CVD event was 15.5% (n = 317) (19.7% in men and 11.7% in women, p < 0.001). High density lipoprotein cholesterol (HDL-C) and triglycerides (TAG) were independently associated with CVD in women; per 10 mg/dL HDL-C increase, hazard ratio (HR) = 0.73, 95% confidence interval (95% CI) (0.53, 1.00); and per 10 mg/dL TAG increase, HR = 1.10, 95% CI (1.00, 1.21). Apolipoprotein A1 (ApoA1) (per 10 mg/dL increase, HR = 0.90, 95% CI (0.81, 0.99)) was inversely associated with CVD in women, while a positive association with apolipoprotein B100 (ApoB100) was observed only in men (per 10 mg/dL increase, HR = 1.10, 95% CI (1.00, 1.21)). Non-HDL-C was associated with CVD in the total sample (HR = 1.10, 95% CI (1.00, 1.21)) and in women (HR = 1.10, 95% CI (1.00, 1.21)); a steep increase in HR was observed for values >185 mg/dL in the total sample and in men, while in women, a raise in CVD risk was observed from lower values (>145 mg/dL). As for non-HDL-C/HDL-C and TC/HDL-C ratios, similar trends were observed. Beyond the common cholesterol-adjusted risk scores, reclassifying total CVD risk according to other lipid markers may contribute to early CVD prevention. Biomarkers such as HDL-C, non-HDL-C, and TAG should be more closely monitored in women.

Cardiovascular disease (CVD) is a leading cause of death in Canada. Nurse practitioners (NPs) play a pivotal role in CVD prevention, and must employ technological innovations to advance practice. Mobile Health (mHealth) is a rapidly emerging and innovative solution for CVD prevention. This manuscript will educate and inform NPs to mHealth interventions and its potential implications to their practice and patients.

Many reproductive-aged women, particularly low-income and minority women, rely solely on obstetrics and gynecology (OBGYN) providers for primary care. As such, visits to an OBGYN may be the best or only opportunity for a young to middle-aged woman to be screened for cardiovascular disease (CVD) and CVD risks, uniquely positioning these providers to address the gap in CVD prevention. However, CVD screening practices, barriers to screening, and knowledge gaps in CVD screening and treatment are largely unknown. A statewide survey was conducted to fill this gap in our understanding of the CVD-related needs and practices of OBGYN practitioners. We conducted an online survey of OBGYN-certified physicians and advanced practice nurses who provide care in Minnesota. A 25-item questionnaire about provider practices, needs, barriers, and knowledge gaps regarding CVD screening and treatment was sent to 794 providers. Ninety-seven (12%) respondents completed the survey; 26.8% (n = 26) of providers reported th...

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Herbal medicine and exercise interventions have individually been shown to be effective in the prevention and management of CVD. However, the complementary roles of herbal medicine and exercise interventions for CVD prevention and management have not been adequately reported. Objective: 1. Identify studies analysing complementary roles of herbal medicine and exercise intervention in CVD prevention and management, 2. Identify herbs and exercise strategies that have been reported to exhibit complementary roles in CVD prevention and management, and 3. Summarize evidence of complementary roles of herbal medicine and exercise interventions for CVD prevention and management. Method: PubMed, CINAHL and Web of Science were searched with a customised search strategy in May 2015. Two reviewers screened the search results for inclusion using pre-specified criteria. Data were extracted from full text of selected abstracts in a predetermined template by two reviewers and verified by the third reviewer when needed. Results: A total of 35 titles were identified for full texts review after screening 827 abstracts. Data were extracted from 23 titles, representing 12 human studies and six animal studies. This review identified effects of 14 different herbs and 10 exercise strategies on over 18 CVD risk factors and markers. Complementary roles of herbal medicine and exercise were reported from five studies. Conclusion: Evidence of complementary role of herbal medicine and exercise is emerging from animal studies. More robust clinical studies on proven risk factors are needed before they can be recommended for clinical practice.

