With more than 4.2 million people, Filipino Americans are the third largest Asian group in the US and the largest Southeast Asian group in the country. Despite relatively favorable average ...socioeconomic indicators compared to the general US population, Filipino Americans face a significant burden of traditional cardiovascular risk factors, particularly among men. Moreover, Filipino Americans have high rates of cardiovascular death, often occurring at a younger age compared to other minority groups and Non-Hispanic White adults. In view of these trends, in 2010 the American Heart Association designated Filipino Americans as a high cardiovascular risk group. Despite this, in 2023, Filipino Americans remain underrepresented in landmark cardiovascular cohort studies and are often over looked as a group at increased cardiovascular risk. In this updated narrative review, we summarize the current state of knowledge about the burden of cardiovascular risk factors and diseases experienced by the Filipino American population. Our aim is to inform enhanced clinical, population, and policy-level prevention interventions and boost research in this space.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The “2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease” provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical ...therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes).
A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate.
Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
Background
Cognitive impairment disproportionately affects women compared to men, and cardiovascular disease (CVD) increases risk. Physical activity and cognitive training may have synergistic ...effects on cognition when delivered together. However, no multimodal intervention has targeted older women (≥65) with CVD or has utilized a scalable lifestyle approach. Our study seeks to evaluate the efficacy of MindMoves, a 24‐week multimodal intervention, on cognition and serum biomarkers in 254 older women with CVD. However, effects of the COVID‐19 pandemic complicated implementation of our original in‐person trial protocol. The purpose of this paper is to describe protocol modifications made by our interdisciplinary team in response to COVID‐19,
Method
We employ a 2x2 factorial randomized controlled trial design to determine independent and combined efficacies of Mind (cognitive training with BrainHQ) and Move (lifestyle physical activity with goal self‐monitoring and nurse‐led group meetings) interventions. Outcome measures of cognition and serum biomarkers (brain‐derived neurotrophic factor, vascular endothelial growth factor, insulin‐like growth factor 1) are collected at baseline, 24, 48, and 72 weeks. Nurse scientists oversee interventions, cardiologists refer women ≥65 years with CVD and no cognitive impairment from clinics, and a cognitive neurologist and neuropsychologist oversee outcome measures. Pandemic‐related protocol changes were implemented to maximize study integrity and participant/staff safety. Targeted mailings were added to in‐person recruitment strategies. Screening activities shifted to phone. In‐person data collection was modified for phone/virtual settings, including accelerometer mailing (device measure of physical activity), neurocognitive tests validated for phone use, and home‐based participant‐administered dried blood spot collection for serum biomarkers. Women are now provided and trained to use iPad tablets to complete intervention activities virtually (e.g., Move group meetings).
Result
The anticipated number of participants (19) in the first cohort was recruited without disruption, in the original timeline. Participants completed all phone‐based questionnaires and mailed devices were returned. Randomization occurred as planned. Intervention activities are ongoing, including phone‐based orientations and ≥90% attendance at virtual meetings.
Conclusion
The modified trial protocol is being successfully implemented during the COVID‐19 pandemic. Results will demonstrate efficacy of pivoting from in‐person to virtual delivery of a lifestyle‐focused multimodal intervention in at‐risk older women with CVD.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
•Focused TTE is a critical diagnostic tool to limit exposure in COVID-19.•Largest COVID-19 cohort to date showing strong prognostic power of RV parameters.•RV dilation significantly associated with ...increased mortality in COVID-19.•RV dysfunction significantly associated with shock in COVID-19.•LV abnormalities did not provide prognostic information in COVID-19.
Focused transthoracic echocardiography (fTTE) has emerged as a critical diagnostic tool during the COVID-19 pandemic, allowing for efficient cardiac imaging while minimizing staff exposure. The utility of fTTE in predicting clinical outcomes in COVID-19 remains under investigation.
We conducted a retrospective study of 2,266 hospitalized patients at Rush University Medical Center with COVID-19 infection between March and November 2020 who received a fTTE. fTTE data were analyzed for association with primary adverse outcomes (60-day mortality) and with secondary adverse outcomes (need for renal replacement therapy, need for invasive ventilation, shock, and venous thromboembolism).
