Latest news with #cardiovascularDisease
Medscape
22-05-2025
- Health
- Medscape
Rapid Review Quiz: Exercise
More than one-quarter of adults in the United States are physically inactive outside of their occupation. However, recommending useful exercises to patients with various conditions, some of whom might need specific modifications, is not easy. Furthermore, extensive studies are constantly conducted in this area, and keeping abreast of them takes time. Do you know the key research on exercise, including cardiovascular disease risk, the benefits of exercise in stroke recovery, and long-term mortality impact? Test yourself with this quick quiz. Medscape © 2025 WebMD, LLC Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape. Cite this: Yasmine S. Ali. Rapid Review Quiz: Exercise - Medscape - May 21, 2025.
Medscape
12-05-2025
- Health
- Medscape
CVD Risk Reduction in Diabetes: A Team Sport
Collaborative, interdisciplinary care, a strategy that relies on multiple specialties working together to coordinate a treatment plan, plays an integral role in disease prevention. This approach is especially important in patients with diabetes, who carry a two- to fourfold increased risk for developing cardiovascular disease (CVD) compared with peers without diabetes. CVD is the primary cause of morbidity in these patients and accounts for as much as a 75% increased mortality rate, underscoring the importance of integrated, collaborative CVD risk prevention. The challenge lies in determining the best strategies to produce the best outcomes. Michael Rakotz, MD 'There are so many factors that can increase cardiovascular risk, and having one person trying to manage all of them is nearly impossible to do well,' said Michael Rakotz, MD, group vice president of Improving Health Outcomes at the American Medical Association and clinical assistant professor of family and community medicine at Northwestern University's Feinberg School of Medicine in Chicago. 'So many people worry about the complications of diabetes, but the reality is that most die from heart disease,' added Heather Ferris, MD, endocrinologist and associate professor of medicine at the University of Virginia Health in Charlottesville, Virginia. 'We can manage people's blood sugars safely with medications, but there's still excess risk that needs to be aggressively managed.' Collaboration, Coordination, and Communication Integrated diabetes care has been shown to reduce mortality, improve physical and mental functioning, and drive self-management and blood pressure control. Collaboration, communication, and coordination are integral to successful outcomes, but they can also be challenging. Sadiya Khan, MD, 'It's important to think of collaboration in two domains,' said Sadiya Khan, MD, a preventive cardiologist at Northwestern Medicine Bluhm Cardiovascular Institute in Chicago. The first — considering associated risks for inherent metabolic dysregulation in diabetes — is collaboration within and across specialties, Khan said. 'Collaboration between the clinician and patient, ie, shared decision-making, is just as important, however, especially now given so many different available therapies,' she said. Heather Ferris, MD Ferris noted that 'the complexity of care these days really necessitates collaboration, almost more so than it did in the past 20 years,' said Ferris, who, echoing Khan, provided the example of glucagon-like peptide 1 agonists and sodium-glucose cotransporter 2 inhibitors that are used by endocrinologists and cardiologists alike. In the past, 'the things that cardiologists and endocrinologists did were complementary and did not affect each other's respective management.' Coordination and quarterbacking most often fall to primary care physicians (PCPs) since they are the first (and most frequent) points of contact for diagnosis and ongoing management of diabetes. Though 'it depends on the individual PCP and the culture of practicing within any given system, it can become complicated, especially when providers are in different institutions,' said Ferris. The same rings true for the millions of patients who do not live in large cities with immediate access to tertiary care health systems. This is where the electronic health record and technology (eg, the ability to access care from anywhere via virtual telehealth visits) play important roles, as well as where communication becomes key. 'It's important to make sure that there's harmonization and a unified approach across the team because every touch with the patient is an opportunity to optimize care,' said Khan. 'Taking a collective responsibility approach is really important,' she said. Duplicate Services, Multiple Specialties The interconnectedness of CVD risk factors (eg, obesity/overweight, dyslipidemia, or hypertension) also highlights another challenge that arises in interdisciplinary care in diabetes: Duplicate service offerings across multiple specialties. Rakotz provided an example: PCP diagnoses diabetes, prescribes medical management PCP then refers the patient to a Certified Diabetes Care and Education Specialist (CDCES) and a nutritionist, and an endocrinologist The endocrinologist has their own CDCES, and might choose to manage CVD risk, take over comprehensive diabetes care and related comorbidities, or refer out to a cardiologist. This is where communication and coordination can break down, leading to medication errors, care fragmentation, and conflicting advice to the patient. Sustained patient self-management and follow-up are at risk as well, underscoring the importance of the PCP's top wide receiver, ie, the CDCES. Grace Derocha, RD, CDCES, spokesperson for the Academy of Nutrition and Dietetics, Chicago, said she combines medical nutrition therapy and lifestyle modifications — the cornerstones of CVD risk prevention and diabetes management — with education, health coaching, and psychosocial and behavioral support. Grace Derocha, RD, CDCES 'Not only am I able to provide the patient information and knowledge as to best practices and evidence-based medicine, but I also consider social determinants of health, culture, tradition, language, and help patients focus on what they can change,' said Derocha. Diabetes care and education specialists are also able to keep patients accountable and motivated. 