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Most-read articles are from the articles published in 2022 during the last three month.

Review Articles
Adverse reactions to antiarrhythmic drugs
Ungjeong Do
Cardiovasc Prev Pharmacother. 2023;5(1):1-14.   Published online January 16, 2023
DOI: https://doi.org/10.36011/cpp.2023.5.e1
  • 65,535 View
  • 218 Download
Abstract PDF
There are various types of adverse reactions to antiarrhythmic drugs (AADs). Proarrhythmia, which refers to an exacerbation of the preexisting arrhythmia or occurrence of a new arrhythmia, may occur under the therapeutic concentration of an AAD. Bradyarrhythmia is the most common type of proarrhythmia due to AADs, and prior myocardial infarction and old age are known risk factors. Atrial flutter with 1:1 atrioventricular conduction usually occurs during rhythm control of atrial fibrillation with class IC AADs. QT prolongation due to AADs, mainly class III AADs, elevates the risk of torsade de pointes by triggered activity due to early afterdepolarization. The addition of clinical factors that promote QT prolongation, such as hypokalemia, hypomagnesemia, female sex, and bradycardia, increases the risk of developing torsade de pointes. Proarrhythmic monomorphic ventricular tachycardia usually occurs as a result of slow conduction and disparity of refractoriness due to class IC AADs. In patients with preexisting left ventricular systolic dysfunction or structural heart disease, the risk of hypotension or cardiogenic shock caused by negative inotropic effects due to AADs should be considered. To prevent these major adverse reactions to AADs, we need to understand the electrophysiologic properties of AADs in detail. Furthermore, the risk of proarrhythmia could be heightened by interplay with clinical factors, such as electrolyte unbalances, heart rate, and hepatic/renal or myocardial dysfunction. Sufficient awareness about drug-drug interactions, which may affect the metabolism of AADs, will improve patient safety during the management of arrhythmia.
Decision-making for recurrent atrial fibrillation after catheter ablation
Jum Suk Ko, Sung Soo Kim, Hyung Ki Jeong, Nam Ho Kim
Cardiovasc Prev Pharmacother. 2023;5(4):102-112.   Published online October 27, 2023
DOI: https://doi.org/10.36011/cpp.2023.5.e15
  • 6,352 View
  • 163 Download
Abstract PDF
Catheter ablation for atrial fibrillation (AF), especially pulmonary vein (PV) isolation, is widely used for rhythm control. However, AF recurrence remains a challenge, affecting 20% to 50% of cases. This review focuses on AF recurrence after catheter ablation. AF recurrence can be categorized into early recurrence (ER) within 3 months after index procedure, late recurrence (LR) within 1 year, and very LR (VLR) occurring beyond 1 year. ER has emerged as a significant predictor of LR, contrary to the traditional understanding. LR is primarily caused by PV reconnection, while VLR more involves non-PV triggers or substrates. Managing AF recurrence includes antiarrhythmic drugs, steroids, colchicine, and repeat ablation. Antiarrhythmic drugs reduce ER but have a limited impact on LR. Steroids have been shown to reduce ER, but not long-term recurrence. Colchicine, an anti-inflammatory agent, shows promise in reducing both ER and LR, although further research is necessary. Whether to perform early repeat ablation after ER remains uncertain, as not all patients require immediate intervention. In conclusion, AF recurrence after ablation remains a complex issue. Understanding the underlying mechanisms is essential for personalized management. Tailored approaches, considering individual characteristics, are crucial for long-term success. Future research should focus on improving therapeutic strategies for AF recurrence.
Calcium channel blockers for hypertension: old, but still useful
Eun Mi Lee
Cardiovasc Prev Pharmacother. 2023;5(4):113-125.   Published online October 30, 2023
DOI: https://doi.org/10.36011/cpp.2023.5.e16
  • 5,396 View
  • 392 Download
  • 1 Citations
Abstract PDF
Calcium channel blockers (CCBs) constitute a heterogeneous class of drugs that can be divided into dihydropyridines (DHPs) and non-DHPs. DHP-CCBs are subcategorized into four generations based on the duration of activity and pharmacokinetics, while non-DHP-CCBs are subcategorized into phenylethylamine and benzodiazepine derivatives. DHP-CCBs are vascular-selective and function as potent vasodilators, whereas non-DHP-CCBs are cardiac-selective and are useful for treating tachyarrhythmia, but reduce cardiac contractility and heart rate. Traditional DHP-CCBs (nifedipine) mainly block L-type calcium channels, whereas novel CCBs block N-type (amlodipine) and/or T-type channels (efonidipine) in addition to L-type channels, leading to organ-protective effects. DHP-CCBs have a potent blood pressure–lowering effect and suppress atherosclerosis and coronary vasospasm. Diltiazem, a non-DHP-CCB, is highly effective for vasospasm control. CCBs reduce left ventricular hypertrophy and arterial stiffness. Amlodipine, a DHP-CCB, reduces blood pressure variability. L/N- and L/T-type CCBs combined with renin-angiotensin system blockers reduce proteinuria and improve kidney function compared with L-type CCBs. According to large-scale trials, DHP-CCBs reduce cardiovascular events in patients with isolated systolic hypertension, as well as in elderly and high-risk patients. Accordingly, CCBs are indicated for hypertension in elderly patients, isolated systolic hypertension, angina pectoris, and coronary vasospasm. Non-DHP-CCBs are contraindicated in high-grade heart block, bradycardia (<60 beats per minute [bpm]), and heart failure with reduced ejection fraction (HFrEF). DHP-CCBs should be used with caution in patients with tachyarrhythmia, HFrEF, and severe leg edema, and non-DHP-CCBs should be used carefully in those with constipation. Each CCB has distinct pharmacokinetics and side effects, underscoring the need for meticulous consideration in clinical practice.

