Subjects -> MEDICAL SCIENCES (Total: 8529 journals)
    - ALLERGOLOGY AND IMMUNOLOGY (216 journals)
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CARDIOVASCULAR DISEASES (332 journals)                  1 2 | Last

Showing 1 - 200 of 337 Journals sorted alphabetically
Acta Angiologica     Open Access   (Followers: 5)
Acta Cardiologica     Hybrid Journal   (Followers: 2)
Acute Cardiac Care     Hybrid Journal   (Followers: 8)
Adipositas - Ursachen, Folgeerkrankungen, Therapie     Hybrid Journal  
AJP Heart and Circulatory Physiology     Hybrid Journal   (Followers: 12)
Aktuelle Kardiologie     Hybrid Journal   (Followers: 1)
American Heart Journal     Hybrid Journal   (Followers: 59)
American Journal of Cardiology     Hybrid Journal   (Followers: 67)
American Journal of Cardiovascular Drugs     Hybrid Journal   (Followers: 17)
American Journal of Hypertension     Hybrid Journal   (Followers: 28)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anatolian Journal of Cardiology     Open Access   (Followers: 6)
Angiología     Full-text available via subscription  
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)
Angiology     Hybrid Journal   (Followers: 3)
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (Followers: 1)
Annals of Circulation     Open Access   (Followers: 1)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 1)
Annals of Pediatric Cardiology     Open Access   (Followers: 12)
AORTA     Open Access  
Archives of Cardiovascular Diseases     Full-text available via subscription   (Followers: 5)
Archives of Cardiovascular Diseases Supplements     Full-text available via subscription   (Followers: 3)
Archives of Cardiovascular Imaging     Open Access   (Followers: 2)
Archivos de cardiología de México     Open Access   (Followers: 1)
Argentine Journal of Cardiology (English edition)     Open Access   (Followers: 2)
Arquivos Brasileiros de Cardiologia     Open Access   (Followers: 2)
Arrhythmia & Electrophysiology Review     Open Access  
Arteriosclerosis, Thrombosis and Vascular Biology     Full-text available via subscription   (Followers: 32)
Artery Research     Hybrid Journal   (Followers: 4)
ARYA Atherosclerosis     Open Access  
ASAIO Journal     Hybrid Journal   (Followers: 3)
ASEAN Heart Journal     Open Access   (Followers: 2)
Asian Cardiovascular and Thoracic Annals     Hybrid Journal   (Followers: 2)
Aswan Heart Centre Science & Practice Services     Open Access   (Followers: 1)
Atherosclerosis : X     Open Access  
Bangladesh Heart Journal     Open Access   (Followers: 3)
Basic Research in Cardiology     Hybrid Journal   (Followers: 10)
BMC Cardiovascular Disorders     Open Access   (Followers: 22)
Brain Circulation     Open Access   (Followers: 1)
British Journal of Cardiology     Full-text available via subscription   (Followers: 18)
Canadian Journal of Cardiology     Hybrid Journal   (Followers: 18)
Cardiac Cath Lab Director     Full-text available via subscription  
Cardiac Electrophysiology Review     Hybrid Journal   (Followers: 2)
Cardiac Failure Review     Open Access  
Cardiocore     Full-text available via subscription   (Followers: 1)
Cardiogenetics     Open Access   (Followers: 3)
Cardiology     Full-text available via subscription   (Followers: 20)
Cardiology and Angiology: An International Journal     Open Access   (Followers: 1)
Cardiology and Therapy     Open Access   (Followers: 12)
Cardiology Clinics     Full-text available via subscription   (Followers: 14)
Cardiology in Review     Hybrid Journal   (Followers: 8)
Cardiology in the Young     Hybrid Journal   (Followers: 34)
Cardiology Journal     Open Access   (Followers: 6)
Cardiology Plus     Open Access   (Followers: 1)
Cardiology Research     Open Access   (Followers: 15)
Cardiology Research and Practice     Open Access   (Followers: 10)
Cardiopulmonary Physical Therapy Journal     Hybrid Journal   (Followers: 8)
Cardiorenal Medicine     Full-text available via subscription   (Followers: 1)
Cardiothoracic Surgeon     Open Access   (Followers: 1)
CardioVasc     Full-text available via subscription   (Followers: 1)
Cardiovascular & Haematological Disorders - Drug Targets     Hybrid Journal   (Followers: 1)
Cardiovascular & Hematological Agents in Medicinal Chemistry     Hybrid Journal   (Followers: 2)
CardioVascular and Interventional Radiology     Hybrid Journal   (Followers: 15)
Cardiovascular and Thoracic Open     Open Access  
Cardiovascular Diabetology     Open Access   (Followers: 10)
Cardiovascular Drugs and Therapy     Hybrid Journal   (Followers: 14)
Cardiovascular Endocrinology & Metabolism     Hybrid Journal   (Followers: 1)
Cardiovascular Engineering     Hybrid Journal   (Followers: 1)
Cardiovascular Engineering and Technology     Hybrid Journal   (Followers: 1)
Cardiovascular Intervention and Therapeutics     Hybrid Journal   (Followers: 5)
Cardiovascular Journal     Open Access   (Followers: 6)
Cardiovascular Journal of Africa     Full-text available via subscription   (Followers: 5)
Cardiovascular Journal of South Africa     Full-text available via subscription   (Followers: 1)
Cardiovascular Medicine in General Practice     Full-text available via subscription   (Followers: 7)
Cardiovascular Pathology     Hybrid Journal   (Followers: 4)
Cardiovascular Regenerative Medicine     Open Access  
Cardiovascular Research     Hybrid Journal   (Followers: 15)
Cardiovascular Revascularization Medicine     Hybrid Journal   (Followers: 1)
Cardiovascular System     Open Access  
Cardiovascular Therapeutics     Open Access   (Followers: 1)
Cardiovascular Toxicology     Hybrid Journal   (Followers: 6)
Cardiovascular Ultrasound     Open Access   (Followers: 5)
Case Reports in Cardiology     Open Access   (Followers: 7)
Catheterization and Cardiovascular Interventions     Hybrid Journal   (Followers: 3)
Cerebrovascular Diseases     Full-text available via subscription   (Followers: 3)
Cerebrovascular Diseases Extra     Open Access  
Chest     Full-text available via subscription   (Followers: 102)
Choroby Serca i Naczyń     Open Access   (Followers: 1)
Circulation     Hybrid Journal   (Followers: 254)
Circulation : Cardiovascular Imaging     Hybrid Journal   (Followers: 15)
Circulation : Cardiovascular Interventions     Hybrid Journal   (Followers: 18)
Circulation : Cardiovascular Quality and Outcomes     Hybrid Journal   (Followers: 11)
Circulation : Genomic and Precision Medicine     Hybrid Journal   (Followers: 16)
Circulation : Heart Failure     Hybrid Journal   (Followers: 26)
Circulation Research     Hybrid Journal   (Followers: 36)
Cirugía Cardiovascular     Open Access  
Clínica e Investigación en Arteriosclerosis     Full-text available via subscription  
Clínica e Investigación en arteriosclerosis (English Edition)     Hybrid Journal  
