Cardiovascular Prevention and Pharmacotherapy

Review Articles

Relationship between autonomic and peripheral neuropathies and cardiovascular outcomes in diabetes: Jae-Seung Yun; Cardiovasc Prev Pharmacother. 2024;6(4):123-127. Published online October 31, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e17

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Abstract PDF: This review explores the complex relationship between diabetic neuropathy and cardiovascular disease (CVD). Neuropathy, a common complication of type 1 and type 2 diabetes, is divided into autonomic and peripheral types, each impacting cardiovascular health. Cardiovascular autonomic neuropathy, a form of autonomic neuropathy, is associated with various CVD complications, including arrhythmias, impaired nocturnal blood pressure regulation, and increased mortality. The prevalence of cardiovascular autonomic neuropathy varies depending on the type and duration of diabetes and is influenced by factors like glycemic control and metabolic stress. Peripheral polyneuropathy, which is often linked to diabetic foot disease, is also correlated with elevated CVD risk; research suggests shared pathophysiological mechanisms between peripheral neuropathy and cardiovascular conditions. Screening for neuropathies using tools like the Michigan Neuropathy Screening Instrument and heart rate variability analyses can facilitate early detection of CVD risk. Additionally, emerging technologies, like deep learning models, have demonstrated promise in detecting early cardiovascular patterns associated with autonomic neuropathy through electrocardiogram analysis. These findings underscore the value of integrating novel diagnostic approaches for early intervention. As CVD represents a leading cause of death among patients with diabetes, this article emphasizes the need for thorough assessment and proactive management of neuropathy to mitigate cardiovascular risk. The review recommends a multidisciplinary approach to diabetes care, including early screening, accurate risk stratification, and targeted therapeutic strategies to prevent or slow the progression of CVD in patients with autonomic and peripheral neuropathies. Further research is warranted to clarify the optimal intervention strategies for reducing CVD risk in these populations.

Sodium-glucose cotransporter 2 inhibitors in cardiocerebrovascular disease: Jin Joo Park; Cardiovasc Prev Pharmacother. 2024;6(4):103-108. Published online October 31, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e16

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Abstract PDF: Cardiovascular disease is a leading cause of global mortality, necessitating effective strategies for prevention and treatment. The cardiovascular disease continuum concept highlights the progression from risk factors such as hypertension and diabetes mellitus to advanced stages, including heart failure (HF) and death. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, initially developed to manage diabetes, have emerged as effective therapies across all stages of the cardiovascular disease continuum. Numerous cardiovascular outcome trials demonstrate that SGLT2 inhibitors significantly reduce major adverse cardiovascular events and hospitalizations for HF in patients with and without established atherosclerotic cardiovascular disease. Notably, SGLT2 inhibitors have shown remarkable benefits in reducing HF risk, even in patients without diabetes, including those with HF and preserved ejection fraction. Furthermore, recent studies in post–myocardial infarction patients suggest potential benefits in reducing hospitalizations for HF. Despite their widespread use, the precise mechanisms by which SGLT2 inhibitors confer cardiovascular protection remain unclear, suggesting the need for further investigation. In conclusion, SGLT2 inhibitors have revolutionized cardiovascular disease management, offering significant therapeutic potential across a broad spectrum of patients, and are expected to play an increasingly prominent role in both the prevention and treatment of cardiovascular disease.

Original Articles

Health behaviors, knowledge, and attitudes toward cardiovascular disease risk factors in young Iraqi adults: a sample from Erbil, Iraq: Halmat Ahmed Sulaiman, Isil Isik Andsoy; Cardiovasc Prev Pharmacother. 2024;6(3):92-101. Published online July 30, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e12

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Abstract PDF: Background
Cardiovascular disease continues to be a leading cause of death among young people globally. This cross-sectional study was designed to assess the health behaviors, knowledge, and attitudes regarding cardiovascular disease risk factors among young adults in Erbil, Iraq.
Methods
Data were collected using the WHO STEPS Instrument for Chronic Disease Risk Factor Surveillance and the Heart Disease Fact Questions.
Results
Ninety percent of participants demonstrated moderate to high knowledge and exhibited a positive attitude. Multiple linear regression analysis revealed that while a history of smoking, a lack of knowledge, and the absence of formal education negatively impacted knowledge levels, being aged 38 to 45 years, recognizing the importance of consuming less salt, walking for at least 10 minutes on 5 or more days per week, and regularly checking blood sugar levels positively contributed to knowledge. Unwillingness to change lifestyle had the most significant negative influence on knowledge.
Conclusions
Establishing effective educational interventions may increase knowledge and promote more positive attitudes.