Citations

Citations to this article as recorded by  
  • Design of Experimental Approach for Development of Rapid High Performance Liquid Chromatographic Process for Simultaneous Estimation of Metoprolol, Telmisartan, and Amlodipine from Formulation: Greenness and Whiteness Evaluation
    Mahesh Attimarad, Mohammed Jassim Alali, Hussain Ali Alali, Dana Hisham Alabdulmuhsin, Aljohara Khalid Alnajdi, Katharigatta Narayanaswamy Venugopala, Anroop B. Nair
    Molecules.2024; 29(5): 1087.     CrossRef
Adverse effects of statin therapy and their treatment
Dae Young Cheon, Sang-Ho Jo
Cardiovasc Prev Pharmacother. 2022;4(1):1-6.   Published online January 20, 2022
DOI: https://doi.org/10.36011/cpp.2022.4.e4
  • 12,588 View
  • 500 Download
  • 2 Citations
Abstract PDF
Statins are one of the most widely used drugs worldwide as first-line drugs for the treatment of hyperlipidemia and the prevention and treatment of cardiovascular diseases. Most of the side effects of statins are known to be mild, and mainly hepatotoxicity and various muscle symptoms are known. Recently, there have been studies on concerns about an increase in the incidence of diabetes after using statins, but it was found that the benefits sufficiently outweigh the risk of side effects. Therefore, the use of statins in the appropriate group should be actively performed, and it seems that the side effects can be prevented through close physical observation and appropriate examination.