Clinical and Experimental Hypertension     Hybrid Journal   (Followers: 3)
Clinical Cardiology     Hybrid Journal   (Followers: 11)
Clinical Hypertension     Open Access   (Followers: 5)
Clinical Medicine Insights : Cardiology     Open Access   (Followers: 6)
Clinical Research in Cardiology     Hybrid Journal   (Followers: 6)
Clinical Research in Cardiology Supplements     Hybrid Journal  
Clinical Trials and Regulatory Science in Cardiology     Open Access   (Followers: 4)
Congenital Heart Disease     Hybrid Journal   (Followers: 6)
Congestive Heart Failure     Hybrid Journal   (Followers: 4)
Cor et Vasa     Full-text available via subscription   (Followers: 1)
Coronary Artery Disease     Hybrid Journal   (Followers: 2)
CorSalud     Open Access  
Critical Pathways in Cardiology     Hybrid Journal   (Followers: 4)
Current Cardiology Reports     Hybrid Journal   (Followers: 7)
Current Cardiology Reviews     Hybrid Journal   (Followers: 4)
Current Cardiovascular Imaging Reports     Hybrid Journal   (Followers: 1)
Current Cardiovascular Risk Reports     Hybrid Journal  
Current Heart Failure Reports     Hybrid Journal   (Followers: 5)
Current Hypertension Reports     Hybrid Journal   (Followers: 6)
Current Hypertension Reviews     Hybrid Journal   (Followers: 6)
Current Opinion in Cardiology     Hybrid Journal   (Followers: 14)
Current Problems in Cardiology     Hybrid Journal   (Followers: 3)
Current Research : Cardiology     Full-text available via subscription   (Followers: 1)
Current Treatment Options in Cardiovascular Medicine     Hybrid Journal   (Followers: 1)
Current Vascular Pharmacology     Hybrid Journal   (Followers: 5)
CVIR Endovascular     Open Access   (Followers: 1)
Der Kardiologe     Hybrid Journal   (Followers: 2)
Echo Research and Practice     Open Access   (Followers: 2)
Echocardiography     Hybrid Journal   (Followers: 4)
Egyptian Heart Journal     Open Access   (Followers: 2)
Egyptian Journal of Cardiothoracic Anesthesia     Open Access  
ESC Heart Failure     Open Access   (Followers: 4)
European Cardiology Review     Open Access  
European Heart Journal     Hybrid Journal   (Followers: 67)
European Heart Journal - Cardiovascular Imaging     Hybrid Journal   (Followers: 10)
European Heart Journal - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 2)
European Heart Journal - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart Journal : Acute Cardiovascular Care     Hybrid Journal   (Followers: 1)
European Heart Journal : Case Reports     Open Access   (Followers: 1)
European Heart Journal Supplements     Hybrid Journal   (Followers: 8)
European Journal of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 9)
European Journal of Cardio-Thoracic Surgery Supplements     Full-text available via subscription   (Followers: 2)
European Journal of Cardiovascular Nursing     Hybrid Journal   (Followers: 5)
European Journal of Heart Failure     Hybrid Journal   (Followers: 14)
European Journal of Preventive Cardiology.     Hybrid Journal   (Followers: 6)
European Stroke Organisation     Hybrid Journal   (Followers: 3)
Experimental & Translational Stroke Medicine     Open Access   (Followers: 9)
Expert Review of Cardiovascular Therapy     Full-text available via subscription   (Followers: 3)
Folia Cardiologica     Open Access  
Forum Zaburzeń Metabolicznych     Hybrid Journal  
Frontiers in Cardiovascular Medicine     Open Access   (Followers: 1)
Future Cardiology     Hybrid Journal   (Followers: 6)
General Thoracic and Cardiovascular Surgery     Hybrid Journal   (Followers: 3)
Global Cardiology Science and Practice     Open Access   (Followers: 5)
Global Heart     Hybrid Journal   (Followers: 3)
Heart     Hybrid Journal   (Followers: 48)
Heart and Mind     Open Access  
Heart and Vessels     Hybrid Journal  
Heart Failure Clinics     Full-text available via subscription   (Followers: 2)
Heart Failure Reviews     Hybrid Journal   (Followers: 3)
Heart India     Open Access   (Followers: 2)
Heart International     Full-text available via subscription  
Heart Rhythm     Hybrid Journal   (Followers: 11)
Heart Views     Open Access   (Followers: 2)
HeartRhythm Case Reports     Open Access  
Hellenic Journal of Cardiology     Open Access   (Followers: 1)
Herz     Hybrid Journal   (Followers: 3)
High Blood Pressure & Cardiovascular Prevention     Full-text available via subscription   (Followers: 2)
Hypertension     Full-text available via subscription   (Followers: 23)
Hypertension in Pregnancy     Hybrid Journal   (Followers: 9)
Hypertension Research     Hybrid Journal   (Followers: 5)
Ibrahim Cardiac Medical Journal     Open Access  
IJC Heart & Vessels     Open Access   (Followers: 1)
IJC Heart & Vasculature     Open Access   (Followers: 1)
IJC Metabolic & Endocrine     Open Access   (Followers: 1)
Indian Heart Journal     Open Access   (Followers: 5)
Indian Journal of Cardiovascular Disease in Women WINCARS     Open Access  
Indian Journal of Thoracic and Cardiovascular Surgery     Hybrid Journal  
Indian Pacing and Electrophysiology Journal     Open Access   (Followers: 1)
Innovations : Technology and Techniques in Cardiothoracic and Vascular Surgery     Hybrid Journal   (Followers: 1)
Insuficiencia Cardíaca     Open Access  
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 7)
International Cardiovascular Forum Journal     Open Access  
International Journal of Angiology     Hybrid Journal   (Followers: 2)
International Journal of Cardiology     Hybrid Journal   (Followers: 18)
International Journal of Cardiology Hypertension     Open Access   (Followers: 1)
International Journal of Cardiovascular and Cerebrovascular Disease     Open Access   (Followers: 2)
International Journal of Cardiovascular Imaging     Hybrid Journal   (Followers: 2)
International Journal of Cardiovascular Research     Hybrid Journal   (Followers: 6)
International Journal of Heart Rhythm     Open Access  
International Journal of Hypertension     Open Access   (Followers: 8)
International Journal of Hyperthermia     Open Access  
International Journal of Stroke     Hybrid Journal   (Followers: 32)
International Journal of the Cardiovascular Academy     Open Access  
Interventional Cardiology Clinics     Full-text available via subscription   (Followers: 2)
Interventional Cardiology Review     Open Access  
JACC : Basic to Translational Science     Open Access   (Followers: 5)
JACC : Cardiovascular Imaging     Hybrid Journal   (Followers: 18)
JACC : Cardiovascular Interventions     Hybrid Journal   (Followers: 18)
JACC : Heart Failure     Full-text available via subscription   (Followers: 14)
JAMA Cardiology     Hybrid Journal   (Followers: 30)
JMIR Cardio     Open Access  