'I like to give patients some of the power over their healthy habits,' she said. Derocha pointed out that although CDCES are often embedded into larger health systems, primary care doctors in smaller or more rural settings might not have ongoing relationships or know where to find them, which is where the Academy of Nutrition and Dietetics resources can help. A Place for Upskilling Upskilling, ie, the transfer of knowledge from a specialist to the PCP, is a strategy that provides opportunities to fill in knowledge gaps and foster team discussions. Derocha reinforced that it is a way for multiple disciplines involved in CVD risk reduction in these patients to speak the same language. 'We're saying the same thing so that the patient is hearing it not just from me, but from them and vice versa,' said Derocha. For many established teams, upskilling is the rule, not the exception. For example, Ferris said that she runs regular teaching programs for primary care practices (especially rural practices) that cover topics like cardiometabolic care. Likewise, Khan emphasized the need for collective, ongoing medical education as new information (eg, guidelines, latest data) becomes available. 'I wouldn't necessarily call it 'upskilling,' but rather, learning from different encounters and making sure that what is being recommended and why is clear,' she said. Studies have shown that additional benefits of upskilling include partnership and trust building (which facilitates timely referral to specialists) and improving practice capacity. A Role for Early Interdisciplinary Intervention Given the alarming trend of increasing rates of newly diagnosed diabetes among younger adults, adolescents, and children (many of which have been associated with serious complications such as hypertension), early intervention is warranted, as is considering additional team members, including pediatricians and cardio-obstetricians. 'It's never too late to begin prioritizing prevention and focusing on lifestyle and heart-healthy behaviors to prevent obesity, hypertension, or diabetes-associated CVD risks,' said Khan, also reinforcing the American Heart Association's PREVENT risk calculator to help guide care. Rakotz, Ferris, Khan, and Derocha reported no relevant financial relationships.
Medscape
12-05-2025
- Health
- Medscape
Multiple Comorbidities Can Have Big Impact on SSc Outcomes
In a cohort of 2000 patients with systemic sclerosis (SSc), 20% were found to have multimorbidity, primarily driven by cardiovascular disease and other important cardiovascular risk factors. The presence of multimorbidity was linked to reduced survival rates and impaired physical function. METHODOLOGY: Researchers aimed to determine the frequency and prognostic impact of multimorbidity in 2000 patients with SSc (median age at SSc onset , 47.4 years; 85.4% women) from the Australian Scleroderma Cohort Study. Charlson Comorbidity Index (CCI) scores were calculated at each visit for all participants, with multimorbidity defined as having a CCI score of ≥ 4. Health Assessment Questionnaire Disability Index scores were collected every year during study visits, whereas data on demographics, disease, and medication use were collected at each visit. The median duration of SSc at recruitment was 7.1 years, and the median follow-up duration was 4.2 years. TAKEAWAY: During the follow-up period, multimorbidity was observed in 20.1% of participants at a median of 12 years after the onset of SSc; the key comorbidities were hypertension (80.5%), dyslipidemia (67.2%), obstructive lung disease (50.4%), malignancy (48.9%), and ischemic heart disease (40.1%). The presence of multimorbidity increased the risk for death by 57% (hazard ratio [HR], 1.57; P < .01), with chronic kidney disease showing the strongest association with mortality (HR, 2.41; P < .01), followed by left ventricular dysfunction (HR, 1.76; P < .01). < .01), with chronic kidney disease showing the strongest association with mortality (HR, 2.41; < .01), followed by left ventricular dysfunction (HR, 1.76; < .01). Having multimorbidity was also associated with poorer physical function ( P < .01), with peripheral vascular disease having the largest impact on physical function, followed by left ventricular dysfunction. IN PRACTICE: 'These data suggest a role for aggressive management of comorbid cardiac and renal disease to potentially improve outcomes in SSc,' the authors wrote. SOURCE: This study was led by Jessica L. Fairley, MBBS, The University of Melbourne and St Vincent's Hospital Melbourne, both in Melbourne, Australia. It was published online on April 21, 2025, in ACR Open Rheumatology . LIMITATIONS: The CCI was modified for application to the database as not all variables were available for analysis, including depression, cellulitis, liver disease, peptic ulcer disease, hemiplegia, HIV/AIDS, and dementia. This likely resulted in underestimating the frequency of multimorbidity in the cohort. Additionally, the Australian Scleroderma Cohort Study exhibits a degree of survivor bias, where more severely ill individuals may not survive to recruitment. DISCLOSURES: The Australian Scleroderma Cohort Study was supported by Janssen, Boehringer Ingelheim, Scleroderma Australia, and other sources. Some authors reported receiving grants, payments, honoraria, consulting fees, and travel support from, and having other ties with various pharmaceutical companies including the funding agencies.