Aims Type 2 diabetes mellitus is characterized by an increased risk of developing long-term cardiovascular complications. Several underlying mechanisms have been proposed for the diabetes-related increase in cardiovascular risk, i.e. chronic hyperglycemia, duration of the disease, drug-induced hypoglycemia, coexistence of multiple cardiovascular risk factors, etc. In the last few years, new pharmacological approaches capable of treating chronic hyperglycemia without increasing the risk of hypoglycemia have emerged for the treatment of diabetes. Data synthesis With data mainly obtained from randomized controlled trials recruiting patients with type 2 diabetes in secondary prevention of cardiovascular disease, some of these newer antihyperglycemic drugs have shown to significantly reduce the risk of cardiovascular disease. In addition, the combined control of traditional cardiovascular risk factors, e.g. dyslipidemia, hypertension, etc., has demonstrated to be effective in reducing the burden of cardiovascular diseases in patients with type 2 diabetes. Conclusions In this document written by some experts of the Italian diabetes society (SID), we will focus our attention on oral antihyperglycemic agents for people with type 2 diabetes in primary or secondary prevention of cardiovascular disease, excluding for brevity the injection therapies for diabetes, such as insulin and glucagon-like peptide-1 receptor agonists.

Atherosclerosis is the underlying cause of major cardiovascular events. The development of atherosclerotic plaques begins early in life, indicating that dietary interventions in childhood might be more effective at preventing cardiovascular disease (CVD) than treating established CVD in adulthood. Although plant sterols are considered safe and consistently effective in lowering plasma cholesterol, the health effects of early-life supplementation are unclear. Studies suggest there is an age-dependent effect on plant sterol metabolism: at a younger age, plant sterol absorption might be increased, while esterification and elimination might be decreased. Worryingly, the introduction of low-cholesterol diets in childhood may unintentionally favor a higher intake of plant sterols. Although CVD prevention should start as early as possible, more studies are needed to better elucidate the long-term effects of plant sterol accumulation and its implication on child development.

Introduction: While the clinical merits of aspirin in secondary cardiovascular disease (CVD) prevention remain undisputed, its role in primary prevention is controversial. Recently, three trials of primary prevention reported neutral net benefit results or evidence of harm for aspirin in patients with no overt CVD. Areas covered: This article aims to inform clinical practitioners by appraising the current body of evidence on the use of aspirin for primary CVD prevention, ranging from general pharmacology to clinical outcomes and future directions. Expert opinion: Based on meta-analyses incorporating latest trials in the field of primary prevention, the modest reduction in ischemic events with aspirin, if any, is offset by a modest increase in nonfatal bleeding. Improved control of CVD risk factors and broader use of statins may have reduced the thrombotic complications of atherosclerosis, thus limiting the opportunity for aspirin to prevent clinical CVD events in the contemporary era. As such, decision-making about aspirin for primary prevention is challenging even when selected patients are considered and involves careful weighing of risks and benefits. Ongoing investigations conducted in patients with cancer could rapidly modify the current perception of the unfavorable benefit-risk ratio of aspirin in patients with no overt CVD.

Approximately 17.3 million people died from cardiovascular disease (CVD) in 2008, and approximately 80% came from low- and middle-income countries. However, previous studies document poor research productivity related to CVD prevention and treatment in these countries between 1991 and 1996. The World Health Organization (WHO) developed a prioritized research agenda emphasizing research on policy development, translation of knowledge and implementation. This study assessed whether research output in priority areas increased between 2002 and 2011. It was reported that only 3–4% of papers from each year related to a priority area, and most were conducted by corresponding authors from high-income countries. Low-income countries were highly underrepresented both in terms of productivity and as the study population. However, there was a significant rise in the productivity of middle-income countries and their representation as the study population. While 30% of priority-related papers addressed a cost-effective strategy, this represents 1% of papers overall. More cost-effectiveness research is encouraged to decrease the millions of deaths per year attributed to CVD in the developing world.