        1 2 | Last

Similar Journals
Journal Cover
Current Cardiovascular Risk Reports
Journal Prestige (SJR): 0.515
Citation Impact (citeScore): 1
Number of Followers: 0  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1932-9563 - ISSN (Online) 1932-9520
Published by Springer-Verlag Homepage  [2626 journals]
  • Approaches to the Diagnosis and Management of Atrial-Esophageal Fistula
           After Catheter Ablation for Atrial Arrhythmias
    • Abstract: Purpose of Review Catheter ablation has become a cornerstone of therapy in the management of patients with atrial fibrillation (AF). Thermal energy generated in the left atrium (LA) during ablation has the potential to damage adjacent structures. The most feared and rare complication in these ablations is atrial-esophageal fistula (AEF) result from the thermal injury to the esophagus due to the proximity to the LA, with potential catastrophic outcome. This review focuses on the diagnosis and management of AEF after catheter ablation for AF, including preventive measures to avoid esophageal lesions. Recent Findings Symptoms of AEF are often vague and nonspecific, sometimes asymptomatic until they present with fistula or perforation, making the diagnosis somewhat challenging. The esophagogastroduodenoscopy is the gold standard for early detection of esophageal lesions related to AF ablation. Chest CT with oral and intravenous contrast is preferred when there is suspicion of perforation. The use of an esophageal temperature probe during ablation to monitoring esophageal temperature, associated with mechanical displacement of the esophagus, may be feasible to prevent thermal esophageal lesions and enabling adequate energy delivery to the posterior wall of the LA. Prophylactic use of proton pump inhibitors after AF ablation is accepted to be effective and justified as preventive treatment. Summary AEF is an unpredictable complication. Be aware of these complications in the follow-up of patients after AF ablation can lead to the early recognition to start treatment, including surgical repair, as soon as possible to prevent the fatal outcome.
      PubDate: 2019-03-16
       
