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European Journal of Preventive... Mar 2020Despite major efforts to reduce atherosclerotic cardiovascular disease (ASCVD) burden with conventional risk factor control, significant residual risk remains. Recent... (Review)
Review
Despite major efforts to reduce atherosclerotic cardiovascular disease (ASCVD) burden with conventional risk factor control, significant residual risk remains. Recent evidence on non-traditional determinants of cardiometabolic health has advanced our understanding of lifestyle-disease interactions. Chronic exposure to environmental stressors like poor diet quality, sedentarism, ambient air pollution and noise, sleep deprivation and psychosocial stress affect numerous traditional and non-traditional intermediary pathways related to ASCVD. These include body composition, cardiorespiratory fitness, muscle strength and functionality and the intestinal microbiome, which are increasingly recognized as major determinants of cardiovascular health. Evidence points to partially overlapping mechanisms, including effects on inflammatory and nutrient sensing pathways, endocrine signalling, autonomic function and autophagy. Of particular relevance is the potential of low-risk lifestyle factors to impact on plaque vulnerability through altered adipose tissue and skeletal muscle phenotype and secretome. Collectively, low-risk lifestyle factors cause a set of phenotypic adaptations shifting tissue cross-talk from a proinflammatory milieu conducive for high-risk atherosclerosis to an anti-atherogenic milieu. The ketone body ß-hydroxybutyrate, through inhibition of the NLRP-3 inflammasome, is likely to be an intermediary for many of these observed benefits. Adhering to low-risk lifestyle factors adds to the prognostic value of optimal risk factor management, and benefit occurs even when the impact on conventional risk markers is discouragingly minimal or not present. The aims of this review are (a) to discuss novel lifestyle risk factors and their underlying biochemical principles and (b) to provide new perspectives on potentially more feasible recommendations to improve long-term adherence to low-risk lifestyle factors.
Topics: Atherosclerosis; Healthy Lifestyle; Heart Disease Risk Factors; Humans; Life Style; Protective Factors; Risk Assessment; Risk Reduction Behavior
PubMed: 31408370
DOI: 10.1177/2047487319869400 -
Respiratory Care Jul 2021Postoperative pulmonary complications have a significant impact on perioperative morbidity and mortality and contribute substantially to health care costs. Surgical... (Review)
Review
Postoperative pulmonary complications have a significant impact on perioperative morbidity and mortality and contribute substantially to health care costs. Surgical stress and anesthesia lead to changes in respiratory physiology, altering lung volumes, respiratory drive, and muscle function that can cumulatively increase the risk of postoperative pulmonary complications. Preoperative medical evaluation requires a structured approach to identify patient-, procedure-, and anesthesia-related risk factors for postoperative pulmonary complications. Validated risk prediction models can be used for risk stratification and to help tailor the preoperative investigation. Optimization of pulmonary comorbidities, smoking cessation, and correction of anemia are risk-mitigation strategies. Lung-protective ventilation, moderate PEEP application, and conservative use of neuromuscular blocking drugs are intra-operative preventive strategies. Postoperative early mobilization, chest physiotherapy, oral care, and appropriate analgesia speed up recovery. High-risk patients should receive inspiratory muscle training prior to surgery, and there should be a focus to minimize surgery time.
Topics: Anesthesia; Humans; Lung; Postoperative Complications; Preoperative Care; Risk Assessment; Risk Factors
PubMed: 34210743
DOI: 10.4187/respcare.09154 -
Current Cardiology Reviews 2020The globalization of the Western lifestyle has resulted in increase of diabetes mellitus, a complex, multifactorial disease. Diabetes mellitus is a condition often... (Review)
Review
The globalization of the Western lifestyle has resulted in increase of diabetes mellitus, a complex, multifactorial disease. Diabetes mellitus is a condition often related to the disorders of the cardiovascular system. It is well established that three quarters of diabetics, aged over 40, will die from cardiovascular disease and are more likely than non-diabetics to die from their first cardiovascular event. Therefore, it is of paramount importance to individualize treatment via risk stratification. Conditions that increase cardiovascular risk in people with diabetes include age more than 40 years, male gender, history of relative suffering from premature CHD, blood pressure and high LDL levels, presence of microalbuminuria, obstructive sleepapnea, erectile dysfunction and other conditions. Several models have been developed in order to assess cardiovascular risk in people with and without diabetes. Some of them have been proven to be inadequate while others are widely used for years. An emerging way of risk assessment in patients with diabetes mellitus is the use of biomarkers but a lot of research needs to be done in this field in order to have solid conclusions.
Topics: Adult; Biomarkers; Cardiovascular Diseases; Diabetes Complications; Female; Heart Disease Risk Factors; Humans; Male; Risk Assessment; Risk Factors
PubMed: 31713488
DOI: 10.2174/1573403X15666191111123622 -
Nature Communications Nov 2023Developing a single-domain assay to identify individuals at high risk of future events is a priority for multi-disease and mortality prevention. By training a neural...