Citations

Citations to this article as recorded by  
  • The Link between Magnesium Supplements and Statin Medication in Dyslipidemic Patients
    Roxana Nartea, Brindusa Ilinca Mitoiu, Ioana Ghiorghiu
    Current Issues in Molecular Biology.2023; 45(4): 3146.     CrossRef
  • The effects of L-carnitine in reducing hepatotoxicity of statins in rats
    Doaa Ibrahim, Shahad Bader, Omar Bader
    Medicinski casopis.2023; 57(3): 59.     CrossRef
Optimal target blood pressure in older patients with hypertension
Kwang-il Kim
Cardiovasc Prev Pharmacother. 2023;5(2):41-48.   Published online April 24, 2023
DOI: https://doi.org/10.36011/cpp.2023.5.e4
  • 3,346 View
  • 204 Download
Abstract PDF
Hypertension is a common condition among older adults, and blood pressure (BP) control is effective for preventing cardiovascular morbidity and mortality even among the oldest-old adults. However, the optimal target BP for older patients with hypertension has been a subject of debate, with previous clinical trials providing conflicting evidence. Determining the optimal target BP for older adults is a complex issue that requires considering comorbidities, frailty, quality of life, and goals of care. As such, BP targets should be individualized based on each patient's unique health status and risk factors, and treatment should be closely monitored to ensure that it is effective and well-tolerated. The benefits and risks of intensive BP control should be carefully weighed in the context of the patient's overall health status and treatment goals. Ultimately, the decision to pursue intensive BP control should be made through shared decision-making between patients and their healthcare providers.
Original Articles
Changes in cardiovascular-related health behaviors during the COVID-19 pandemic
Eunji Kim, Chan-Hee Jung, Dae Jung Kim, Seung-Hyun Ko, Hae-Young Lee, Kyung-Yul Lee, Dae Ryong Kang, Sung Kee Ryu, Won-Young Lee, Eun-Jung Rhee, Hyeon Chang Kim
Cardiovasc Prev Pharmacother. 2023;5(1):15-23.   Published online January 27, 2023
DOI: https://doi.org/10.36011/cpp.2023.5.e2
  • 2,387 View
  • 45 Download
  • 2 Citations
Abstract PDFSupplementary Material
Background
The COVID-19 pandemic has been the most pressing health challenge in recent years. Meanwhile, prevention for other diseases, such as cardiovascular disease (CVD) has been less prioritized during the pandemic. COVID-19, a novel infectious disease, both had a direct impact on public health and provoked changes in health-related behaviors, including those for CVD prevention. This study sought to examine changes in CVD-related health behaviors during the COVID-19 pandemic and related sociodemographic factors.
Methods
We used data from the Cardiovascular Disease Prevention Awareness Survey conducted in Korea in June 2022. A total of 2,000 adults across Korea’s 17 provinces completed a structured questionnaire online or on a mobile device. Self-reported changes in CVD-related health behaviors were investigated. We used unadjusted and adjusted logistic regression models to explore the associations between negative changes and sociodemographic factors.
Results
In smoking, drinking, and healthcare service use, the proportion of those with positive changes surpassed the proportion of respondents who reported negative changes. In contrast, negative changes predominated for diet, exercise, and stress. Most individuals (52.6%) reported a deterioration of psychological distress. These negative changes were significantly associated with age, sex, marital status, and the presence of cardiometabolic disease.
Conclusions
The COVID-19 pandemic has affected CVD-related health behaviors. Based on these changes, CVD prevention should be encouraged with appropriate and prioritized strategies.