  • Neighborhood Social Environment and Cardiovascular Disease Risk
    • Abstract: Purpose of Review Limited physical activity (PA) and obesity are two primary risk factors for cardiovascular disease (CVD). Within a socio-ecological framework, neighborhood social environment may play a key role in influencing PA and obesity. However, the mechanisms underlying this relationship remain ambiguous. Our goals in this review are as follows: (1) to summarize findings from the recent studies on neighborhood social environment in relation to PA and obesity as CVD risk factors, and (2) to briefly describe several innovative approaches to assessing neighborhood social environment. Recent Findings Almost all recent studies assessed neighborhood social environment around residential areas. There were consistent associations between neighborhood social environment and PA and obesity, with some exceptions (indicating null associations or paradoxical associations). However, a focus on residential social environment may limit results because these studies did not account for any exposures occurring away from individuals’ homes. Additionally, the majority of studies utilized a cross-sectional design, which limits our ability to make inferences regarding the causality of the association between neighborhood social environment and PA or obesity as CV risk factors. Summary The majority of the studies on neighborhood social environment characterized factors around residential areas and assessed participant activity via self-reported surveys. Future research should leverage tools to account for the spatial mismatch between environmental exposures and outcomes by using global positioning systems, ecological momentary assessments, virtual neighborhood audits, and simulation modeling. These approaches can overcome major limitations by tracking individuals’ daily activity and real-time perceptions of neighborhood social environments linked to CVD events.
      PubDate: 2019-03-08
       
  • Triglycerides: Mendelian Randomization Studies Suggest Causal Role, but
           How to Treat in 2019'
    • Abstract: Purpose of Review Hypertriglyceridemia (HTG), defined by fasting levels at or exceeding 200 mg/dL, is characterized as a pro-inflammatory, pro-thrombotic, metabolic state associated with endothelial dysfunction, insulin resistance, type 2 diabetes mellitus (T2DM), and increased risk of cardiovascular disease (CVD). Mendelian randomization studies now support a causal role for TG-rich lipoproteins in CVD risk enhancement. Yet, until recently, only post-hoc analyses from clinical trials suggested that treating HTG would translate into reduced CVD risk. Recent Findings The results of Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial demonstrated for the first time that patients with HTG and elevated CVD risk (i.e., pre-existing CVD or DM with additional risk factors) benefited after treatment with icosapent ethyl (IPE), a highly purified eicosapentanoic acid (EPA) taken 4 g daily. Ironically, the TG-lowering effect of IPE was relatively modest (20%), suggesting the interplay of other mechanisms beyond TG lowering that contributed to the robust benefits observed (25% relative risk reduction in the primary CVD endpoint). These mechanisms include downregulation of pro-inflammatory signaling pathways and restoration of endothelial dysfunction, cellular processes that are aggravated in HTG states. Consequently, high-risk patients with HTG should be considered for IPE therapy beyond traditional measures outlined in the 2018 American Heart Association/American College of Cardiology/Multi-Society Cholesterol Guidelines, pending the results of two ongoing clinical outcome trials, Statin Residual Risk Reduction with omega-3 carboxylic acids (Epanova®) in High Cardiovascular Risk Patients With Hypertriglyceridemia and Pemafibrate to Reduce Cardiovascular Outcomes by Reducing Triglycerides in Patients With Diabetes. Summary Taken together, HTG reflects a highly atherogenic and pro-inflammatory state for which evidence-based therapy has now been demonstrated.
      PubDate: 2019-02-28
       
  • The Role of Atrial Arrhythmia Ablation in Adolescent and Adult Congenital
           Heart Disease
    • Abstract: Purpose of Review Atrial arrhythmias cause significant morbidity in patients with congenital heart disease (CHD). Catheter ablation remains one of the most effective treatment modalities for atrial arrhythmias. However, patients with congenital heart disease present unique challenges for catheter ablation. Recent Findings Recent expert consensus guidelines inform physicians about treating arrhythmias in patients with CHD. These guidelines outline appropriate selection criteria for ablation and highlight treatment alternatives. The authors also suggest electrophysiology laboratory and physician standards for performing these complex procedures. Recent studies report that 51% of atrial arrhythmias in CHD involve the cavo-tricuspid isthmus (CTI), 28% were non-CTI related and two types of IART were present in 21%. These studies link recurrence of tachycardia after ablation to CHD complexity, non-CTI-related arrhythmias, and patients with prolonged intra-atrial conduction. An analysis of patients with displaced AV nodes showed that cryoablation is a safe and effective technology to perform ablation in CHD with perinodal substrates. Changes in surgical Fontan palliation away from intracardiac baffles to extracardiac conduit has hopefully decreased arrhythmia burden in single ventricle patients. However, in those with atrial arrhythmias, access to the atria is complicated by no direct systemic venous access to the heart. Recent single-center and multicenter studies evaluated the success of ablation in these patients and outline safe approaches to transbaffle puncture. Acute success was 83% with similar complication profile to other CHD patients. Summary The anatomic variations of congenital heart disease create special problems for catheter ablation. Teams performing ablation need pre-procedural preparation and specialized understanding of a vast anatomic variation and surgical repairs. This understanding coupled with the knowledge of the pathophysiology of arrhythmia disorders and the biophysics of catheter ablation technology is required to perform successful and safe ablation procedures.
      PubDate: 2019-02-18
       
