Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Oct 2021
ReviewHow can exercise reduce cardiovascular disease risk? A primer for the clinician.
Despite advances in drug development and medical treatments, cardiovascular diseases (CVDs) remain a leading cause of mortality across the globe. Fortunately, CVD can be delayed by engaging in appropriate lifestyle behaviors. An abundance of epidemiological evidence supports a direct association between increased levels of physical activity or cardiovascular fitness and reduced premature CVD morbidity and mortality. ⋯ Thus, the purpose of this review is to highlight the cardioprotective effects of exercise training and to explore the underlying mechanistic pathways that might explain these benefits. The review will focus on those physiological pathways that are directly involved in atherosclerotic disease development. They include hypercholesterolemia, hypertension, chronic inflammation, and insulin resistance.
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Pol. Arch. Med. Wewn. · Oct 2021
Multicenter Study Observational StudyDistrict versus academic hospital - clinical outcomes of patients with atrial fibrillation. MultiCenter expeRience in Atrial Fibrillation Patients Treated With Oral Anticoagulants (CRAFT) study.
Introduction: Atrial fibrillation (AF) is associated with increased hospitalization. Objectives: We aimed to compare long-term outcomes in patients with AF hospitalized in academic and district hospitals. Patients and methods: This retrospective observational study included data from the Multicenter Experience in Atrial Fibrillation Patients Treated with Oral Anticoagulants (CRAFT; NCT02987062) study which included AF patients hospitalized between 2011 and 2016 in academic and district hospitals. The primary end point was a major adverse event (MAE) defined as all-cause death and thromboembolic and hemorrhagic events during the median 4-year follow-up. Results: We analyzed 2983 patients with AF: 2271 (76%) from academic and 712 (24%) from district hospitals. ⋯ Heart failure, renal failure, and vitamin K antagonist (in academic hospitals), and coronary artery disease (in district hospitals) were associated with greater likelihood of hemorrhagic events. District (vs academic) conditions were associated with higher risk of MAEs and all-cause death in men and those with low risk of bleeding, and with higher incidence of thromboembolic events in women, elderly patients, and those with high risk of bleeding and with diabetes. Conclusions: Patients with AF treated at district hospitals had worse long-term outcomes than those treated in academic conditions.
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Plant‑based diets are considered to improve cardiometabolic health and to protect against cardiovascular disease. Although they center around plant‑based foods, they do not necessarily exclude all animal products and comprise of a range of intakes that vary according to the type and the proportion of animal products included. Numerous metabolic pathways have been identified through which plant‑based diets can exert beneficial effects including improved body composition, lipid profile, and glucose metabolism and decreased inflammation and blood pressure. ⋯ Ample evidence for the effects of individual dietary components of plant‑based diets on thrombotic risk factors exists, but the effect of whole diets and / or dietary patterns remains less‑well explored with the existing literature reporting inconsistent and inconclusive findings. Here we aim to review the literature describing the effect of different plant‑based diets (vegan, lacto‑vegetarian, lacto‑ovo‑vegetarian, pescatarian, and flexitarian) and dietary patterns (Mediterranean, Nordic, Portfolio, and DASH) on specific thrombotic risk factors (fibrinogen, platelets, factor VII, fibrinolysis) in order to better clarify these relationships and to try to explain the apparent discrepant findings. We demonstrate that a one‑size‑fits-all conclusion cannot be drawn and that the potential antithrombotic effect of different plant‑based diets depends on the nutrient composition, the content of active antithrombotic dietary components, the relative absence of prothrombotic dietary factors as well as the degree of total caloric restriction.
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Pol. Arch. Med. Wewn. · Oct 2021
Computed tomography assessment of the aortic root morphology in predicting the development of paravalvular leak following transcatheter aortic valve implantation.
Introduction: Transcatheter aortic valve implantation (TAVI) is an effective treatment of significant aortic stenosis. Paravalvular leaks (PVLs) are one of the most common complications after the procedure. Objectives: The aim of this study was to assess whether the aortic root morphology affects the occurrence of PVL after TAVI. Patients and methods: We enrolled 50 patients with bicuspid and 50 patients with tricuspid aortic valve who underwent multislice computed tomography (MSCT) and transthoracic echocardiography prior to TAVI. ⋯ Patients were divided in 2 groups according to the PVL severity: less than moderate PVL (n = 80) and moderate or worse PVL (n = 20), and comparisons between the groups were performed. Results: Patients with at least moderate PVL, compared with those with less than moderate PVL, had greater mean (SD) area (5.2 [1.1] cm2 vs 4.7 [0.8] cm2; P = 0.02), perimeter (8.4 [0.9] cm vs 7.9 [0.7] cm; P = 0.01), and long axis (29.5 [2.7] mm vs 28 [2.7] mm; P = 0.04) of the aortic annulus and greater mean (SD) area (5.3 [1.3] cm2 vs 4.7 [1.1] cm2; P = 0.04) and perimeter (8.6 [1.1] cm vs 8.1 [0.9] cm; P = 0.02) of the left ventricular outflow tract. In multivariable analysis, bicuspid aortic valve disease, interventricular septum hypertrophy, greater left ventricular outflow tract, and postdilatation were significant predictors of moderate PVL following TAVI. Conclusions: The assessment of the aortic root morphology with MSCT can be helpful in predicting PVL after TAVI.