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

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Abstract PDF Supplementary 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

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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.

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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

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

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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

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2 Citations

Abstract PDF Supplementary 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

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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

Public awareness of cardiovascular disease prevention in Korea: Eunji Kim, Chan-Hee Jung, Eun-Jung Rhee, Junghyun Noh, Jae Hyuk Lee, Hun-Jun Park, Sungha Park, Sang-Hyun Ihm, Won-Young Lee, Hyeon Chang Kim; Cardiovasc Prev Pharmacother. 2022;4(4):149-157. Published online October 26, 2022; DOI: https://doi.org/10.36011/cpp.2022.4.e20

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Abstract PDF Supplementary Material: Background
The burden of cardiovascular disease (CVD) is significant in Korea. Ultimately, public knowledge and awareness of CVD risk factors and prevention are essential to reduce its burden. Hence, this study aimed to examine the level of public awareness of CVD risk factors and prevention in Korea in 2022.
Methods
We used data from the Cardiovascular Disease Prevention Awareness Survey conducted by the Korean Society of Cardiovascular Disease Prevention in June 2022. Using a structured web-based questionnaire, 2,000 individuals aged 20 years or more were surveyed on computers or mobile devices. Information on sociodemographic characteristics, the presence of cardiometabolic disease, CVD concerns and self-assessed likelihood, and awareness of CVD prevention were analyzed.
Results
Cancer (44.3%) was the most feared disease, followed by CVD (19.5%). Nevertheless, most respondents stated that they were likely to develop CVD in their lifetime (67.4%). Only 9.2% of respondents were aware of the details of recommendations to prevent CVD, and this level of knowledge was also low among respondents with cardiometabolic diseases (10.7%). Not smoking, being physically active, eating a healthy diet, and reducing alcohol consumption were deemed easy to implement. On the contrary, reducing stress, being physically active, and eating a healthy diet were considered the most difficult recommendations to practice.
Conclusions
Public awareness of CVD risk factors and prevention appeared to be insufficient in Korea. Our research suggests that simple but practical recommendations should be conveyed and promoted to raise public awareness, which is currently inadequate.

Review Articles

Cardiovascular diseases in HIV patients: Hyun-Ha Chang; Cardiovasc Prev Pharmacother. 2022;4(3):95-98. Published online July 29, 2022; DOI: https://doi.org/10.36011/cpp.2022.4.e14

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Abstract PDF

New and more effective antiretroviral therapy regimens have increased viral suppression and improved immune function recovery, leading to the extension of the lifespan of people living with HIV (PLWH). The extended lifespan of PLWH has recently been reported as a significant factor associated with diabetes mellitus, dyslipidemia, and long-term metabolic consequences, such as cardiovascular diseases. Therefore, this article briefly reviews the epidemiology and risk factors of cardiovascular diseases, including dyslipidemia and diabetes mellitus, in PLWH.

Citations

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Bariatric surgery and HIV: Joint venture between family, primary care, and HIV physicians
Ceren Aydemir, Raniah Al Saidi, Ji Soo Choi, Mohamed H. Ahmed, Dushyant Mital
Journal of Family Medicine and Primary Care.2024; 13(12): 5920. CrossRef

Body Weight Change and Cardiovascular Disease: Effect of Weight Gain, Weight Loss, and Weight Cycling: Jung-Hwan Cho, Eun-Jung Rhee, Won-Young Lee; Cardiovasc Prev Pharmacother. 2021;3(4):73-81. Published online October 31, 2021; DOI: https://doi.org/10.36011/cpp.2021.3.e12