  • How to Choose Between His Bundle Pacing and Biventricular Pacing for
           Cardiac Resynchronization Therapy
    • Abstract: Purpose of Review The goal of this critical appraisal is to evaluate the role for His bundle pacing (HBP) in cardiac resynchronization, examine early clinical and physiologic data, as well as offer recommendations for selecting patients for HBP versus biventricular pacing for CRT. Recent Findings Biventricular pacing with a left ventricular (LV) coronary sinus lead has been the primary mode of delivering cardiac resynchronization therapy (CRT) for over two decades. By fusing multiple wavefronts of activation, biventricular pacing shortens and homogenizes ventricular activation, increases left ventricular ejection fraction (LVEF), reduces mitral regurgitation, and is also associated with improved clinical outcomes, including reduced heart failure (HF) hospitalization and mortality. Despite these myriad benefits, approximately one-third of patients do not derive benefit from traditional CRT. HBP is a means of delivering CRT which restores electromechanical synchrony by activating the His-Purkinje system distal to the site of proximal bundle branch block. Early clinical data suggest that CRT with HBP may be associated with comparable clinical benefits to biventricular pacing in CRT-eligible patients, although randomized data are not yet available. Summary The available data suggest that HBP is an alternative approach to biventricular pacing to achieve cardiac resynchronization by restoration of native Purkinje activation. The applicability is most clear in patients with typical BBB patterns. Further research and randomized studies are necessary to evaluate the role of HBP in CRT.
      PubDate: 2019-02-11
       
  • Worldwide Dyslipidemia Guidelines
    • Abstract: Purpose of Review This review aims to identify common features of guidelines by comparing and summarizing similarities between five guidelines distributed by high-profile cardiovascular societies across the globe. We include guidelines from North America: ACC/AHA (2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults) and CCS (2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult) and from Europe: PoLA (2016 Polish Lipid Association), ESC/EAS (2016 European Society for Cardiology/European Atherosclerosis Society Guidelines for the Management of Dyslipidemias), and NICE (National Institute for Health and Care Excellence) from the UK. We also include the 2016 Chinese guidelines for the management of dyslipidemia in adults in this comparison. Recent Findings All of these guidelines employ a rigorous review of clinical evidence and emphasize the immense importance of statins in the primary and secondary prevention of atherosclerotic cardiovascular disease. Moreover, they place great emphasis on the dialog between the clinician and the patient regarding treatment and the risks associated with it. Summary Despite the differences in statin intensities, safety concerns, use of risk estimators, or treatment of specific patient subgroups, there are more similarities than differences between the guidelines from both a clinical and practical point of view. Physicians ought to understand both similarities and differences in guideline recommendations to make the right decision regarding statin therapy for individual patients.
      PubDate: 2019-01-25
       
  • Optimizing Anticoagulation in Older Patients with Nonvalvular Atrial
           Fibrillation
    • Abstract: Purpose of Review We sought to review the current issues on optimization of anticoagulation in elderly patients with nonvalvular atrial fibrillation (NVAF). Recent Findings Advanced age is a risk factor for stroke and as one advances in age, the risk of stroke also increases. One of the many challenges of oral anticoagulation for stroke prevention in the elderly patients with NVAF is the underutilization of anticoagulants. Commonly cited reasons for hesitation by physician in prescribing oral anticoagulants are advanced age, increase risk of bleeding, and the difficulty in maintaining an adequate time in therapeutic range and the need for frequent monitoring for those who are given warfarin. The non-vitamin K antagonist oral anticoagulants (NOAC) have been shown to have similar or superior efficacy, and a better safety profile compared with warfarin due to its wider therapeutic window, low interaction with food, and less frequent monitoring of anticoagulation levels. It is also important to note that renal dysfunction is becoming increasingly common in elderly patients with AF. This poses a therapeutic challenge for physicians due to a higher bleeding risk; thus, renal function should be taken into consideration when prescribing NOACs. Warfarin, on the other hand, remains to be a viable therapeutic option in certain clinical scenarios. Summary In elderly patients, the choice of oral anticoagulants for stroke prevention in NVAF should be individualized and should include considerations for the best estimate of absolute benefit weighed against bleeding risks in order to optimize anticoagulation.
      PubDate: 2019-01-25
       
