The Roundtable on Obesity Solutions (ROOS), established in 2014, is a unique organization of multisectoral voices addressing the public health challenge of obesity. The ROOS brings together practitioners, researchers, fu...The Roundtable on Obesity Solutions (ROOS), established in 2014, is a unique organization of multisectoral voices addressing the public health challenge of obesity. The ROOS brings together practitioners, researchers, funders, companies, health systems, government agencies, and the lived experience to dialogue and guide the national conversation about the multilevel challenges and opportunities related to obesity. This paper presents insights and key learnings from a symposium developed to celebrating the 10th Anniversary of the ROOS. The first six years (2014-2019) of the ROOS marked a period in which dialogue was initiated, multi-sectoral perspectives were captured, and important viewpoints were deliberated and published. In 2020, the ROOS engaged in a strategic planning process enabled by systems science that ultimately resulted in the creation of a roadmap focused on drivers and solutions of obesity. This roadmap generated an agenda focused on upstream social and structural drivers of obesity with an emphasis on the integration of equity, gaps, strategies, and the lived experience. Three main priorities identified in this roadmap included structural racism, social norms, and health communications. Based on this work, the ROOS has had significant impact in the areas of equity, weight stigma, and the lived experience. Much work remains. To date, obesity solutions available for prevention and treatment have been vastly underutilized. Future directions should: 1) include increasing access to effective prevention and treatment options; 2) a focus on how best to implement new technologies in obesity prevention and care; 3) addressing issues of equity, literacy, and stigma that remain unresolved; and 4) leveraging the influence of regional cultures, policies, and social norms. We hope that insights gained over the previous 10 years will inspire another decade of impact for the ROOS.
BACKGROUND: Regular physical activity (PA) is important for reducing the risk of chronic diseases and improving overall health. Activity Quotient (AQ) is a novel metric that translates heart rate during PA into a weekly...BACKGROUND: Regular physical activity (PA) is important for reducing the risk of chronic diseases and improving overall health. Activity Quotient (AQ) is a novel metric that translates heart rate during PA into a weekly score, providing an objective measure of an individual's PA. We prospectively examined the association of AQ with cancer and cardiovascular (CVD) mortality outcomes, the two major causes of death, in a Taiwanese population. METHODS: A cohort of 515,608 healthy adults (52 % women) enrolled in a standard medical screening program was followed for mortality outcomes. The weekly AQ score of each participant was estimated based on self-reported PA intensity and weekly duration, and placed into six categories (0, ≤50, 51-99,100-149, 150-199, or ≥ 200 AQ per week). We used multivariable Cox proportional hazard models adjusted for potential confounders to estimate the hazard ratios (HR) and 95 % confidence intervals (CI). RESULTS: Higher weekly AQ scores were associated with lower risks of CVD, cancer, and all-cause mortalities. Compared with inactive individuals, HRs (CI) for the association of AQ scores of ≤50, 50-99, 100-149, 150-199, and ≥ 200 were 0.93 (0.89-0.97), 0.91 (0.85-0.96), 0.84 (0.77-0.91), 0.84 (0.74-0.96), and 0.81 (0.73-0.90) with cancer mortality; and 0.88 (0.83-0.93), 0.86 (0.80-0.93), 0.81 (0.73-0.90), 0.71 (0.60-0.85), and 0.73 (0.64-0.84) with CVD mortality, respectively. Subgroup analyses showed that meeting 50 AQ a week was associated with lower risk of disease specific mortality risk across age groups and among individuals with known risk factors. Higher weekly AQ scores were also associated with longer life expectancy, with the highest gains observed among those achieving 150-199 weekly AQ. CONCLUSION: Our findings show that AQ may be an objective tool for assessing and tracking PA and predicting mortality risks. Encouraging individuals to achieve ≥50 AQ a week could have substantial public health benefits, including lower mortality from major chronic diseases as well as prolonged health- and life expectancy.