Background: The prevention of cardiovascular disease (CVD) can substantially contribute to reducing the mortality rate across countries. The level of interest in cholesterol among experts increases when the subjects are elderly and obese individuals. However, specialists do not recommend that children should receive the cholesterol test. The objective of this study was to investigate the distribution of cholesterol levels among the children of public school and their parents’ lifestyles that are associated with cholesterol levels, and to assess the need for and utility of cholesterol testing in school settings. Methods: The study investigated a group of 226 fourth-grade public school children aged between 9 and 10 years and guardians in Akitakatacity of Hiroshima Prefecture, Japan. Multiple regression analyses were performed with the logarithmic value of cholesterol levels as a response variable, awareness about lifestyles and health of children as an explanatory variable, and child’s sex and body mass index (BMI) as moderating variables. Using questionnaires about lifestyles, the step-down procedure was applied in multiple regression analyses to narrow down relevant lifestyle variables. Results: The percentage of children with the high total cholesterol (TC) value was about 15 and with low-density lipoprotein (LDL) cholesterol value was about 10. Children with low high-density lipoprotein (HDL) cholesterol value were 5%. Treatment was not required according to the comprehensive assessment. Cholesterol levels were associated with the situation of the children and their guardians as follows, guardian need to consider the food, and child has the correct knowledge about food like how to eat snacks. Conclusions: Children had poor cholesterol levels. From childhood, along with the parents, there is a need to learn about appropriate level of cholesterol for CVD prevention.

In 2019, Preventive Cardiology welcomed many exciting discoveries that improve our ability to reduce the burden of cardiovascular disease (CVD) nationwide. Not only did 2019 further clarify how various environmental exposures and innate and acquired risk factors contribute to the development of CVD, but it also provided new guidelines and therapeutics to more effectively manage existing CVD. Cardiovascular disease prevention requires the prioritization of early and effective detection of CVD in order to implement aggressive lifestyle and pharmacologic therapies, which can slow, halt, or even reverse the progression of the disease. To help streamline and simplify the process of CVD prevention, The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease has historically adopted an ‘ABC’ approach, which focuses on optimizing individual CVD risk through lifestyle, behavioral, and pharmacologic interventions. Given the practice changing research and innovation from the past year, this article intends to summarize the Ciccarone Center’s key takeaways from CVD prevention in 2019 utilizing our expanded ‘ABC’ approach.

Background Cardiovascular disease (CVD)-related deaths in sub-Saharan Africa (SSA) are on the rise, and primary care physicians could facilitate the reversal of this trend through treatment and prevention strategies. Aim The aim of this study was to determine the relationship between physician lifestyle practices, CVD prevention knowledge and patient CVD counselling practices among family physicians (FPs) and family medicine (FM) trainees affiliated to FM colleges and organisations in SSA. Setting FPs and FM trainees affiliated to FM colleges and organisations in Anglophone SSA. Methods A web-based cross-sectional analytical study was conducted using validated, self-administered questionnaires. Following collation of responses, the relationship between the participants’ CVD prevention knowledge, lifestyle practices and CVD counselling rates was assessed. Results Of the 174 participants (53% response rate), 83% were married, 51% were females and the mean age was 39.2 (standard deviation [SD] 7.6) years. Most of the participants responded accurately to the CVD prevention knowledge items, but few had accurate responses on prioritising care by 10-year risk. Most participants had less than optimal lifestyle practices except for smoking, vegetable or fruit ingestion and sleep habits. Most participants (65%) usually counselled patients on nutrition, but less frequently on weight management, exercise, smoking and alcohol. The region of practice and physicians with poor lifestyle were predictive of patient counselling rates. Conclusion Training on patient counselling and self-awareness for CVD prevention may influence patient counselling practice. Promoting quality training on patient counselling among FPs as well as a healthy self-awareness for CVD prevention is thus needed. The complex relationship between physician lifestyle and patient counselling warrants further study. Keywords family physicians; cardiovascular diseases; lifestyle counselling; sub-Saharan Africa; online survey; family medicine trainee.