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Abstract PDF

Obesity is an independent risk factor for the development and progression of cardiovascular disease (CVD). Various cardiovascular outcomes are related to the association between body weight change and CVD. Metabolically healthy obese individuals could have a better prognosis in terms of cardiovascular morbidity and mortality than metabolically unhealthy obese individuals. Smoking cessation causes significant weight gain and consequent deterioration of the metabolic profile despite not impairing the cardiovascular benefits. Intentional weight loss has a consistent cardiovascular protective effect, but unintentional weight loss due to progressive catabolism and loss of muscle mass could be associated with poor cardiovascular outcomes. Obese individuals who are successful in losing weight with subsequent regain (weight cycling) could have an unfavorable cardiometabolic profile and the risk of CVD. Further studies are needed to evaluate the impact of weight changes on CVD by identifying unknown pathophysiology and to decide appropriate management and interventions for various phenotypes of weight change.

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Investigating the efficacy and feasibility of using a whole-of-diet approach to lower circulating levels of C-reactive protein in postmenopausal women: a mixed methods pilot study
Stephanie Cowan, Aimee Dordevic, Andrew J. Sinclair, Helen Truby, Surbhi Sood, Simone Gibson
Menopause.2023; 30(7): 738. CrossRef

Special Article

Geriatric Considerations in the Management of Elderly Patients with Cardiovascular Diseases: Doo Soo Jeon; Cardiovasc Prev Pharmacother. 2021;3(2):38-46. Published online April 30, 2021; DOI: https://doi.org/10.36011/cpp.2021.3.e6

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Abstract PDF

Cardiovascular disease (CVD) is the most frequently diagnosed disease as well as the leading cause of death in the elderly. It usually results from long-term effects of cardiovascular risk factors as well as the aging process itself. Elderly people commonly have geriatric syndrome, which is an age-specific problem that is complicated by the presence of cardiovascular, cognitive, and physical dysfunction and is accompanied by many other chronic diseases. While caring for the elderly, in addition to CVD, various inherent problems must be considered. The patient-centered approach, instead of evidence-based guidelines that are designed for young adult patients, is the most important concept when it comes to elderly patients with CVD and multiple comorbidities. This approach should be used to maintain the functionality, independence, quality of life, and dignity of these patients.

Citations

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Assessment of Quality of Life in Patients With Cardiovascular Disease Using the SF-36, MacNew, and EQ-5D-5L Questionnaires
Aikaterini Chatzinikolaou, Stergios Tzikas, Maria Lavdaniti
Cureus.2021;[Epub] CrossRef

Original Article

Changes in Target Achievement Rates after Statin Prescription Changes at a Single University Hospital: Seon Choe, Jiwon Shinn, Hun-Sung Kim, Ju Han Kim; Cardiovasc Prev Pharmacother. 2020;2(3):103-111. Published online July 31, 2020; DOI: https://doi.org/10.36011/cpp.2020.2.e14

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Abstract PDF

Background
We investigated the changes in low-density lipoprotein cholesterol (LDL-C) target achievement rates (<70 and <100 mg/dL) when the prescription changed from various statins to Lipilou^®, a generic formulation of atorvastatin.
Methods
This was a retrospective cohort study of patients who had been prescribed Lipilou^® for more than 3 months at Seoul National University Hospital from 2012 to 2018. For patients who were treated with a previous statin before the prescription of Lipilou^®, changes in target achievement rates of LDL-C less than 70 and less than 100 mg/dL were confirmed 3–6 months after the prescription of Lipilou^®.
Results
Among the 683 enrolled patients, when their prescription was changed to Lipilou^®, the target achievement rate of LDL-C significantly increased for LDL-C less than 70 mg/dL (from 22.1% to 66.2%, p<0.001) and less than 100 mg/dL (from 26.8% to 75.3%, p<0.001). In particular, when a moderate-low potency statin was changed to Lipilou^® (10 mg), the target achievement rates for LDL-C less than 70 mg/dL (from 28.9% to 66.7%, p<0.001) and less than 100 mg/dL (from 42.2% to 86.7%, p<0.001) significantly increased. The change from a moderate-high potency statin to Lipilou^® (20 mg) showed an increased target achievement rates for LDL-C <70 mg/dL (from 33.3% to 80.0%, p=0.008) and 100 mg/dL (from 40.0% to 73.3%, p<0.025).
Conclusions
We cannot simply conclude that Lipilou^® is superior to other statins. However, when the target LDL-C was not reached with previous statin treatments, a high target achievement rate could be achieved by changing the prescription to Lipilou^®. Physicians should always consider aggressive statin prescription changes for high target achievement rates.