Ejection fraction (EF) is the principal parameter used clinically to assess cardiac function and provides prognostic information. However, significant myocardial damage can be present despite preserved EF. Recently, the...Ejection fraction (EF) is the principal parameter used clinically to assess cardiac function and provides prognostic information. However, significant myocardial damage can be present despite preserved EF. Recently, the measurement of left ventricle (LV) deformation by global longitudinal strain (GLS) has been introduced as a novel early marker of cardiac dysfunction. Cardiotoxicity is a frequent side effect of several drugs most notably those used in the treatment of cancer. Although oncology drugs remain the best known cardiotoxic medications, many other drugs can potentially affect LV function. The early recognition of LV dysfunction due to cardiotoxicity is important and of increasing clinical relevance particularly with the rapid pace of development of new drugs. The aim of our review is to provide an overview of the current literature regarding utility of GLS to assess drug-induced myocardial damage. We propose that GLS is a sensitive early marker of myocardial dysfunction associated with the use of certain medications with high risk of cardiotoxicity. Thus, the use of this technique can potentially alert the clinician to myocardial toxicity before reductions in EF are seen.
Raynaud's phenomenon (RP) is a vascular disease characterized by exaggerated vasoconstriction in response to stressors, mainly cold and emotional stress. This vasoconstriction is mediated solely by alpha 2C-adrenoceptors...Raynaud's phenomenon (RP) is a vascular disease characterized by exaggerated vasoconstriction in response to stressors, mainly cold and emotional stress. This vasoconstriction is mediated solely by alpha 2C-adrenoceptors (α-AR) expressed in vascular smooth muscle cells of dermal arterioles. Several factors, among which is cigarette smoking, are associated with aggravated symptoms of and increased risk for RP. Evidence shows that cigarette smoking induces the production of reactive oxygen species (ROS), which is a major driver of RP pathogenesis. However, the exact mechanism by which smoking contributes to RP or α-AR remains unclear. Here, we show that cigarette smoke extract (CSE) upregulates the expression of α-AR in a concentration- and time-dependent manner in VSMCs extracted from human dermal arterioles. This increase is associated with the activation of p38 MAPK, as pretreatment with SB-202190, a p38 specific inhibitor, attenuated CSE-induced α-AR expression. Furthermore, our results show that CSE induces ROS production followed by increased RhoA activation. We also show that CSE induces translocation of vascular α-AR to the plasma membrane, and that this mobilization is attenuated by inhibiting ROS via N-acetylcysteine or apocynin. Similarly, inhibition of Rho kinase via H- 11522 abolished CSE-induced α-AR translocation. Collectively, these results indicate that CSE activates two different signaling pathways to induce the expression and the translocation of α-AR. While CSE activates a p38-dependent mechanism to increase α-AR expression, it initiates the receptor's spatial and functional rescue via a ROS/RhoA signaling pathway. These results provide mechanistic insight into the effect of cigarette smoking on RP, and further reinforce that smoking avoidance/cessation is critical to manage this disease, especially in the absence of a definitive drug for RP.
Complications of percutaneous coronary intervention (PCI) can lead to significant morbidity and mortality. In-depth understanding of the mechanisms and management options of these complications as well as timely recognit...Complications of percutaneous coronary intervention (PCI) can lead to significant morbidity and mortality. In-depth understanding of the mechanisms and management options of these complications as well as timely recognition and action can sometimes be lifesaving. In this review we discuss the mechanisms, prevention methods, diagnosis, and management of three major PCI complications: a) perforation b) acute vessel closure, and c) equipment loss.