OBJECTIVE: We aimed to estimate the proportion of underdiagnosis and undertreatment of cardiovascular risk factors (CVRF) in an international multicentre cohort of patients with psoriasis (PsC) and psoriatic arthritis (PsA). METHODS: A cross-sectional analysis of patients with psoriatic disease from the International Psoriasis and Arthritis Research Team (IPART) cohort was conducted. The presence of modifiable CVRF (diabetes, hypertension, dyslipidemia, smoking, elevated BMI and central obesity) and the use of appropriate therapies for hypertension and dyslipidemia were determined. The 10-year CV risk was calculated according to the Framingham Risk Score (FRS). Physician adherence with guidelines for the treatment of dyslipidemia and hypertension was assessed. Regression analysis was used to assess predictors of undertreatmnet of hypertension and dyslipidemia. RESULTS: A total of 2254 patients (58.9% PsA, 41.1% PsC) from 8 centres in Canada, US and Israel were included. Their mean age was 52±13.8 years and 53% were males. 87.6% of the patients had at least one modifiable CVRF. 45.1% of the patients had hypertension, 49.4% dyslipidemia, 13.3% diabetes, 75.3% were overweight or obese, 54.3% central obesity and 17.3% were current smokers. We found 59.2% of patients with hypertension and 65.6% of patients with dyslipidemia were undertreated. Under-treatment was associated with younger age (≤50 years), having PsC and male gender. CONCLUSIONS: In real-world settings, a large proportion of patients with psoriasis and PsA were underdiagnosed and undertreated for hypertension and dyslipidemia. Strategies to improve the management of CVRF in psoriatic patients are warranted.

This review summarizes recent developments in nutrition and cardiovascular disease (CVD) prevention. Contemporary dietary guidance recommends healthy dietary patterns with emphasis on food-based recommendations because the totality of the diet (i.e., the combinations and quantities of foods and nutrients consumed) is an important determinant of health. In many guidelines, recommendations are still made for saturated fat, added sugar, sodium, and dietary cholesterol because these are over-consumed by many people and are related to chronic disease development. Epidemiological research illustrates the importance of considering the total diet and the interrelatedness of nutrients in a dietary pattern. Traditionally, epidemiological research focused on individual nutrients in isolation, which can result in erroneous conclusions. An example of this, which has led to substantial controversy, is the evidence from studies evaluating the association between saturated fat and CVD without considering the replacement nutrient. Another controversial topic is the relationship between dietary cholesterol and CVD, which is confounded by saturated fat intake. Finally, the totality of evidence shows that high sodium intake is associated with greater CVD risk; however, some epidemiological research has suggested that a low-sodium intake is detrimental, which has caused some controversy. Overall, this reductionist approach has led to a debate about recommendations for saturated fat, cholesterol, and sodium. However, if approaches that accounted for the interrelatedness of nutrients had been taken, it is likely that there would be less controversy about these nutrients. To encourage dietary pattern-based approaches and consideration of total intake, dietary guidelines should emphasize food-based recommendations that meet nutrient targets. Thus, nutrient targets should underpin food-based dietary guidelines, and recommended dietary patterns should comply with nutrient-based targets. The evidence reviewed shows that it is imperative to consider total dietary patterns for CVD prevention. Dietary guidance should be aligned with nutrient targets and recommendations should be food and dietary pattern based.

The human gastrointestinal tract is home to trillions of bacteria, which vastly outnumber host cells in the body. Although generally overlooked in the field of endocrinology, gut microbial symbionts organize to form a key endocrine organ that converts nutritional cues from the environment into hormone-like signals that impact both normal physiology and chronic disease in the human host. Recent evidence suggests that several gut microbial-derived products are sensed by dedicated host receptor systems to alter cardiovascular disease (CVD) progression. In fact, gut microbial metabolism of dietary components results in the production of proatherogenic circulating factors that act through a meta-organismal endocrine axis to impact CVD risk. Whether pharmacological interventions at the level of the gut microbial endocrine organ will reduce CVD risk is a key new question in the field of cardiovascular medicine. Here we discuss the opportunities and challenges that lie ahead in targeting meta-organismal endocrinology for CVD prevention.