Of the 427 hospitalized patients who had a fTTE performed (mean 62 years, 43% female), 109 (26%) had died by 60 days. Among patients with an available fTTE measurement, right ventricular (RV) dilation was noted in 34% (106/309), 43% (166/386) had RV dysfunction, and 17% (72/421) had left ventricular (LV) dysfunction. In multivariable models accounting for fTTE data, RV dilation was significantly associated with 60-day mortality (OR 1.93 CI 1.13–3.3, p = 0.016). LV dysfunction was not significantly associated with 60-day mortality (OR 0.95 CI: 0.51–1.78, p = 0.87).
Abnormalities in RV echocardiographic parameters are adverse prognosticators in COVID-19 disease. Patients with RV dilation experienced double the risk for 60-day mortality due to COVID-19. To our knowledge, this is the largest study to date that highlights the adverse prognostic implications of RV dilation as determined through fTTE in hospitalized COVID-19 patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
...the American College of Cardiology’s Cardiovascular Disease in Women Committee sought to compare these findings in patients with AF to identify potential interventions that may help to rectify ...disparities of care. Whites have a higher incidence than blacks, and white men have a higher incidence than white women for all levels of risk factor burden, including smoking, alcohol consumption, body mass index, blood pressure, and diabetes (2,4). Registry data found women with AF were significantly less likely to receive oral anticoagulants at all stroke risk scores using the CHA2DS2-VASc algorithm (1 point for Congestive heart failure, Hypertension, Age >65 years, Diabetes, Female Sex, and Vascular disease, and 2 points for Stroke and Age >75 years) and less likely to receive oral anticoagulants than men (6). Compared with white men, women and certain ethnic groups with AF often experience longer lasting and more frequent symptomatic AF episodes, have worse quality of life, have more drug-related adverse events, have lower rates of anticoagulation, have less aggressive care in terms of rate versus rhythm management, and have a higher adjusted risk of death.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Cognitive impairment disproportionately affects older women with cardiovascular disease (CVD). Physical activity (PA) and cognitive training (CT) may have synergistic effects in combined ...interventions. However, no combined intervention has targeted women with CVD or utilized a sustainable and preferable lifestyle approach. The purpose was to test feasibility and acceptability of the 24-week MindMoves program, a lifestyle intervention that combined PA and CT developed for older women with CVD.
The PA component included goal setting with Fitbits and 5 behavioral group meetings. The CT component was evidence-based BrainHQ delivered on a tablet in three 30-minute weekly sessions. Participants included 10 women aged ≥65 years with CVD. Exclusion criteria were cognitive impairment, regular PA, and CT use. Measures were feasibility (recruitment, attendance, participation, retention, and acceptability), change in PA (Fitbit min/steps), and change in cognitive function (NIH Toolbox®).
Of the 10 participants, 70% attended ≥4/5 group meetings, and overall attendance was 76%. Participants completed 2.3/3 CT sessions weekly. Participant retention was 100%. Over 90% of participants rated MindMoves with the highest levels of satisfaction. Participants had significant improvements in steps, light PA, and moderate PA, and there was a trend for improved cognition.
Findings support testing MindMoves in an efficacy trial.
Clinical guidelines include diuretics for the treatment of heart failure (HF), not to decrease mortality but to decrease symptoms and hospitalizations. More attention has been paid to the worse ...outcomes, including mortality, associated with continual diuretic therapy due to hypochloremia. Studies have revealed a pivotal role for serum chloride in the pathophysiology of HF and is now a target of treatment to decrease mortality. The prognostic value of serum chloride in HF has been the subject of much attention. Mechanistically, the macula densa, a region in the renal juxtaglomerular apparatus, relies on chloride levels to sense salt and volume status. The recent discovery of with-no-lysine (K) (WNK) protein kinase as an intracellular chloride sensor sheds light on the possible reason of diuretic resistance in HF. The action of chloride on WNKs results in the upregulation of the sodium-potassium-chloride cotransporter and sodium-chloride cotransporter receptors, which could lead to increased electrolyte and fluid reabsorption. Genetic studies have revealed that a variant of a voltage-sensitive chloride channel (CLCNKA) gene leads to almost a 50% decrease in current amplitude and function of the renal chloride channel. This variant increases the risk of HF. Several trials exploring the prognostic value of chloride in both acute and chronic HF have shown mostly positive results, some even suggesting a stronger role than sodium. However, so far, interventional trials exploring serum chloride as a therapeutic target have been largely inconclusive. This study is a review of the pathophysiologic effects of hypochloremia in HF, the genetics of chloride channels, and clinical trials that are underway to investigate novel approaches to HF management.
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