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Heart rate variability (HRV) is a reliable tool for the evaluation of several physiological factors modulating the heart rate (HR). Importantly, variations of HRV parameters may be indicative of cardiac diseases and altered psychophysiological conditions. Recently, several studies focused on procedures for contactless HR measurements from facial videos. However, the performances of these methods decrease when illumination is poor. Infrared thermography (IRT) could be useful to overcome this limitation. In fact, IRT can measure the infrared radiations emitted by the skin, working properly even in no visible light illumination conditions. This study investigated the capability of facial IRT to estimate HRV parameters through a face tracking algorithm and a cross-validated machine learning approach, employing photoplethysmography (PPG) as the gold standard for the HR evaluation. The results demonstrated a good capability of facial IRT in estimating HRV parameters. Particularly, strong correlations between the estimated and measured HR ( r = 0.7), RR intervals ( r = 0.67), TINN ( r = 0.71), and pNN50 (%) ( r = 0.70) were found, whereas moderate correlations for RMSSD ( r = 0.58), SDNN ( r = 0.44), and LF/HF ( r = 0.48) were discovered. The proposed procedure allows for a contactless estimation of the HRV that could be beneficial for evaluating both cardiac and general health status in subjects or conditions where contact probe sensors cannot be used.

Purpose of Review Cardiovascular diseases are the leading cause of mortality globally. Identifying patients at risk is important to initiate preventive strategies. Over the last few decades, the role of the endothelium and its impact on arterial stiffness have been recognised as playing a pivotal role in cardiovascular disease. This review will focus on the effect of arterial stiffness in different patient cohorts with regard to cardiovascular morbidity and mortality, as well as its use in clinical practice. Recent Findings Arterial stiffness is associated with a range of cardiovascular risk factors and is an independent predictor of cardiovascular mortality. The gold standard for evaluating arterial stiffness is pulse wave velocity. Recently, cardio-ankle vascular index has been implemented as an easy and highly reproducible measure of arterial stiffness. Moreover, certain pharmacologic agents may modify arterial stiffness and alter progression of cardiovascular disease. Summary The endothelium plays an important role in cardiovascular disease. Implementing assessment of arterial stiffness in clinical practice will improve stratification of patients at risk of cardiovascular disease and help modify disease progression.

Background Biomarkers may contribute to improved cardiovascular risk estimation. Glycated hemoglobin A 1c (HbA 1c ) is used to monitor the quality of diabetes treatment. Its strength of association with cardiovascular outcomes in the general population remains uncertain. This study aims to assess the association of HbA 1c with cardiovascular outcomes in the general population. Methods Data from six prospective population-based cohort studies across Europe comprising 36,180 participants were analyzed. HbA 1c was evaluated in conjunction with classical cardiovascular risk factors (CVRFs) for association with cardiovascular mortality, cardiovascular disease (CVD) incidence, and overall mortality in subjects without diabetes (N = 32,496) and with diabetes (N = 3684). Results Kaplan–Meier curves showed higher event rates with increasing HbA 1c levels (log-rank-test: p < 0.001). Cox regression analysis revealed significant associations between HbA 1c (in mmol/mol) in the total study population and the examined outcomes. Thus, a hazard ratio (HR) of 1.16 (95% confidence interval (CI) 1.02–1.31, p = 0.02) for cardiovascular mortality, 1.13 (95% CI 1.03–1.24, p = 0.01) for CVD incidence, and 1.09 (95% CI 1.02–1.17, p = 0.01) for overall mortality was observed per 10 mmol/mol increase in HbA 1c . The association with CVD incidence and overall mortality was also observed in study participants without diabetes with increased HbA 1c levels (HR 1.12; 95% CI 1.01–1.25, p = 0.04) and HR 1.10; 95% CI 1.01–1.20, p = 0.02) respectively. HbA 1c cut-off values of 39.9 mmol/mol (5.8%), 36.6 mmol/mol (5.5%), and 38.8 mmol/mol (5.7%) for cardiovascular mortality, CVD incidence, and overall mortality, showed also an increased risk. Conclusions HbA 1c is independently associated with cardiovascular mortality, overall mortality and cardiovascular disease in the general European population. A mostly monotonically increasing relationship was observed between HbA 1c levels and outcomes. Elevated HbA 1c levels were associated with cardiovascular disease incidence and overall mortality in participants without diabetes underlining the importance of HbA 1c levels in the overall population.