Preeclamptic women have an increased risk of hypertension and cardiovascular disease (CVD) later in life. The aim was to compare the latest clinical recommendations on post-preeclamptic prevention of hypertension and CVD published by eight National Associations of Gynecologists and Obstetricians. Definitions of preeclampsia differ internationally. Recommendations on when, how and who to screen to reduce post-preeclamptic CVD risk also show substantial variation. The diverging preeclampsia definitions make CVD prevention strategies difficult to compare. The variations in clinical recommendations are in line with the lacking evidence of cost-efficient follow-up strategies and stress the need for further research to optimize prevention strategies.

Objective To quantify absolute cardiovascular disease (CVD) risk in Aboriginal and Torres Strait Islander people and their use of lipid-lowering therapies. Design, participants Cross-sectional analysis of nationally representative data from 2820 participants aged 18-74 years who provided biomedical data for the National Aboriginal and Torres Strait Islander Health Measures Survey component of the 2012-13 Australian Aboriginal and Torres Strait Islander Health Survey. Main outcome measures Prior CVD and use of lipid-lowering medications were ascertained at interview. 5-year absolute risk of a primary CVD event was calculated with the Australian National Vascular Disease Prevention Alliance algorithm, with categories low ( 15%). Results Among participants aged 35-74 years, 9.6% (95% CI, 7.2-12.0%) had prior CVD; 15.7% (95% CI, 13.0-18.3%) were at high, 4.9% (95% CI, 3.3-6.6%) at moderate, and 69.8% (95% CI, 66.8-72.8%) at low absolute primary CVD risk. 82.6% of those at high primary risk were identified on the basis of clinical criteria. High primary absolute risk affected 1.1% (95% CI, 0.0-2.5%) of 18-24-year-olds, 4.7% (95% CI, 2.0-7.5%) of 25-34-year-olds, and 44.2% (95% CI, 33.1-55.3%) of 65-74-year-olds. Lipid-lowering therapy was being used by 52.9% (95% CI, 38.2-67.6%) of people aged 35-74 years with prior CVD and by 42.2% (95% CI, 30.5-53.8%) of those at high primary CVD risk. Conclusion Absolute CVD risk is high among Aboriginal and Torres Strait Islander people, and most of those at high risk are undertreated. Substantial proportions of people under 35 years of age are at high risk, but are not targeted by current guidelines for absolute CVD risk assessment, compromising CVD prevention in this population.

Health effects of dietary fats have been extensively studied for decades. However, controversies exist on the effects of various types of fatty acids, especially saturated fatty acid (SFA), on cardiovascular disease (CVD). Current evidence supports that different types of dietary fatty acids have divergent effects on CVD risk, and the effects also depend strongly on the comparison or replacement macronutrient. A significant reduction in CVD risk can be achieved if SFAs are replaced by unsaturated fats, especially polyunsaturated fatty acids. Intake of industrially produced trans fat is consistently associated with higher CVD risk. Both n-6 and n-3 polyunsaturated fatty acids are associated with lower CVD risk, although the effects of fish oil supplementation remains inconsistent. The 2015–2020 Dietary Guidelines for Americans place greater emphasis on types of dietary fat than total amount of dietary fat and recommend replacing SFAs with unsaturated fats, especially polyunsaturated fatty acids for CVD prevention.

Although at least 80% of cardiovascular disease (CVD) is potentially preventable by the elimination of health risk behaviours, implementation of effective, large scale and sustainable CVD prevention programs is still a challenge. In this issue of Heart , Connolly et al 1 describe an experience in which patients at high risk of or with established CVD underwent a 12 week community-based nurse-led prevention programme called My Action (figure 1) which included lifestyle and risk factor management, prescription of medication and weekly exercise and education sessions. The programme is in accordance to recent British recommendations that CVD should be managed as a family of diseases in the community. The study was conducted in Westminster, a culturally and socioeconomically diverse borough in central London. Over a 6 year period, 3232 patients attended an initial assessment, 63% were male and 48% belonged to black and minority ethnic groups; 56% attended an end of programme assessment and 33% a 1 year assessment. The results were very encouraging in both high risk and CVD patients, with improvement in goals related to unhealthy habits and increase in proportions of patients achieving their BP (CVD +15.4%; high-risk +25%) and LDL-cholesterol targets (CVD +6%, high-risk +23%), as well increase …