Citations

Citations to this article as recorded by  
  • Changes in cardiovascular-related health behaviors after the end of social distancing: the 2023 Cardiovascular Disease Prevention Awareness Survey
    Jaeyong Lee, Eunji Kim, Won-Young Lee, Eun-Jung Rhee, Hyeon Chang Kim
    Cardiovascular Prevention and Pharmacotherapy.2024; 6(2): 57.     CrossRef
  • Cardiovascular-related health behavior changes: lessons from the COVID-19 pandemic and post-pandemic challenges
    Inha Jung, Won-Young Lee
    Cardiovascular Prevention and Pharmacotherapy.2023; 5(4): 99.     CrossRef
Cardiovascular risk assessment of newborns in Nigeria using the atherogenic index of plasma and its associations with gestational age and birth weight: a cross-sectional hospital-based study
Obinna Victory Obaji, Uche Charles Adizua, Ndubuisi Kennedy Chukwudi, Daberechi Kenneth Adiele, Justus Uchenna Onu
Cardiovasc Prev Pharmacother. 2024;6(2):65-73.   Published online April 26, 2024
DOI: https://doi.org/10.36011/cpp.2024.6.e9
  • 1,062 View
  • 25 Download
Abstract PDF
Background
The prevalence of atherosclerotic cardiovascular disease is rising, and its onset from childhood is widely studied. Prematurity and low birth weight were associated with higher atherogenic risk when assessed using some lipid ratios. However, the atherogenic index of plasma (AIP), a sensitive marker for atherosclerosis is understudied in newborns. Utilizing AIP, this study aimed to determine atherogenic risk prevalence among newborns and its association with gestational age and birth weight.
Methods
Newborns were consecutively recruited, and their lipid profiles were determined. The AIP was calculated as the logarithm to base 10 (log10) of the ratio of molar concentrations of triglyceride to high-density lipoprotein cholesterol. The atherogenic risk was operationalized using AIP: high, >0.24; medium, 0.1–0.24; and low/no risk, <0.1. The relationship between AIP values, gestational age, and birth weight was analyzed using Pearson correlation.
Results
The mean AIP of the 167 newborns studied was –0.35±0.34, which is within the global reference range. Three (1.8%), 10 (6.0%), and 154 (92.2%) newborns were in the high, medium, and low/no atherogenic risk categories, respectively. Hence, 13 newborns (7.8%) had medium to high atherogenic risk. AIP had a moderate significantly positive relationship only with gestational age (r=0.35, P<0.001).
Conclusions
The study found an atherogenic risk prevalence of 7.8% using AIP in newborns which, contrary to previous studies that used other ratios, has no significant association with birth weight, correlating positively with gestational age, though is lowest in late preterms. Follow-up studies will elucidate these findings.
Effects of physical activity on cardiovascular outcomes and mortality in Korean patients with diabetes: a nationwide population-based cohort study
Inha Jung, Sun Joon Moon, Hyemi Kwon, Se Eun Park, Kyung-Do Han, Eun-Jung Rhee, Won-Young Lee
Cardiovasc Prev Pharmacother. 2022;4(1):42-55.   Published online January 20, 2022
DOI: https://doi.org/10.36011/cpp.2022.4.e3
  • 3,890 View
  • 46 Download
  • 2 Citations
Abstract PDFSupplementary Material
Background
Since a sedentary lifestyle is considered a modifiable risk factor for cardiovascular disease (CVD), physical activity (PA) is recommended for type 2 diabetes mellitus (T2DM) patients to prevent CVD. We investigated the association between different levels of PA and the risk for CVD and all-cause mortality in patients with T2DM using nationwide data.
Methods
We examined health examination data and claims records of 2,745,637 participants with T2DM at baseline from the Korean National Health Insurance Service who underwent health examinations between 2009 and 2012. We excluded subjects with a history of myocardial infarction or stroke. Each participant was asked to report their weekly PA levels according to three categories: vigorous, moderate, and walking. The incidence of CVD and death was analyzed until 2017.
Results
The risk of CVD was lower in regular exercisers than in nonexercisers after adjusting for confounding variables. A dose-response trend was evident in the association between the degree of PA and CVD risk. All categories of PA were inversely associated with CVD risk and mortality. The reduction in CVD risk and all-cause mortality was more profound in patients aged ≥65 years.
Conclusions
Augmenting PA might have positive effects on the prevention of CVD and all-cause death, especially in the elderly. The benefits of PA were consistently observed in various subgroups regardless of the presence of chronic conditions. Therefore, clinicians should encourage elderly patients with T2DM to increase their daily PA.