Medscape
06-05-2025
- Health
- Medscape
Heart Health Worsened in Pts With Chronic Hypoparathyroidism
Patients with chronic hypoparathyroidism faced a significantly higher risk for cardiovascular diseases and mortality from cardiovascular causes than control individuals without the condition, with the effect being particularly prominent among women. METHODOLOGY: Researchers conducted this study by merging data from population-based registries in Sweden to assess the risk for cardiovascular diseases in patients with chronic hypoparathyroidism. They included 1982 patients with chronic hypoparathyroidism (mean age, 54.7 years; 76.7% women) and matched them to 19,494 control individuals without the condition. The median follow-up time was 9.09 years for patients with chronic hypoparathyroidism and 8.91 years for control individuals. The outcome was the presence of at least one cardiovascular event such as acute myocardial infarction, atrial fibrillation/flutter, heart failure, valvular heart disease, peripheral artery disease, or stroke or transient ischaemic attack; fatal cardiovascular disease was defined as death from any cardiovascular causes. TAKEAWAY: Patients with chronic hypoparathyroidism showed higher risks for valvular heart disease (hazard ratio [HR], 2.08; 95% CI, 1.67-2.60), peripheral artery disease (HR, 1.78; 95% CI, 1.41-2.26), heart failure (HR, 1.66; 95% CI, 1.44-1.90), atrial fibrillation/flutter (HR, 1.58; 95% CI, 1.38-1.81), and acute myocardial infarction (HR, 1.31; 95% CI, 1.05-1.64) than control individuals. The risk for fatal cardiovascular disease was 59% higher in patients with chronic hypoparathyroidism than in control individuals (HR, 1.59; 95% CI, 1.40-1.80). Women with chronic hypoparathyroidism showed significantly higher risks for valvular heart disease, peripheral artery disease, heart failure, atrial fibrillation, myocardial infarction, and fatal cardiovascular disease than their matched control individuals; however, no significant differences in any cardiovascular outcomes were observed between men with chronic hypoparathyroidism and their matched control individuals. The increased risk for cardiovascular diseases in patients with chronic hypoparathyroidism remained consistent, regardless of the surgical or non-surgical aetiology of chronic hypoparathyroidism. IN PRACTICE: "[The study] findings highlight the need for close monitoring and preventive management of cardiovascular risk factors, particularly in women," the authors wrote. SOURCE: This study was led by Sigridur Björnsdottir, MD, PhD, Karolinska Institutet, Stockholm, Sweden. It was published online on April 28, 2025, in The Journal of Clinical Endocrinology & Metabolism . LIMITATIONS: This study lacked data on biochemical measures, physical activity, height, body weight, and blood pressure and relied on chronic obstructive pulmonary disease as a proxy variable for heavy smoking. Information about dosages of active vitamin D, calcium, and levothyroxine was not available in the registries. DISCLOSURES: This study was supported by a research grant from the Swedish Research Council, Knut and Alice Wallenberg Foundation, Novo Nordisk Foundation, Torsten and Ragnar Söderberg's Foundations, and Kristian Gerhard Jebsen Foundation. Several authors reported serving as research investigators, members of the advisory board and steering committees, and consultants and receiving research grants, consultancy fees, and personal fees from various pharmaceutical companies.