ObjectiveTo identify, critically appraise and summarise existing systematic reviews on the impact of global cardiovascular risk assessment in the primary prevention of cardiovascular disease (CVD) in adults.DesignSystematic review of systematic reviews published between January 2005 and October 2016 in The Cochrane Library, EMBASE, MEDLINE or CINAHL databases, and post hoc analysis of primary trials.Participants, interventions, outcomesSystematic reviews of interventions involving global cardiovascular risk assessment relative to no formal risk assessment in adults with no history of CVD. The primary outcomes of interest were CVD-related morbidity and mortality and all-cause mortality; secondary outcomes were systolic blood pressure (SBP), cholesterol and smoking.ResultsWe identified six systematic reviews of variable but generally of low quality (mean Assessing the Methodological Quality of Systematic Reviews 4.2/11, range 0/11 to 7/11). No studies identified by the systematic reviews reported CVD-related morbidity or mortality or all-cause mortality. Meta-analysis of reported randomised controlled trials (RCTs) showed small reductions in SBP (mean difference (MD) −2.22 mm Hg (95% CI −3.49 to −0.95); I2=66%; n=9; GRADE: very low), total cholesterol (MD −0.11 mmol/L (95% CI −0.20 to −0.02); I2=72%; n=5; GRADE: very low), low-density lipoprotein cholesterol (MD −0.15 mmol/L (95% CI −0.26 to −0.05), I2=47%; n=4; GRADE: very low) and smoking cessation (RR 1.62 (95% CI 1.08 to 2.43); I2=17%; n=7; GRADE: low). The median follow-up time of reported RCTs was 12 months (range 2–36 months).ConclusionsThe quality of existing systematic reviews was generally poor and there is currently no evidence reported in these reviews that the prospective use of global cardiovascular risk assessment translates to reductions in CVD morbidity or mortality. There are reductions in SBP, cholesterol and smoking but they may not be clinically significant given their small effect size and short duration. Resources need to be directed to conduct high-quality systematic reviews focusing on hard patient outcomes, and likely further primary RCTs.Trial registration numberCRD42015019821.

Patients with rheumatoid arthritis (RA) have an increased risk of developing cardiovascular disease (CVD). Identification of at-risk patients is paramount to initiate preventive care and tailor treatments accordingly. Despite international guidelines recommending all patients with RA undergo CVD risk assessment, rates remain suboptimal. The objectives of this review were to map the strategies used to conduct CVD risk assessments in patients with RA in routine care, determine who delivers CVD risk assessments, and identify what composite measures are used. The Joanna Briggs Institute methodological guidelines were used. A literature search was conducted in electronic and grey literature databases, trial registries, medical clearing houses, and professional rheumatology organisations. Findings were synthesised narratively. A total of 12 studies were included. Strategies reported in this review used various system-based interventions to support delivery of CVD risk assessments in patients with RA, operationalised in different ways, adopting two approaches: (a) multidisciplinary collaboration, and (b) education. Various composite measures were cited in use, with and without adjustment for RA. Results from this review demonstrate that although several strategies to support CVD risk assessments in patients with RA are cited in the literature, there is limited evidence to suggest a standardised model has been applied to routine care. Furthermore, extensive evidence to map how health care professionals conduct CVD risk assessments in practice is lacking. Research needs to be undertaken to establish the extent to which healthcare professionals are CVD risk assessing their patients with RA in routine care.Key Points• A limited number of system-based interventions are in use to support the delivery of CVD risk assessments in patients with RA.• Multidisciplinary team collaboration, and education are used to operationalise interventions to support Health Care Professionals in conducting CVD risk assessments in practice.• The extent to which Health Care Professionals are CVD risk assessing their patients with RA needs to be established.