Citations

Citations to this article as recorded by  
  • Incentivised physical activity intervention promoting daily steps among university employees in the workplace through a team-based competition
    Ayazullah Safi, Sanjoy Deb, Adam Kelly, Matthew Cole, Natalie Walker, Mohammed Gulrez Zariwala
    Frontiers in Public Health.2024;[Epub]     CrossRef
  • Effect of physical activity on incident atrial fibrillation in individuals with varying duration of diabetes: a nationwide population study
    JungMin Choi, So‑Ryoung Lee, Eue-Keun Choi, Kyung-Yeon Lee, Hyo-Jeong Ahn, Soonil Kwon, Kyung‑Do Han, Seil Oh, Gregory Y. H. Lip
    Cardiovascular Diabetology.2024;[Epub]     CrossRef
Review Articles
The emergence and clinical significance of artificial intelligence–enhanced electrocardiography
Yong-Soo Baek
Cardiovasc Prev Pharmacother. 2024;6(2):41-47.   Published online April 26, 2024
DOI: https://doi.org/10.36011/cpp.2024.6.e7
  • 965 View
  • 11 Download
Abstract PDF
The integration of artificial intelligence (AI) with electrocardiography (ECG), a technology known as AI-ECG, represents a transformative leap in the field of cardiovascular medicine. This innovative approach has significantly advanced the capabilities of ECG, traditionally used for diagnosing heart diseases. AI-ECG excels in detecting subtle changes and interconnected patterns in cardiac waveforms, offering a level of precision and sensitivity that was previously unattainable with conventional methods. The scope of AI-ECG extends beyond the realm of heart diseases. It has shown remarkable potential in predicting and identifying the impacts of noncardiac conditions on heart health, thereby broadening the diagnostic capabilities of ECG. This is especially valuable given the complex nature of cardiovascular diseases and their interactions with other health conditions. Despite its groundbreaking potential, AI-ECG faces several challenges. One of the primary concerns is the "black box" nature of AI algorithms, which can make the decision-making process opaque and difficult to interpret. This poses a challenge in medical settings where understanding the rationale behind a diagnosis is crucial. Additionally, the effectiveness of AI-ECG is dependent on the quality and diversity of the datasets used to train the algorithms. Limited or biased datasets can lead to inaccuracies and diminish the reliability of the technology. However, the benefits of AI-ECG are significant. It enables faster, more accurate diagnoses and has the potential to greatly enhance the efficiency of cardiovascular care. As research and technology continue to evolve, AI-ECG is poised to become an indispensable tool in the diagnosis and management of heart diseases.
Expectations and concerns regarding medical advertisements via large commercial medical platform advertising companies: a legal perspective
Raeun Kim, Hakyoung Park, Jiwon Shinn, Hun-Sung Kim
Cardiovasc Prev Pharmacother. 2024;6(2):48-56.   Published online April 26, 2024
DOI: https://doi.org/10.36011/cpp.2024.6.e8
  • 935 View
  • 11 Download
Abstract PDF
Advertising in the medical and legal fields, which are among Korea's leading professions, has increasingly utilized major advertising platforms such as LawTalk and UNNI—two of the most prominent and contentious platforms in their respective fields. While it is generally unproblematic for professionals like lawyers and doctors to promote public interest through advertising on these commercial platforms, the creation of a profit-driven structure has the potential to undermine their professional ecosystems. This article explores the issues associated with advertising in the medical field through large commercial platforms, drawing on notable examples from the legal and medical fields in Korea. Specifically, we analyze two of the most popular yet controversial platforms in these sectors, LawTalk and UNNI. In Korea, the format and method of advertising are legal as long as they do not involve referring or soliciting clients, thereby making platform advertising lawful when used solely for that purpose. Nevertheless, it is crucial to prevent medical advertising platforms from establishing market monopolies by skirting various profit regulations and laws. In response to these concerns, the Korean Bar Association has prohibited all advertisements by platform companies. The medical community should closely examine the rationale and process behind this decision. Given the significant social influence of large corporate platforms and the unique social responsibilities of the medical and legal professions, future platform advertising should be subject to distinct legal and institutional regulations that differ from those applied to general services.