Developing a single-domain assay to identify individuals at high risk of future events is a priority for multi-disease and mortality prevention. By training a neural network, we developed a disease/mortality-specific proteomic risk score (ProRS) based on 1461 Olink plasma proteins measured in 52,006 UK Biobank participants. This integrative score markedly stratified the risk for 45 common conditions, including infectious, hematological, endocrine, psychiatric, neurological, sensory, circulatory, respiratory, digestive, cutaneous, musculoskeletal, and genitourinary diseases, cancers, and mortality. The discriminations witnessed high accuracies achieved by ProRS for 10 endpoints (e.g., cancer, dementia, and death), with C-indexes exceeding 0.80. Notably, ProRS produced much better or equivalent predictive performance than established clinical indicators for almost all endpoints. Incorporating clinical predictors with ProRS enhanced predictive power for most endpoints, but this combination only exhibited limited improvement when compared to ProRS alone. Some proteins, e.g., GDF15, exhibited important discriminative values for various diseases. We also showed that the good discriminative performance observed could be largely translated into practical clinical utility. Taken together, proteomic profiles may serve as a replacement for complex laboratory tests or clinical measures to refine the comprehensive risk assessments of multiple diseases and mortalities simultaneously. Our models were internally validated in the UK Biobank; thus, further independent external validations are necessary to confirm our findings before application in clinical settings.
Topics: Humans; Proteomics; Risk Factors; Risk Assessment; Neoplasms
PubMed: 38016990
DOI: 10.1038/s41467-023-43575-7 -
Ugeskrift For Laeger Jan 2024Interstitial lung abnormalities (ILA) are incidentally observed specific CT findings in patients without clinical suspicion of interstitial lung disease (ILD). ILA with... (Review)
Review
Interstitial lung abnormalities (ILA) are incidentally observed specific CT findings in patients without clinical suspicion of interstitial lung disease (ILD). ILA with basal and peripheral predominance and features suggestive of fibrosis in more than 5% of any part of the lung should be referred for pulmonologist review. The strategy for monitoring as described in this review is based on clinical and radiological risk factors. ILA are associated with risk of progression to ILD and increased mortality. Early identification and assessment of risk factors for progression are essential to improve outcome.
Topics: Humans; Disease Progression; Lung Diseases, Interstitial; Lung; Risk Factors; Risk Assessment
PubMed: 38235774
DOI: 10.61409/V06230395 -
JACC. Cardiovascular Imaging Nov 2022
Topics: Humans; Cardiovascular Diseases; Predictive Value of Tests; Risk Factors; Coronary Angiography; Coronary Vessels; Heart Disease Risk Factors; Coronary Artery Disease; Vascular Calcification; Risk Assessment; Calcium
PubMed: 36357135
DOI: 10.1016/j.jcmg.2022.08.007 -
Journal of the National Cancer Institute Jan 2023
Topics: Humans; Diverticular Diseases; Risk; Neoplasms; Risk Factors
PubMed: 36200895
DOI: 10.1093/jnci/djac191 -
Gut and Liver Jul 2022
Topics: Cardiovascular Diseases; Heart Disease Risk Factors; Humans; Non-alcoholic Fatty Liver Disease; Risk Factors
PubMed: 35843683
DOI: 10.5009/gnl220276 -
Revista Do Colegio Brasileiro de... 2022The number of surgical procedures in the world is large and in Brazil it has been expressing a growth trend higher than the population growth. In this context,... (Review)
Review
The number of surgical procedures in the world is large and in Brazil it has been expressing a growth trend higher than the population growth. In this context, perioperative risk assessment safeguards the optimization of the outcomes sought by the procedures. For this evaluation, anamnesis and physical examination constitute an irreplaceable initial stage which may or may not be followed by complementary exams, interventions for clinical stabilization and application of risk estimation tools. The use of these tools can be very useful in order to obtain objective data for decision making by weighing surgical risk and benefit. Global and cardiovascular risk assessments are of greatest interest in the preoperative period, however information about their methods is scattered in the literature. Some tools such as the American Society of Anesthesiologists Physical Status (ASA PS) and the Revised Cardiac Risk Index (RCRI) are more widely known, while others are less known but can provide valuable information. Here, the main indices, scores and calculators that address general and cardiovascular perioperative risk were detailed.
Topics: Brazil; Heart Disease Risk Factors; Physical Examination; Risk Assessment
PubMed: 35319563
DOI: 10.1590/0100-6991e-20223124 -
Revista Portuguesa de Cardiologia :... Jan 2016
Topics: Cardiovascular Diseases; Cardiovascular System; Humans; Risk Assessment; Risk Factors
PubMed: 26755402
DOI: 10.1016/j.repc.2015.11.002