Purpose Patients with adrenal insufficiency (AI) are known to have a higher cardiovascular risk (CVR) than the normal population. In particular arteriosclerosis, coronary heart disease, arterial hypertension, hyperlipoproteinemia as well as metabolic disturbances contribute to the increased morbidity and mortality. Aim of this study was to evaluate known CVR factors along with the quality of care by the treating physicians. Methods To this end the medical records of AI patients were screened for CVR factors and the treatment initiated was documented. In addition, a questionnaire evaluating CVR factors was analyzed if available. Results In total, 327 AI patients were included in the study. At least 298 of these patients were found to have one or more CVR factors. Ninety-one patients were diagnosed with arterial hypertension, of these 40 patients (44%) still showed increased blood pressure (BP) values. Of all AI patients, about 25% ( n  = 83) did not have measurements to calculate their BMI, even though obesity is known as a major risk factor for cardiovascular events. Out of 46 patients with diabetes, one-quarter still had increased HbA1c values. Regarding hyperlipoproteinemia, only 2% of AI patients achieved normal lipid values across all parameters ( n  = 8). Interestingly, at least one lipid variable was untested in 150 patients (46%). Conclusion Our study demonstrates (1) the high rate of CVR factors in AI patients, leading to increased morbidity and eventually mortality, (2) AI patients are inadequately monitored and treated for CVR factors, (3) treating physicians should be aware of this risk to minimize complications where possible.

Background Apolipoprotein A‐I (ApoA‐I), the principal protein component of high‐density lipoproteins (HDL), plays a pivotal role in cardiovascular physiology and has gained increasing attention in atherosclerotic cardiovascular disease (ASCVD). Its involvement extends beyond lipid transport to include anti‐inflammatory and antioxidant mechanisms. Objective To comprehensively evaluate the role of ApoA‐I in ASCVD, including its biological functions, clinical relevance as a biomarker, and potential as a therapeutic target. Methods A scoping review of the literature was conducted to examine current evidence on ApoA‐I in cardiovascular health and disease. Studies assessing its role in reverse cholesterol transport (RCT), association with cardiovascular outcomes, and emerging therapeutic strategies were included. Results ApoA‐I contributes significantly to reverse cholesterol transport and exhibits antioxidant and anti‐inflammatory properties that protect against atherosclerosis. Elevated ApoA‐I levels are consistently associated with reduced risk of major adverse cardiovascular events, supporting its utility as a biomarker for cardiovascular risk assessment. However, variability in HDL particle composition and the influence of confounding factors such as comorbidities and lifestyle limit its interpretability. Therapeutic approaches targeting ApoA‐I, including infusion therapies and mimetic peptides, have shown mixed results in clinical trials, highlighting ongoing challenges. Conclusion ApoA‐I remains a promising biomarker and therapeutic target in ASCVD, though its clinical application is complicated by biological and methodological variability. Future research focusing on gene therapies, small molecule modulators, and ApoA‐I mimetics may enhance its functional properties and clinical utility. Integrating ApoA‐I into personalized treatment strategies could improve cardiovascular outcomes and reduce disease burden. Apolipoprotein A‐I (ApoA‐I), the principal protein of HDL, plays a key role in reverse cholesterol transport, inflammation modulation, and plaque stabilization in atherosclerotic cardiovascular disease. Emerging ApoA‐I–based therapies, including CSL112, enhance cholesterol efflux capacity, though definitive reductions in cardiovascular events remain under investigation in ongoing clinical trials.

Background Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality in India. CVDs are to a large extent preventable with the availability of wide range of interventions focusing on primary and secondary prevention. However human resource deficit is the biggest challenge for implementing these prevention programs. Task shifting of the cardiovascular risk assessment and communication to nurses can be one of the most viable and sustainable option to run prevention programs. Methods The study was quasi experimental in nature with 1 year follow up to determine the effect of CVD risk assessment and communication by nurses with the help of risk communication package on primary and secondary prevention of CVDs. The study was done in the outpatient departments of a tertiary health care center of Northern India. All the nurses ( n  = 16) working in selected OPDs were trained in CVD risk assessment and communication of risk to the patients. A total of 402 patients aged 40 years and above with hypertension (HTN) were recruited for primary prevention of CVDs from medicine and allied OPDs, whereas 500 patients who had undergone CABG/PTCA were recruited from cardiology OPDs for secondary prevention of CVDs and were randomized to intervention ( n  = 250) and comparison group ( n  = 250) by using block randomization. CVD risk modification and medication adherence were the outcomes of interest for primary and secondary prevention of CVDs respectively. Results The results revealed high level of agreement (k = 0.84) between the risk scores generated by nurses with that of investigator. In the primary prevention group, there were significantly higher proportion of participants in the low risk category (70%) as compared to baseline assessment (60.6%) at 1 year follow up. Whereas in secondary prevention group the mean medication adherence score among intervention group participants (7.60) was significantly higher than that of the comparison group (5.96) with a large effect size of 1.1.( p  < 0.01). Conclusion Nurse led intervention was effective in risk modification and improving medication adherence among subjects for primary and secondary prevention of CVDs respectively. Trial registration Trial registration no CTRI/2018/01/011372 [Registered on: 16/01/2018] Trial Registered Retrospectively.