Prog Cardiovasc Dis
· 2025 · PMID 39788340
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Myocardial viability assessment is used to determine if chronically dysfunctional myocardium may benefit from coronary revascularization. Cardiac magnetic resonance with late gadolinium enhancement is the current gold st...Myocardial viability assessment is used to determine if chronically dysfunctional myocardium may benefit from coronary revascularization. Cardiac magnetic resonance with late gadolinium enhancement is the current gold standard for visualizing myocardial scar and provides valuable insight into myocardial viability. Viability assessments can also be made with Cardiac Positron Emission Tomography, Echocardiography, Single Photon Emission Tomography, and Cardiac Computed Tomography with each having advantages and disadvantages. Despite the classical interpretation that viability predicts segmental functional improvement, more recent studies have found that revascularization of viable myocardium has conflicting roles in predicting benefits for patients, especially as it relates to major adverse cardiovascular events, development of heart failure symptoms, and all-cause mortality. This review covers these conflicts along with an in-depth review of the pathophysiologic processes that are fundamental to myocardial viability and the various methods used for determining viability.
Vascular access for coronary, peripheral, and structural interventions has changed significantly over the past two decades. The evolving demand for both large-bore access for valvular interventions and mechanical support...Vascular access for coronary, peripheral, and structural interventions has changed significantly over the past two decades. The evolving demand for both large-bore access for valvular interventions and mechanical support devices, and for safer access for coronary interventions, in patients with comorbidities have driven progress in these areas. This review will provide an overview of the techniques of arterial access in the femoral, forearm (radial and ulnar), and alternative (transcarotid, transaxillary, and transcaval) locations based on the latest evidence and experience.
Shin D, Galougahi KK, Singh M
… +12 more, Caron E, Cannata M, Ciftcikal Y, Gujja M, Sakai K, Moses J, Shlofmitz R, Al-Azizi K, Doshi D, Jeremias A, Shlofmitz E, Ali ZA
Coronary artery disease (CAD) is the leading cause of mortality among patients with chronic kidney disease (CKD), presenting unique challenges in diagnosis and management. Advanced CKD patients often present with atypica...Coronary artery disease (CAD) is the leading cause of mortality among patients with chronic kidney disease (CKD), presenting unique challenges in diagnosis and management. Advanced CKD patients often present with atypical symptoms, and conventional diagnostic and interventional approaches carry risks, including contrast-induced nephropathy and the potential need for renal replacement therapy. These risks have led to the phenomenon of "renalism," where necessary procedures may be deferred due to concerns over renal injury. Emerging techniques, such as ultra-low contrast angiography (ULCA) and zero-contrast percutaneous coronary intervention (PCI), offer promising solutions by minimizing or eliminating contrast exposure. This review discusses the clinical presentation of CAD in CKD patients, limitations of traditional diagnostic approaches, and the challenges in managing these high-risk patients. It also provides an overview of ULCA and zero-contrast PCI techniques, which have shown both safety and feasibility even in complex cases. As these techniques continue to evolve, zero-contrast PCI holds the potential to become an essential component of revascularization strategies for high-risk CKD patients, enhancing procedural safety while maintaining therapeutic efficacy.
Coronary artery in-stent restenosis (ISR) is driven by neointimal hyperplasia and neo-atherosclerosis in previously placed stents. Drug eluting stents (DES) have been adopted as first line therapy for the initial episode...Coronary artery in-stent restenosis (ISR) is driven by neointimal hyperplasia and neo-atherosclerosis in previously placed stents. Drug eluting stents (DES) have been adopted as first line therapy for the initial episode of ISR. However, recurrent ISR has limited durable salvage options. In this article we review the pathophysiology, incidence, and management options of recurrent DES- ISR.
Revascularization has been demonstrated to be clearly superior to medical therapy for significant unprotected left main coronary artery (LMCA) disease. Coronary artery bypass graft surgery (CABG) has a class 1 indication...Revascularization has been demonstrated to be clearly superior to medical therapy for significant unprotected left main coronary artery (LMCA) disease. Coronary artery bypass graft surgery (CABG) has a class 1 indication in both the American and European society guidelines for the treatment of LMCA disease. However, for the population of patients who are declined CABG after a heart team evaluation, percutaneous coronary interventional (PCI) may be an efficacious alternative. This review summarizes the data on percutaneous coronary intervention of distal left main coronary artery disease including the various contemporary techniques and associated challenges.