The National Heart, Lung and Blood Institute Expert Panel Integrated Guidelines promote the prevention of cardiovascular disease (CVD) events by encouraging healthy behaviors in all children, screening and treatment of children with genetic dyslipidemias, usage of specific lifestyle modifications, and limited administration of lipid pharmacotherapy in children with the highest CVD risk. These recommendations place children in the center of the fight against future CVD. Pediatric providers may be in a position to shift the focus of CVD prevention from trimming multiple risk factors to cutting out the causes CVD.

Statin therapy significantly reduces major vascular events irrespective of age, but less direct evidence is available on the benefit of statins for the primary prevention of cardiovascular disease in people aged >75 years, according to a meta-analysis by the Cholesterol Treatment Trialists' Collaboration.

Introduction: Homozygous familial hypercholesterolemia (HoFH) is a rare disorder characterized by severely increased cholesterol levels that lead to an extremely high risk of premature cardiovascular disease (CVD). Aggressive lipid-lowering therapy should be started at an early age with highly potent statins. Rosuvastatin is such a highly efficacious statin with a favorable safety profile that might be advantageous in pediatric HoFH. Areas covered: The authors conducted a PubMed search for rosuvastatin papers and papers on statin use in HoFH published in English. This review describes the pharmacology, safety and efficacy of rosuvastatin and discusses its use in pediatric HoFH. Expert opinion: To date, there is very little evidence on the efficacy and safety of rosuvastatin in pediatric HoFH. Sufficient clinical evidence has proven the lipid-lowering capacity and subsequent CVD prevention of rosuvastatin in hypercholesterolemic adults. Furthermore, clinical studies in children heterozygous familial hypercholesterolemia aged 6 years and older revealed no untoward safety concerns. Rosuvastatin is, therefore, a promising agent in the treatment of pediatric HoFH

Cardiovascular disease (CVD) is the number 1 cause of death in women, accounting for about 1 in 3 deaths. This article reviews the 2011 American Heart Association effectiveness-based guidelines for CVD prevention in women. Risk assessment, prevention, and management of risks through lifestyle changes and pharmacotherapy are discussed. The article concludes with implications for nurse practitioners on ways to improve cardiovascular health among women in their practice.

Purpose of review Abundant evidence has documented inverse associations of physical activity and the risk of cardiovascular disease (CVD). However, the effects of different types of physical activity (e.g., leisure time and occupational physical activity) are still poorly understood. Recent findings Drawing on recommended and established guidelines for study selection, we identified and included 23 prospective epidemiological studies published during the last 2 years. These studies included a total of more than 790 000 adults at baseline with some 22 000 incident cases occurring during follow-up. Our findings suggest that moderate and high levels of leisure time physical activity are associated with a moderately reduced risk of CVD. In contrast, moderate and high levels of occupational physical activity showed weak positive associations, that is, a slightly increased risk of CVD. Summary This updated meta-analysis supports the notion of primary prevention of CVD through engagement in leisure time physical activity. The role of occupational physical activity in CVD prevention is questionable.

Cardiovascular disease (CVD) is the leading cause of global mortality and is expected to reach 23 million deaths by 2030. Eighty percent of CVD deaths occur in low-income and middle-income countries (LMICs). Although CVD prevention and treatment guidelines are available, translating these into practice is hampered in LMICs by inadequate health care systems that limit access to lifesaving medications. In this review article, we describe the deficiencies in the current LMIC supply chains that limit access to effective CVD medicines, and discuss existing solutions that are translatable to similar settings so as to address these deficiencies.