Background and aims In Latin America (LATAM), the level of awareness and clinical implementation of lipoprotein(a) (Lp(a)) testing among physicians remain largely unknown. This study aimed to evaluate the knowledge, frequency of use, and clinical management practices related to Lp(a) among LATAM physicians. Methods We conducted a cross-sectional, 36-item Spanish-language online survey using convenience sampling through medical societies in twenty LATAM countries. All items were mandatory. The questionnaire included two sections based on whether respondents requested Lp(a) testing and explored barriers among nonusers. Results A total of 512 physicians from various LATAM countries responded, with Mexico representing 75.4% of the participants. Overall, 36.7% of the physicians reported currently requesting Lp(a) testing, primarily in patients with premature cardiovascular diseases (CVD), familial hypercholesterolemia (FH), or recurrent events despite low-density lipoprotein (LDL-C) at goal. Among those never ordering Lp(a) testing, the main barriers were lack of availability (57.4%) and high cost (33.6%). Knowledge gaps were identified: Only half of the respondents correctly identified Lp(a) risk thresholds or LDL-C targets. Despite this, most physicians who ordered the Lp(a) test reported taking active measures such as intensifying lipid-lowering therapy (LLT) (90%) and intensifying the management of other CV risk factors (68%) if Lp(a) was > 50 mg/dL or 125 nmol/L. Conclusions Awareness and clinical use of Lp(a) testing among LATAM physicians remain limited and focused on high-risk scenarios. Improving test accessibility, providing clearer clinical guidelines, and reinforcing the evidence for Lp(a) as a therapeutic target may enhance its adoption and integration into cardiovascular risk assessment across the region.

People living with type 1 diabetes (T1D) have an increased risk of cardiovascular disease (CVD), and it is the leading cause of morbidity and mortality in this population. CVD risk increases with each uncontrolled risk factor, even in individuals with good glycaemic control. Recommendations for assessing CVD risk in the T1D population are extended from those for type 2 diabetes (T2D) even though the physiopathology and underlying mechanisms of atherosclerosis in T1D are poorly understood and differ from those in T2D. Unlike the assessment of microvascular complications, which is well established in T1D, this is far from being the case for the comorbidities and risk associated with CVD. Aside from classical cardiovascular comorbidities, carotid ultrasound can be useful to stratify CVD risk. The utilization of specific risk scales such as the Steno Type 1 Risk Engine can help to more accurately classify cardiovascular risk in these individuals. The cornerstones of the management of cardiovascular risk in T1D are the promotion of the Mediterranean diet, tight glycaemic control (glycated haemoglobin (HbA1c) < 7%), blood pressure < 130/80 mmHg in most patients, and low-density lipoprotein (LDL) cholesterol < 100 mg/dL in moderate-risk individuals, < 70 mg/dL in high-risk individuals, and < 55 mg/dL in very high-risk individuals. Conventional medical follow-up of patients with T1D should be individualized (approximately 2–3 visits per year), and a carotid ultrasound evaluation is recommended every 5 years in the absence of significant preclinical atherosclerosis or more often in those with severe preclinical atherosclerosis. Antithrombotic therapy is recommended in those receiving secondary prevention, those with stenosis > 50% in any arterial bed, and those with an impaired ankle-brachial index. This document is a proposal of a practical approach for the evaluation, classification, and management of CVD risk in individuals living with T1D.