Prog Cardiovasc Dis
· 2025 · PMID 39743126
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American culture encourages overconsumption, fueled by ubiquitous availability and pervasive marketing of ultra-processed foods and other addictive substances. This chronic overindulgence has contributed to rising rates...American culture encourages overconsumption, fueled by ubiquitous availability and pervasive marketing of ultra-processed foods and other addictive substances. This chronic overindulgence has contributed to rising rates of obesity, type 2 diabetes (T2D), substance abuse, mental health disorders and premature mortality. Glucose-like peptide-1 agonists (GLP-1RAs) affect the brain's reward pathway that mediates addiction to foods and various other substances. Evolving data suggest that tirzepatide and semaglutide may be the first effective "anti-consumption" agents with potential applications in reducing food cravings, obesity, alcohol consumption, nicotine addiction, recreational drug use, and even uncontrollable shopping behaviors. Tirzepatide and semaglutide, unlike prior weight-loss drugs, are effective and relatively safe/well-tolerated medications that are associated with reduced risks for myocardial infarction, stroke, cardiovascular death, heart failure, progressive kidney and liver disease, obstructive sleep apnea, debilitating osteoarthritis, polycystic ovarian syndrome, neurodegenerative disease and premature mortality. Observational studies show that GLP-1RAs are associated with spontaneous nonvolitional reductions in use of alcohol, nicotine, and recreational drugs. Because obesity and substance abuse are so prevalent in the United States, GLP-1RA drugs may be uniquely helpful in addressing overconsumption and addiction issues thereby improving overall health and life expectancy.
Ischemic cardiomyopathy (ICM) is characterized by myocardial dysfunction due to myocardial ischemia, associated with the presence of significant coronary artery disease (CAD). We provide a comprehensive review of the cur...Ischemic cardiomyopathy (ICM) is characterized by myocardial dysfunction due to myocardial ischemia, associated with the presence of significant coronary artery disease (CAD). We provide a comprehensive review of the current evidence for coronary revascularization in ICM, including consideration of the different modalities of coronary artery bypass grafting and percutaneous coronary intervention. In addition to a contemporary assessment of the literature, we aim to provide real-world insights and perspectives to guide clinical decision-making in this heterogeneous and complex patient population.
The retrograde approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has significantly contributed to the success rates of CTO PCI. It is usually performed in complex CTO lesions, in which th...The retrograde approach to chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has significantly contributed to the success rates of CTO PCI. It is usually performed in complex CTO lesions, in which the antegrade approach is not feasible or fails. In this article we discuss the steps to perform retrograde CTO PCI and its complications and success rates. Considering the moderate to high success rates of the retrograde approach in the hands of experienced operators and higher complication rates than antegrade only procedures, optimizing the safety of retrograde CTO PCI is of paramount importance.
The presence and severity of calcified coronary plaque negatively impacts angiographic and clinical outcomes following percutaneous coronary intervention (PCI). Severe coronary calcification is associated with suboptimal...The presence and severity of calcified coronary plaque negatively impacts angiographic and clinical outcomes following percutaneous coronary intervention (PCI). Severe coronary calcification is associated with suboptimal stent delivery, deployment, apposition and expansion which can lead to in-stent restenosis and/or thrombosis. Severe coronary calcification is associated with incremental hazard for adverse clinical events, including death, during 5-10 years following PCI despite the use of new generation drug- eluting stents. Multiple technologies including high-pressure noncompliant and modified (cutting/scoring) balloons, atheroablative technologies (laser, rotational or orbital atherectomy), and more recently, intravascular lithotripsy have been used to modify calcified plaque and facilitate optimal coronary stent implantation. Intravascular imaging is critically important to determine the extent and distribution (superficial or deep) of coronary calcification and to aid selection and sequence for use of calcium modifying technologies. Unfortunately, large scale randomized comparative trials of calcium modifying technologies are limited and the relative safety and effectiveness of these modalities is poorly defined. Recent mechanistic and clinical data supporting the use of plaque modifying technologies are reviewed to provide insights into their optimal use.
