Current Cardiovascular Risk Reports

Obesity and cardiovascular disease are uncommon in people consuming plant-based diets. In contrast, overweight and obesity are surging in US children and adults, increasing their risk for cardiovascular disease and diabetes. Plant-based diets are primarily comprised of whole plant foods that are rich in fiber and several beneficial phytochemicals and low to moderate in fat. Plant-based dietary patterns have been shown to reduce body weight and cardiovascular risk factors in adults, children, and adolescents. Well-planned plant-based diets are nutritionally adequate, well-accepted, and sustainable for the long term and represent an effective strategy in the control of obesity and cardiovascular disease risk.

Atrial fibrillation is a common cardiac arrhythmia found in the elderly. The cornerstones of therapy are prevention of thromboembolism with anticoagulation therapy, control of ventricular rate, and restoration of sinus rhythm when feasible. The use of warfarin therapy has been shown to be effective in reducing strokes, but management can be difficult, and the development of new oral anticoagulant medications is an area of ongoing research. In addition, new strategies to promote the maintenance of sinus rhythm, including new pharmacotherapy as well as catheter-based and surgical procedures, are becoming more widespread. Data regarding the use of more invasive modalities in elderly patients are accumulating. In this article, we will give a brief overview of current management options of atrial fibrillation, and will focus specifically on new data pertaining to the role of these strategies in elderly patients.

Results from early studies suggested an association between dairy products and higher cardiovascular risk (CR). Considering that dairy products are rich in saturated fatty acids (SFA) and that a consistent association between higher SFA consumption and plasma cholesterol concentrations had been shown, these results were considered evident. However, several later investigations dispute such an association between consumption of dairy products and greater CR, and even find the association between dairy intake and hypercholesterolemia to be inconsistent. Moreover, recent meta-analyses have reported an inverse relationship between dairy consumption and CR, and a favorable effect on lipid profile has been suggested. Despite numerous studies, the effect of genetic variation has not been investigated in depth to explain the heterogeneity of results and provide better balance in the recommendations. Recent work suggests that variations in the lactase gene could be of importance in this relationship.

Reduction of cardiovascular disease (CVD) events in patients with type 2 diabetes remains an area of intense interest and research. Recent trials of lower systolic blood pressure goals and combination lipid therapy have failed to show a significant reduction in CVD events in patients with diabetes. Antiplatelet agents are an additional option for CVD risk reduction in patients both with and without diabetes. However, two recent trials have questioned the role of aspirin in the primary prevention of CVD events in patients with diabetes. Although sub-analyses of larger trials have suggested a potential benefit of thienopyridine therapy in patients with diabetes, direct comparative trials are lacking and aspirin remains the appropriate first-line agent. Recent guidelines issued by the American Diabetes Association, American Heart Association, and American College of Cardiology Foundation on the use of aspirin for primary prevention in patients with diabetes remain the standard of practice. Two ongoing trials will help to address the question of the relative benefit of aspirin in patients with diabetes. The Aspirin and Simvastatin Combination for Cardiovascular Events Prevention Trial in Diabetes (ACCEPT-D) and A Study of Cardiovascular Events in Diabetes (ASCEND) are both randomized trials of 100 mg of aspirin compared to placebo and will enroll a combined 15,000 patients with diabetes between the two trials. Results may become available as soon as 2012.

Coronary artery disease (CAD) is a common and etiologically complex disease worldwide. Current guidelines for primary prevention, or the prevention of a first acute event, include relatively simple risk assessment and leave substantial room for improvement both for risk ascertainment and selection of prevention strategies. Here, we review how advances in big data and predictive modeling foreshadow a promising future of improved risk assessment and precision medicine for CAD. Artificial intelligence (AI) has improved the utility of high dimensional data, providing an opportunity to better understand the interplay between numerous CAD risk factors. Beyond applications of AI in cardiac imaging, the vanguard application of AI in healthcare, recent translational research is also revealing a promising path for AI in multi-modal risk prediction using standard biomarkers, genetic and other omics technologies, a variety of biosensors, and unstructured data from electronic health records (EHRs). However, gaps remain in clinical validation of AI models, most notably in the actionability of complex risk prediction for more precise therapeutic interventions. The recent availability of nation-scale biobank datasets has provided a tremendous opportunity to richly characterize longitudinal health trajectories using health data collected at home, at laboratories, and through clinic visits. The ever-growing availability of deep genotype-phenotype data is poised to drive a transition from simple risk prediction algorithms to complex, “data-hungry,” AI models in clinical decision-making. While AI models provide the means to incorporate essentially all risk factors into comprehensive risk prediction frameworks, there remains a need to wrap these predictions in interpretable frameworks that map to our understanding of underlying biological mechanisms and associated personalized intervention. This review explores recent advances in the role of machine learning and AI in CAD primary prevention and highlights current strengths as well as limitations mediating potential future applications.

The obesity is a conventional cardiovascular risk factor. Obesity has detrimental effects on heart failure, but has been found to be paradoxically associated with improved survival. The obesity paradox remains controversial in the literatures. There are various underlying mechanisms to explain the obesity paradox in heart failure. Epidemiologic, biochemical, animal studies revealed this unexpected phenomenon, which was described as an obesity paradox. BMI does not provide information body composition and cardiopulmonary fitness status, which can be related to obesity paradox. Still, the obesity paradox is controversial; therefore, intentional weight gaining may not be recommended. Many researches related to obesity paradox have been introduced and further research needs to be done in the future.

Nicotine dependence continues to be a major public health problem worldwide and there is unequivocal evidence that genetics play a substantial role in its etiology. This review provides an overview of the evidence for genetic influences and recent advances in the field. Traditional quantitative genetics studies have revealed nicotine dependence is heritable and molecular genetics studies are providing increasing evidence that the genes responsible for nicotine’s pharmacokinetics and pharmacodynamics are particularly important. Despite considerable progress, a number of significant complexities and challenges remain. These include determining the specificity of genetic influences and clarifying the role of interactive contributions. One promising strategy for addressing these issues is an intermediate phenotype approach that attempts to identify the intervening proximal mechanisms that confer differential genetic risk. Understanding these mechanisms may permit more precision in understanding genetic influences and may also identify novel targets for intervention or prevention.