Original Article
Changes in cardiovascular-related health behaviors after the end of social distancing: the 2023 Cardiovascular Disease Prevention Awareness Survey
Jaeyong Lee, Eunji Kim, Won-Young Lee, Eun-Jung Rhee, Hyeon Chang Kim
Cardiovasc Prev Pharmacother. 2024;6(2):57-64.   Published online April 5, 2024
DOI: https://doi.org/10.36011/cpp.2024.6.e6
  • 932 View
  • 5 Download
Abstract PDFSupplementary Material
Background
The COVID-19 pandemic and the implementation of social distancing have been reported to negatively impact cardiovascular-related health behaviors. However, the effects of lifting social distancing restrictions on these health behaviors remain unclear. This study investigated public awareness and behavioral changes related to cardiovascular disease prevention after the end of social distancing.
Methods
Between June 5 and June 12, 2023, 2,000 adults participated in the 2023 Cardiovascular Disease Prevention Awareness Survey in Korea. The survey comprehensively addressed sociodemographic factors, cardiometabolic disease history, cardiovascular disease concern, prevention awareness, and behavioral changes after the end of social distancing. Logistic regression analyses were performed to assess the associations between behavioral changes and sociodemographic factors.
Results
Cardiovascular disease ranked as the second most feared disease (most feared, 18.0%; second most feared, 26.3%) after cancer (most feared, 42.3%; second most feared, 21.7%). Among nine cardiovascular disease prevention recommendations, stress management, being physically active, and maintaining a healthy diet were perceived as the most challenging recommendations. After the end of social distancing, there were more positive changes than negative changes in smoking, alcohol consumption, dietary habits, physical activity, and healthcare service use, whereas stress management more frequently changed negatively (40.0%) than it changed positively (19.5%).
Conclusions
Positive changes in cardiovascular-related health behaviors, except for stress management, were observed after the end of social distancing. Further research is necessary to fully comprehend the impact of discontinuing social distancing practices.
Review Articles
COVID-19 vaccination–related cardiovascular complications
Jae Yeong Cho, Kye Hun Kim
Cardiovasc Prev Pharmacother. 2023;5(4):134-143.   Published online October 27, 2023
DOI: https://doi.org/10.36011/cpp.2023.5.e17
  • 1,584 View
  • 24 Download
  • 1 Citations
Abstract PDF
The global response to the COVID-19 pandemic has led to rapid vaccine development and distribution. As vaccination efforts continue, concerns have arisen regarding potential adverse events associated with COVID-19 vaccination. This article examines emerging evidence on adverse events, including myocarditis, pericarditis, and thrombotic complications, in relation to COVID-19 vaccination. Reports of myocarditis and pericarditis cases following messenger RNA vaccines have sparked interest, with discussions revolving around potential mechanisms and genetic predispositions. The contrasting findings on pericarditis risk postvaccination highlight the complexity of studying this phenomenon. Thrombotic events, particularly vaccine-induced thrombotic thrombocytopenia, have garnered attention, prompting investigations into antibody responses and mechanisms. This article underscores the importance of ongoing research, collaboration, and data analysis for accurately understanding adverse events. While the COVID-19 vaccination campaign may have ended, it is still vital to maintain vigilance, collect comprehensive data and foster interdisciplinary collaboration to uphold vaccine safety and steer public health strategies in the upcoming period.