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Understanding and Utilizing Claim Data from the Korean National Health Insurance Service (NHIS) and Health Insurance Review & Assessment (HIRA) Database for Research
Dae-Sung Kyoung, Hun-Sung Kim
Journal of Lipid and Atherosclerosis.2022; 11(2): 103. CrossRef

Special Article

Effects of Low-Carbohydrate, High-Fat Diets on Weight Loss, Cardiovascular Health and Mortality: Bo-Yeon Kim; Cardiovasc Prev Pharmacother. 2020;2(2):43-49. Published online April 30, 2020; DOI: https://doi.org/10.36011/cpp.2020.2.e7

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Abstract PDF

Obesity is a worldwide health challenge. The clinical consequences of obesity include nonalcoholic fatty liver disease, type 2 diabetes, and coronary heart disease. Numerous diets have been developed to reduce the incidence of cardiovascular diseases and induce weight loss. Low-carbohydrate, high-fat diets (LCHFDs) have become increasingly popular for weight loss. LCHFDs have led to weight loss in some clinical studies. However, the safety of LCHFDs and their long-term effects on the human body are still controversial. In this review, I will discuss the effects of LCHFDs on weight loss, cardiovascular health, and mortality.

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Cholesterol, fatty acids profile and the indices of atherogenicity and thrombogenicity of raw lamb and mutton offal
B. Pretorius, H.C. Schönfeldt
Food Chemistry.2021; 345: 128868. CrossRef

Review Articles

Paradigm Shift for the Treatment of Type 2 Diabetes Mellitus in Patients with Cardiovascular Disease: Cardiologist's Perspective: Doo Soo Jeon; Cardiovasc Prev Pharmacother. 2020;2(1):11-17. Published online January 31, 2020; DOI: https://doi.org/10.36011/cpp.2020.2.e4

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Abstract PDF: Type 2 diabetes mellitus (T2DM) is a complex disorder and is associated with an increased risk for developing atherosclerotic cardiovascular disease. Control of major risk factors of T2DM can reduce major adverse cardiovascular events (MACEs) in patients. Glycemic control has long been the gold standard for treatment of T2DM. However, strict blood glucose control strategies have repeatedly failed in the prevention of cardiovascular events in key clinical trials. The 2019 American and European practice guidelines for the prevention of cardiovascular disease in patients with T2DM have recommended the use of novel hypoglycemic agents, such as sodium glucose transporter 2 inhibitors and glucagonlike peptide-1 receptor antagonist, which have shown significant reductions in the risk of MACE in spite of their modest glycemic control capacity. A paradigm shift from the glucosecentered approach in treating diabetic patients with cardiovascular disease is imperative. Based on positive outcomes from previous evidence, the reduction of the risk of MACE should be a primary objective for treatment.

Pregnancy at Late Maternal Age and Future Cardiovascular Health: Mi-Jeong Kim; Cardiovasc Prev Pharmacother. 2019;1(2):50-56. Published online October 31, 2019; DOI: https://doi.org/10.36011/cpp.2019.1.e9

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Abstract PDF: Increasing numbers of women are delivering their first child at a later age. First pregnancy at a later age is, per se, a high-risk pregnancy. Pregnancy after 35 years is traditionally considered a late maternal age. The risks of obstetric complications including fetal and maternal complications are increased. Defective placenta syndrome, including hypertensive disorders, preterm birth, and intrauterine growth retardation, shares similar pathophysiologic mechanisms with endothelial dysfunction, although their clinical presentations differ. Recent medical advances have improved the medical performance of pregnancy-related cardiovascular disease (CVD). Recent evidence has shown that women with underlying defective placental syndrome or other pregnancy-related complications have an increased risk of unfavorable cardiovascular outcomes in later life. An increasing number of women delivering their first child at a later age have epidemiological characteristics that differ from those reported previously and for which data are limited data regarding the cardiovascular prognosis. Therefore, increased attention to public health and CVD prevention is required for women with complicated pregnancies.

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