OBJECTIVE: To determine the cardiorespiratory fitness (CRF) levels needed to avoid the Grim Reaper (Death) among older adults. We hypothesized that an above average peak oxygen uptake (VO) is needed for 70-77-year-old me...OBJECTIVE: To determine the cardiorespiratory fitness (CRF) levels needed to avoid the Grim Reaper (Death) among older adults. We hypothesized that an above average peak oxygen uptake (VO) is needed for 70-77-year-old men and women to delay the encounter with Death. DESIGN: Prospective cohort study. SETTING: General population of older adults in Norway. PARTICIPANTS: 788 women and 777 men aged 70-77 years. INTERVENTION: Clinical assessments, including a test of VO. Participants were categorised based on their baseline VO and changes after 1 year. This study explored associations between VO and 5-year all-cause mortality using Cox proportional hazard models. MAIN OUTCOME MEASURE: All-cause mortality. RESULTS: Death caught up with 5.3 % of men and 3.7 % of women. Compared to unfit men and women, fewer men (Hazard Ratio [HR]: 0.34, 95 % Confidence Interval [CI] 0.15-0.78) and women (HR: 0.41, 95 % CI 0.17-0.98) classified as moderately fit encountered Death with no additional risk reduction among those classified as being more fit. It appears to be easier for the Grim Reaper to claim those in poorer physical condition, specifically VO levels <26.5 mL/kg/min for men and 22.2 mL/kg/min for women (corresponding to ≥85 % of the observed age- and sex-specific average). CONCLUSION: The Grim Reaper typically targets individuals with VO levels <26.5 mL/kg/min/ and <22.2 mL/kg/min when chasing male and female souls aged 70-77 years, respectively, reflecting his penchant for limited CRF. These data underscore the importance of maintaining or enhancing CRF throughout life, providing clear targets for clinicians in assessing patient CRF levels. TRIAL REGISTRATION: ClinicalTrials.govNCT01666340.
O'Keefe EL, O'Keefe JH, Abuissa H
… +5 more, Metzinger M, Murray E, Franco G, Lavie CJ, Harris WS
Prog Cardiovasc Dis
· 2025 · PMID 39617283
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OBJECTIVE: Studies regarding effects of omega-3 fatty acids, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), on risk of atrial fibrillation (AF) have reported discordant results. The aim of this...OBJECTIVE: Studies regarding effects of omega-3 fatty acids, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), on risk of atrial fibrillation (AF) have reported discordant results. The aim of this review is to clarify effects of marine omega-3 intake on risk of AF. PATIENTS AND METHODS: A PubMed search was performed using terms: atrial fibrillation, omega-3, EPA, DHA, vagal tone. We summarized findings from randomized clinical trials (RCTs), epidemiology studies, and meta-analyses evaluating effects/associations of DHA + EPA on risk of AF. Also, vagal tone was explored as a mediator between omega-3 and risk of AF. RESULTS: Meta-analyses of 8 RCTs and 17 prospective cohort studies comprised of 83,112 and 54,799 individuals, respectively, investigated the link between omega-3 intake and incident AF. The RCTs reported that treatment with DHA and/or EPA was associated with a 24 % increased relative risk of AF (absolute risk 4.0 % vs 3.3 %; relative risk [RR] 1.24, 95 % confidence interval [CI] 1.11-1.38, p = 0.0002). This was dose-dependent; DHA + EPA doses of ∼1000 mg/d increased AF risk ∼12 %, whereas 1800 to 4000 mg/d increased AF risk by ∼50 %. In contrast, observational studies focused on DHA + EPA blood levels or dietary intake have generally reported that higher omega-3 levels/consumption are associated with lower AF risk. Maximal AF risk reduction. (12 %) occurred at ∼650 mg/d of dietary DHA + EPA. Other studies have indicated that omega-3 fatty acids can dose-dependently increase vagal tone, which could explain the biphasic relationship between DHA + EPA and AF risk. Experimental studies show that low-level vagal stimulation decreases risk of AF, whereas high-level vagal stimulation increases risk of AF. CONCLUSION: Higher consumption of dietary omega-3 is associated with decreased AF risk. In contrast, pharmaceutical dosing of omega-3 increases AF in a dose-dependent manner, which may be mediated by vagal tone.