  • Noninvasive Cardiac Radioablation for Ventricular Arrhythmias
    • Abstract: Purpose of Review In this review, we describe the general principles and clinical use of stereotactic radioablation (SR) and its specific application to the treatment of malignant cardiac ventricular arrhythmias, or stereotactic arrhythmia radioablation (STAR). The principles of STAR, and the unmet needs in cardiac arrhythmia ablation are described. The basic pathophysiology of radioablative effect on cardiac tissues, the clinical experience to date, and future directions are discussed. Recent Findings Basic preclinical research has demonstrated in large animal models (porcine, canine) that delivery of SR energy to cardiac targets, specifically left atrial ablation for atrial fibrillation, results in physiologic and histopathologic evidence of treatment effect without evidence of harm. Clinical treatments delivering SR to ventricular and atrial targets for ventricular tachycardia (VT) and atrial fibrillation (AF) have demonstrated clinical response without evidence of obvious harm or complication thus far. Summary In the nascent but exciting field of stereotactic radioablation for treatment of cardiac arrhythmias, preclinical evidence has demonstrated treatment effect without to date risk of significant collateral injury. In limited clinical experience treating both ventricular and atrial arrhythmias, clinical benefit in arrhythmia reduction without notable risk of complication has been observed. Further basic mechanistic research, refinement of delivery approaches, and further clinical experience are all anticipated and needed.
      PubDate: 2019-01-21
       
  • Management of Brugada Syndrome in the Developing Countries
    • Abstract: Purpose of Review The goal of this article is to review the current paradigm for the diagnosis and management of Brugada Syndrome. Recent Findings One area of particular interest is the recent reports on the use of ablation for treatment and the relevance to our understanding of this genetic disorder. Summary This review discusses issues with management and treatment of Brugada Syndrome that have applications that should apply to patients in the developed and developing world.
      PubDate: 2018-11-20
       
  • Social Networks and Health Outcomes: Importance for Racial and
           Socioeconomic Disparities in Cardiovascular Outcomes
    • Abstract: Purpose of Review A large body of research has indicated social network characteristics are associated with health and mortality. Additional literature suggests the structure and function of social networks differ by race and socioeconomic status. The current paper seeks to synthesize and further contextualize these two separate bodies of work, as well as illustrate potential mechanisms by which social networks may contribute to current disparities in cardiovascular disease outcomes. Recent Findings An increasing number of studies have examined the link between social networks and cardiovascular outcomes. Social isolation and loneliness are two network-based sources of risk for coronary heart disease and stroke. Social resource theory provides a framework for how network structure and function may differ among distinct population groups, and argues for more research regarding differential access to social drivers of health. While previous studies have often focused on lack of support or resources within networks, recent studies have also pointed to potentially negative effects of networks, including burden, which provide additional pathways through which networks affect health. Other mechanisms linking social networks with cardiovascular disease risk, including social influence for behaviors associated with ideal cardiovascular health, are discussed. Summary Examination of social network structure and function among diverse populations, including Black Americans and low socioeconomic status individuals, may elucidate potential sources of physiological and psychological distress, as well as sources of support, that are associated with cardiovascular disease outcomes. A richer understanding of these associations may offer solutions for alleviating systemic causes of cardiovascular disease disparities among high-risk populations.
      PubDate: 2018-10-25
       
  • Personalized Approach to Statin Selection in Primary Prevention: Genetic
           Risk Scores Vs Imaging Risk Scores
    • Abstract: Purpose of Review This review addresses how assessment of coronary artery calcium (CAC) and information on genetic profile can guide statin therapy in primary prevention of atherosclerotic cardiovascular disease (ASCVD). Recent Findings CAC provides information beyond that given by standard risk factors, improving discrimination and risk reclassification, especially in the intermediate-risk stratum. A substantial proportion of individuals in primary prevention have CAC = 0 and very good prognosis over 10 years (ASCVD risk <5%). Conversely, CAC >100 is usually associated with 10-year ASCVD risk >7.5%, even in individuals considered to be at low risk by traditional risk factors. Recent studies have reported genetic risk scores (GRSs) for prediction of coronary artery disease (CAD), composed by a variable number (up to millions) of genetic variants. The most recent GRSs have shown to improve prediction of CAD over conventional risk factors. GRSs may also identify a subset of individuals (1 in 53) with risk of early-onset CAD as high as those with familial monogenic hypercholesterolemia. Summary CAC score has a definite role in reclassifying individuals in primary prevention to more accurate risk strata, which may help decisions regarding statin initiation. CAC testing is appropriate in individuals aged 40–75 years with intermediate 10-year ASCVD risk (5–20%) and in selected cases of low risk. GRSs are rapidly evolving and recent data on CAD risk prediction are encouraging. More detailed information on ability to reclassify individuals and further validation are needed before their routine implementation. Nevertheless, a potential clinical utility can be envisioned, especially at younger ages, before the emergence of risk factors.
      PubDate: 2018-10-17
       
  • Sugar-Sweetened Beverage Taxes: the Potential for Cardiovascular Health
    • Abstract: Purpose of Review Global sugar-sweetened beverage (SSB) consumption is high, with important implications for cardiovascular health. International momentum with the adoption and implementation of SSB taxes has been mounting in recent years, as has the evidence supporting such a policy for population health. In this review, we summarise the influence of regular SSB consumption on cardiovascular health and provide a global perspective on SSB consumption and SSB tax action and evidence. We further discuss the might and organised opposition of the beverage industry and the policy enablers for affirmative action. Recent Findings Compelling evidence demonstrates a link between regular SSB consumption and adverse cardiovascular health. Although global SSB consumption appears to be declining slightly, consumption remains high. Forty-five jurisdictions around the world have now implemented a notable tax on SSBs and consistent evidence demonstrates the effectiveness of this policy at reducing the purchase or consumption of SSBs at the population level. However, the political influence of industry remains a major barrier to further action. Enablers to policy action include the realisation of the revenue-raising potential of taxes, evidence base advocacy framing from trusted sources, broad-based advocacy coalitions and the communication of clear policy objectives. Summary SSB taxes represent a promising strategy, alongside a broader comprehensive approach, for improving population diets and cardiovascular health, but face stiff industry opposition. Future research must focus on the influence of different SSB tax designs and context on population diet and health.
      PubDate: 2018-10-10
       