Citations

Citations to this article as recorded by  
  • The Role of COVID-19 Vaccination for Patients With Atherosclerotic Cardiovascular Disease in the Upcoming Endemic Era
    Kye Hun Kim
    Journal of Lipid and Atherosclerosis.2024; 13(1): 21.     CrossRef
The crosstalk between insulin resistance and nonalcoholic fatty liver disease/metabolic dysfunction-associated fatty liver disease: a culprit or a consequence?
Dae-Jeong Koo, Won-Young Lee
Cardiovasc Prev Pharmacother. 2022;4(4):132-141.   Published online October 20, 2022
DOI: https://doi.org/10.36011/cpp.2022.4.e17
  • 2,691 View
  • 67 Download
  • 1 Citations
Abstract PDF
Nonalcoholic fatty liver disease (NAFLD), which has recently undergone a change in its definition and acronym to “metabolic dysfunction associated fatty liver disease (MAFLD),” is clinically significant as an increasingly prevalent independent risk factor for cardiovascular diseases. Insulin resistance is considered to be a key mechanism in the development and progression of NAFLD/MAFLD, and fatty liver disease itself may exacerbate insulin resistance. In this review, we describe the mechanisms underlying the interaction between insulin resistance and fatty liver, and we summarize the therapeutic attempts based on those mechanisms.

Citations

Citations to this article as recorded by  
  • Insulin Resistance, Non-Alcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus: Clinical and Experimental Perspective
    Inha Jung, Dae-Jeong Koo, Won-Young Lee
    Diabetes & Metabolism Journal.2024; 48(3): 327.     CrossRef
Lipid variability in patients with diabetes mellitus
Jeongmin Lee, Seung-Hwan Lee
Cardiovasc Prev Pharmacother. 2023;5(4):126-133.   Published online October 25, 2023
DOI: https://doi.org/10.36011/cpp.2023.5.e18
  • 1,463 View
  • 65 Download
Abstract PDF
Diabetic dyslipidemia is characterized by hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C), elevated low-density lipoprotein cholesterol (LDL-C), and the predominance of small dense LDL particles caused by insulin resistance in patients with type 2 diabetes mellitus (DM) or insulin deficiency in patients with type 1 DM. Dyslipidemia is a major risk factor for atherosclerotic cardiovascular disease in individuals with DM, and lowering lipid levels can reduce the associated morbidity and mortality. The current guidelines for dyslipidemia management recommend an LDL-C goal lower than 55 to 100 mg/dL, depending on the underlying risk factors. However, greater visit-to-visit variability in cholesterol levels might be an independent predictor of major adverse cardiovascular events, high incidence of atrial fibrillation, poor renal outcomes, and cognitive dysfunction in patients with DM. This review focuses on the clinical implications of lipid variability in patients with DM.
Original Article
Cardiac rehabilitation using intensive lifestyle habituation combined with outdoor exercise in an urban forest environment for primary and secondary prevention of coronary artery disease: a feasibility test
Jong-Young Lee, Kee-Chan Joo, Kyung-Su Choi, Dae-Sik Yoon
Cardiovasc Prev Pharmacother. 2024;6(2):74-83.   Published online April 25, 2024
DOI: https://doi.org/10.36011/cpp.2024.6.e10
  • 723 View
  • 7 Download
Abstract PDF
Background
We aimed to examine the feasibility of intensive lifestyle habituation with a subsequent home program, including forest-based exercise, as an alternative approach to conventional cardiac rehabilitation for both primary and secondary prevention of coronary artery disease (CAD).
Methods
A total of 28 participants were included in a 1-week intensive education program aimed at fostering desirable lifestyle habits in the study: 17 patients who underwent percutaneous coronary intervention and 11 participants at high risk of CAD. Subsequently, they engaged in a self-directed, home-based program that included unstructured exercise in an urban forest. The terrain of the urban forest was analyzed to estimate metabolic equivalent levels and to assess safety and accessibility for patient exercise.
Results
Throughout the program, no adverse cardiac events were reported. Additionally, risk factors for CAD—including body composition, blood sugar levels, hemodynamic variables, total cholesterol levels, and cardiorespiratory endurance—showed significant improvement in both groups.
Conclusions
Intensive lifestyle habituation and unstructured, self-directed exercise in the forest were as effective and safe as conventional cardiac rehabilitation for patients with CAD. The study demonstrated that an urban forest could serve as a safe exercise environment in both primary and secondary prevention strategies for CAD.

CPP : Cardiovascular Prevention and Pharmacotherapy