BACKGROUND: Giant cell myocarditis (GCM) and cardiac sarcoidosis (CS) are rare inflammatory diseases of the myocardium with poor prognosis. Cardiovascular disease outcomes among both diseases have not been well studied w...BACKGROUND: Giant cell myocarditis (GCM) and cardiac sarcoidosis (CS) are rare inflammatory diseases of the myocardium with poor prognosis. Cardiovascular disease outcomes among both diseases have not been well studied with limited literature. OBJECTIVE: This study aims to investigate the cardiovascular outcomes among patients with GCM and CS. METHOD: We queried the TriNeTX Global Collaborative Network for adult patients with giant cell myocarditis and cardiac sarcoidosis between January 2000 to May 2023 and created two groups: one with giant cell myocarditis and second with cardiac sarcoidosis. Both the groups were followed for 6 months and 12 months. RESULT: After propensity score matched analysis (PSM), among the 4804 patients (2402 patients in each group), the mean age of patients was 57.1 and 57.6 years in GCM and CS groups, respectively. PSM analysis showed that primary outcome i.e., all-cause mortality was significantly higher in GCM group both after 6 months [relative risk (RR) 2.33, 95 % confidence interval (CI): 1.64-3.30, p < 0.01] and 1 year follow up [RR, 1.54 (95 % CI: 1.20-1.98), p < 0.01] as compared with CS group. However, secondary outcomes i.e., heart failure (HF) at 6 month (RR 0.66, 95 % CI: 0.52-0.85, p < 0.01), and at 1 year (RR 0.60, 95 % CI: 0.49-0.73, p < 0.01), ventricular tachycardia (VT) at 6 months (RR 0.34, 95 % CI: 0.25-0.46, p < 0.01), and at 1 year (RR 0.32, 95 % CI: 0.25-0.41, p < 0.01), atrioventricular (AV) node block at 6 month (RR 0.45, 95 % CI: 0.33-0.61, p < 0.01), and at 1 year (RR 0.43, 95 % CI: 0.34-0.55, p < 0.01), and atrial flutter and fibrillation (AF) at 6 months (RR 0.67, 95 % CI: 0.48-0.94, p = 0.02), and at 1 year (RR 0.59, 95 % CI: 0.45-0.76, p < 0.01) were found significantly lower in GCM group as compared to CS group. On the other hand, heart transplant incidence was comparable between both the groups. CONCLUSION: These findings suggest that GCM patients have high risk of mortality and lower risk of HF, VT, AV node block, and AF when compared with CS.
Infective endocarditis (IE) describes the infection of native and prosthetic cardiac valves as well as cardiac implantable electronic devices. Echocardiography is the most widely used imaging technique for evaluation of...Infective endocarditis (IE) describes the infection of native and prosthetic cardiac valves as well as cardiac implantable electronic devices. Echocardiography is the most widely used imaging technique for evaluation of IE. Due to its reduced sensitivity in detection of prosthetic valve IE and cardiac implantable electronic device related IE and related complications, complementary techniques such as cardiac computed tomography (CT) and 18-flurodeoxyglucose positron emission tomography/CT play an emerging role. Therefore, multiple guidelines recommend the use of multimodality imaging in the diagnosis and management of IE. In this review, we aim to compare the various guidelines and to discuss the role of imaging in the diagnosis, detection of complications, monitoring of treatment response, and prognostication of IE.