  • Lipoprotein(a)—It Is Risky, but What Do We Do About It'
    • Abstract: Purpose of Review Lipoprotein(a) [Lp(a)] is a pro-inflammatory, pro-thrombotic, and pro-atherogenic lipoprotein particle. Lp(a) binds and transports oxidized phospholipids in the bloodstream. It is one of the strongest genetic risk factors for coronary artery disease, stroke, and calcific aortic valve stenosis. Recent Findings Elevated Lp(a) levels, or hyperlipoproteinemia(a), is associated with cardiovascular outcomes even in high-risk individuals who achieve their low-density lipoprotein cholesterol target with statins. Lifestyle modification therapy and dietary supplements have little impact on plasma Lp(a) levels. However, in individuals with hyperlipoproteinemia(a), the adherence to ideal cardiovascular health metrics (not smoking, having a healthy diet, being physically active, having a normal body mass index, having a normal blood pressure as well as blood sugar and cholesterol levels) might reduce the cardiovascular risk associated with elevated Lp(a) levels. Cardiovascular drugs such as proprotein convertase subtilisin/kexin type 9 inhibitors and niacin provide modest reductions in Lp(a) levels. Lp(a)-targeted therapies are currently being developed, and their impact on cardiovascular risk is yet to be determined. Summary In the absence of approved Lp(a)-targeted therapies, a holistic approach combining strict control of traditional cardiovascular risk factors and the adequate management of lifestyle-related risk factors is likely to significantly reduce cardiovascular risk in patients with hyper-Lp(a).
      PubDate: 2018-09-29
       
  • Time to Make a Change: Assessing LDL-C Accurately in the Era of Modern
           Pharmacotherapeutics and Precision Medicine
    • Abstract: Purpose of Review The Friedewald equation for estimation of low-density lipoprotein cholesterol (LDL-C) was published in 1972 as an alternative to direct assessment by preparative ultracentrifugation. In this equation, very low-density lipoprotein is estimated by dividing triglycerides by a fixed factor (5 in mg/dL or 2.2 in mmol/L) and subtracting this term from non-high-density lipoprotein cholesterol (non-HDL-C). This method was derived in fasting samples from a small cohort of patients with primarily genetic dyslipidemias followed at the NIH. The method served well as the global standard for LDL-C estimation for decades, but is not well suited to modern clinical practice because it tends to underestimate LDL-C at low LDL-C and high triglyceride levels. The concern is that underestimation could lead to undertreatment in high-risk patients. Recent Findings Derived from big data and now validated around the world, a novel LDL-C equation created at Johns Hopkins replaces the fixed factor seen in the classic equation with a patient-specific variable based on triglyceride and non-HDL-C levels. Summary Given its superior accuracy in fasting and non-fasting populations alike, the novel equation is now the preferred method for LDL-C estimation and is being incorporated by leading clinical laboratories.
      PubDate: 2018-09-13
       
  • Delivery of Automated External Defibrillators (AED) by Drones:
           Implications for Emergency Cardiac Care
    • Abstract: Purpose of Review Out-of-hospital cardiac arrest (OHCA) remains a significant health problem in the USA and only 8.6% of victims survive with good neurological function, despite advances in emergency cardiac care. The likelihood of OHCA survival decreases by 10% for every minute without resuscitation. Recent Findings Automatic external defibrillators (AEDs) have the potential to save lives yet public access defibrillators are underutilized (< 2% of the time) because they are difficult to locate and rarely available in homes or residential areas, where the majority (70%) of OHCA occur. Even when AEDs are within close proximity (within 100 m), they are not used 40% of the time. Summary Unmanned aerial vehicles, or drones, have the potential to deliver AEDs to a bystander and augment emergency medical service (EMS) care. We review the use of drones in medicine, what is currently known, and clinical implications for advancing emergency cardiac care.
      PubDate: 2018-09-03
       
  • Use of Wearable Technologies for Early Diagnosis and Management of Acute
           Coronary Syndromes and Arrhythmias
    • Abstract: Purpose of Review We sought to describe current issues in patient healthcare access to diagnostics and potential solutions via wearable and/or mobile/digital technologies. Recent Findings There are ongoing as well as completed studies showing feasibility of direct-to-consumer FDA-approved technologies to identify acute coronary syndromes and/or arrhythmias. Summary Improvement in direct-to-consumer technology, cloud-based services, and access to the internet have the potential to greatly benefit and impact patient engagement and access to healthcare as well as early diagnosis of cardiovascular-related diseases.
      PubDate: 2018-08-25
       