Lipid modification holds the key to effective secondary prevention of cardiovascular disease (CVD). However there is a controversy on whether it’s all about targeting specific lipid sub fractions to a particular level or a direct effect of the agent(s) used or both. This review intends to look into these important issues from an evidence-based perspective. What is the appropriate timing of testing for lipid profile after a cardiovascular event? What is the rationale behind initiating with a high dose statin after an acute coronary event? What is the role of targeting lipid sub fractions beside LDL cholesterol? Is there any role for non-statin based therapy after an acute cardiovascular event? What constitutes a long-term lipid modification strategy in patients post CVD? These are very important questions, which needs to be addressed adequately as well as scientifically. The secondary CVD preventive strategies form a lipid perspective, which requires a thorough review.

Nutrition advice is devolved within each of the four UK countries, but share a common evidence base provided through the Scientific Advisory Committee on Nutrition (SACN). Current UK dietary recommendations to prevent cardiovascular disease (CVD) is based upon recommendations from SACN and its predecessor committee. Dietary advice in the UK has recently been revised in relation to intakes of free sugar and fibre. This paper highlights current UK recommendations for the prevention of CVD, in particular related to energy intake, saturated fat, free sugars, salt, fruit, vegetables, oily fish and fibre. It describes how this advice is promulgated including the refresh of the Eatwell Guide and wider action that will impact on CVD.

Low and middle income countries (LMICs) bear a huge, disproportionate and growing burden of cardiovascular disease (CVD) which constitutes a threat to development. Efforts to tackle the global burden of CVD must therefore emphasise effective control in LMICs by addressing the challenge of scarce resources and lack of pragmatic guidelines for CVD prevention, treatment and rehabilitation. To address these gaps, in this analysis article, we present an implementation cycle for developing, contextualising, communicating and evaluating CVD recommendations for LMICs. This includes a translatability scale to rank the potential ease of implementing recommendations, prescriptions for engaging stakeholders in implementing the recommendations (stakeholders such as providers and physicians, patients and the populace, policymakers and payers) and strategies for enhancing feedback. This approach can help LMICs combat CVD despite limited resources, and can stimulate new implementation science hypotheses, research, evidence and impact.

Prevention of cardiovascular diseases (CVDs), particularly atherosclerosis, remains a priority on the global health agenda. A healthy lifestyle at both individual and population levels, combined with pharmacological treatment of CVD risk factors, is recommended. In this Year in Review article, we discuss the major advances in CVD prevention in 2014.

Although prediabetes is associated with increased cardiovascular disease (CVD) risk, it is not often targeted in CVD prevention programs. We sought to evaluate the impact of a tailored prediabetes program to reverse prediabetes and lower CVD risk. Consecutive subjects of the Integrative Cardiac

Tracking medication use and lifestyle counseling to prevent CVD among patients with diabetes mellitus (DM) may identify opportunities to improve care delivery and patient outcomes. Trends in the proportion of visits of patients age ≥ 40 with preventive medication (antiplatelet therapy [aspirin or

Background New cardiovascular disease (CVD) risk factors are being recognized and suggested to be included in CVD risk stratification. High-sensitivity C-reactive protein (hs-CRP) and the metabolic syndrome (MetS) are among these risk factors. However, CVD risk classification may be divergent when using different approaches. Objectives To compare differences in CVD risk estimation using the Framingham risk score (FRS), hs-CRP and the presence of the MetS in a group of 109 postmenopausal women in primary CVD prevention. Methods The FRS and presence of the MetS were determined. CVD risk was evaluated with a cardiovascular point scoring system based on Framingham covariables and hs-CRP values (Women's Health Study [WHS] model). The estimated CVD risks based on hs-CRP levels and the WHS model were compared with the FRS. Results Using the FRS, 99% of women (n=108) were determined to have a low CVD risk. The MetS was identified in 39.4% (n=43) of the women. When hs-CRP was used alone to estimate CVD risk, 37.6% (n=41) of women were classified as being at low, 33.9% (n=37) at moderate and 28.4% (n=31) at high CVD risk. With the WHS model, 83.5% (n=91), 14.7% (n=16) and 1.8% (n=2) of women were classified as being at low, moderate and high CVD risk, respectively. Conclusions A substantial number of postmenopausal women showing evidence of the MetS were not identified by the FRS, even though women with the MetS are at higher risk of CVD. Estimation of risk by hs-CRP is significantly divergent when using conventional hs-CRP cutoff values compared with an integrated use in the WHS model.

The prevalence of chronic disease has increased as individuals with spinal cord injuries (SCIs) experience longer survival. Cardiovascular disease (CVD) is a leading cause of their morbidity and mortality. A necessary component of any CVD prevention is a healthy diet. This can be especially challenging for persons experiencing body composition changes, low resting metabolic rates, functional impairments, and barriers to healthy living; together these comprise an obesogenic environment. This monograph will discuss critical features of a healthy diet and dietary interventions providing risk reduction after SCI. If well designed and appropriately supported, diet can make a significant contribution to CVD prevention.

Cardiovascular disease (CVD) is a leading cause of mortality and is responsible for one-third of all global deaths. Regrettably, surveys of physician’s clinical practice patterns indicate that the recommendations made in the guidelines are sometimes not implemented and the predefined goals of therapy for patients with cardiovascular diseases are not achieved. CVD prevention and management can only be improved through an integrated approach that addresses overall cardiovascular risk and that involve general practitioners as well as specialists.

In Brief People with diabetes are at much higher risk for cardiovascular disease(CVD) than the average population. Evidence-based, prioritized, and strategic management of CVD risk factors among people with diabetes is necessary for the improvement of its burden on disability, morbidity, mortality, and high health care costs. Risk factors for diabetes and CVD are similar, and most can be effectively decreased by lifestyle modification. Medical nutrition therapy and other lifestyle recommendations for CVD prevention and treatment are discussed.

Aims: To determine nurses’ perception of the knowledge and skills needed to deliver cardiovascular disease (CVD) prevention programmes and to describe their continuing professional development (CPD) needs. Design: Two cross-sectional descriptive surveys using two postal questionnaires were conducted with first, past students (n=83) of the ‘Managing Cardiovascular Risk Factors’ course and second, practice nurses (PN) (n=690), taken from a purposeful sample of Scottish health boards. Results: Past students rated knowledge and skills possibly needed to deliver CVD care. Those categorized as ‘advanced clinical’ were rated significantly higher than ‘management’ or ‘nurse development’ (P Conclusions: Nurses perceiving they had a high input into CVD care or who had completed courses on CVD were more likely to seek further higher-level education. This has implications for CVD CPD delivery.

Background/Aims: The prevalence of cardiovascular diseases (CVD) is rising and it is the prime cause of death in all developed countries. Bioactive compounds (BACs) can play a role in CVD prevention and treatment. To examine the scientific evidence supporting BACs groups' efficacy in CVD prevention and treatment, we conducted a systematized review. Methods: All available information on Medline, LILACS and EMBASE; all randomized controlled trials (RCTs) with prospective, parallel or crossover designs in humans in which the BACs effect was compared with that of placebo/control. Vascular homeostasis, blood pressure, endothelial function, oxidative stress and inflammatory biomarkers were considered primary outcomes. Results: We selected 26 articles, verifying their quality based on the Scottish Intercollegiate Guidelines Network, establishing diverse quality levels of scientific evidence according to the design and bias risk of a study. Grades of recommendation were included, depending on the evidence strength of antecedents. Conclusions: Evidence shows that certain BACs' derivative from active lipids and nitrogen compounds, mainly from horse chestnut seed extract, sterol plants, allium derivatives, and certain doses of beta-glucans, can be helpful in decreasing the prevalence of CVD risk factors. However, further rigorous evidence is necessary to support and prove BACs' effect on CVD prevention and treatment.

Women age 65 and older without known cardiovascular disease (CVD), women of any age with established CVD, and women of any age with an estimated 10-year risk of CVD ≥10%, are likely to experience a net benefit from preventive low-dose aspirin therapy and should be considered for such therapy unless contraindicated.

Statin treatment is a cornerstone in the prevention of cardiovascular disease, but questions remain regarding its effects in patients with ankylosing spondylitis. Is there enough evidence supporting the use of statins in these patients?