  • The Timing and Role of Atrial Fibrillation Ablation in Heart Failure
           Patients
    • Abstract: Purpose of Review Atrial fibrillation (AF) and heart failure (HF) are cardiovascular disease epidemics with increasing prevalence worldwide. AF can either be a cause or consequence of cardiomyopathy and HF. Catheter ablation (CA) has been a proven therapy for symptomatic, medically refractory AF patients. The purpose of this review is to highlight the role as well as timing of CA in treating AF patients with HF. Recent Findings Multiple randomized clinical trials in recent years have elegantly demonstrated the superiority of CA in improving survival, quality of life, ventricular function, and reduce hospitalizations, when compared to antiarrhythmic drugs, medical rate control, as well as AV nodal ablation and biventricular pacing, in patients with HF and cardiomyopathy. These data clearly show that restoration and maintenance of sinus rhythm in HF patients, when accomplished by CA, improves hard clinical endpoints in this complex population. A substantial reduction in AF burden, and not complete elimination, was strongly associated with better outcomes and suggests an occult ‘arrhythmia induced cardiomyopathy’. Long-term success rate of a single ablation procedure remains subpar, and additional procedures are often necessary to achieve durable rhythm control. Summary Catheter ablation now occupies a central role in rhythm control of AF in HF patients and should be considered as a first-line therapy in these patients. More data is needed regarding optimal timing of CA in HF patients but it stands to reason that early ablation should aid in long-term reduction in AF burden and allow favorable LA and LV remodeling.
      PubDate: 2018-07-19
       
  • Coronary Calcium Score vs. Computed Tomography Angiography as Tools to
           Stratify Cardiovascular Risk
    • Abstract: Purpose of Review This review evaluates the evidence for and against the use of coronary artery calcium (CAC) score and coronary computed tomography angiography (CTA) on the cardiovascular risk stratification for primary prevention in asymptomatic individuals. Recent Findings Recent evidence suggests that the presence and extent of CAC are robust predictors of events across various populations and variable baseline risk. On the other hand, the absence of CAC is associated with a good prognosis event in older individuals or in those with multiple risk factor or high clinical risk. While coronary CTA is also useful for risk stratification, its results did not provide incremental discrimination of individuals once the CAC is accounted for. Thus, current evidence does not support its use in asymptomatic individuals. Summary CAC is a powerful tool for additional cardiovascular risk stratification in individuals where the need for pharmacological therapy for risk reduction in primary prevention is uncertain, such as in individuals with intermediate risk. Since coronary CTA does not further improve risk stratification in this population, it is not currently recommended in asymptomatic individuals.
      PubDate: 2018-06-22
       
  • The Relationship of Objective Physical Activity with Traditional and
           Nontraditional Cardiovascular Disease Risk Factors in Women
    • Abstract: Purpose of Review Cardiovascular disease (CVD) is the leading cause of death among women in the USA, accounting for one of every three deaths. Physical activity (PA) has been shown to have numerous beneficial effects for CVD risk reduction in women. Nonetheless, much of the previous research on the impact of PA on CVD risk factors has been measured using self-report questionnaires. The purpose of this review was to summarize the main findings for the association between objectively measured PA and PA interventions on traditional and nontraditional CVD risk factors from randomized controlled trials (RCT), cohort, and cross-sectional studies published in or after 2011. Traditional risk factors included hypertension, lipids, diabetes mellitus, and obesity whereas nontraditional risk factors included hypertension during pregnancy, gestational diabetes mellitus (GDM), polycystic ovary syndrome (PCOS), and depression. Recent Findings Shifting from traditional CVD risk factors to nontraditional, researchers have been assessing objective PA and PA interventions on pregnancy-related CVD risk factors. A recent meta-analysis and RCT found that exercise during pregnancy reduces the risk of GDM compared to standard maternity care. Recent intervention studies show the beneficial effects of strength training and high-intensity interval training on insulin resistance in women with PCOS. Summary More research looking at PA interventions with objectively measured compliance to PA (actual number of minutes, intensity, etc.) and observational studies using objective measures for PA (accelerometers, pedometers, etc.) are necessary at this time due to the difficulty of measuring light PA and the overestimation of MVPA through self-report.
      PubDate: 2018-06-15
       
  • Debunking the Myth of Diabetes Mellitus as Cardiovascular Disease
           Equivalent: What Took So Long'
    • Abstract: Purpose of Review Individuals with diabetes mellitus (DM) have historically been reported to have the same risk of having a future myocardial infarction (MI) as an individual with known coronary heart disease (CHD). In other words, DM has been widely accepted as a coronary heart disease (CHD) equivalent. We review the literature that established DM as a CHD risk equivalent and how over time it has become clear that DM carries a spectrum of risk. Recent Findings Newer studies suggest that DM is heterogeneous, with certain subgroups such as women, those with longer duration of DM, and increased severity of disease may be more susceptible to downstream complications and cardiovascular events than those in other subgroups. The use of coronary artery calcium scoring for risk stratification in this group has now been shown to have clinical utility. Summary DM surely does infer increased risk of developing coronary heart disease upon an individual; however, this risk is not as high as historically presumed. Certain subgroups among the DM population may have a higher risk of CHD when identified by burden of subclinical disease; these individuals can be identified early to begin personalized management of their disease.
      PubDate: 2018-06-15
       
 
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